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  • 1.
    Brännström, Lars
    et al.
    Stockholms Universitet.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Arnoldsson, Göran
    Umeå universitet.
    Boendesegregation. Konsekvenser för ungdomars framtida levnadsförhållanden2010In: Social rapport 2010, Stockholm: Socialstyrelsen , 2010, , p. 313p. 204-220Chapter in book (Other academic)
  • 2.
    Carlsund, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Eriksson, Ulrika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Swedish Parent’s Experiences of Joint Physical Custody2014In: Open Family Studies Journal, ISSN 1874-9224, Vol. 6, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Abstract: Aim: This study’s aim was to learn more about parent experiences, when living in joint physical custody with their children. Methods: The study design was descriptive, using a qualitative approach. Interviews were conducted with 28 parents who lived in joint physical custody with their children. Content was analysed using inductive content analysis. Results: Participants with joint custody reported many positive experiences, and a similar process of adapting to the new living- arrangement. Results indicate that shortly after the separation parents were mainly occupied with emotional reactions to the new family situation. After two to three years, or in some cases longer, things seemed to settle down and the participants became more accustomed to the arrangements. Conclusion: This qualitative study provides insights into parents’ experiences of living in joint physical custody with their children. Many positive experiences and a similar process of adapting to the new arrangement were revealed. In the initial period, the parents seemed mainly to have been occupied with emotional reactions to the new family situation.

  • 3.
    Carlsund, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Eriksson, Ulrika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Löfstedt, Petra
    Swedish Natl Inst Publ Hlth, Dept Children & Older Peoples Hlth, Östersund, Sweden.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Risk behaviour in Swedish adolescents: is shared physical custody after divorce a risk or a protective factor?2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The increase in shared physical custody in Sweden has been dramatic; 20 years ago only a small percentage of adolescents lived in shared physical custody, but currently ∼30% of the adolescents whose parents have separated or divorced divide their residence between parents. We hypothesized that living in shared physical custody or in a single-parent family is associated with a higher prevalence of adolescent risk behaviour than living in a two-parent family. METHODS: Data on 15-year-old adolescents from the 2005/2006 to 2009/2010 Swedish Health Behaviour in School-aged Children (HBSC) survey were analysed using logistic regression. RESULTS: Adolescents living in shared physical custody had slightly higher rates of risk behaviour compared with adolescents from two-parent families, but significantly lower rates than their counterparts from single-parent families. Their odds of being a smoker or having been drunk were 60 and 50% higher, respectively, than those of their counterparts in two-parent families. CONCLUSION: Shared physical custody after marriage break-up seems to constitute a health protective factor for adolescents' health and problem behaviour. In order to deepen our understanding of the positive and negative aspects of shared physical custody, our study should be followed by qualitative analyses and longitudinal studies of adolescents' experiences.

  • 4.
    Carlsund, Åsa
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Eriksson, Ulrika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Shared physical custody after family split-up: implications for health and well-being in Swedish schoolchildren.2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 3, p. 318-323Article in journal (Refereed)
    Abstract [en]

    AIM: In Sweden, shared physical custody following a parental separation has emerged as means for children to keep close relationships with both parents. Previous studies show that children benefit from regular contact with both parents, who share responsibility for their social, emotional, and economic welfare. In this study we investigate any associations between family arrangements, i.e. two parent, single and shared physical custody families and child health outcomes and whether this association was modified by parent-child communication Methods Data on 11-15-year-old children from the 2005/2006 and 2009/2010 Swedish Health Behaviour in School-aged Children survey were analysed using multivariate logistic regression RESULTS: Children in shared physical custody were more likely than children in two-parent families to report multiple health complaints (OR 1.26) and low well-being (OR 1.71). When variables of parent-child communication were entered in the model, the initial differences remained between children living in shared physical custody and those living in two-parent families. Conclusion Children in shared physical custody and single parent families are more at risk of negative outcomes compared to children in two parent families. This association was not modified by parent-child communication in children in shared custody families, indicating that the communication equals that in two-parent family children.

  • 5.
    Eriksson, Ulrika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Growing up in rural community - children's experiences of social capital from perspectives of wellbeing2010In: Rural and remote health, ISSN 1445-6354, Vol. 10, no 3, p. 1322-Article in journal (Refereed)
    Abstract [en]

    Introduction: People are influenced by the neighborhood in which they live. The neighborhood may be particularly important for children’s wellbeing because of the constraints it imposes on their patterns of daily activities. Furthermore, the neighborhood is a central context for social development, being a place where children form networks and learn social skills and values. The aim of this study was to describe how social capital in the neighborhood is perceived by children living in rural areas, and to reveal what this adds to their sense of wellbeing. Methods: The study had a descriptive research design with a qualitative approach. Seven single-sex focus group interviews were conducted with children the in 6th grade (aged 11–12 years). Data were analyzed using deductive content analysis. Results: The children perceived a lack of social capital due to environmental and social constraints in their everyday lives. However, their wellbeing was enhanced by strong cohesion in the neighborhood. In addition, settings such as the school, the natural environment, and sporting associations were highly valued and emerged as crucial factors for enhancing the children’s wellbeing. The spatial isolation that characterizes rural areas created a special context of social network structures, cohesion and trust, but was also a breeding ground for exclusion and social control. The stories revealed paradoxical feelings of living in a good and safe area that simultaneously felt isolated and restricted. Conclusions: From a rural perspective, this study reveals the complexity of the children’s perceptions of their social environment, and the ways in which these perceptions have both positive and negative effects on wellbeing. The results highlight how important it is for health professionals in rural areas to consider the complex influence of bonding social capital on children’s wellbeing, and to be aware that it can promote exclusion as well as cohesion.

  • 6.
    Eriksson, Ulrika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Carlsund, Åsa
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hochwälder, Jacek
    Department of Psychology, Mälardalens University, Eskilstuna, Sweden.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Health outcomes among Swedish children: the role of social capital in the family, school, and neighbourhood2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 5, p. 513-517Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to explore the extent to which Swedish children's perceptions of social capital in the family, school and neighbourhood predicted health complaints and well-being. Methods: The study used data from the Swedish Health Behaviour in School-agedChildren survey. The sample consisted of 3926 children aged 11-15 years. Correlations and hierarchical multiple linear regression were performed. Results: Higher degrees of family, school and neighbourhood social capital corresponded to lower levels of health complaints and higher levels of well-being. Social capital in these three spheres had a cumulative effect on children's health and well-being. Conclusions: Social capital in the family, school and neighbourhood matters for children's health and well-being and the contributions from each context seem to be additive. Besides the family context, investments for improving child health should primarily be in the school, focusing on social relations and on creating safe and cohesive school environments. Neighbourhood social capital is also of importance and so must be taken into consideration when planning childhealth promotion interventions. © 2011 The Author(s)/Acta Pædiatrica.

  • 7.
    Eriksson, Ulrika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Chiappe, I
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Att vårdas på sjukhus: Vad är patienter missnöjda med?2003In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 23, no 2, p. 36-39Article in journal (Refereed)
  • 8.
    Eriksson, Ulrika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hochwälder, Jacek
    Department of Psychology, Mälardalens University, Eskilstuna, Sweden.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Perceptions of community trust and safety: Consequences for children’s well-being in rural and urban contexts2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 10, p. 1373-1378Article in journal (Refereed)
    Abstract [en]

    Aim:  To explore the associations between subjective well-being and perceptions of community trust and safety amongst children in rural and urban areas.

    Methods:  The study used self-reported data from the 2001/2002 Swedish cross-national WHO study Health Behaviour in School-aged Children. The sample consisted of 3852 children aged 11–15 years, living in different residential areas. Bivariate analyses and multivariate logistic regression were performed.

    Results:  The results indicated that a greater proportion of children in urban areas perceived low community trust and safety, compared with children in rural areas. Further, the multivariate analysis revealed that perceived community trust and safety significantly impacts upon children’s subjective well-being in both rural and urban contexts.

    Conclusion:  Children’s perceptions of trust and safety have different magnitudes in urban and rural areas. The associations of perceptions of community trust and safety for children’s subjective well-being are relevant in both urban and rural areas. As perceptions of low trust and safety in the community seem to be related to low subjective well-being, efforts to encourage community trust and safety should be included amongst the key priorities in community health promotion.

  • 9.
    Eriksson, Ulrika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    School demands and subjective health complaints among Swedish schoolchildren: A multilevel study2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 4, p. 344-350Article in journal (Refereed)
    Abstract [en]

    Objectives: As children spend a great deal of their time in school, the climate in the classroom can constitute a resource, but also a risk factor in the development of the pupils' health. The aim of the present study was to determine the extent to which demands in the classroom are associated with subjective health complaints in Swedish schoolchildren. Methods: Data from the 2001/2002 and 2005/2006 Swedish cross-national Health Behaviour in School-aged Children (HBSC) survey were analysed using a multilevel logistic regression technique. Results: The study demonstrated a substantial variation between school classes in pupils' subjective health complaints. In school classes with high demands, the odds of having subjective health complaints was about 50% higher than in school classes with low demands. Further, the results indicated that these effects were mediated by sex so as to girls being more affected by high levels of demands in the school class. Conclusions: The findings are important since they point at the crucial role that teachers play in creating a favourable school climate. Therefore interventions aiming at supporting teachers to set realistic demands and expectations are one way to improve the school climate. Such interventions should also make clear the need to take into consideration the fact that the school class effect was mediated by sex, i.e. girls being more vulnerable to high level of school class demands.

  • 10. Forslin, B
    et al.
    Jacobsson, I
    Sandberg, K
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Olycksfallsskador, våld och otrygghet2000Report (Other scientific)
  • 11. Grönvik, M.
    et al.
    Sellström, Eva
    Svedin, G.
    Mot ett jämställt föräldraskap del 3.1988Report (Other academic)
  • 12. Lyons, Ronan
    et al.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Delahunty, Annie M
    Loeb, Mitch
    Varilo, Susanna
    Incidence and cause of fractures in European districts2000In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 82, no 6, p. 452-455Article in journal (Refereed)
    Abstract [en]

    Aims - To compare fracture rates in European districts. Setting - Geographically defined areas of Wales (Swansea and Neath Port Talbot), Norway (Harstad, Trondheim, Stavanger, and Drammen), Sweden (Jamtlands), and Finland (Porvoo). Methods - Surveillance of fractures at emergency departments and hospitals and linkage with population data. Comparison of age adjusted and crude rates. Calculation of confidence intervals for ratios. Results - A total of 4113 fractures occurred in 167 560 children during 1996. Fracture rates in south Wales (36 per 1000) were substantially higher than in Scandinavian districts (which were similar). Limiting analysis to the most severe injuries to correct for the possibility of ascertainment bias reduced some of the excess rate in Wales: the Welsh:Scandinavian fracture ratio was 1.82 (95% confidence interval: 1.64 to 2.03). Conclusions - Fracture rates in Welsh children are substantially higher than in Scandinavian children.

  • 13.
    Nordenmark, Mikael
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gillander Gådin, Katja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Selander, John
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sjödin, Jenny
    Umeå Universitet.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Self-rated health among young Europeans not in employment, education or training-with a focus on the conventionally unemployed and the disengaged2015In: Vulnerable Groups & Inclusion, ISSN 2000-8023, E-ISSN 2000-8023, Vol. 6, article id 25824Article in journal (Refereed)
    Abstract [en]

    NEET is an acronym for Not in Employment, Education or Training. For the year 2010, it isestimated that 12.5% of all young people aged 1524 in the OECD countries could be categorised as NEETs. Within this group, various subgroups of NEET are identified. Our study, which was conducted using cross-sectional data collected through the European Social Survey, focuses on the category of people who are assumed to be most marginalised and inactive: ‘‘the disengaged.’’ Participants in the study were men and women aged 1830, originating from 33 European countries. The results show that disengaged NEETs reported poorer health than both young people who were conventionally unemployed and those in employment or studying. It is also shown that ‘‘the disengaged’’ scored worse on other social and welfare variables, for example, trust and social activity. Being disengaged is discussed in relation to the gross domestic products of the different countries.

  • 14.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Fewer children with head injuries following helmet campaign. 1994In: Vårdfacket, ISSN 0347-0911, Vol. 18, no 4Article in journal (Other scientific)
  • 15.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Arnoldsson, Göran
    Alricsson, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Obesity prevalence in a cohort of women in early pregnancy from a neighbourhood perspective2009In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 9Article in journal (Refereed)
    Abstract [en]

    Background The evidence of an association between neighbourhood deprivation and overweight is established for different populations. However no previous studies on neighbourhood variations in obesity in pregnant women were found. In this study we aimed to determine whether obesity during early pregnancy varied by neighbourhood economic status.

    Methods A register based study on 94,323 primiparous pregnant women in 586 Swedish neighbourhoods during the years 1992-2001. Multilevel technique was used to regress obesity prevalence on socioeconomic individual-level variables and the neighbourhood economic status. Five hundred and eighty-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992-2001, were included. The majority of neighbourhoods had a population of 4 000-10 000 inhabitants

    Results Seven per cent of the variation in obesity prevalence was at the neighbourhood level and the odds of being obese were almost doubled in poor areas.

    Conclusion Our findings supports a community approach in the prevention of obesity in general and thus also in pregnant women

  • 16.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Arnoldsson, Göran
    Bremberg, Sven
    Hjern, Anders
    The neighbourhood they live in: Does it matter to women's smoking habits during pregnancy?2008In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 14, no 2, p. 155-166Article in journal (Refereed)
    Abstract [en]

    Abstract Socioeconomic factors in the neighbourhood are associated with smoking habits in various populations. We studied a 10-year-cohort to determine whether women�s smoking behaviour during pregnancy can similarly be determined by neighbourhood economic and ethnic factors. The cohort included 297,526 pregnant women in 594 Swedish neighbourhoods during the years 1992-2001. Multilevel technique was used to regress pregnancy smoking on socioeconomic individual-level variables and neighbourhood characteristics. Seven per cent of the variation in pregnancy smoking was at the neighbourhood level and the odds of smoking during pregnancy were doubled in poorer areas. Health education and smoking cessation interventions should be directed at maternity care units in deprived neighbourhoods.

  • 17.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bauer, M.
    Grönvik, M.
    Barnolycksfall i Jämtlands län 1989- 1990. : Rapport från samhällsmedicinska enheten, Jämtlands läns landsting, 1991.1991Report (Other scientific)
  • 18.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Björck, M.L.
    Barnolycksfallsprojektet 1989- 1993. : Rapport från samhällsmedicinska enheten, Jämtlands läns landsting, 1994.1994Report (Other scientific)
  • 19.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bremberg, Sven
    Education of staff - a key factor for a safe environment in day care. 2000In: Acta Paediatrica, ISSN 0803-5253, Vol. 89, no 5, p. 601-607Article in journal (Refereed)
  • 20.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bremberg, Sven
    Is there a ‘‘school effect’’ on pupil outcomes?: A review of multilevel studies2006In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 60, no 2, p. 149-155Article, review/survey (Refereed)
    Abstract [en]

    Study objective: The school environment is of importance for child outcomes. Multilevel analyses can separate determinants operating at an individual level from those operating at a contextual level. This paper aims to systematically review multilevel studies of school contextual effects on pupil outcomes. Design: Key word searching of five databases yielded 17 cross-sectional or longitudinal studies meeting the inclusion criteria. Results are summarized with reference to type of school contextual determinant. Main results: Four main school effects on pupil outcomes were identified. Having a health or anti-smoking policy, a good school climate, high average socio-economic status [SES], and urban localization had a positive effect on pupil outcomes. Outcomes under study were smoking habits, well-being, problem behaviour and school achievement. Conclusions: Despite the different pupil outcomes and the variety of determinants used in the included papers, a school effect was evident. However, in order to improve our understanding of school effects, presentations of results from multilevel studies need to be standardized. Intra-class correlation (ICC) and explained between-school variance give relevant information on factors in the school environment influencing pupil outcomes, and should be included in all multilevel studies. Inclusion of pupil-level predictors in the multilevel models should be based on theoretical considerations on how schools and communities are interconnected and through which paths pupils and their families are influenced by school contextual factors.

  • 21.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bremberg, Sven
    Närmiljöns betydelse för barns och ungdomars hälsa och välbefinnande: en systematisk kunskapsöversikt2004Report (Other scientific)
    Abstract [sv]

    Barn påverkas inte bara av sina föräldrar utan även av den miljö de växer upp i. Barn tillbringar ofta en stor del av alla sin tid i bostadsområdet där de går i förskola och skola, tar del av fritidsverksamhet och träffar andra barn och vuxna. Flera äldre undersökningar tyder på att barn som växer upp i resursrika områden också gynnas hälsomässigt. Studierna har dock varit så utformade att det är möjligt att den påvisade effekten helt kan förklaras av de enskilda familjernas situation. Under det senaste decenniet har ny säkrare statistik metodik börjat användas för att klargöra frågor av denna typ. Avsikten har därför varit att analysera studier genomförda med modern flernivåteknik för att klargöra om närmiljöns karaktär kan påverka barns och ungdomars hälsa. Totalt identifierades 16 studier som uppfyllde uppställda kvalitetskrav. Studier som enbart behandlade skolmiljö exkluderades för att presenteras i en särskild genomgång. Översikten visar att en resursrik närmiljön både minskar risken för att barn ska födas med låg födelsevikt och minskar risken för att barn ska utveckla beteendeproblem. Det är redan känt att en risken för låg födelsevikt och risken för beteendeproblem är lägre i socialt gynnade familjer. Vad denna genomgång tillför är att bostadsområdets karaktär förefaller ha en självständig effekt, oberoende av den enskilda familjens situation. Flera analyser tyder vidare på att effekter av bostadsområdet inte bara adderas till den enskilda familjens risk utan även förstärker denna.

  • 22.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bremberg, Sven
    Perceived social norms as crucial determinants of mother's injury-preventive behaviour1996In: Acta Paediatrica, ISSN 0803-5253, Vol. 85, no 6, p. 702-707Article in journal (Refereed)
  • 23.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bremberg, Sven
    Karolinska Institute; National Public Health Institute, Stockholm.
    The significance of community context to child and adolescent health and well-being: A systematic review of multilevel studies2006In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, no 5, p. 544-554Article, review/survey (Refereed)
    Abstract [en]

    Growing up in a poor neighbourhood has negative effects on children and adolescents. In the literature it has been concluded that the risk of low birth weight, childhood injury and abuse, and teenage pregnancy or criminality double in poor areas. However, the validity of such studies has been questioned, as they have been associated with ecological or individualistic fallacies. Studies using multilevel technique might thus contribute important knowledge in this field. The present review clarifies the importance of neighbourhood contextual factors in child and adolescent health outcomes, through considering only studies using multilevel technique. Keyword searching of the Medline, ERIC, PsycInfo, Sociological Abstracts, and Social Citation Index databases was performed. Original studies using multilevel technique to examine the effect of neighbourhood characteristics on child and adolescent health outcomes, and focusing on populations in high‐income countries were included. Neighbourhood socioeconomic status and social climate were shown to have small to moderate effects on child health outcomes, i.e. birth weight, injuries, behavioural problems, and child maltreatment. On average, 10% of variation in health outcomes was explained by neighbourhood determinants, after controlling for important individual and family variables. This review demonstrates that interventions in underprivileged neighbourhoods can reduce health risks to children, especially in families that lack resources. An analysis of methodological fallacies indicates that observed effects and effect sizes can be underestimated, and that interventions may well have greater impact than this review was able to establish.

  • 24.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bremberg, Sven
    Chang, Albert
    Injuries in Swedish Day-Care Centers1994In: Pediatrics, ISSN 0031-4005, Vol. 84, no 6, p. 1033-1036Article in journal (Refereed)
    Abstract [en]

    In the developed countries, an increasing number of children are enrolled in day-care centers. When parents leave their child in a day-care center they expect high standards of health and safety. Accidental injuries are a major threat in this age group. In a comparable institution that serves children, the school, the risk of injury is higher than in the home environment.1-2 Thus, safety in day-care centers cannot be taken for granted. A few studies of injuries in day-care centers have been reported, from the Nordic countries2,3-5 and from the US.6-10 Most of these studies, however, have been small and most lack information on time of exposure. Information about the risk of injury in Swedish day-care centers might be of interest as enrollment has been high for a long time. In Sweden, within the frame of a national injury program,11 a number of local hospital- and health center-based injury report systems have been set up. All have a basic common coding. These systems enable compilation of injuries in day-care centers on a national basis. The aim of our study was to analyze child injuries in day-care centers as reported in 10 local injury registry systems in Sweden regarding incidence, type, and mechanism of injury. METHOD Data were compiled from 10 local injury registry systems, covering 1- to 2-year periods. The earliest registers were from the years 1983 to 1984 and the latest from 1991. These systems were set up in all medical institutions at a predefined level, covering all individuals in a total or a part of a county.

  • 25.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bremberg, Sven
    Gärling, Anita
    Hörnquist, Jan Olof
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Risk of childhood injury: Predictors of mothers' perceptions2000In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 28, no 3, p. 188-193Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Safety education often targets parental risk perception. Predictors of risk perception, however, are not well known, thus limiting the feasibility of effective safety education. Accordingly, in this study, a range of predictors of maternal risk perception were examined. METHODS: A random sample of 870 mothers in northern Sweden was included in the study. Three different questionnaires, with scenarios of a burn injury, a bicycle injury in the home environment, and a bicycle injury in traffic, were completed by the subjects. Multiple linear regression models tested the possible influence of causal attributions, normative beliefs, and sociodemographic and behaviour-related variables on mothers' risk perception. RESULTS: Only 14-23% of the variance in mothers' risk perception could be explained by the multivariate models. Causal attribution to the child was found to be the most important predictor of maternal risk perception. CONCLUSION: Present theoretical models give few clues about how to design educational models that might influence risk perception. To make safety education more effective, other modifiable factors that influence parental safety behaviour, such as subjective norms and self-efficacy, might be better targets.

  • 26.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bremberg, Sven
    National Institute of Public Health, Östersund, Sweden.
    O'Campo, Patricia
    Centre for Research on Inner City Health, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada.
    Yearly incidence of mental disorders in economically inactive young adults2011In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 21, no 6, p. 812-814Article in journal (Refereed)
    Abstract [en]

    Increasing rates of mental health problems in youth and an extended period of school-to-work transition is a major concern in Sweden and many other European countries. In this study, being out of the workforce and not in education was associated with severe mental disorders. The risk of being admitted in hospital due to depression was more than doubled in economically inactive young adults. Similarly, the risk of being admitted to hospital due to self-harm and alcohol-related disorder was tripled. Drug abuse was seven times more prevalent among inactive young adults. Processes leading to economic inactivity and to deteriorating mental health are inextricably intertwined. Even if it is not possible to clarify if the association is caused by selection or if it is being outside of labour force that causes mental disorders, it is still urgent to prevent young persons from ending up in long-term economic inactivity.

  • 27.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Guldbrandsson, K
    Bremberg, Sven
    Hjern, A
    Arnoldsson, G
    Association between childhood community safety interventions and hospital injury records: a multilevel study.2003In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 57, no 9, p. 724-729Article in journal (Refereed)
    Abstract [en]

    Study objective: To study municipal variations in children's injury risk and to assess the impact of safety promotion measures in general municipal, preschool, school, and leisure activity settings, on injury outcome.Design: A cohort study based on individual data on children's consumption of hospital care as a result of injury, the age and sex of each child, and socioeconomic data on each child's mother. Municipal characteristics-that is, population density and municipal safety measures-were also used. Connections between individual and community level determinants were analysed with multilevel logistic regression.Setting: Twenty five municipalities in Stockholm County in Sweden were studied.Participants: Children between 1 and 15 years old in 25 municipalities in Stockholm County, identified in the Total Population Register in Sweden. The study base included 1 055 179 person years.Main results: Municipality injury rates varied between 3.84-7.69 per 1000 person years among 1-6 year olds and, between 0.86-6.18 among 7-15 year olds. Implementation of multiple safety measures in a municipality had a significant effect on the risk of injury for preschool children. In municipalities that implemented few safety measures, the risk of injury was 33% higher than in municipalities that implemented many. A similar effect, though insignificant, was observed in the school aged children.Conclusions: This study shows that how municipalities organise their safety activities affect injury rates. Sweden has a comparatively low injury rate and thus, in a European perspective, there is an obvious potential for municipal safety efforts.

  • 28.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hjern, A
    Arnoldsson, G
    Bremberg, S
    Are there differences in birth weight between neighbourhoods in a Nordic welfare state: a 10 year cohort study2007In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 7, p. 267-Article in journal (Refereed)
    Abstract [en]

    Background. The objective of this cohort study was to examine the effect on birth weight of living in a disadvantaged neighbourhood in a Nordic welfare state. Birth weight is a health indicator known to be sensitive to political and welfare state conditions. No former studies on urban neighbourhood differences regarding mean birth weight have been carried out in a Nordic country. Methods. A register based on individual data on children�s birth weight and maternal risk factors was used. Neighbourhood characteristics, i.e. aggregated measures on ethnicity and income, were also included. Connections between individual- and neighbourhood-level determinants and the outcome were analysed using multi-level regression technique. The study covered six hundred and ninety-six neighbourhoods in the three major cities of Sweden, Stockholm, Göteborg and Malmö, during 1992-2001. The majority of neighbourhoods had a population of 4 000�10 000 inhabitants. An average of 500 births per neighbourhood were analysed in this study. Results. Living in a deprived neighbourhood in Sweden did not add to the more proximal risk of giving birth to lower weight infants connected to individual socioeconomic status. Infants born in homogenous ethnic neighbourhoods weighed 69 g less than did infants born in homogeneous Swedish neighbourhoods. No independent effect of neighbourhood income was observed. ICC was less than 1 per cent indicating that most variability in birth weight was on the individual level. Conclusions. Social policies in Sweden, including universal social benefits, gender equality seen in high female labour market participation, and a general and free maternal health care, could possibly explain the non-existent differences in mean birth weight in Swedish urban neighbourhoods.

  • 29.
    Sellström, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    O'Campo, Patricia
    Li Ka Shing Knowledge Inst St Michaels Hosp, Ctr Res Inner City Hlth, Toronto, ON, Canada .
    Muntaner, Carles
    Univ Toronto, Fac Nursing, Dept Psychiat & Publ Hlth Sci, Toronto, ON, Canada .
    Arnoldsson, Göran
    Umea Univ, Dept Stat, S-90187 Umea, Sweden.
    Hjern, Anders
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Hospital admissions of young persons for illicit drug use or abuse: does neighborhood of residence matter?2011In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 17, no 2, p. 551-557Article in journal (Refereed)
    Abstract [en]

    Adolescence constitutes a period of risk for drug use and drug use disorders.  Previous research, largely focused on individual risk factors, has failed to include neighborhood structure in the study of determinants of youth drug abuse. A cohort of 76,693 adolescents ages 13–15 from 586 urban neighborhoods in Sweden were followed up for 12 years, from age 16 to age 28. Multilevel modeling was used to analyze neighborhood variations in hospital admissions due to illicit drug abuse. We found that illicit drug abuse varied by 8% by neighborhood economic status and the risk of being admitted to hospital increased 73% in  low- compared to high-income neighborhoods. Our results suggest that neighborhood of residence in adolescence plays a significant role in predicting future health-related behaviors and that the need for drug abuse interventions at a neighborhood level is compelling.

  • 30. Sellström, Eva
    et al.
    Svedin, Göran
    Mot ett jämställt föräldraskap del 1.1986Report (Other academic)
  • 31. Svärdby, Karin
    et al.
    Nordström, Lennart
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Primiparas with or without oxytocin augmentation: A prospective descriptive study2007In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 1, p. 179-184Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim of this study was to determine during which phase of delivery augmentation is started when used and to establish any correlation that might exist between the oxytocin infusion and the evaluations by primiparas themselves of their labour pain, strength of contractions and fatigue. In addition, we wanted to determine any differences in duration between labour with and labour without augmentation. We finally wanted to measure the incidence of instrumental deliveries, perineal trauma and neonatal outcome among the augmented vs. the non-augmented groups. BACKGROUND: The most commonly diagnosed complication in primiparas is ineffective contractions or protracted labour, otherwise known as dystocia, which literally means arrested or prolonged labour. Different treatments have been tried during the active phase of labour as well as the second stage of labour. The most common treatment today is amniotomy, often used in combination with an intravenous oxytocin infusion. MATERIALS AND METHODS: The study was conducted at the hospital in Ostersund in central Sweden from August 1998 to September 1999. Consecutive primiparas giving birth at full-term were selected to the study. The inclusion criteria were an uncomplicated pregnancy and a spontaneous single delivery with head presentation. The total number of participants was 164. RESULTS: The results showed that 50 of 164 primiparas needed no augmentation, while 88 were augmented during the active phase and 26 during the second stage of labour. The duration of the active phase [median (md) 4 hours 45 minutes, 6 hours 49 minutes and 6 hours 20 minutes respectively for the different groups, P = 0.03], the time between full dilation of the cervix and the start of the second stage (md 20 minutes, 30 minutes and 60 minutes respectively, P = 0.012) and the duration of the second stage of labour (md 40 minutes, 44 minutes and 60 minutes respectively, P = 0.04) were significantly longer in the augmented groups. Operative deliveries, too, were more frequent in the augmented groups. There was a significantly higher rate of perineotomies in the group augmented during the second stage of labour. There were, however, no differences in Apgar score <7 at 1 minute. pH in the umbilical cord and the base deficit were higher in the group which were augmented during the second stage of labour (P = 0.02 and P = 0.06 respectively). Women describing their impression of the experience as a whole generally gave it a high rating, but women who were augmented during the second stage of labour gave the experience a significantly lower score (P = 0.01). CONCLUSION: Augmentation is used in unusually prolonged deliveries. We did not find that augmentation involved a higher frequency of perineal trauma, although it was correlated with a higher frequency of operative deliveries. There was no correlation between the oxytocin infusion and the primiparas' descriptions of the strength of contractions, pain and fatigue, although greater use of epidurals was observed in women with augmented labour. The number of nulliparas in this study was too small to analyse the incidence of ruptures in the sphincter or draw conclusions about differences between the groups with regard to Apgar scores or metabolic acidosis. RELEVANCE TO CLINICAL PRACTICE: In clinical practice, good routines concerning oxytocin augmentation are crucial. Interventions as oxytocin augmentation seem to cause harm to mother and child. To evaluate interventions continuously in obstetric care is therefore important.

  • 32. Thomson, H
    et al.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Thomas, S
    Housing improvement as a strategy to improve health and reduce health inequalities: a systematic review of best available evidence2007In: EUROPEAN JOURNAL OF PUBLIC HEALTH, Oxford University Press, 2007, p. 127-127Conference paper (Refereed)
  • 33. Thomson, H.
    et al.
    Thomas, S.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Housing improvement and health: a systematic review of world literature (1900-2005)2006In: EUROPEAN JOURNAL OF PUBLIC HEALTH, 2006, Vol. 16, p. 93-93Conference paper (Refereed)
    Abstract [en]

    Improving living conditions, such as poor housing may be an important means of tackling the socio-economic roots of health inequalities. A systematic review of the health impacts of housing improvement carried out in 2000 identified 18 completed studies and 13 studies approaching completion in 2003. It is now appropriate to update this systematic review to incorporate recently completed studies. Published and unpublished studies dating from 1936, in any language or format, were identified from bibliographic databases, expert consultation and bibliographies. The review included studies where the physical fabric of the housing had improved and which had assessed a change in health status among residents. Improvements to reduce exposure to lead, allergens, or rodent/insect infestation were excluded. Rehousing on medical grounds and housing improvement restricted to furniture adaptations were also excluded. 32 eligible studies of housing improvement were identified dating from 1936; 11 studies used prospective controlled designs. Thirteen studies evaluated housing improvements which were accompanied by wider neighbourhood improvement; 13 studies assessed the health impacts of energy efficiency improvements. Unclear study methods and poor reporting made data interpretation difficult. A preliminary synthesis suggests that small improvements in health, particularly in mental health, were reported although occasionally health outcomes deteriorated following housing improvement. Few studies reported impacts on socio-economic determinants of health. The growing body of impact evaluation in this field is welcome, but it is disappointing that the evidence base for healthy housing policy remains weak.

  • 34. Thomson, H
    et al.
    Thomas, S
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Petticrew, M
    Best available evidence on housing improvement and health: A systematic review: Meeting abstract2008In: JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2008, p. 11-11Conference paper (Refereed)
  • 35.
    Thomson, Hilary
    et al.
    Medical research Unit, Glasgow University, Glasgow, UK.
    Thomas, Sean
    Medical research Unit, Glasgow University, Glasgow, UK.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Petticrew, Mark
    Medical research Unit, Glasgow University, Glasgow, UK.
    The health impacts of housing improvement: a systematic review of intervention studies from 1887 to 20072009In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 99, no 3, p. 681-692Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We conducted a systematic review of the health impacts of housing improvement.

    METHODS: Forty-two bibliographic databases were searched for housing intervention studies from 1887 to 2007. Studies were appraised independently by H. T. and S. T. or E. S. for sources of bias. The data were tabulated and synthesized narratively, taking into account study quality.

    RESULTS: Forty-five relevant studies were identified. Improvements in general, respiratory, and mental health were reported following warmth improvement measures, but these health improvements varied across studies. Varied health impacts were reported following housing-led neighborhood renewal. Studies from the developing world suggest that provision of basic housing amenities may lead to reduced illness. There were few reports of adverse health impacts following housing improvement. Some studies reported that the housing improvement was associated with positive impacts on socioeconomic determinants of health.

    CONCLUSIONS: Housing improvements, especially warmth improvements, can generate health improvements; there is little evidence of detrimental health impacts. The potential for health benefits may depend on baseline housing conditions and careful targeting of the intervention. Investigation of socioeconomic impacts associated with housing improvement is needed to investigate the potential for longer-term health impacts.

  • 36.
    Thomson, Hilary
    et al.
    MRC, Social & Publ Hlth Sci Unit, Glasgow G12 8RZ, Lanark, Scotland .
    Thomas, Sian
    MRC, Social & Publ Hlth Sci Unit, Glasgow G12 8RZ, Lanark, Scotland .
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Petticrew, Mark
    London Sch Hyg & Trop Med, Fac Publ Hlth & Policy, Dept Social & Environm Hlth Res, London WC1, England.
    Housing improvements for health and associated socio-economic outcomes2013In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 2, p. Art. No. CD008657-Article, review/survey (Refereed)
    Abstract [en]

    Background The well established links between poor housing and poor health indicate that housing improvement may be an important mechanism through which public investment can lead to health improvement. Intervention studies which have assessed the health impacts of housing improvements are an important data resource to test assumptions about the potential for health improvement. Evaluations may not detect long term health impacts due to limited follow-up periods. Impacts on socio-economic determinants of health may be a valuable proxy indication of the potential for longer term health impacts. Objectives To assess the health and social impacts on residents following improvements to the physical fabric of housing. Search methods Twenty seven academic and grey literature bibliographic databases were searched for housing intervention studies from 1887 to July 2012 (ASSIA; Avery Index; CAB Abstracts; The Campbell Library; CINAHL; The Cochrane Library; COPAC; DH-DATA: Health Admin; EMBASE; Geobase; Global Health; IBSS; ICONDA; MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; NTIS; PAIS; PLANEX; PsycINFO; RIBA; SCIE; Sociological Abstracts; Social Science Citations Index; Science Citations Index expanded; SIGLE; SPECTR). Twelve Scandinavian grey literature and policy databases (Libris; SveMed+; Libris uppsok; DIVA; Artikelsok; NORART; DEFF; AKF; DSI; SBI; Statens Institut for Folkesundhed; Social.dk) and 23 relevant websites were searched. In addition, a request to topic experts was issued for details of relevant studies. Searches were not restricted by language or publication status. Selection criteria Studies which assessed change in any health outcome following housing improvement were included. This included experimental studies and uncontrolled studies. Cross-sectional studies were excluded as correlations are not able to shed light on changes in outcomes. Studies reporting only socio-economic outcomes or indirect measures of health, such as health service use, were excluded. All housing improvements which involved a physical improvement to the fabric of the house were included. Excluded interventions were improvements to mobile homes; modifications for mobility or medical reasons; air quality; lead removal; radon exposure reduction; allergen reduction or removal; and furniture or equipment. Where an improvement included one of these in addition to an included intervention the study was included in the review. Studies were not excluded on the basis of date, location, or language. Data collection and analysis Studies were independently screened and critically appraised by two review authors. Study quality was assessed using the risk of bias tool and the Hamilton tool to accommodate non-experimental and uncontrolled studies. Health and socio-economic impact data were extracted by one review author and checked by a second review author. Studies were grouped according to broad intervention categories, date, and context before synthesis. Where possible, standardized effect estimates were calculated and statistically pooled. Where meta-analysis was not appropriate the data were tabulated and synthesized narratively following a cross-study examination of reported impacts and study characteristics. Qualitative data were summarized using a logic model to map reported impacts and links to health impacts; quantitative data were incorporated into the model. Main results Thirty-nine studies which reported quantitative or qualitative data, or both, were included in the review. Thirty-three quantitative studies were identified. This included five randomised controlled trials (RCTs) and 10 non-experimental studies of warmth improvements, 12 non-experimental studies of rehousing or retrofitting, three non-experimental studies of provision of basic improvements in low or mIddle Income countries (LMIC), and three non-experimental historical studies of rehousing from slums. Fourteen quantitative studies (42.4%) were assessed to be poor quality and were not included in the synthesis. Twelve studies reporting qualitative data were identified. These were studies of warmth improvements (n = 7) and rehousing (n = 5). Three qualitative studies were excluded from the synthesis due to lack of clarity of methods. Six of the included qualitative studies also reported quantitative data which was included in the review. Very little quantitative synthesis was possible as the data were not amenable tometa-analysis. This was largely due to extreme heterogeneity both methodologically as well as because of variations in the intervention, samples, context, and outcome; these variations remained even following grouping of interventions and outcomes. In addition, few studies reported data that were amenable to calculation of standardized effect sizes. The data were synthesised narratively. Data from studies of warmth and energy efficiency interventions suggested that improvements in general health, respiratory health, and mental health are possible. Studies which targeted those with inadequate warmth and existing chronic respiratory disease were most likely to report health improvement. Impacts following housing-led neighbourhood renewal were less clear; these interventions targeted areas rather than individual households in most need. Two poorer quality LMIC studies reported unclear or small health improvements. One better quality study of rehousing from slums (pre-1960) reported some improvement in mental health. There were few reports of adverse health impacts following housing improvement. A small number of studies gathered data on social and socioeconomic impacts associated with housing improvement. Warmth improvements were associated with increased usable space, increased privacy, and improved social relationships; absences from work or school due to illness were also reduced. Very few studies reported differential impacts relevant to equity issues, and what data were reported were not amenable to synthesis. Authors' conclusions Housing investment which improves thermal comfort in the home can lead to health improvements, especially where the improvements are targeted at those with inadequate warmth and those with chronic respiratory disease. The health impacts of programmes which deliver improvements across areas and do not target according to levels of individual need were less clear, but reported impacts at an area level may conceal health improvements for those with the greatest potential to benefit. Best available evidence indicates that housing which is an appropriate size for the householders and is affordable to heat is linked to improved health and may promote improved social relationships within and beyond the household. In addition, there is some suggestion that provision of adequate, affordable warmth may reduce absences from school or work. While many of the interventions were targeted at low income groups, a near absence of reporting differential impacts prevented analysis of the potential for housing improvement to impact on social and economic inequalities.

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