Svenn-Erik Mamelund

Tracking parental attitudes on vaccination across European countries: The Vaccine Safety, Attitudes, Training and Communication Project (VACSATC)

The paper presents the first results from the European project VACSATC which aimed to track parental attitudes on vaccinations across several European countries. We compared five cross-sectional surveys of parents with children less than 3 years of age in England, Norway, Poland, Spain and Sweden carried out during 2008-2009. Data were collected from 6611 respondents. Two countries used face-to face interviews, one used telephone interviews, and two other countries used mail-in questionnaires. In all countries health professionals were indicated as the most important and trusted source of information on vaccination. The study results also show that parental attitudes on vaccinations in the childhood vaccination programs are generally positive. However, there were differences in attitudes on vaccination between the five countries, possibly reflecting different methods of sampling the respondents, context-specific differences (e.g. level of activity of governmental agencies), but also individual-level parental variation in demographic and socioeconomic status variables.

Geography may explain adult mortality from the 1918-20 influenza pandemic.

Seasonal influenza takes its most pronounced toll on children and the elderly, giving the crude age-specific mortality rates a U-shape. In contrast, A(H1N1) 1918-20 pandemic mortality was W-shaped. When adjusting for the seasonal baseline, young adults had higher but the elderly lower than expected mortality. The lower than expected mortality for the elderly is one reason why total mortality in urban societies were relatively low in 1918-20 (<1%). Why mortality peaked at age 30 but declined into old age is still not clear. It has been suggested that cohorts >30 years was protected because they were exposed to H1-like viruses prior to 1889. This hypothesis assumes that people lived within the reach of the urban disease pools. Here I analyze mortality after age 30 in aboriginal populations assumed to be infrequently exposed to influenza due to their geographic isolation. Results show that Arctic and Pacific peoples also experienced a decline in relative mortality after age 30. However, the remotely living elderly did not have lower than expected mortality, suggesting that they had less prior exposure to influenza than their urban counterpart. Crude total mortality and mortality for all adults >30 years was nevertheless extremely high in the remote populations. Parish records quantitatively confirmed the anecdotes that children 5-14 years were the only survivors in some Arctic communities. Low exposure to H1-like viruses in adults could not alone explain the high total mortality in remote populations (up to 90%). A high concurrent disease load, crowding, low genetic variability, a lack of basic care, and infrequent exposure to other forms of influenza virus 1890-1917 may have played a role as well. This form of immunological cross-protection from previous exposure to A-type influenza viruses other than H1N1 can only be explained as a consequence of cellular immunity against internal proteins that show less inter-strain variation than the surface proteins.

Spanish Influenza Mortality of Ethnic Minorities in Norway 1918–1919

Previous studies into SpanishInfluenza mortality have reported thatindigenous populations were the prime victims.The explanations put forward in those studieswere not convincing, however, as no controlshad been made for possibly confounding factors.The multivariate analysis in this paper showsthat areas of Norway with high shares of theSami population (Laps) had high SpanishInfluenza mortality, net of such confoundingfactors as wealth, poverty, crowding, and occupationalstructure. The cause is probably a lack ofinherited and acquired immunity againstinfluenza among the Sami. Another ethnicminority, Kven (Finnish immigrants and theirdescendants), however, did not differsignificantly from the ethnic Norwegianmajority population with respect to SpanishInfluenza mortality. This is explained by arelatively high degree of economic and culturalassimilation of the Kven in the Norwegiansociety, as opposed to the Sami in the late1910s.

Can the Spanish Influenza Pandemic of 1918 Explain the Baby Boom of 1920 in Neutral Norway

Deux ans apres la fin de la premiere guerre mondiale, les taux de natalite ont enregistre une vive progression en Europe, y compris en Norvege, pays reste neutre lors du conflit. Cet article tente de valider l’hypothese selon laquelle la responsabilite du baby-boom en Norvege revient plutot a la grippe espagnole qu’a la fin de la guerre. Alors que les recherches anterieures ont repose sur des analyses univariees et essentiellement descriptives, cette etude s’appuie sur des analyses multivariees. L’effet propre de la morbidite due a la grippe espagnole sur la fecondite, en controlant l’effet de la mortalite, a ete estime pour la periode 1918-1920 a partir de donnees mensuelles regionales. En raison de la neutralite de la Norvege, la guerre n’a pas interfere avec l’effet de la grippe espagnole sur la fecondite et la nuptialite. De surcroit, les donnees disponibles sont parmi les plus fiables d’Europe, etant donne que l’enregistrement des donnees demographiques, y compris d’etat civil, n’a pas ete perturbe par le conflit.

Fertility Fluctuations in Times of War and Pandemic Influenza

TO THE EDITOR—Bloom-Feshbach et al [1] conclude that fluctuations in fertility in the United States, Norway, Denmark, and Sweden during 1919–1920 were an effect of miscarriages and deaths of pregnant women due to infection with influenza in fall 1918. The authors find no role for World War I (WWI) and behavioral factors in the observed patterns. Their article is not the first comparative study published on the topic. Here, I comment on their findings in light of research on 15 European countries, including a detailed study of Norway [2]. Miscarriages in 1918 may be 1 reason for the fertility fluctuations during 1919– 1920, and deaths of pregnant women arguably led to fewer births in 1919. However, deaths from influenza of women in the first trimester of pregnancy during August–November 1918 had no effect on the birth rates (the outcome measure used in [1]) during April–July 1919 because the denominator (women at risk of a live birth) is depressed by the same number as the numerator (fetal deaths). Nonpregnant influenza victims could not conceive in 1918 and are, therefore, along with pregnant women who died, not in the population at risk of a live birth in 1919. Competing hypotheses are inadequately discussed. First, the authors state that “because all 4 countries had the postpandemic birth depression pattern, we conclude that war-related population changes cannot explain the observed patterns.” This conclusion is too hasty. Reliance only on research published in medical journals may explain why the conclusion lacks geographical and historical context [2–9]. Nine European countries that entered WWI early experienced a sharp decline in fertility 1914–1918 [2]. This was due to separation of soldiers from their wives and because the war hindered young adults from marrying. On the other hand, 6 neutral countries (Finland, Norway, Sweden, Switzerland, the Netherlands, Spain) [2] and the United States [1], which entered WWI in spring 1917, did not have fertility dips during the war. World War I created a large potential for compensation in marriages/births in warring nations in Europe, but not in the United States [1] and neutral countries in Europe [2, 7]. However, the baby boom in the belligerent countries—with the potential for compensation in births after 5 years of war and some months of influenza—was modest compared with that in neutral countries—with the potential for compensation in births after influenza only [2]. Bloom-Feshbach et al note that “the compensatory increase in the birth rates was not as pronounced in the United States as in the other locations,” but they do not note that the US pattern was shared with belligerent Europe and that neutral countries in Europe had similar experiences. The reason for the modest baby boom in belligerent countries is perhaps that the war took a heavy toll on young adult males, thereby lowering the chances of marriage for spinsters and of remarriage for war and influenza widows. This, in turn, may explain why the potential rebound in births is far from fully exploited [2]. The modest baby boom in belligerent Europe is especially striking, given the much larger potential for compensation in births there compared with the United States. Second, Bloom-Feshbach et al [1] conclude that illness and fear from infection did not interfere with reproductive behavior during the mild 1918 spring/summer outbreaks. However, Denmark and Norway had large waves of reported morbidity at that time that may even be underestimated. Survey information for Norway shows that official records (the latter data source used in [1]) captured only one-third of the new influenza-pneumonia cases in summer 1918, whereas underreporting of new disease cases in official records was low during the lethal fall wave [2]. Two-thirds of the fertility decline in Norway associated with the 1918 pandemic occurred during January–June 1919 (conceptions April–September 1918), and a cross-sectional regression analysis (N = 37 rural and urban areas covering the whole population) showed that the higher the increase in monthly morbidity was in a region during the summer of 1918, the larger the decline in fertility was in that region 9 months later [2]. This provides evidence that changes in reproductive behavior in spring/summer 1918 were central to explaining the fertility decline in Norway during 1919, and perhaps also in Denmark, New York [10], and other places with early documented outbreaks. The effect of influenza bereavement on (re)marriage and fertility is not discussed as a confounder by Bloom-Feshbach et al. The bereaved were temporarily hindered from conceiving, at least legitimately. Data for Norway support this hypothesis; in 1920, the increase in the illegitimate birth rate was 2.5 times larger than the increase in the legitimate birth rate [2]. Remarriage rates declined from 1918 to 1919 but

Influenza vaccine--for whom?

«Ikke vaer barsk,» skrev Aftenposten 2.1. 2009 (1), med henvisning til en representant fra Folkehelseinstituttet for a oppfordre folk i risikogruppene og deres naerkontakter til a ta arets influensavaksine i stedet for a gjennomga sykdommen. Under halvparten av dem som i 2005/06 tilhorte risikogruppene, var nemlig vaksinert (2). Folkehelseinstituttet anbefaler at personer som tilhorer visse risikogrupper blir vaksinert mot influensa hvert ar. Det gjelder dem som har fylt 65 ar, beboere i omsorgsboliger og sykehjem, gravide i 2. – 3. trimester og barn og voksne med enkelte kroniske og/eller alvorlige sykdommer, svaert alvorlig fedme eller nedsatt infeksjonsresistens. I tillegg bor husstandskontakter til svaert immunsupprimerte pasienter vurdere a la seg vaksinere, og helsepersonell med pasientkontakt og svineroktere anbefales a ta vaksinen (3). Ved a vaksinere helsepersonell som er i jevnlig kontakt med pasienter, kan man hindre at utsatte grupper blir smittet (4) – som vist ved «det japanske eksperiment», der overdodeligheten av pneumoni og influensaliknende sykdom hos eldre ble sterkt redusert i de arene skolebarna regelmessig ble vaksinert mot influensa (5). Men i en storre analyse kunne det ikke pavises noen vesentlig effekt av slik vaksinasjon av helsepersonell pa forekomsten av influensa og pneumoni eller innleggelse i sykehus/dod pga. luftveissykdom hos minst 60 ar gamle pleiepasienter og beboere i omsorgsboliger (6). Det har heller ikke vist seg kostnadseffektivt a vaksinere friske, voksne arbeidstakere for a redusere sykefravaeret (7). I Norge har vi til na brukt ikke-replikerende, eller «ikke-levende», influensavaksiner som hovedsakelig bestar av virusets ytre deler – enten som splittvirus eller som renset antigen. Disse ytterproteinene – hemagglutinin (H) og nevraminidase (N) – er i stadig endring. Selv om endringene

Fit for fight? A cross-sectional study of union apathy in Norway:

The article synthesizes the literature on union commitment and union renewal through employing the concept of union apathy. This is done with a view to analyse the association between union strategies and union apathy, and the association between apathy and willingness to become a union delegate in Norway. To this end, the authors have run multivariate regressions on the YS Employment Outlook Survey. Results show that union strategy is significantly associated with apathy, and that apathetic union members are less willing to work for their union in the capacity of union delegate. The authors conclude that if unions are to counter apathy in an effort at renewal, and to ensure a sufficient pool of potential union delegates, they must mobilize the talents, ideas and energy of their members. Finally, the authors suggest that unions with an ‘organizing’ soul seem better equipped to counter apathy than unions bent on the ‘servicing’ model.

A Missed Summer Wave of the 1918–1919 Influenza Pandemic: Evidence From Household Surveys in the United States and Norway

Background. Reanalysis of influenza survey data from 1918 to 1919 was done to obtain new insights into the geographic and host factors responsible for the various waves. Methods. We analyzed the age- and sex-specific influenza morbidity, fatality, and mortality for the city of Baltimore and smaller towns and rural areas of Maryland and the city of Bergen (Norway), using survey data. The Maryland surveys captured the 1918 fall wave, whereas the Bergen survey captured 3 waves during 1918–1919. Results. Morbidity in rural areas of Maryland was higher than in the city of Baltimore during the fall of 1918, that was almost equal to that in Bergen during the summer of 1918. In Bergen, the morbidity in the fall was only half of that in the summer, with more females than males just above the age of 20 falling ill, as seen in both regions of Maryland. In contrast, more males than females fell ill during the summer wave in Bergen. Individuals <40 years had the highest morbidity, whereas school-aged children had the lowest fatality and mortality. Conclusion. A previously unrecognized pandemic summer wave may have hit the 2 regions of Maryland in 1918.

Are you moving up or falling short? An inquiry of skills-based variation in self-perceived employability among Norwegian employees

This article investigates how educational level, job-related skills and employers’ support for competence development jointly determine Norwegian employees’ expectations of maintaining employment and career advancement. The data were collected in 2010 and 2013, and they comprise a representative sample of Norwegian employees. In contrast to previous research on self-perceived employability, this study divides expectations of advancement and continued employment. The results show that these are different measures of labour market success. While education is significantly correlated with both measures, the employer’s support for competence development is important for expectations of career advancement, especially among the highly educated, whereas the job–skills match is most relevant for the expectation of maintaining employment.

The Influence of Hispanic Ethnicity and Nativity Status on 2009 H1N1 Pandemic Vaccination Uptake in the United States

Previous research suggests Hispanic vaccination rates for H1N1 were similar to non-Hispanic whites. These previous estimates do not take into account nativity status. Using the 2010 National Health Interview Survey, we estimate adult H1N1 vaccination rates for non-Hispanic whites (n = 8780), U.S.-born Hispanics (n = 1142), and foreign-born Hispanics (n = 1912). To test Fundamental Cause Theory, we estimate odds of H1N1 vaccination while controlling for flexible resources (e.g., educational and economic capital), ethnicity, and nativity status. Foreign-born Hispanics experienced the lowest rates of H1N1 vaccination (15%), followed by U.S.-born Hispanics (18%) and non-Hispanic whites (21%). Regression models show odds of H1N1 vaccination did not differ among these three groups after controlling for sociodemographic characteristics. Insufficient access to flexible resources and healthcare coverage among foreign-born Hispanics was responsible for relatively low rates of H1N1 vaccination. Addressing resource disparities among Hispanics could increase vaccination uptake in the future, reducing inequities in disease burden.