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Santosa, A., Rocklöv, J., Högberg, U. & Byass, P. (2015). Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study. BMC Medicine, 13(65)
Öppna denna publikation i ny flik eller fönster >>Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study
2015 (Engelska)Ingår i: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 13, nr 65Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: The 2012 World Health Assembly set a target for Member States to reduce premature non-communicable disease (NCD) mortality by 25% over the period 2010 to 2025. This reflected concerns about increasing NCD mortality burdens among productive adults globally.

OBJECTIVES: We firstly considered whether the WHO target of a 25% reduction in the unconditional probability of dying between ages of 30 and 70 from NCDs (cardiovascular diseases, cancer, diabetes or chronic respiratory diseases) had already taken place in Sweden during an equivalent 15-year period. Secondly, we assessed which population sub-groups had been more or less successful in contributing to overall changes in premature NCD mortality in Sweden.

METHODS: A retrospective dynamic cohort database was constructed from Swedish population registers in the Linnaeus database, covering the entire population in the age range 30-69 years for the period 1991 to 2006, which was used directly to measure reductions in premature NCD mortality. Multivariate Poisson regression models were used to assess the contributions of individual background factors to decreases in premature NCD mortality.

RESULTS: A total of 292,320 deaths occurred in the 30-69 year age group during the period 1991 to 2006, against 70,768,848 person-years registered. The crude all-cause mortality rate declined from 5.03 to 3.72 per 1,000 person-years, a 26% reduction. Within this, the unconditional probability of dying between the ages of 30 and 70 from NCD causes as defined by WHO fell by 30.0%. Age was consistently the strongest determinant of NCD mortality. Background determinants of NCD mortality changed significantly over the four time periods 1991-1994, 1995-1998, 1999-2002 and 2003-2006.

CONCLUSIONS: Sweden, now at a late stage of epidemiological transition, has already exceeded the 25% premature NCD mortality reduction target during an earlier 15-year period. This should be encouraging news for countries currently implementing premature NCD mortality reduction programmes. Our findings suggest, however, that it may be difficult for Sweden and other late-transition countries to reach the current 25x25 target, particularly where substantial premature mortality reductions have already been achieved.

Nyckelord
non-communicable disease, mortality, Sweden, World Health Organization, 25x25 target
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Forskningsämne
folkhälsa
Identifikatorer
urn:nbn:se:umu:diva-103028 (URN)10.1186/s12916-015-0313-8 (DOI)000352599700001 ()25889300 (PubMedID)
Tillgänglig från: 2015-05-15 Skapad: 2015-05-15 Senast uppdaterad: 2018-06-07Bibliografiskt granskad
Hayati, E. N., Eriksson, M., Hakimi, M., Högberg, U. & Emmelin, M. (2013). "Elastic band strategy": women's lived experience of coping with domestic violence in rural Indonesia. Global Health Action, 6, 1-12
Öppna denna publikation i ny flik eller fönster >>"Elastic band strategy": women's lived experience of coping with domestic violence in rural Indonesia
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2013 (Engelska)Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, s. 1-12Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Experiencing domestic violence is considered a chronic and stressful life event. A theoretical framework of coping strategies can be used to understand how women deal with domestic violence. Traditional values strongly influenced by religious teachings that interpret men as the leaders of women play an important role in the lives of Javanese women, where women are obliged to obey their husbands. Little is known about how sociocultural and psychosocial contexts influence the ways in which women cope with domestic violence.

Objective: Our study aimed to deepen our understanding of how rural Javanese women cope with domestic violence. Our objective was to explore how the sociocultural context influences coping dynamics of women survivors of domestic violence in rural Purworejo.

Design: A phenomenological approach was used to transform lived experiences into textual expressions of the coping dynamics of women survivors of domestic violence.

Results: Experiencing chronic violence ruined the women's personal lives because of the associated physical, mental, psychosocial, and financial impairments. These chronic stressors led women to access external and internal resources to form coping strategies. Both external and internal factors prompted conflicting impulses to seek support, that is, to escape versus remain in the relationship. This strong tension led to a coping strategy that implied a long-term process of moving between actively opposing the violence and surrendering or tolerating the situation, resembling an elastic band that stretches in and out.

Conclusions: Women survivors in Purworejo face a lack of institutional support and tend to have traditional beliefs that hamper their potential to stop the abuse. Although the women in this study were educated and economically independent, they still had difficulty mobilizing internal and external support to end the abuse, partly due to internalized gender norms.

Nyckelord
domestic violence, coping, lived experience, Indonesia
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-66469 (URN)10.3402/gha.v6i0.18894 (DOI)000313061600001 ()23336615 (PubMedID)
Tillgänglig från: 2013-02-21 Skapad: 2013-02-21 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Wennberg, A. L., Lundqvist, A., Högberg, U., Sandström, H. & Hamberg, K. (2013). Women's experiences of dietary advice and dietary changesduring pregnancy. Midwifery, 29(9), 1027-1034
Öppna denna publikation i ny flik eller fönster >>Women's experiences of dietary advice and dietary changesduring pregnancy
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2013 (Engelska)Ingår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, nr 9, s. 1027-1034Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: to describe women's experiences of dietary information and the change of dietary habits during pregnancy. DESIGN: a qualitative design was used. In 2007 we conducted six focus group interviews using open-ended questions. SETTINGS: five rural and city antenatal clinics in northern Sweden were included PARTICIPANTS: twenty-three women in mid-pregnancy participated in groups of three to seven FINDINGS: three domains were found 'Dietary information gain', 'Reactions to dietary information' and 'Dietary management'. The women had to discover dietary information by themselves, and only when health problems or symptoms occurred did they receive guidance from the midwife. Their reactions to the dietary information were 'being confused', 'feeling fear and guilt' and 'being monitored', summed up in 'being uncertain'. The diet was managed by 'checking food content', 'following bodily signals', 'using common sense', and 'making exceptions', summed up as 'being responsible but with a pinch of salt'. KEY CONCLUSIONS: the women expressed problems with dietary changes, but they could mostly manage them on their own. The pregnant women experienced that the midwives gave dietary information and advice first when problems arise. When struggling with diet, the women experienced confusion, and they had to seek information by themselves. IMPLICATIONS FOR PRACTICE: sources of information about diet during pregnancy were experienced as inconsistent and contradictory. Midwives are important in motivation for healthy lifestyle during pregnancy and with sufficient dietary knowledge and counselling skills they can help pregnant women effect dietary changes by providing guidance and support in early pregnancy.

Nyckelord
Pregnancy; Dietary advice; Dietary changes; Quality methods
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:umu:diva-66838 (URN)10.1016/j.midw.2012.09.005 (DOI)000321744500002 ()23427852 (PubMedID)
Tillgänglig från: 2013-03-05 Skapad: 2013-03-05 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Nyström, M. E., Westerlund, A., Höög, E., Millde-Luthander, C., Högberg, U. & Grunewald, C. (2012). Healthcare system intervention for prevention of birth injuries: process evaluation of self-assessment, peer review, feedback and agreement for change. BMC Health Services Research, 12, Article ID 274.
Öppna denna publikation i ny flik eller fönster >>Healthcare system intervention for prevention of birth injuries: process evaluation of self-assessment, peer review, feedback and agreement for change
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2012 (Engelska)Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, artikel-id 274Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors' mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased.

Methods: Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change.

Results: The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions). The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change.

Conclusions: Our findings are in line with several studies stressing the importance of self-evaluation by encouraging a thorough review of objectives, practices and outcomes for the continuous improvement of an organisation. Even though effects of the peer review were limited, feedback from peers, or other change agents involved, and the support that a clear and well-structured action plan can provide are considered to be two important complements to future self-assessment procedures related to patient safety improvement.

Nationell ämneskategori
Hälsovetenskaper
Identifikatorer
urn:nbn:se:umu:diva-61987 (URN)10.1186/1472-6963-12-274 (DOI)000310146300001 ()2920327 (PubMedID)
Tillgänglig från: 2012-12-12 Skapad: 2012-12-04 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Salazar, M., Högberg, U., Valladares, E. & Persson, L.-Å. (2012). Intimate partner violence and early child growth: a community-based cohort study in Nicaragua. BMC Pediatrics, 12, 82
Öppna denna publikation i ny flik eller fönster >>Intimate partner violence and early child growth: a community-based cohort study in Nicaragua
2012 (Engelska)Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 12, s. 82-Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: This study analyses whether a mother's exposure to different forms of Intimate Partner Violence (IPV) during pregnancy was associated with the index child linear growth, and whether these associations were modified by the gender of the child.

Methods: A pregnancy cohort of 478 women in Leon, Nicaragua, resulted in 461 live births. From this group, 81% (375/461) children were available for anthropometric follow-up at 40 to 46 months. Analysis of covariance (ANCOVA) was used to assess the association between IPV and height-for-age Z-scores, adjusting for confounding factors.

Results: Sixty-three percent (236/375) of the mothers had been exposed to some form of IPV during pregnancy (emotional, physical, sexual or controlling behavior). After adjustment for confounding factors, maternal exposure to any IPV during pregnancy was associated with 0.24 lower mean height-for-age Z-scores (p = 0.02). A separate analysis of each IPV type showed that emotional, physical or sexual IPV during pregnancy were not significantly associated with lower mean height-for-age Z-scores, whereas ever exposure to controlling behavior by the father of the child was related to 0.29 lower mean height-for-age Z-scores (p < 0.01) When stratified by gender, these associations remained significant only for young girls.

Conclusions: This study has contributed to the growing amount of evidence pointing to the pervasive effect of different forms of IPV on child health. Our study highlights the relevance of maternal autonomy for linear child growth, especially for young girls in the Nicaraguan context.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2012
Nyckelord
Intimate partner violence, Child growth, Gender
Nationell ämneskategori
Pediatrik Pedagogik
Identifikatorer
urn:nbn:se:umu:diva-58920 (URN)10.1186/1471-2431-12-82 (DOI)000307404700001 ()
Tillgänglig från: 2012-09-07 Skapad: 2012-09-06 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Salazar, M., Valladares, E. & Högberg, U. (2012). Questions about intimate partner violence should be part of contraceptive counselling: findings from a community-based longitudinal study in Nicaragua. Journal of family planning and reproductive health care, 38(4), 221-228
Öppna denna publikation i ny flik eller fönster >>Questions about intimate partner violence should be part of contraceptive counselling: findings from a community-based longitudinal study in Nicaragua
2012 (Engelska)Ingår i: Journal of family planning and reproductive health care, ISSN 1471-1893, E-ISSN 2045-2098, Vol. 38, nr 4, s. 221-228Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND AND METHODOLOGY: The study aim was to examine whether exposure to intimate partner violence (IPV) was associated with reversible contraceptive use in ever-pregnant partnered women. The authors conducted a longitudinal panel study in León municipality, Nicaragua. At baseline (2002-2003), 478 pregnant women were interviewed and 398 were available for questioning about contraceptive use 40-47 months after childbirth. IPV was assessed at baseline and follow-up, with women classified as never abused, ending abuse, continued abuse or new abuse. Reversible contraceptive use was defined as women using any form of contraception apart from sterilisation. Adjusted odds ratios (AORs) were used to assess the association between reversible contraceptive use, IPV patterns and IPV exposures at follow-up. RESULTS: Eighty percent of the women were not pregnant and with a partner at follow-up. Half were using reversible contraceptives and 28% were sterilised. Women exposed to a continued abuse pattern (AOR 2.50, 95% CI 1.04-5.99), and those exposed to emotional (AOR 2.80, 95% CI 1.32-5.95), physical (AOR 3.60, 95% CI 1.15-11.10) or any IPV at follow-up (AOR 2.59, 95% CI 1.24-5.40) had higher odds of reversible contraceptive use than those not exposed, even after adjusting for demographic factors. No significant differences in the type of reversible contraceptive used were found between women exposed or not to IPV. DISCUSSION AND CONCLUSIONS: IPV exposure was associated with more reversible contraceptive use. Abuse inquiring at health facilities providing contraceptives should be implemented to identify women exposed to IPV and provide adequate support.

Ort, förlag, år, upplaga, sidor
London, England: BMJ Publishing Group, 2012
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-59946 (URN)10.1136/jfprhc-2011-000043 (DOI)22167533 (PubMedID)
Tillgänglig från: 2012-09-27 Skapad: 2012-09-27 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Millde-Luthander, C., Högberg, U., Nyström, M. E., Pettersson, H., Wiklund, I. & Grunewald, C. (2012). The impact of a computer assisted learning programme on the ability to interpret cardiotochography. A before and after study. Sexual & Reproductive HealthCare, 3(1), 37-41
Öppna denna publikation i ny flik eller fönster >>The impact of a computer assisted learning programme on the ability to interpret cardiotochography. A before and after study
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2012 (Engelska)Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, nr 1, s. 37-41Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To evaluate if a computer assisted learning programme could bring about a higher degree of individuals who correctly classified cardiotochography (CTG) recordings in a non-selected population of midwives and physicians.

Study design: A before and after study. Setting: Sodersjukhuset, Stockholm, Sweden.

Subjects: One hundred and thirty midwives and 49 physicians at the maternity unit, September 2009-April 2010. A computer assisted learning programme for interpreting CTG patterns has been created. All 179 individuals included made the first interpretation and the 135 individuals also completing the education made the second interpretation. A third randomly selected interpretation was performed immediately following the second: permitting two participants to classify a CTG together. Comparison between the before and after-test was based on the Fisher exact test.

Main Outcome measure: The proportion of individuals who correctly classified CTGs before and after the training.

Results: Sixty four percentage of the individuals classified the CTGs correctly before and 66% after the training (P = 0.76). There was no difference between the two professional groups. Normal CTGs were correctly identified by 36% of the individuals before and in 80% after the training (P = 0.065). Corresponding figures for pathological CTGs were 83% and 85% (P = 1.00), respectively.

Conclusion: We found no improvement in the proportion of individuals who classified CTGs correctly after the completion of a computer assisted learning programme in fetal monitoring. The baseline level of competence was higher than expected. (C) 2011 Elsevier B.V. All rights reserved.

Nyckelord
Cardiotochography, CTG, Fetal surveillance, Computer assisted learning programme
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Identifikatorer
urn:nbn:se:umu:diva-64063 (URN)10.1016/j.srhc.2011.10.001 (DOI)000312282000006 ()
Tillgänglig från: 2013-01-14 Skapad: 2013-01-14 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Elvander, C., Högberg, U. & Ekéus, C. (2012). The influence of fetal head circumference on labor outcome: a population-based register study. Acta Obstetricia et Gynecologica Scandinavica, 91(4), 470-475
Öppna denna publikation i ny flik eller fönster >>The influence of fetal head circumference on labor outcome: a population-based register study
2012 (Engelska)Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, nr 4, s. 470-475Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective. To investigate the association between postnatal head circumference and the occurrence of the three main indications for instrumental delivery, namely prolonged labor, signs of fetal distress and maternal distress. We also studied the association between postnatal fetal head circumference and the use of vacuum extraction and emergency cesarean section. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. A total of 265 456 singleton neonates born to nulliparous women at term between 1999 and 2008 in Sweden. Methods. Register study with data from the Swedish Medical Birth Register. Main outcome measures. Prolonged labor, signs of fetal distress, maternal distress, use of vacuum extraction and emergency cesarean section. Results. The prevalence of each outcome increased gradually as the head circumference increased. Compared with women giving birth to a neonate with average size head circumference (35 cm), women giving birth to an infant with a very large head circumference (3941 cm) had significantly higher odds of being diagnosed with prolonged labor [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.331.67], signs of fetal distress (OR 1.73, 95% CI 1.492.03) and maternal distress (OR 2.40, 95% CI 1.962.95). The odds ratios for vacuum extraction and cesarean section were thereby elevated to 3.47 (95% CI 3.103.88) and 1.22 (95% CI 1.041.42), respectively. The attributable risk proportion percentages associated with vacuum extraction and cesarean section were 46 and 39%, respectively among the cases exposed to a head circumference of 3741 cm. Conclusions. Large fetal head circumference is associated with complicated labor and is etiological to a considerable proportion of assisted vaginal births and emergency cesarean sections.

Nyckelord
Head circumference, prolonged labor, dystocia, fetal distress, maternal distress, vacuum extraction, emergency cesarean section
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-54309 (URN)10.1111/j.1600-0412.2012.01358.x (DOI)000301712700010 ()
Tillgänglig från: 2012-04-24 Skapad: 2012-04-24 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Salazar, M., Högberg, U., Valladares, E. & Öhman, A. (2012). The supportive process for ending intimate partner violence after pregnancy: the experience of nicaraguan women. Violence against Women, 18(11), 1257-1278
Öppna denna publikation i ny flik eller fönster >>The supportive process for ending intimate partner violence after pregnancy: the experience of nicaraguan women
2012 (Engelska)Ingår i: Violence against Women, ISSN 1077-8012, E-ISSN 1552-8448, Vol. 18, nr 11, s. 1257-1278Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

This grounded theory study found that Nicaraguan mothers exposed to intimate partner violence (IPV) during pregnancy eventually acted to protect their children and themselves. They experienced ending abuse as an empowerment process characterized by a cognitive change in women's attitudes toward partner abuse and the emergence of help-seeking strategies that lead to ending violence with or without ending the relationship. This process was facilitated by a supportive environment that challenged abusive behaviors as well as being asked about abuse during their last pregnancy. Although environmental changes can facilitate ending abuse, Nicaragua's public institutions must be strengthened to reach women in need.

Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-64352 (URN)10.1177/1077801212470549 (DOI)23334814 (PubMedID)
Tillgänglig från: 2013-01-24 Skapad: 2013-01-24 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Hayati, E. N., Högberg, U., Hakimi, M., Ellsberg, M. C. & Emmelin, M. (2011). Behind the silence of harmony: risk factors for physical and sexual violence among women in rural Indonesia.. BMC Women's Health, 11, 52
Öppna denna publikation i ny flik eller fönster >>Behind the silence of harmony: risk factors for physical and sexual violence among women in rural Indonesia.
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2011 (Engelska)Ingår i: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 11, s. 52-Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Indonesia has the fourth largest population in the world. Few studies have identified the risk factors of Indonesian women for domestic violence. Such research will be useful for the development of prevention programs aiming at reducing domestic violence. Our study examines associations between physical and sexual violence among rural Javanese Indonesian women and sociodemographic factors, husband's psychosocial and behavioral characteristics and attitudes toward violence and gender roles.

METHODS: A cohort of pregnant women within the Demographic Surveillance Site (DSS) in Purworejo district, Central Java, Indonesia, was enrolled in a longitudinal study between 1996 and 1998. In the following year (1999), a cross-sectional domestic violence household survey was conducted with 765 consenting women from that cohort. Female field workers, trained using the WHO Multi-Country study instrument on domestic violence, conducted interviews. Crude and adjusted odds ratios at 95% CI were applied for analysis.

RESULTS: Lifetime exposure to sexual and physical violence was 22% and 11%. Sexual violence was associated with husbands' demographic characteristics (less than 35 years and educated less than 9 years) and women's economic independence. Exposure to physical violence among a small group of women (2-6%) was strongly associated with husbands' personal characteristics; being unfaithful, using alcohol, fighting with other men and having witnessed domestic violence as a child. The attitudes and norms expressed by the women confirm that unequal gender relationships are more common among women living in the highlands and being married to poorly educated men. Slightly more than half of the women (59%) considered it justifiable to refuse coercive sex. This attitude was also more common among financially independent women (71%), who also had a higher risk of exposure to sexual violence.

CONCLUSIONS: Women who did not support the right of women to refuse sex were more likely to experience physical violence, while those who justified hitting for some reasons were more likely to experience sexual violence. Our study suggests that Javanese women live in a high degree of gender-based subordination within marriage relationships, maintained and reinforced through physical and sexual violence. Our findings indicate that women's risk of physical and sexual violence is related to traditional gender norms.

Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-82693 (URN)10.1186/1472-6874-11-52 (DOI)22112243 (PubMedID)
Tillgänglig från: 2013-11-06 Skapad: 2013-11-06 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
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