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Hulterström, Anna Karin
Alternative names
Publications (10 of 10) Show all publications
Sirili, N., Kiwara, A., Gasto, F., Goicolea, I. & Hurtig, A.-K. (2017). Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements. Human Resources for Health, 15, Article ID 27.
Open this publication in new window or tab >>Training and deployment of medical doctors in Tanzania post-1990s health sector reforms: assessing the achievements
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2017 (English)In: Human Resources for Health, ISSN 1478-4491, E-ISSN 1478-4491, Vol. 15, article id 27Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The shortage of a skilled health workforce is a global crisis. International efforts to combat the crisis have shown few benefits; therefore, more country-specific efforts are required. Tanzania adopted health sector reforms in the 1990s to ensure, among other things, availability of an adequate skilled health workforce. Little is documented on how the post-reform training and deployment of medical doctors (MDs) have contributed to resolving Tanzania's shortage of doctors. The study aims to assess achievements in training and deployment of MDs in Tanzania about 20 years since the 1990s health sector reforms.

METHODS: We developed a human resource for health (HRH) conceptual model to study achievements in the training and deployment of MDs by using the concepts of supply and demand. We analysed secondary data to document the number of MDs trained in Tanzania and abroad, and the number of MDs recommended for the health sector from 1992 to 2011. A cross-sectional survey conducted in all regions of the country established the number of MDs available by 2011.

RESULTS: By 1992, Tanzania had 1265 MDs working in the country. From 1992 to 2010, 2622 MDs graduated both locally and abroad. This translates into 3887 MDs by 2011. Tanzania needs between 3326 and 5535 MDs. Our survey captured 1299 MDs working throughout the country. This number is less than 40% of all MDs trained in and needed for Tanzania by 2011. Maldistribution favouring big cities was evident; the eastern zone with less than 30% of the population hosts more than 50% of all MDs. No information was available on the more than 60% of MDs uncaptured by our survey.

CONCLUSIONS: Two decades after the reforms, the number of MDs trained in Tanzania has increased sevenfold per year. Yet, the number and geographical distribution of MDs practicing in the country has remained the same as before the reforms. HRH planning should consider the three stages of health workforce development conceptualized under the demand and supply model. Auditing and improvement of the HRH database is highly recommended in dealing with Tanzania's MD crisis.

Keywords
Health sector reforms, Human resource for health model, Medical doctors, Planning, Shortage of doctors, Training and deployment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-138467 (URN)10.1186/s12960-017-0202-7 (DOI)000411104500001 ()28376823 (PubMedID)
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2018-09-11Bibliographically approved
Månsdotter, A., Ekman, B., Feldman, I., Hagberg, L., Hurtig, A.-K. & Lindholm, L. (2017). We Propose a Novel Measure for Social Welfare and Public Health: Capability-Adjusted Life-Years, CALYs. Applied Health Economics and Health Policy, 15(4), 437-440
Open this publication in new window or tab >>We Propose a Novel Measure for Social Welfare and Public Health: Capability-Adjusted Life-Years, CALYs
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2017 (English)In: Applied Health Economics and Health Policy, ISSN 1175-5652, E-ISSN 1179-1896, Vol. 15, no 4, p. 437-440Article in journal, Editorial material (Refereed) Published
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-138469 (URN)10.1007/s40258-017-0323-0 (DOI)000411078700001 ()28374165 (PubMedID)
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2018-06-09Bibliographically approved
Hulterström, A. K., Sellin, M., Monsen, T., Widerström, M., Gurram, B. K. & Berggren, D. (2016). Bacterial flora and the epidemiology of staphylococcus aureus in the nose among patients with symptomatic nasal septal perforations. Acta Oto-Laryngologica, 136(6), 620-625
Open this publication in new window or tab >>Bacterial flora and the epidemiology of staphylococcus aureus in the nose among patients with symptomatic nasal septal perforations
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2016 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 136, no 6, p. 620-625Article in journal (Refereed) Published
Abstract [en]

Conclusions Patients with symptomatic perforations of the nasal septum had a high prevalence of S. aureus in the nasal mucosa. Pulsed field gel electrophoresis (PFGE) analysis revealed a high genetic heterogeneity of S. aureus among both patients and controls. This indicates that presence of different strains of S. aureus can maintain a chronic inflammation in symptomatic nasal septal perforations. Objective The purpose of this study was to investigate the microbial flora around nasal septal perforations in patients having severe symptoms regarding bleeding, obstruction, and crustation associated with their perforation. Methods Twenty-five patients with untreated symptomatic nasal septal perforations were included. For culture, swabs around the perforations were collected. Bacteria were identified with standard laboratory techniques including a MALDI-TOF mass spectrometer. Epidemiological analysis was done using PFGE protocols. Bacteriological data were compared with data from a healthy control group. Results Staphylococcus aureus was present in the mucosa surrounding the nasal perforation significantly more often (p < 0.0001) in the patients (88%) compared to a control group (13%). Corynebacterium spp. and Propionibacterium spp. were significantly more frequently identified in the control group. The PFGE analysis of S. aureus strains revealed a high genetic heterogeneity and no specific S. aureus genotypes were associated with septal perforation.

National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-117369 (URN)10.3109/00016489.2016.1139743 (DOI)000375483400015 ()26852671 (PubMedID)
Available from: 2016-02-29 Created: 2016-02-29 Last updated: 2018-06-07Bibliographically approved
Hulterström, A. K. (2012). Silicone obturators and the bacterial flora in symptomatic nasal septal perforations. (Doctoral dissertation). Umeå: Umeå Universitet
Open this publication in new window or tab >>Silicone obturators and the bacterial flora in symptomatic nasal septal perforations
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background A perforation in the nasal septum can cause symptoms such as bleeding, obstruction, crusts and pain, and can be a challenge to treat. Surgery is the treatment of choice, but disease, size of the perforation, or the patient’s wish may contradict surgery. A custom-made silicone obturator is a successful treatment option, but little is known how this treatment affects the microbial flora. The purposes of this thesis were (i) to investigate the microbial flora around symptomatic nasal septal perforations before treatment, (ii) during and after a 12-month treatment period with a custom-made obturator, (iii) to compare the microbial flora around symptomatic perforations with the flora from the same area of the septum in healthy individuals, (iv) to investigate the microbial colonization of the silicone obturator, and (v) also to investigate the water sorption, solubility and if the wettability of silicones are affected by water. The hypotheses were (i) that the bacterial flora around symptomatic perforations would not differ from that found in healthy individuals, apart from a possible presence of Helicobacter pylori; (ii) the bacterial flora would change in composition during the course of treatment and that microorganisms and proteins could be seen on the surface of the silicone obturators; (iii) a material that has adsorbed water would also show an increase in wettability and the surface free energy of the material.

 Methods Twenty-seven patients and 101 healthy individuals volunteered. Swabs were made around the rim of the perforation, or on the septum in the locus Kisselbachi area in the healthy individuals. Bacteria and fungi were isolated and identified with standard laboratory techniques. A biopsy of the granulated tissue at the perforation was taken and cultivated for Helicobacter pylori. Swabs were also taken three, six and twelve months after inserting the obturator. The obturator was analysed after being used twelve months in the nose.  Seven silicones were tested for water sorption and solubility according to ISO standards 1567:1999 and ISO 10477:2004. The change in wettability was examined by measuring the contact angle with a contact goniometer at various stages of the sorption/solubility test.

Results Staphylococcus aureus was present in 88% of the untreated patients. With treatment a significant reduction of S. aureus occurred to 54.5% (p<0.05). In the healthy group S. aureus was present in 13% of the subjects. No Helicobacter pylori could be cultivated from the biopsies taken of the granulated tissue at the perforation. The flora round the untreated perforation was dominated by S. aureus with few other bacterial species detected. In the healthy group there was a diversified flora with both aerobic and anaerobic bacteria. SEM revealed a rough surface on the silicone obturator and crazing of the silicone surrounding the pigment granules. Both bacteria and proteins could be seen on the obturators in SEM. Candida albicans was detected in one obturator, but not in the mucosal swab at the corresponding time. That patient had, however, been treated for Candida in the nose six months prior to the last visit in the study. Wettability was affected but did not increase with amount of adsorbed water. Some materials showed an increase and some a decrease in the surface-free energy. The tested addition silicones showed little sorption and solubility.

Conclusions The patients with symptomatic perforations of the nasal septum had a bacterial flora totally dominated by S. aureus. The massive presence of S. aureus around symptomatic perforations may have an impact on the persistence of the granulated and inflamed tissue present in symptomatic perforations, thus forming a vicious circle with bleeding and crustation.

S. aureus dominance in the mucosa surrounding symptomatic perforations was diminished by using a custom-made obturator. The microbial flora became more diversified with the treatment, although not resembling the flora in healthy individuals. The microbial flora of the obturators was similar, but not the same as the corresponding mucosal flora. The discovery of Candida in the obturator of a patient who had been treated for Candida in the nose six months earlier suggests that obturators need to be exchanged when fungal infections are being treated to prevent the fungus from re-infecting the patient at a later stage.

The silicone had a rough surface and a poor wettability, both aspects favours colonization of microorganisms. The silicone was negatively affected by the colouring pigments, this should be considered when colouring is not necessary. The slight, but existing solubility of silicones emphasises the importance of using medical grade silicones that are more purified than industrial silicones. 

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2012. p. 36
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 124
Keywords
Nasal mucosa, perforation, symptomatic, inflammation, Staphylococcus aureus, obturator treatment, medical silicone, wettability
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-60831 (URN)978-91-7459-494-2 (ISBN)
Public defence
2012-11-23, Biomedicinhuset, sal E04, byggnad 6E, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-10-31 Created: 2012-10-30 Last updated: 2018-06-08Bibliographically approved
Hulterström, A. K., Sellin, M. & Berggren, D. (2012). The microbial flora in the nasal septum area prone to perforation. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 120(3), 210-214
Open this publication in new window or tab >>The microbial flora in the nasal septum area prone to perforation
2012 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 120, no 3, p. 210-214Article in journal (Refereed) Published
Abstract [en]

To explore the colonizing bacterial flora of the nasal septum area, that is mostly afflicted by perforations, 101 healthy police students had swab samples taken from that location. The described culture strategy recovered positive cultures from 95% of the test subjects and from 60% with more than one organism. In total, 191 bacterial isolates were classified according to colony morphology, Gram-stain and a panel of standard laboratory techniques. A part of the bacteria was identified to species-level by biochemical methods and by sequencing of the 16S rRNA gene. The predominant finding was Gram-positive irregular rods - 65 presumptive Corynebacterium isolates, both lipophilic and non-lipophilic, and 37 anaerobic Propionibacterium isolates. The second largest bacterial group was Gram-positive catalase-positive cocci, of which 13 isolates were identified as Staphylococcus aureus and 53 as coagulase-negative staphylococci. The few potential airway pathogens included Streptococcus pneumonia (n = 1) and Moraxella catarrhalis (n = 3) isolates. The bacterial flora colonizing the nasal septum mainly consists of Gram-positive bacteria. Although of low virulence, the microbial flora may impact on occlusion treatment of nasal septum perforations with silicone obturators.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-52714 (URN)10.1111/j.1600-0463.2011.02821.x (DOI)000300447200006 ()22339678 (PubMedID)
Available from: 2012-03-01 Created: 2012-03-01 Last updated: 2018-06-08Bibliographically approved
Dijken, J. W. .., Ardlin, B., Tillberg, A., Wahlin, Y. B., Berglund, A., Sunnegårdh-Grönberg, K., . . . Hulterström, A. K. (2008). Samarbete breddar forskning: Oral Biomaterialgruppen, Umeå. Tandläkartidningen, 100(5), 74-79
Open this publication in new window or tab >>Samarbete breddar forskning: Oral Biomaterialgruppen, Umeå
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2008 (Swedish)In: Tandläkartidningen, Vol. 100, no 5, p. 74-79Article in journal (Other (popular science, discussion, etc.)) Published
Abstract [sv]

Vid institutionen för odontologi vid Umeå Universitet finns en lång tradition av biomaterialforskning. För drygt två år sedan samlades större delen av den forskningen i ett vetenskapligt nätverk. Här beskrivs ett axplock av det breda forskningsarbetet.

Place, publisher, year, edition, pages
Sveriges Tandläkarförbund, 2008
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-10009 (URN)
Available from: 2008-06-09 Created: 2008-06-09 Last updated: 2018-06-09Bibliographically approved
Hulterström, A. K., Berglund, A. & Ruyter, I. E. (2008). Wettability, water sorption and water solubility of seven silicone elastomers used for maxillofacial prostheses. Journal of materials science. Materials in medicine, 19(1), 225-231
Open this publication in new window or tab >>Wettability, water sorption and water solubility of seven silicone elastomers used for maxillofacial prostheses
2008 (English)In: Journal of materials science. Materials in medicine, ISSN 0957-4530, E-ISSN 1573-4838, Vol. 19, no 1, p. 225-231Article in journal (Refereed) Published
Abstract [en]

The wettability, water sorption and solubility of silicone elastomers used for maxillofacial prostheses were studied. The hypothesis was, that a material that has absorbed water would show an increase in the wettability and thus also the surface free energy of the material.

Seven silicone elastomers, both addition- and condensation type polymers, were included. Five specimens of each material were subjected to treatment according to ISO standards 1567:1999 and 10477: 2004 for water sorption and solubility. The volumes of the specimens were measured according to Archimedes principle. The contact angle was measured with a contact angle goniometer at various stages of the sorption/solubility test.

Wettability changed over the test period, but not according to theory. The addition type silicones showed little or no sorption and solubility, but two of the condensation type polymers tested had a significant sorption and solubility. This study showed that condensation type polymers may show too large volumetric changes when exposed to fluids, and therefore should no longer be used in prosthetic devices. The results of this study also suggests that it might be of interest to test sorption and solubility of materials that are to be implanted, since most of the materials had some solubility.

National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-10958 (URN)17597370 (PubMedID)
Available from: 2008-11-06 Created: 2008-11-06 Last updated: 2018-06-09Bibliographically approved
Berglund, A., Hulterström, A. K., Gruffman, E. & van Dijken, J. (2006). Dimensional change of a calcium aluminate cement for posterior restorations in aqueous and dry media.. Dental Materials, 22(5), 470-476
Open this publication in new window or tab >>Dimensional change of a calcium aluminate cement for posterior restorations in aqueous and dry media.
2006 (English)In: Dental Materials, ISSN 0109-5641, E-ISSN 1879-0097, Vol. 22, no 5, p. 470-476Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: A calcium aluminate cement has recently been developed, with claims of being an alternative to dental amalgam and resin composites in posterior cavities. However, its' mechanical properties are not well evaluated and the aim of the study was therefore, to evaluate its' dimensional stability over time. METHODS: The dimensional changes of the cement, Doxadent, and two composite resins, Esthet-X and InTen-S, were tested during 360 d. The specimens were stored at 37+/-1 degrees C either in 100% air humidity (dry) or immersed in distilled water (wet), except for the first 24h when all specimens were stored at 100% air humidity and 37+/-1 degrees C. RESULTS: During the first 24h, Doxadent decreased in volume with 0.04%, while InTen-S and Esthet-X decreased with 1.60 and 1.75%, respectively. From d 1-360, the dry Doxadent specimens increased in volume with 2.0% and in weight with 5.5%, while the corresponding increase for the wet specimens were 4.1 and 6.3%, respectively. The volume of both composites increased 0.8% or less in dry and wet conditions, while the increase in weight for InTen-S was 1.2% for the wet specimens and 0.6% for the dry. The corresponding figures for Esthet-X were 0.7 and 0.2%. SIGNIFICANCE: Doxadent was less dimensionally stable than the composites tested. Doxadent increased 2 times more in volume immersed in water than in 100% air humidity, while the increase in weight was almost similar. The clinical implications of the results found in the present study are uncertain. A material that continues to absorb water during prolonged periods and continues to react is questionable for clinical use.

National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-16116 (URN)10.1016/j.dental.2005.04.041 (DOI)16154630 (PubMedID)
Available from: 2007-11-08 Created: 2007-11-08 Last updated: 2018-06-09Bibliographically approved
Hulterström, A. K., Sellin, M. & Berggren, D. High prevalence of S. aureus around symptomatic perforations of the nasal septum.
Open this publication in new window or tab >>High prevalence of S. aureus around symptomatic perforations of the nasal septum
(English)Manuscript (preprint) (Other academic)
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-60833 (URN)
Note

Submitted

Available from: 2012-10-30 Created: 2012-10-30 Last updated: 2018-06-08Bibliographically approved
Hulterström, A. K., Sellin, M. & Berggren, D.The effect of obturator treatment on the microbial flora surrounding symptomatic nasal septal perforations.
Open this publication in new window or tab >>The effect of obturator treatment on the microbial flora surrounding symptomatic nasal septal perforations
(English)Manuscript (preprint) (Other academic)
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-60835 (URN)
Available from: 2012-10-30 Created: 2012-10-30 Last updated: 2018-06-08Bibliographically approved
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