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  • 1.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundell, Sara
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Barnekow-Bergkvist, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Jansson, Eva
    Westerståhl, Maria
    The Swedish physical activity and fitness cohort born in 1958 - dropout analysis and overview at 36-year follow-up2017In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 27, no 4, p. 418-429Article in journal (Refereed)
    Abstract [en]

    The main aim of the Swedish physical activity and fitness cohort study (SPAF-1958) was to describe physical fitness, physical activity, health, and lifestyle across part of the lifespan, and to assess the influences on these factors from the environment, personal factors, and genetics. There is inevitable dropout from longitudinal studies, and it may be systematic. The aim of this first paper of the second follow-up of SPAF-1958 was to provide a dropout analysis to consider to what extent the participants, at 52 years of age, remain a representative sample of the original adolescent study population. Additional aims were to provide an overview of the study protocol and the ongoing study population. Ongoing study participants in SPAF born in 1958 were, at the second follow-up at the age of 52, still representative of the study cohort in terms of sex, adolescent geographical area, upper secondary school program, adolescent body composition, muscular strength, and muscular endurance. However, a higher physical activity and, among women, a higher aerobic capacity in adolescence decreased the risk for dropout. It is important when interpreting results from longitudinal studies to adjust for the systematic dropout that could bias the conclusions drawn from the results.

  • 2. Abbara, Aula
    et al.
    Rawson, Timothy M.
    Karah, Nabil
    Umeå University, Faculty of Medicine, Department of Molecular Biology (Faculty of Medicine). Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS). Umeå University, Faculty of Medicine, Umeå Centre for Microbial Research (UCMR).
    El-Amin, Wael
    Hatcher, James
    Tajaldin, Bachir
    Dar, Osman
    Dewachi, Omar
    Abu Sitta, Ghassan
    Uhlin, Bernt Eric
    Umeå University, Faculty of Medicine, Umeå Centre for Microbial Research (UCMR). Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS). Umeå University, Faculty of Medicine, Department of Molecular Biology (Faculty of Medicine).
    Sparrow, Annie
    A summary and appraisal of existing evidence of antimicrobial resistance in the Syrian conflict2018In: International Journal of Infectious Diseases, ISSN 1201-9712, E-ISSN 1878-3511, Vol. 75, p. 26-33Article, review/survey (Refereed)
    Abstract [en]

    Antimicrobial resistance (AMR) in populations experiencing war has yet to be addressed, despite the abundance of contemporary conflicts and the protracted nature of twenty-first century wars, in combination with growing global concern over conflict-associated bacterial pathogens. The example of the Syrian conflict is used to explore the feasibility of using existing global policies on AMR in conditions of extreme conflict. The available literature on AMR and prescribing behaviour in Syria before and since the onset of the conflict in March 2011 was identified. Overall, there is a paucity of rigorous data before and since the onset of conflict in Syria to contextualize the burden of AMR. However, post onset of the conflict, an increasing number of studies conducted in neighbouring countries and Europe have reported AMR in Syrian refugees. High rates of multidrug resistance, particularly Gram-negative organisms, have been noted amongst Syrian refugees when compared with local populations. Conflict impedes many of the safeguards against AMR, creates new drivers, and exacerbates existing ones. Given the apparently high rates of AMR in Syria, in neighbouring countries hosting refugees, and in European countries providing asylum, this requires the World Health Organization and other global health institutions to address the causes, costs, and future considerations of conflict-related AMR as an issue of global governance. (c) 2018 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

  • 3.
    Abdelmoety, Ahmed
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    An investigation into the lived experiences of parents and health professionals involved in the treatment of children with cleft lip and/ or cleft palate in Egypt2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 4.
    Abedpour Dehkordi, Adel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mental health in Northern Sweden: focusing on depressive symptoms; a risk factors analysis2016Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: World Health Organization (WHO) and Global Burden of Disease (GBD) have classified depressive disorders as the unique most burdensome disease from the point of overall DALYs (disability-adjusted life years) among individuals in working ages. The continuous monitoring is of great importance for prevention and controlling strategies and it could be linked to economic development in the country via reducing DALYs. The rate of mental disorders has increased in Sweden during last years. In the present thesis, we aim to analyze the risk factors and prevalence of clinical depression in Northern Sweden.

    Material & Methods:An empirical cross-sectional study performed based on a questionnaire distributed to a random sample of inhabitants in Northern Sweden. 23560 individuals responded to the question about taking medicine for depression in last three months, which considered as the target sample. Descriptive statistics was used to measure prevalence of depression across different sociodemographic, social and behavioral factors. Pearson Chi square test was used for comparative purposes. Univariate/Multiple logistic regressions were conducted to estimate crude and adjusted odds ratio for depression across different explanatory variables (P<0.05 considered significant). Hosmer-Lemeshow test was applied for goodness of fit in regression models (P>0.05 considered good fit).

    Results & Discussion:The point prevalence of clinical depression estimated 6.06% (4.24% in male and 7.61% in female) in Northern Sweden for 2014. Logistic regression showed that using medicines (for anxiety, sleeplessness, diabetes), physical inactivity, vegetable-free diet were all associated with increased risk of depression in north of Sweden (P<0.00.5-0.05). High physical activity, being Farmer and Self-employed, high social support were strongly associated with low risk of depression (P<0.00.5-0.05). No ascending linear association was observed for clinical depression in relation to increasing age, education, and vegetable (P>0.05). However, a gradient was detected for income, physical activity and social support (P<0.05).

    Conclusion:This study shows that the depressive symptoms is relatively higher in Northern Sweden than whole Sweden on average. There is a slight increase in the rate of depression in Northern Sweden compared to 2009. Meanwhile, women are more susceptible to get diagnosed with clinical depression in Northern Sweden. Protective factors for clinical depression are being employed as a farmer and being physically active. Nevertheless, a combination of different risk factors related to depression was observed. Further research is required to find underlying causes of the higher rate of depression in women, risk factors related to different age groups.

  • 5.
    Aboka, Deliana
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Prescribing practices of oral anticoagulants in atrial fibrillation stroke prophylaxis: An online survey among practitioners from Sweden and the United Kingdom2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 6. AbouZahr, Carla
    et al.
    Boerma, Ties
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Witwatersrand, Sch Publ Hlth, Johannesburg, South Africa ; Univ Aberdeen, Inst Appl Hlth Sci, Aberdeen, Scotland.
    Bridging the data gaps: do we have the right balance between country data and global estimates?2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1299978Article in journal (Refereed)
  • 7. Adam-Poupart, Ariane
    et al.
    Labreche, France
    Smargiassi, Audrey
    Duguay, Patrice
    Busque, Marc-Antoine
    Gagne, Charles
    Rintamaki, Hannu
    Kjellström, Tord
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Zayed, Joseph
    Climate Change and Occupational Health and Safety in a Temperate Climate: Potential Impacts and Research Priorities in Quebec, Canada2013In: Industrial Health, ISSN 0019-8366, E-ISSN 1880-8026, Vol. 51, no 1, p. 68-78Article in journal (Refereed)
    Abstract [en]

    The potential impacts of climate change (CC) on Occupational Health and Safety (OHS) have been studied a little in tropical countries, while they received no attention in northern industrialized countries with a temperate climate. This work aimed to establish an overview of the potential links between CC and OHS in those countries and to determine research priorities for Quebec, Canada. A narrative review of the scientific literature (2005-2010) was presented to a working group of international and national experts and stakeholders during a workshop held in 2010. The working group was invited to identify knowledge gaps, and a modified Delphi method helped prioritize research avenues. This process highlighted five categories of hazards that are likely to impact OHS in northern industrialized countries: heat waves/increased temperatures, air pollutants, UV radiation, extreme weather events, vector-borne/zoonotic diseases. These hazards will affect working activities related to natural resources (i.e. agriculture, fishing and forestry) and may influence the socioeconomic context (built environment and green industries), thus indirectly modifying OHS. From this consensus approach, three categories of research were identified: 1) Knowledge acquisition on hazards, target populations and methods of adaptation; 2) Surveillance of diseases/accidents/occupational hazards; and 3) Development of new occupational adaptation strategies.

  • 8. Adams, D.
    et al.
    Coelho, T.
    Conceicao, I.
    Cruz, M. Waddington
    Schmidt, H.
    Buades, J.
    Campistol, J.
    Pouget, J.
    Berk, J. L.
    Ziyadeh, N.
    Partisano, A. M.
    Sweetser, M.
    Chen, J.
    Gollob, J.
    Suhr, Ole
    Umeå University.
    Phase 2 open-label extension (OLE) study of patisiran for the treatment of hereditary ATTR (hATTR) amyloidosis: 24-month safety and efficacy in subgroup of patients with cardiac involvement2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no Suppl: 1, p. 19-19Article in journal (Refereed)
  • 9.
    Adane, Daniel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Effectiveness of PMTCT programs in Sub-Saharan Africa, a meta-analysis2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 10.
    Adcock, Joanna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Overseas Development Institute, London, UK.
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    The North-South information highway: case studies of publication access among health researchers in resource-poor countries2008In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 1Article in journal (Refereed)
    Abstract [en]

    Background: Less than 2% of scientific publications originate in low-income countries. Transfer of information from South to North and from South to South is grossly limited and hinders understanding of global health, while Northern-generated information fails to adequately address the needs of a Southern readership.

    Methods: A survey of a new generation of health researchers from nine low-income countries was conducted using a combination of email questionnaires and face-to-face interviews. Data were gathered on personal experiences, use and aspirations regarding access and contribution to published research.

    Results: A total of 23 individuals from 9 countries responded. Preference for journal use over textbooks was apparent, however a preference for print over online formats was described among African respondents compared to respondents from other areas. Almost all respondents (96%) described ambition to publish in international journals, but cited English language as a significant barrier.

    Conclusion: The desire to contribute to and utilise contemporary scientific debate appears to be strong among study respondents. However, longstanding barriers

  • 11. Ademuyiwa, Adesoji O.
    et al.
    Arnaud, Alexis P.
    Drake, Thomas M.
    Fitzgerald, J. Edward F.
    Poenaru, Dan
    Bhangu, Aneel
    Harrison, Ewen M.
    Fergusson, Stuart
    Glasbey, James C.
    Khatri, Chetan
    Mohan, Midhun
    Nepogodiev, Dmitri
    Soreide, Kjetil
    Gobin, Neel
    Freitas, Ana Vega
    Hall, Nigel
    Kim, Sung-Hee
    Negeida, Ahmed
    Khairy, Hosni
    Jaffry, Zahra
    Chapman, Stephen J.
    Tabiri, Stephen
    Recinos, Gustavo
    Amandito, Radhian
    Shawki, Marwan
    Hanrahan, Michael
    Pata, Francesco
    Zilinskas, Justas
    Roslani, April Camilla
    Goh, Cheng Chun
    Irwin, Gareth
    Shu, Sebastian
    Luque, Laura
    Shiwani, Hunain
    Altamimi, Afnan
    Alsaggaf, Mohammed Ubaid
    Spence, Richard
    Rayne, Sarah
    Jeyakumar, Jenifa
    Cengiz, Yucel
    Raptis, Dmitri A.
    Fermani, Claudio
    Balmaceda, Ruben
    Marta Modolo, Maria
    Macdermid, Ewan
    Chenn, Roxanne
    Yong, Cheryl Ou
    Edye, Michael
    Jarmin, Martin
    D'amours, Scott K.
    Iyer, Dushyant
    Youssef, Daniel
    Phillips, Nicholas
    Brown, Jason
    Dickfos, Marilla
    Mitul, Ashrarur Rahman
    Mahmud, Khalid
    Oosterkamp, Antje
    Assouto, Pamphile A.
    Lawani, Ismail
    Souaibou, Yacoubou Imorou
    Devadasar, Giridhar H.
    Chong, Chean Leung
    Qadir, Muhammad Rashid Minhas
    Aung, Kyaw Phyo
    Yeo, Lee Shi
    Castillo, Vanessa Dina Palomino
    Munhoz, Monique Moron
    Moreira, Gisele
    Palomino Castillo, Vanessa Dina
    Barros De Castro Segundo, Luiz Carlos
    Khouri Ferreira, Salim Anderson
    Careta, Maira Cassa
    Araujo, Rafael
    Menegussi, Juliana
    Leal, Marisa
    Barroso de Lima, Caio Vinicius
    Tatagiba, Luiza Sarmento
    Leal, Antonio
    Nigo, Samuel
    Kabba, Juana
    Ngwa, Tagang Ebogo
    Brown, James
    King, Sebastian
    Zani, Augusto
    Azzie, Georges
    Firdouse, Mohammed
    Kushwaha, Sameer
    Agarwal, Arnav
    Bailey, Karen
    Cameron, Brian
    Livingston, Michael
    Horobjowsky, Alexandre
    Deckelbaum, Dan L.
    Razek, Tarek
    Montes, Irene
    Sierra, Sebastian
    Mendez, Manuela
    Isabel Villegas, Maria
    Mendoza Arango, Maria Clara
    Mendoza, Ivan
    Aristiza Ibal, Fred Alexander Naranjo
    Montoya Botero, Jaime Andres
    Quintero Riaza, Victor Manuel
    Restrepo, Jakeline
    Morales, Carlos
    Cruz, Herman
    Munera, Alejandro
    Karlo, Robert
    Domini, Edgar
    Mihanovic, Jakov
    Radic, Mihael
    Zamarin, Kresimir
    Pezelj, Nikica
    Khyrallh, Ahmed
    Hassan, Ahamed
    Shimy, Gamal
    Fahmy, Mohamed A. Baky
    Nabawi, Ayman
    Gohar, Muhammad Saad Ali Muhammad
    Elfil, Mohamed
    Ghoneem, Mohamed
    Gohar, Muhammad El-Saied Ahmad Muhammad
    Asal, Mohamed
    Abdelkader, Mostafa
    Gomah, Mahmoud
    Rashwan, Hayssam
    Karkeet, Mohamed
    Gomaa, Ahmed
    Hasan, Amr
    Elgebaly, Ahmed
    Saleh, Omar
    Fattah, Ahmad Abdel
    Gouda, Abdullah
    Elshafay, Abd Elrahman
    Gharib, Abdalla
    Hanafy, Mohammed
    Al-Mallah, Abdullah
    Abdulgawad, Mahmoud
    Baheeg, Mohamad
    Alhendy, Mohammed
    Fattah, Ibrahim Abdel
    Kenibar, Abdalla
    Osman, Omar
    Gemeah, Mostafa
    Mohammed, Ahmed
    Adel, Abdalrahman
    Mesreb, Ahmed Maher Menshawy
    Mohammed, Abdelrahman
    Sayed, Abdelrahman
    Abozaid, Mohamed
    Kotb, Ahmed Hafez El-Badri
    Ata, Ali Amin Ahmed
    Nasr, Mohammed
    Alkammash, Abdelrahman
    Saeed, Mohammed
    El Hamid, Nader Abd
    Attia, Attia Mohamed
    Abd El Galeel, Ahmed
    Elbanby, Eslam
    El-Dien, Khalid Salah
    Hantour, Usama
    Alahmady, Omar
    Mansour, Billal
    Elkorashy, Amr Muhammad
    Taha, Emad Mohamed Saeed
    Lasheen, Kholod Tarek
    Elkolaly, Salma Said
    Abdel-Wahab, Nehal Yosri Elsayed
    Abozyed, Mahmoud Ahmed Fathi
    Adel, Ahmed
    Saeed, Ahmed Moustafa
    El Sayed, Gehad Samir
    Youssif, Jehad Hassan
    Ahmed, Soliman Magdy
    El-Shahat, Nermeen Soubhy
    Khedr, Abd El-Rahman Hegazy
    Elsebaaye, Abdelrhman Osama
    Elzayat, Mohamed
    Abdelraheim, Mohamed
    Elzayat, Ibrahim
    Warda, Mahmoud
    El Deen, Khaled Naser
    Essam, Abdelrhman
    Salah, Omar
    Abbas, Mohamed
    Rashad, Mona
    Elzayyat, Ibrahim
    Hemeda, Dalia
    Tawfik, Gehad
    Salama, Mai
    Khaled, Hazem
    Seisa, Mohamed
    Elshaer, Kareem
    Hussein, Abdelfatah
    Elkhadrawi, Mahmoud
    Afifi, Ahmed Mohamed
    Ebrahim, Osama Saadeldeen
    Metwally, Mahmoud Mohamed
    Elmelegy, Rowida
    Elsawahly, Diaa Moustafa Elbendary
    Safa, Hisham
    Nofal, Eman
    Elbermawy, Mohamed
    Raya, Metwally Abo
    Ghazy, Ahmed Abdelmotaleb
    Samih, Hisham
    Abdelgelil, Asmaa
    Abdelghany, Sarah
    El Kholy, Ahmed
    Elkady, Fatma
    Salma, Mahmoud
    Samy, Sarah
    Fakher, Reem
    Aboarab, Aya
    Samir, Ahmed
    Sakr, Ahmed
    Haroun, Abdelrahman
    Al-Aarag, Asmaa Abdel-Rahman
    Elkholy, Ahmed
    Elshanwany, Sally
    Ghanem, Esraa
    Tammam, Ahmed
    Hammad, Ali Mohamed
    El Shoura, Yousra
    El Ashal, Gehad
    Antar, Sarah
    Mehrez, Sara
    Abdelshafy, Mahmoud
    Hamad, Maha Gamal Mohamad
    Hosh, Mona
    Abdallah, Emad
    Magdy, Basma
    Alzayat, Thuraya
    Gamaly, Elsayed
    Elfeki, Hossam
    Abouzahra, Amany
    Elsheikh, Shereen
    Elgendy, Fatimah I.
    Abd El-Salam, Fathia
    Seifelnasr, Osama
    Ammar, Mohamed
    Eysa, Athar
    Sadek, Aliaa
    Toeema, Aliaa Gamal
    Nasr, Aly
    Abuseif, Mohamed
    Zidan, Hagar
    Barakat, Sara Abd Elmageed
    Elsayed, Nadin
    Abd Elrasoul, Yasmin
    El-Kelany, Ahmed
    Ammar, Mohamed Sabry
    Mustafa, Mennat-Allah
    Makhlouf, Yasmin
    Etman, Mohamed
    Saad, Samar
    Alrahawy, Mahmoud
    Raslan, Ahmed
    Morsi, Mahmoud
    Sabry, Ahmed
    Elwakil, Hager
    Shaker, Heba
    Elkelany, Ahmed
    El-Kashef, Hussein
    Shaalan, Mohamed
    Tarek, Areej
    Elwan, Ayman
    Nayel, Ahmed Ragab
    Seif, Mostafa
    Shafik, Doaa Emadeldin
    Ghoname, Mohamed Ali
    Almallah, Ahmad
    Fouad, Ahmed
    Sayma, Eman Adel
    Elbatahgy, Ahmad
    El-Ma'doul, Angham Solaiman
    Mosad, Ahmed
    Tolba, Hager
    Elsorogy, Diaa Eldin Abdelazeem Amin
    Mostafa, Hassan Ali
    Omar, Amira Atef
    Abd El Hameed, Ola Sherief
    Lasheen, Ahmed
    Abd El Salam, Yasser
    Morsi, Ashraf
    Ismail, Mohammed
    Ahmed, Hager
    Amer, Mohamed A.
    El-Hamouly, Ahmed Sabry
    Attallah, Noura
    Mosalum, Omnia
    Afandy, Ahmed
    Mokhtar, Ahmed
    Abouelnasr, Alaa
    Ayad, Sara
    Shaker, Ramdan
    Sakr, Rokia
    Amreia, Mahmoud
    Elsobky, Soaad
    Mustafa, Mohamed
    El Magd, Ahmed Abo
    Marey, Abeer
    Tarek, Amr
    Fadel, Mohamed
    Mohamed, Mohamed Moamen
    Fadel, Amr
    Ahmed, Emad Ali
    Ali, Ahmad
    Alwafai, Mohammad Ghassan
    Alnawam, Ehab Abdulkader Hemida Ghazy
    Dwydar, Abdullah
    Kharsa, Sara
    Mamdouh, Ehab
    El-Sheemy, Hatem
    Alyoussef, Ibrahim
    Aly, Abouelatta Khairy
    Aldalaq, Ahmad
    Alnawam, Ehab
    Alkhabbaz, Dalia
    Saad, Mahmoud
    Hussein, Shady
    Elazayem, Ahmed Abo
    Meshref, Ahmed
    Elashmawy, Marwa
    Mousa, Mohammed
    Nashaat, Ahmad
    Ghanem, Sara
    Elsayed, Zaynab M.
    Elwaey, Aya
    Elkadsh, Iman
    Darweesh, Mariam
    Mohameden, Ahmed
    Hafez, Mennaallah
    Badr, Ahmed
    Badwy, Assmaa
    Abd El Slam, Mohamed
    Elazoul, Mohamed
    Al-Nahrawi, Safwat
    Eldamaty, Lotfy
    Nada, Fathee
    Ameen, Mohamed
    Hagar, Aya
    Elsehimy, Mohamed
    Abo-ryia, Mohammad
    Dawoud, Hossam
    El Mesery, Shorouk
    El Gendy, Abeer
    Abdelkareem, Ahmed
    Marey, Ahmed Safwan
    Allam, Mostafa
    Shehata, Sherif
    Abozeid, Khaled
    Elshobary, Marwa
    Fahiem, Ahmed
    Sarsik, Sameh
    Hashish, Amel
    Zidan, Mohamed
    Hashish, Mohamed
    Aql, Shaimaa
    Elhendawy, Abdelaziz Osman Abdelaziz
    Husseini, Mohamed
    Khater, Omar
    Kasem, Esraa Abdalmageed
    Gheith, Ahmed
    Elfouly, Yasmin
    Soliman, Ahmed Ragab
    Hani, Yasmein
    Elfouly, Nesma
    Fawzy, Ahmed
    Hassan, Ahmed
    Rashid, Mohammad
    Elsherbiny, Abdallah Salah
    Sieda, Basem
    Badwi, Nermin Mohamed
    Mohammed, Mohammed Mustafa Hassan
    Mohamed, Osama
    Habeeb, Mohammad Abdulkhalek
    Worku, Mengistu
    Starr, Nichole
    Desta, Semay
    Wondimu, Sahlu
    Abebe, Nebyou Seyoum
    Thomas, Efeson
    Asele, Frehun Ayele
    Dabessa, Daniel
    Abebe, Nebiyou Seyoum
    Zerihun, Abebe Bekele
    Scalabre, Aurelien
    Frade, Fernanda
    Irtan, Sabine
    Parent, Valentine
    Martin, Amandine
    Graffeille, Vivien
    Gaignard, Elodie
    Alimi, Quentin
    Abbo, Olivier
    Mouttalib, Sofia
    Bouali, Ourdia
    Hervieux, Erik
    Aigrain, Yves
    Botto, Nathalie
    Faure, Alice
    Fievet, Lucile
    Panait, Nicoleta
    Eyssartier, Emilie
    Schmitt, Francoise
    Podevin, Guillaume
    Muller, Cecile
    Bonnard, Arnaud
    Peycelon, Matthieu
    Abantanga, Francis
    Boakye-Yiadom, Kwaku
    Bukari, Mohammed
    Owusu, Frank
    Awuku-Asabre, Joseph
    Bray, Lemuel Davies
    Lytras, Dimitrios
    Psarianos, Kyriakos
    Bamicha, Anastasia
    Anthoulakis, Christos
    Nikoloudis, Nikolaos
    Mitroudis, Nikolaos
    Estupinian, Sergio
    Forno, Walter
    Guevara, Romeo
    Aguilera, Maria
    Mendez, Napoleon
    Mendizabal, Cesar Augusto Azmitia
    Ramazzini, Pablo
    Urquizu, Mario Contreras
    Rodriguez, Daniel Estuardo Marroquin
    Velsquez, Carlos Ivan Perez
    Merida, Sara Maria Contreras
    Regalado, Francisco
    Lopez, Mario
    Siguantay, Miguel
    Prasad, S. S.
    Kirishnan, Anand
    Gyanchandani, Nidhi
    Bhat, Sriram
    Sreedharan, Anjana
    Kinnera, S. V.
    Nadkami, Shravan
    Lakshmi, Harish Neelamraju
    Malik, Puneet
    Bin Mahamood, Abid
    Khajanchi, Monty
    Satoskar, Savni
    Satoskar, Rajeev
    Reddy, Yella
    Venugopal, Caranj
    Kumar, Sunil
    Sutanto, Eldaa Prisca Refianti
    Soeselo, Daniel Ardian
    Tedjaatmadja, Chintya
    Rahmawati, Fitriana Nur
    Mayasari, Maria
    Al-Hasani, Ruqaya Kadhim Mohammed Jawad
    Al-Hameedi, Hasan Ismael Ibraheem
    Al-Azraqi, Israa Abdullah Aziz
    Sabeeh, Lubna
    Kamil, Rahma
    Rasendran, Amoudtha
    Sheehan, Jacqueline
    Kerley, Robert
    Normile, Caoimhe
    Gilbert, Richard William
    Song, Jiheon
    Mauro, Linnea
    Dablouk, Mohammed Osman
    Kielty, Paul
    Marks, Eleanor
    Gosling, Simon
    Mccarthy, Michelle
    Mirghani, Diya
    Naqvi, Syed Altaf
    Wong, Chee Siong
    Gosling, Simon George
    Fahy, Ciara
    Cadogan, Diana Duarte
    Powell, Anna
    Gilbert, Richard
    Clifford, Caroline
    Driscoll, Aoife
    Paul, Stassen
    Lee, Chris
    Bowe, Ross
    Hutch, William
    Mohan, Helen
    O'Neill, Maeve
    Mealy, Kenneth
    Danelli, Piergiorgio
    Bondurri, Andrea
    Maffioli, Anna
    Bonavina, Luigi
    Macchitella, Yuri
    Ceriani, Chiara
    Veronese, Ezio
    Bortolasi, Luca
    Hasheminia, Alireza
    Benevento, Angelo
    Tessera, Gaetano
    Turati, Luca
    Sgroi, Giovanni
    Rausa, Emanuele
    Venskutonis, Donatas
    Bradulskis, Saulius
    Urbanavicius, Linas
    Austraite, Aiste
    Riauka, Romualdas
    Dambrauskas, Zilvinas
    Coomber, Ross
    Johnson, Kenneth
    Nowers, Jennifer
    Periasammy, Dineshwary
    Salleh, Afizah
    Das, Andre
    Tze, Reuben Goh Em
    Kumar, Milaksh Nirumal
    Abdullah, Nik Azim Nik
    Chong, Hoong Yin
    Agius, Marija
    Borg, Elaine
    Bezzina, Maureen
    Bugeja, Roberta
    Vella-Baldacchino, Martinique
    Spina, Andrew
    Psaila, Josephine
    Francois-Coridon, Helene
    Tolg, Cecilia
    Colombani, Jean-Francois
    Jacobe, Mario
    Mapasse, Domingos
    Snyder, Elizabeth
    Oumer, Ramadan
    Osman, Mohammed
    Mohammad, Aminu
    Anyanwu, Lofty-John
    Sheshe, Abdulrahman
    Adesina, Alaba
    Faturoti, Olubukola
    Taiwo, Ogechukwu
    Ibrahim, Muhammad Habib
    Nasir, Abdulrasheed A.
    Suleiman, Siyaka Itopa
    Adeniyi, Adewale
    Adesanya, Opeoluwa
    Adebanjo, Ademola
    Osuoji, Roland
    Atobatele, Kazeem
    Ogunyemi, Ayokunle
    Wiiliams, Omolara
    Oludara, Mobolaji
    Oshodi, Olabode
    Razzaq, Abdul
    Lawal, Oluwagbemiga
    Alakaloko, Felix
    Elebute, Olumide
    Osinowo, Adedapo
    Bode, Christopher
    Adesuyi, Abidemi
    Tade, Adesoji
    Adekoya, Adeleke
    Nwokoro, Collins
    Ayandipo, Omobolaji O.
    Lawal, Taiwo Akeem
    Ajao, Akinlabi E.
    Ali, Samuel Sani
    Odeyemi, Babatunde
    Olori, Samson
    Popoola, Ademola
    Adeyeye, Ademola
    Adeniran, James
    Lossius, William J.
    Havemann, Ingemar
    Thorsen, Kenneth
    Narvestad, Jon Kristian
    Wold, Trude Beate
    Nymo, Linn
    Elsiddig, Mohammed
    Dar, Manzoor
    Bhopal, Kamran Faisal
    Iftikhar, Zainab
    Furqan, Muhammad Mohsin
    Nighat, Bakhtiar
    Jawaid, Masood
    Khalique, Abdul
    Zil-E-Ali, Ahsan
    Rashid, Anam
    Aguilar, Wendy Leslie Messa
    Chiong, Jose Antonio Cabala
    Cecilia, Ana
    Bautista, Manchego
    Huaman, Eduardo
    Zegarra, Sergio
    Camacho, Rony
    Vergara Celis, Jose Maria
    Romani Pozo, Diego Alonso
    Hamasaki, Jose
    Temoche, Edilberto
    Herrera-Matta, Jaime
    Garcia Torres, Carla Pierina
    Alvarez Barreda, Luis Miguel
    Barrionuevo Ojeda, Ronald Renato
    Garaycochea, Octavio
    Mollo, Melanie Castro
    Delgado, Mitchelle Solange De Fa Tima Linares
    Fujii, Francisco
    Manchego Bautista, Ana Cecilia
    Messa Aguilar, Wendy Leslie
    Cabala Chiong, Jose Antonio
    Aranzabal Durand, Susana Yrma
    Arroyo Basto, Carlos Alejandro
    Urbina Rojas, Nelson Manuel
    Shu Yip, Sebastian Bernardo
    Contreras Vergara, Ana Lucia
    Rosas Moran, Andrea Echevarria
    Borda Luque, Giuliano
    Rodriguez Castro, Manuel
    Alvarado Jaramillo, Ramon
    Sila, George Manrique
    Lopez, Crislee Elizabeth
    De Leon, Mardelangel Zapata Ponze
    Machaca, Massiell
    Coasaca Huaraya, Ronald
    Arenas, Andy
    Herrera Puma, Clara Milagros
    Pino, Wilfredo
    Hinojosa, Christian
    Ponze De Leon, Melanie Zapata
    Limache, Susan
    Manrrique Sila, George
    Mercado Rodriguez, Layza-Alejandra
    Sauvat, Frederique
    Vida, Lucian Corneliu
    Muntean, Liviu Iuliu
    Mironescu, Aurel Sandu
    Alomar, Ibrahim N.
    Alnuqaydan, Saleh A.
    Altwigry, Abdulrahman M.
    Othman, Moayad
    Osman, Nohad
    Alqahtani, Enas
    Alzahrani, Mohammed
    Alyami, Rifan
    Aljohani, Emad
    Alhabli, Ibrahim
    Mikwar, Zaher
    Almuallem, Sultan
    Nawawi, Abrar
    Bakhaidar, Mohamad
    Maghrabi, Ashraf A.
    Alsaggaf, Mohammed
    Aljiffry, Murad
    Altaf, Abdulmalik
    Khoja, Ahmad
    Habeebullah, Alaa
    Akeel, Nouf
    Ghandora, Nashat
    Almoflihi, Abdullah
    Huwait, Abdulmalik
    Al-Shammari, Abeer
    Al-Mousa, Mashael
    Alghamdi, Masood
    Adham, Walid
    Albeladi, Bandar
    Alfarsi, Muayad Ahmed
    Mahdi, Atif
    Al Awwad, Saad
    Nouh, Thamer
    Hassanain, Mazen
    Aldhafeeri, Salman
    Sadig, Nawal
    Algohary, Osama
    Aledrisy, Mohannad
    Gudal, Ahmad
    Alrifaie, Ahmad
    AlRowais, Mohammed
    Althwainy, Amani
    Shabkah, Alaa
    Alamoudi, Uthman
    Alrajraji, Mawaddah
    Alghamdi, Basim
    Aljohani, Saud
    Daqeeq, Abdullah
    Al-Faifi, Jubran J.
    Jennings, Vicky
    Ngayu, Nyawira
    Moore, Rachel
    Kong, Victor
    Sampson, Colleen
    Panieri, Eugenio
    Tun, Myint
    Mphatsoe, Albert Mohale
    Carreira, Jo-Anne
    Teasdale, Ella
    Wagener, Mark
    Botes, Stefan
    Du Plessis, Danelo
    Pagnozzi, Janet
    Quezada, Jimy Harold Jara
    Rodicio, Jose Luis
    Minguez, German
    Rodriguez-Uria, Raquel
    Ugalde, Paul
    Lopez-Arevalo, Camilo
    Barneo, Luis
    Gonzales Stuva, Jessica Patricia
    Aguilar-Jimenez, Jose
    Andres Garcia-Marin, Jose
    Ortega-Vazquez, Irene
    Rodriguez, Lorena
    Herrera, Norberto
    Arachchi, Prasad Pitigala
    Jan, Wanigasekara Senanayake Mudiyanselage Kithsiri
    Arachchige, Lalith Asanka Jayasooriya Jayasooriya
    Sivaganesh, Sivasuriya
    Samaraweera, Dulan Irusha
    Thanusan, Vimalakanthan
    Musa, Ahmed Elgaili Khalid
    Balila, Reem Mohammed Hassan
    Mohamed, Mohamed Awad Elkarim Hamad
    Ali, Hussein
    Elabdin, Hagir Zain
    Hassan, Alaa
    Mahdi, Sefeldin
    Ahmed, Hala
    Idris, Sahar Abdoun Ishag
    Elsayed, Makki
    Elsayed, Mohammed
    Mahmoud, Mohamed
    Thorarinsdottir, Hildur
    Utter, Maria
    Sundstrom, Sami Martin
    Wredberg, Cecilia
    Kjellin, Ann
    Nyberg, Johanna
    Frisk, Bjorn
    Ahlqvist, Sandra
    Bjorklund, Ida
    Hjertberg, Maria
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Andersson, Linda
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Gunnarsson, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Royson, Hanna
    Weber, Per
    Schmid, Roger
    Schivo, Debora
    Despotidis, Vasileios
    Breitenstein, Stefan
    Staerkle, Ralph F.
    Schadde, Erik
    Deichsel, Fabian
    Gerosa, Alexandra
    Nocito, Antonio
    Raptis, Dimitri Aristotle
    Mijuskovic, Barbara
    Zuber, Markus
    Eisner, Lukas
    Kruspi, Swantje
    Reinisch, Katharina Beate
    Schoewe, Christin
    Novak, Allan
    Palma, Adrian F.
    Teufelberger, Gerfried
    Balkan, Ali Zeynel Abidin
    Gumar, Mehmet
    Yavuz, Mehmet Ali
    Karabacak, Ufuk
    Lap, Gokhan
    Ozkan, Bahar Busra
    Adams, Ryan
    Morton, Robert
    Henderson, Liam
    Gratton, Ruth
    Clement, Keiran David
    Chang, Kate Yu-Ching
    McNish, David
    McIntosh, Ryan
    Milligan, William
    Skelly, Brendan
    Anderson-Knight, Hannah
    Lawther, Roger
    Onimowo, Jemina
    Shatkar, Veereanna
    Tharmalingam, Shivanee
    Woin, Evelina
    Fautz, Tessa
    Ziff, Oliver
    Dindyal, Shiva
    Arman, Sam
    Talukder, Shagorika
    Gadhvi, Vijay
    Chew, Luen Shaun
    Heath, Jonathan
    Mannu, Gurdeep Singh
    Zachariades, Dimitris-Christos
    Snaith, Ailsa Claire
    Hettiarachchi, Thusitha Sampath
    Nesaratnam, Arjun
    Wheeler, James
    Sykes, Mark
    Behar, Nebil
    Jordan, Harriet
    Arulampalam, Tan
    Shah, Apar
    Brown, Damien
    Blower, Emma
    Sutton, Paul
    Gasteratos, Konstantinos
    Vimalachandran, Dale
    Magee, Cathy
    Mcguigan, Andrew
    Mcaleer, Stephen
    Morgan, Clare
    Braungart, Sarah
    Lafferty, Kirsten
    Labib, Peter
    Tanase, Andrei
    Mangan, Clodagh
    Reza, Lillian
    Woodward, Helen
    Gouldthorpe, Craig
    Turner, Megan
    Wild, Jonathan R. L.
    Malik, Tom Am
    Proctor, Victoria K.
    Hewage, Kalon
    Davies, James
    Dubois, Andre
    Sarwary, Sayed
    Zardab, Ali
    Grant, Alan
    Mcintyre, Robert
    Tewari, Shirish
    Humm, Gemma
    Farinella, Eriberto
    Parthiban, Sunil
    Hall, Nigel J.
    Wright, Naomi J.
    Major, Christina P.
    Xerri, Thelma
    De Bono, Phoebe
    Amin, Jasim
    Farhad, Mustafa
    Camilleri-Brennan, John F.
    Robertson, Andrew G. N.
    Swann, Joanna
    Richards, James
    Jabbar, Aijaz
    Attard, Myranda
    Burns, Hannah
    Macdonald, Euan
    Baldacchino, Matthew
    Skehan, Jennifer
    Camilleri-Brennan, Julian
    Hall, Tom Falconer
    Gimzewska, Madelaine
    Mclachlan, Greta
    Shah, Jamie
    Giles, James
    Hassan, Maleeha
    Beasley, William
    Vlachogiorgos, Apostolos
    Dias, Stephen
    Maharaj, Geta
    McDonald, Rosie
    Cross, Kate
    Rees, Clare M.
    Van Duren, Bernard
    Upchurch, Emma
    Karandikar, Sharad
    Bowley, Doug
    Karim, Ahmed
    Chachulski, Witold
    Richardson, Liam
    Dawnay, Giles
    Thompson, Ben
    Mistry, Ajayesh
    Ghetia, Millika
    Roy, Sudipta
    Al-Obaedi, Ossama
    Das, Kaustuv
    Prabhudesai, Ash
    Cocker, D. M.
    Tan, Jessica Juliana
    Vivekanantham, Sayinthen
    Gillespie, Michael
    Gudlaugsdottir, Katrin
    Pezas, Theodore
    Currow, Chelise
    Kim, Matthew Young-Han
    Salama, Yahya
    Shah, Rohi
    Ibrahem, Ahmad Aboelkassem
    Ebdewi, Hamdi
    Gravante, Gianpiero
    El-Rabaa, Saleem
    Chan, Zoe
    Hassan, Zaffar
    Makinde, Misty
    Hemingway, David
    Dean, Ramzana
    Boddy, Alexander
    Aber, Ahmed
    Patel, Vijay
    Kotecha, Deevia
    Ubhi, Harmony Kaur
    Hosein, Simon-Peter
    Ward, Simon
    Malik, Kamran
    Jennings, Leifa
    Newton, Tom
    Alkhouri, Mirna
    Kang, Min Kyu
    Houlden, Christopher
    Barry, Jonathan
    Wilson, Michael S. J.
    Neo, Yan Ning
    Ibrahim, Ibrahim
    Chan, Emily
    Peck, Fraser S.
    Lim, Pei J.
    North, Alexander S.
    Blundell, Rebecca
    Williamson, Adam
    Fouad, Dina
    Minocha, Ashish
    Mccarthy, Kathryn
    Court, Emma
    Chambers, Alice
    Yee, Jenna
    Tham, Ji Chung
    Beaton, Ceri
    Walsh, Una
    Lockey, Joseph
    Bokhari, Salman
    Howells, Lara
    Griffiths, Megan
    Yallop, Laura
    Singh, Shailinder
    Nasher, Omar
    Jackson, Paul
    Ramzi, Saed
    Zeidan, Shady
    Doughty, Jennifer
    Sinha, Sidhartha
    Davenport, Ross
    Lewis, Jason
    Duffy, Leo
    Mcaleer, Elizabeth
    Williams, Eleanor
    Obute, Rhalumi Daniel
    Glover, Thomas E.
    Clark, David J.
    Boshnaq, Mohamed
    Akhtar, Mansoor
    Capleton, Pascale
    Doughan, Samer
    Rabie, Mohamed
    Mohamed, Ismail
    Samuel, Duncan
    Dickson, Lauren
    Kennedy, Matthew
    Dempster, Eleanor
    Brown, Emma
    Maple, Natalie
    Monaghan, Eimear
    Wolf, Bernhard
    Garland, Alicia
    Lund, Jonathan
    Boereboom, Catherine
    Murphy, Jennifer
    Tierney, Gillian
    Tou, Samson
    Zimmermann, Eleanor Franziska
    Smart, Neil James
    Warwick, Andrea Marie
    Stasinou, Theodora
    Daniels, Ian
    Findlay-Cooper, Kim
    Mitrasinovic, Stefan
    Ray, Swayamjyoti
    Varcada, Massimo
    D'souza, Rovan
    Omara, Sharif
    Boyce, Tamsin
    Whewell, Harriet
    Jones, Elin
    Ma, Jennifer
    Abington, Emily
    Ramcharn, Meera
    Williams, Gethin
    Winstanley, Joseph
    Kennedy, Ewan D.
    Yeung, Emily N. W.
    Fergusson, Stuart J.
    Jones, Catrin
    O'neill, Stephen
    Lim, Shujing Jane
    Liew, Ignatius
    Nair, Hari
    Fairfield, Cameron
    Oh, Julia
    Koh, Samantha
    Wilson, Andrew
    Fairfield, Catherine
    Th'ng, Francesca
    Robertson, Nichola
    Anandkumar, Delran
    Kirupagaran, Ashok
    Jones, Timothy F.
    Torrance, Hew D.
    Fowler, Alexander J.
    Chandrakumar, Charmilie
    Patel, Priyank
    Ashraf, Syed Faaz
    Lakhani, Sonam M.
    Mclean, Aaron Lawson
    Basson, Sonia
    Batt, Jeremy
    Bowman, Catriona
    Stoddart, Michael
    Benons, Natasha
    Barker, Tom
    Summerour, Virginia
    Harper, Edward
    Smith, Caroline
    Hampton, Matthew
    Mckechnie, Doug
    Farah, Ayaan
    Chun, Anita
    Pereira, Bernadette
    Nemeth, Kristof
    Decker, Emily
    Giuliani, Stefano
    Shalaby, Aly
    Szczap, Aleksandra
    Chidambaram, Swathikan
    Chen, Chee Yang
    Kulasabanathan, Kavian
    Chhabra, Srishti
    Kostov, Elisabeth
    Harbord, Philippe
    Barnacle, James
    Palliyil, Madan Mohan
    Zikry, Mina
    Porter, Johnathan
    Raslan, Charef
    Hafiz, Shazia
    Soltani, Niksa
    Baillie, Katie
    Mirza, Ahmad
    Saeed, Haroon
    Galloway, Simon
    Elena, Gia
    Afzal, Mohammad
    Zakir, Mohamed
    Sodde, Peter
    Hand, Charles
    Sriram, Aiesha
    Clark, Tamsyn
    Holton, Patrick
    Livesey, Amy
    Sinha, Yashashwi
    Iqbal, Fahad Mujtaba
    Bharj, Indervir Singh
    Rotundo, Adriana
    Jenvey, Cara
    Slade, Robert
    Golding, David
    Haines, Samuel
    Abdullah, Ali Adel Ne'ma
    Tilston, Thomas W.
    Loughran, Dafydd
    Donoghue, Danielle
    Giacci, Lorenzo
    Sherif, Mohamed Ashur
    Harrison, Peter
    Tang, Alethea
    Elshaer, Mohamed
    Urbonas, Tomas
    Riaz, Amjid
    Chapman, Annie
    Acharya, Parisha
    Shalhoub, Joseph
    Grossart, Cathleen
    McMorran, David
    Mlotshwa, Makhosini
    Hawkins, William
    Loizides, Sofronis
    Thomson, Peter
    Khan, Shahab
    Taylor, Fiona
    Shukla, Jalak
    Howie, Emma Elizabeth
    Macdonald, Linda
    Komolafe, Olusegun
    Mcintyre, Neil
    Cragg, James
    Parker, Jody
    Stewart, Duncan
    Lintin, Luke
    Tracy, Julia
    Farooq, Tahir
    Sion, Melanie
    Weinstein, Michael S.
    Punja, Viren
    Bugaev, Nikolay
    Goodstein, Monica
    Razmdjou, Shadi
    Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries2016In: BMJ Global Health, ISSN 2059-7908, Vol. 1, no 4, article id e000091Article in journal (Refereed)
    Abstract [en]

    Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.

    Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.

    Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.

    Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.

  • 12. Aden, A S
    et al.
    Brännström, Inger
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Mohamud, K A
    Persson, Lars-Åke
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    The growth chart - a road to health chart?: Maternal comprehension of the growth chart in two Somali villages1990In: Paediatric and Perinatal Epidemiology, ISSN 0269-5022, E-ISSN 1365-3016, Vol. 4, no 3, p. 340-350Article in journal (Refereed)
    Abstract [en]

    Growth monitoring is so far not implemented on a large scale in the Somali health services. Available reports indicate that growth faltering is common. However, the use of growth charts as a tool for health education has been questioned. This study examines the ability of 199, predominantly illiterate, rural Somali mothers to understand the growth chart message after an intensive period of growth chart use and education. During a home-based interview the mothers were asked to combine a set of four growth curves with a set of four pictures, showing the corresponding developments of four children. The mothers managed significantly better to interpret the charts than could be expected by chance alone. Maternal age, number of children and literacy did not differ much between those who correctly and incorrectly combined pictures and charts. Almost all mothers recognised the value of the growth chart as being good for the control and promotion of their children's health and/or growth. We conclude that the growth chart may be an applicable and appropriate tool even with illiterate mothers, provided that other prerequisites for successful growth monitoring, e.g. appropriate health services, are available.

  • 13. Adlard, B.
    et al.
    Donaldson, S. G.
    Odland, J. O.
    Weihe, P.
    Berner, J.
    Carlsen, A.
    Bonefeld-Jorgensen, E. C.
    Dudarev, A. A.
    Gibson, J. C.
    Krümmel, E. M.
    Olafsdottir, K.
    Abass, K.
    Rautio, A.
    Bergdahl, Ingvar A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Mulvad, G.
    Future directions for monitoring and human health research for the Arctic Monitoring and Assessment Programme2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1480084Article in journal (Refereed)
    Abstract [en]

    For the last two and a half decades, a network of human health experts under the Arctic Monitoring and Assessment Program (AMAP) has produced several human health assessment reports. These reports have provided a base of scientific knowledge regarding environmental contaminants and their impact on human health in the Arctic. These reports provide scientific information and policy-relevant recommendations to Arctic governments. They also support international agreements such as the Stockholm Convention on Persistent Organic Pollutants (POPs) and the Minamata Convention on Mercury. Key topics discussed in this paper regarding future human health research in the circumpolar Arctic are continued contaminant biomonitoring, health effects research and risk communication. The objective of this paper is to describe knowledge gaps and future priorities for these fields.

  • 14. Afshin, Ashkan
    et al.
    Forouzanfar, Mohammad H.
    Reitsma, Marissa B.
    Sur, Patrick
    Estep, Kara
    Lee, Alex
    Marczak, Laurie
    Mokdad, Ali H.
    Moradi-Lakeh, Maziar
    Naghavi, Mohsen
    Salama, Joseph S.
    Vos, Theo
    Abate, Kalkidan H.
    Abbafati, Cristiana
    Ahmed, Muktar B.
    Al-Aly, Ziyad
    Alkerwi, Ala'a
    Al-Raddadi, Rajaa
    Amare, Azmeraw T.
    Amberbir, Alemayehu
    Amegah, Adeladza K.
    Amini, Erfan
    Amrock, Stephen M.
    Anjana, Ranjit M.
    Arnlov, Johan
    Asayesh, Hamid
    Banerjee, Amitava
    Barac, Aleksandra
    Baye, Estifanos
    Bennett, Derrick A.
    Beyene, Addisu S.
    Biadgilign, Sibhatu
    Biryukov, Stan
    Bjertness, Espen
    Boneya, Dube J.
    Campos-Nonato, Ismael
    Carrero, Juan J.
    Cecilio, Pedro
    Cercy, Kelly
    Ciobanu, Liliana G.
    Cornaby, Leslie
    Damtew, Solomon A.
    Dandona, Lalit
    Dandona, Rakhi
    Dharmaratne, Samath D.
    Duncan, Bruce B.
    Eshrati, Babak
    Esteghamati, Alireza
    Feigin, Valery L.
    Fernandes, Joao C.
    Furst, Thomas
    Gebrehiwot, Tsegaye T.
    Gold, Audra
    Gona, Philimon N.
    Goto, Atsushi
    Habtewold, Tesfa D.
    Hadush, Kokeb T.
    Hafezi-Nejad, Nima
    Hay, Simon I.
    Horino, Masako
    Islami, Farhad
    Kamal, Ritul
    Kasaeian, Amir
    Katikireddi, Srinivasa V.
    Kengne, Andre P.
    Kesavachandran, Chandrasekharan N.
    Khader, Yousef S.
    Khang, Young-Ho
    Khubchandani, Jagdish
    Kim, Daniel
    Kim, Yun J.
    Kinfu, Yohannes
    Kosen, Soewarta
    Ku, Tiffany
    Defo, Barthelemy Kuate
    Kumar, G. Anil
    Larson, Heidi J.
    Leinsalu, Mall
    Liang, Xiaofeng
    Lim, Stephen S.
    Liu, Patrick
    Lopez, Alan D.
    Lozano, Rafael
    Majeed, Azeem
    Malekzadeh, Reza
    Malta, Deborah C.
    Mazidi, Mohsen
    McAlinden, Colm
    McGarvey, Stephen T.
    Mengistu, Desalegn T.
    Mensah, George A.
    Mensink, Gert B. M.
    Mezgebe, Haftay B.
    Mirrakhimov, Erkin M.
    Mueller, Ulrich O.
    Noubiap, Jean J.
    Obermeyer, Carla M.
    Ogbo, Felix A.
    Owolabi, Mayowa O.
    Patton, George C.
    Pourmalek, Farshad
    Qorbani, Mostafa
    Rafay, Anwar
    Rai, Rajesh K.
    Ranabhat, Chhabi L.
    Reinig, Nikolas
    Safiri, Saeid
    Salomon, Joshua A.
    Sanabria, Juan R.
    Santos, Itamar S.
    Sartorius, Benn
    Sawhney, Monika
    Schmidhuber, Josef
    Schutte, Aletta E.
    Schmidt, Maria I.
    Sepanlou, Sadaf G.
    Shamsizadeh, Moretza
    Sheikhbahaei, Sara
    Shin, Min-Jeong
    Shiri, Rahman
    Shiue, Ivy
    Roba, Hirbo S.
    Silva, Diego A. S.
    Silverberg, Jonathan I.
    Singh, Jasvinder A.
    Stranges, Saverio
    Swaminathan, Soumya
    Tabares-Seisdedos, Rafael
    Tadese, Fentaw
    Tedla, Bemnet A.
    Tegegne, Balewgizie S.
    Terkawi, Abdullah S.
    Thakur, J. S.
    Tonelli, Marcello
    Topor-Madry, Roman
    Tyrovolas, Stefanos
    Ukwaja, Kingsley N.
    Uthman, Olalekan A.
    Vaezghasemi, Masoud
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Vasankari, Tommi
    Vlassov, Vasiliy V.
    Vollset, Stein E.
    Weiderpass, Elisabete
    Werdecker, Andrea
    Wesana, Joshua
    Westerman, Ronny
    Yano, Yuichiro
    Yonemoto, Naohiro
    Yonga, Gerald
    Zaidi, Zoubida
    Zenebe, Zerihun M.
    Zipkin, Ben
    Murray, Christopher J. L.
    Health Effects of Overweight and Obesity in 195 Countries over 25 Years2017In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 377, no 1, p. 13-27Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. 

  • 15.
    Ahangari, Alebtekin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Chronic pelvic pain: 8 years after the 2006 WHO systematic review2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 16.
    Ahangari, Alebtekin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pain and Alcohol Consumption among Elderly: Evidences from WHO Study on global AGEing and adult health (Wave 1)2014Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
  • 17.
    Ahangari, Alebtekin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Prevalence of Chronic Pelvic Pain Among Women: An Updated Review2014In: Pain Physician, ISSN 1533-3159, E-ISSN 2150-1149, Vol. 17, no 2, p. E141-E147Article, review/survey (Refereed)
    Abstract [en]

    Background: Chronic pelvic pain (CPP), defined as a noncyclical pain lasting for more than 6 months can lead to lower physical performance and quality of life in women. CPP is a worldwide problem affecting women of all ages. However, health care professionals and researchers, due to its complex nature and the lack of knowledge surrounding the condition, frequently neglect CPP. Subsequently, basic data and knowledge regarding CPP remain incomplete. Objective: To update the review of the worldwide estimation of the CPP prevalence considering the World Health Organization systematic review by Latthe et al in 2006 as point of departure. Study Design: A systematic review of CPP prevalence studies. Method: Electronic search was performed to find related articles through PubMed between 2005 and 2012 based on the PRISMA statement (2009). Results: From 140 studies, only 7 studies were about CPP prevalence. Their study design consisted of 3 cross sectional studies, one population based mailing questionnaire study, one survey study (computer assisted telephone interview), one data analysis by questionnaire, and one prospective community based study. Limitations: Paucity of population based studies in addition to probability of existence of studies at the local level with limited access to worldwide databases, lack of consensus about definition of CPP among researchers and therapists, and non-inclusion of CPP related key words in databases such as PubMed. Conclusion: Based on these articles, prevalence in general ranged between 5.7% and 26.6%. There were many countries and regions without basic data in the field of CPP. This review shows the paucity of studies, especially multidisciplinary researches with multifactorial views on CPP. Multidisciplinary studies would provide more reliable data for estimating the prevalence of CPP and its psycho-socioeconomic burden, as well as finding its etiologies and characteristics. This would be the first step towards better treatment and care for women with CPP.

  • 18.
    Ahangari, Alebtekin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Generational, Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pain and alcohol consumption among older adults: findings from the World Health Organization Study on global AGEing and adult health, Wave 12016In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 21, no 10, p. 1282-1292Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate cross-sectional associations between self-reported recent pain and alcohol use/abstinence, and previous-day pain and previous-week alcohol consumption in adults aged 50 + in six low- and middle-income countries (LMICs). METHODS: The WHO Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010) in China, Ghana, India, Mexico, Russia and South Africa is the data source. Prevalence of alcohol use/abstinence is reported by previous-day and previous-month pain. Multinomial logistic regressions (crude and adjusted for sex and country) tested associations between recent pain and alcohol use in the pooled multicountry sample. RESULTS: Across the six SAGE countries, about one-third of respondents reported alcohol use, being highest in Russia (74%) and lowest in India (16%). Holding the effects of sex and country constant, compared with abstainers, people with previous-day pain were more likely to be previous-day or other users. With regard to the quantity and frequency of alcohol use, people with previous-day pain were more likely to be non-heavy drinkers. CONCLUSION: Overall, we found that, in this population of older adults in six LMICs, recent pain was associated with moderate use of alcohol, although there were differences between countries. The findings provide a platform for country-specific research to better understand bi-directional associations between pain and alcohol in older adults.

  • 19.
    Ahlm, Clas
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Vapalahti, O.
    University of Helsinki and Helsinki University Central Hospital Laboratory, Finland.
    Evander, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Seroprevalence of Sindbis virus and associated risk factors in northern Sweden2014In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 142, no 7, p. 1559-1565Article in journal (Refereed)
    Abstract [en]

    Mosquito-borne Sindbis virus (SINV) cause disease characterized by rash, fever and arthritis which often leads to long-lasting arthralgia. To determine the seroprevalence of SINV and associated risk factors in northern Sweden, a randomly selected population aged between 25 and 74 years were invited to join the MONICA study. Serum from 1611 samples were analysed for specific IgG antibodies. Overall, 2·9% had IgG against SINV. More men (3·7%) than women (2·0%) were SINV seropositive (P = 0·047) and it was more common in subjects with a lower educational level (P = 0·013) and living in small, rural communities (P < 0·001). Seropositivity was associated with higher waist circumference (P = 0·1), elevated diastolic blood pressure (P = 0·037), and history of a previous stroke (P = 0·011). In a multiple logistic regression analysis, adjusting for known risk factors for stroke, seropositivity for SINV was an independent predictor of having had a stroke (odds ratio 4·3, 95% confidence interval 1·4–13·0,P = 0·011).

  • 20.
    Ahmad, Shafqat
    et al.
    Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Zhao, Wei
    Philadelphia, PA, US.
    Renström, Frida
    Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Rasheed, Asif
    Karachi, Pakistan.
    Samuel, Maria
    Karachi, Pakistan.
    Zaidi, Mozzam
    Karachi, Pakistan.
    Shah, Nabi
    Karachi, Pakistan; Abbottabad, Pakistan.
    Mallick, Nadeem Hayyat
    Punjab Institute of Cardiology, Lahore, Pakistan.
    Zaman, Khan Shah
    Karachi, Pakistan.
    Ishaq, Mohammad
    Karachi, Pakistan.
    Rasheed, Syed Zahed
    Karachi, Pakistan.
    Memon, Fazal-ur-Rheman
    Karachi, Pakistan.
    Hanif, Bashir
    Karachi, Pakistan.
    Lakhani, Muhammad Shakir
    Karachi, Pakistan.
    Ahmed, Faisal
    Karachi, Pakistan.
    Kazmi, Shahana Urooj
    Karachi, Pakistan.
    Frossard, Philippe
    Karachi, Pakistan; Nazarbayev University, Astana, Kazakhstan.
    Franks, Paul W.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
    Saleheen, Danish
    Philadelphia, PA, US; Karachi, Pakistan.
    Physical activity, smoking, and genetic predisposition to obesity in people from Pakistan: the PROMIS study2015In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 16, article id 114Article in journal (Refereed)
    Abstract [en]

    Background: Multiple genetic variants have been reliably associated with obesity-related traits in Europeans, but little is known about their associations and interactions with lifestyle factors in South Asians.

    Methods: In 16,157 Pakistani adults (8232 controls; 7925 diagnosed with myocardial infarction [MI]) enrolled in the PROMIS Study, we tested whether: a) BMI-associated loci, individually or in aggregate (as a genetic risk score - GRS), are associated with BMI; b) physical activity and smoking modify the association of these loci with BMI. Analyses were adjusted for age, age(2), sex, MI (yes/no), and population substructure.

    Results: Of 95 SNPs studied here, 73 showed directionally consistent effects on BMI as reported in Europeans. Each additional BMI-raising allele of the GRS was associated with 0.04 (SE = 0.01) kg/m(2) higher BMI (P = 4.5 x 10(-14)). We observed nominal evidence of interactions of CLIP1 rs11583200 (P-interaction = 0.014), CADM2 rs13078960 (P-interaction = 0.037) and GALNT10 rs7715256 (P-interaction = 0.048) with physical activity, and PTBP2 rs11165643 (P-interaction = 0.045), HIP1 rs1167827 (P-interaction = 0.015), C6orf106 rs205262 (P-interaction = 0.032) and GRID1 rs7899106 (P-interaction = 0.043) with smoking on BMI.

    Conclusions: Most BMI-associated loci have directionally consistent effects on BMI in Pakistanis and Europeans. There were suggestive interactions of established BMI-related SNPs with smoking or physical activity.

  • 21.
    Ahmadi, Sumaiya
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Risk factors for self-perceived oral health in Northern Sweden:: a cross-sectional study2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Authors have reported socioeconomic inequalities in self-perceived oral health around the world, including Sweden. However, no study has been carried out in Northern Sweden.

    Purpose: the aim of this study is to investigate different risk factors such as age, education, civil status, occupational class, income, place of birth and smoking have an association with self- perceived oral health in Northern Sweden.

    Methods: A cross-sectional study design (N=22,975; 50% response rate), based on a survey questionnaire, Health on Equal Terms survey of 2014 in four Northern counties of Sweden. The age group was 16-84 years. The responses are linked to Statistics Sweden registry through Swedish Personal number. A multiple logistic regression while controlling for confounders, was used to analyze the differences in self-perceived oral health with respect to sex, age, educational level, civil-status, income and country of birth.

    Results: 75% of the respondents reported good self-perceived oral health. The higher odds of poor self-perceived oral health were observed among men, middle age, low education, blue-collar workers, low income, those who had their last visit to dentist in more than 5 years and those not born in Sweden.

    Conclusion: The results suggest the presence of a social gradient in Northern Sweden in self-perceived oral health. The inequity needs to be addressed by the researchers and policy makers.

  • 22.
    Ahmed Hassan Ahmed, Osama
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rift Valley fever: challenges and new insights for prevention and control using the “One Health” approach2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Rift Valley fever (RVF) is an emerging viral zoonosis that causes frequent outbreaks in east Africa and on the Arabian Peninsula. The likelihood of RVF global expansion due to climate change and human anthropogenic factors is an important issue. The causative agent, RVF virus, is an arbovirus that is transmitted by several mosquito species and is able to infect a wide range of livestock as well as people. The infection leads to mass abortions and death in livestock and a potentially deadly hemorrhagic fever in humans. RVF has severe socio-economic consequences such as animal trade bans between countries, disruption of food security, and economic disaster for farmers and pastoralists as well as for countries. Human behavior such as direct contact with infected animals or their fluids and exposure to mosquito bites increases the risk for contracting the disease.

    To better understand the challenges associated with RVF outbreaks and to explore prevention and control strategies, we used the One Health approach. The local community had to be involved to understand the interaction between the environment, animals, and humans. We focused on Sudan, Saudi Arabia, and Kenya. First, we systematically reviewed the literature and then we performed cross sectional community-based studies using a special One Health questionnaire. Climatic and remote sensing data were used in combination with statistics to develop a sub-region predictive model for RVF.

    For both Saudi Arabia and Sudan, the ecology and environment of the affected areas were similar. These areas included irrigation canals and excessive rains that provide an attractive habitat for mosquito vectors to multiply. The surveillance systems were unable to detect the virus in livestock before it spread to humans. Ideally, livestock should serve as sentinels to prevent loss of human lives, but the situation here was reversed. Differences between countries regarding further spread of RVF was mainly determined by better economic and infrastructure resources.

    In Sudan, there was a lack of knowledge and appropriate practices at the studied community regarding RVF disease symptoms and risk factors for both animals and humans. The community was hesitant in notifying the authorities about RVF suspicion in livestock due to the lack of a compensation system. The perceived role of the community in controlling RVF was fragmented, increasing the probability of RVF transmission and disease.

    In Kenya, our study found that better knowledge about RVF does not always translate to more appropriate practices that avoid exposure to the disease. However, the combination of good knowledge, attitudes, and practices may explain why certain communities were less affected. Strategies to combat RVF should consider socio-cultural and behavioral differences among communities. We also noticed that RVF outbreaks in Kenya occurred in regions with high livestock density exposed to heavy rains and wet soil fluxes, which could be measured by evapotranspiration and vegetation seasonality variables. We developed a RVF risk map on a sub-regional scale. Future outbreaks could be better managed if such relevant RVF variables are integrated into early warning systems.

    To confront RVF outbreaks, a policy is needed that better incorporates ecological factors and human interactions with livestock and environment that help the RVF pathogen spread. Early detection and notification of RVF is essential because a delay will threaten the core of International Health Regulations (IHR), which emphasizes the share of information during a transboundary disease outbreak to avoid unnecessary geographical expansion.

  • 23. Ahmed, Syed Masud
    et al.
    Hadi, Abdullahel
    Razzaque, Abdur
    Ashraf, Ali
    Juvekar, Sanjay
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Indonesia.
    Kanungsukkasem, Uraiwan
    Soonthornthada, Kusol
    Van Minh, Hoang
    Huu Bich, Tran
    Clustering of chronic non-communicable disease risk factors among selected Asian populations: levels and determinants2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, no 1, p. 68-75Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The major chronic non-communicable diseases (NCDs) operate through a cluster of common risk factors, whose presence or absence determines not only the occurrence and severity of the disease, but also informs treatment approaches. Primary prevention based on mitigation of these common risk factors through population-based programmes is the most cost-effective approach to contain the emerging epidemic of chronic NCDs.

    OBJECTIVES: This study was conducted to explore the extent of risk factors clustering for the major chronic NCDs and its determinants in nine

    INDEPTH Health and Demographic Surveillance System (HDSS) sites of five Asian countries. DESIGN: Data originated from a multi-site chronic NCD risk factor prevalence survey conducted in 2005. This cross-sectional survey used a standardised questionnaire developed by the WHO to collect core data on common risk factors such as tobacco use, intake of fruits and vegetables, physical inactivity, blood pressure levels, and body mass index. Respondents included randomly selected sample of adults (25-64 years) living in nine rural HDSS sites in Bangladesh, India, Indonesia, Thailand, and Vietnam.

    RESULTS: Findings revealed a substantial proportion (>70%) of these largely rural populations having three or more risk factors for chronic NCDs. Chronic NCD risk factors clustering was associated with increasing age, being male, and higher educational achievements. Differences were noted among the different sites, both between and within country.

    CONCLUSIONS: Since there is an extensive clustering of risk factors for the chronic NCDs in the populations studied, the interventions also need to be based on a comprehensive approach rather than on a single factor to forestall its cumulative effects which occur over time. This can work best if it is integrated within the primary health care system and the HDSS can be an invaluable epidemiological resource in this endeavor.

  • 24. Ajeani, Judith
    et al.
    Ayiasi, Richard Mangwi
    Tetui, Moses
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Makerere University School of Public Health (MakSPH), Makerere University College of Health Sciences, Kampala, Uganda.
    Ekirapa-Kiracho, Elizabeth
    Namazzi, Gertrude
    Kananura, Rornald Muhumuza
    Kiwanuka, Suzanne Namusoke
    Beyeza-Kashesya, Jolly
    A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1345497Article in journal (Refereed)
    Abstract [en]

    Background: There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers.

    Objectives: This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model.

    Methods: The cascade model started with initial training of health workers from three districts of Pallisa, Kibuku and Kamuli from where potential local mentors were selected for further training and mentorship by central mentors. These local mentors then went on to conduct mentorship visits supported by the external mentors. The mentorship process concentrated on partograph use, newborn resuscitation, prevention and management of Post-Partum Haemorrhage (PPH), including active management of third stage of labour, preeclampsia management and management of the sick newborn. Data for this paper was obtained from key informant interviews with district-level managers and local mentors.

    Results: Mentorship improved several aspects of health-care delivery, ranging from improved competencies and responsiveness to emergencies and health-worker professionalism. In addition, due to better district leadership for Maternal and Newborn Health (MNH), there were improved supplies/medicine availability, team work and innovative local problem-solving approaches. Health workers were ultimately empowered to perform better.

    Conclusions: The study demonstrated that it is possible to improve the competencies of frontline health workers through performance enhancement for MNH services using locally built capacity in clinical mentorship for Emergency Obstetric and Newborn Care (EmONC). The cascade mentoring process needed strong external mentorship support at the start to ensure improved capacity among local mentors to provide mentorship among local district staff.

  • 25.
    Akhter Urmi, Sharmeen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Parental attitude towards their autistic child and the underlying factors regulating parental attitude in Bangladesh: A Study Protocol2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background Autism is a global health crisis. Among other developing countries, Bangladesh has the highest rate on prevalence of autism which ranges from 0.15%-0.84%. Several factors have been found to influence parent’s attitude towards autistic child such as lack of knowledge and understanding of autism, societal stigma, cultural belief in karma, parent’s expectations, parent’s uncertainty about child’s future, worry about child’s educational development, parent’s guilt as caregivers, hampering family relationship. Bangladesh is still lacking in knowledge and awareness of autism, thus, giving rise to negative attitude among parents towards their autistic child. The aim of the study is to understand parental attitude towards their autistic child comparing both the father and mother’s attitude and to explore the underlying factors regulating their attitude.

    Methods This will be a qualitative study protocol with abductive approach following emergent design conducted with semi-structured interviews with open-ended questions among both the parents having an autistic child diagnosed for minimum 6 months, living together in Dhakaand registered on files of Center for Neurodevelopment and Autism in Children (CNAC) in Bangabandhu Sheikh Mujib Medical University (BSMMU).

    Conclusion This study is expected to bring out deeper understanding of parental attitude towards their autistic child providing a baseline for interventions and evaluations of support programs for autistic child and their parents in Bangladesh. This study will influence for having autism support groups, autistic child-family support group, social support groups and trained social workers in public sector workers for reducing stigma of autism.

  • 26.
    Akuamoah-Boateng, Henrietta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Self-reported vision health status among older people in the Kassena-Nankana District, Ghana2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background: If current trends continue, Ghana's aged population will increase in the coming decades. Currently, there is little knowledge on the health of the aged in Ghana. Research on vision problems among this group is virtually non-existent. This research gap needs to be filled immediately in order to promote the general health among older people in Ghana.

    Objective: The objective of the study was to analyse vision health and its determinants among the older adult population in a district in one of the poorest regions in Ghana - the Kassena-Nankana district.

    Methods: Data were obtained from the WHO multi-country studies unit (SAGE). A total of 4,294 people over the age of 50 responded to the survey. Data analysis was conducted using Stata statistical package. The aim of the analysis was to identify the prevalence of self-reported vision problems and assistive device use. Age, level of education, marital status, living arrangement, socio-economic status and proportion of people aged 50 and over in a household were used as determinants of vision health.

    Results: In total, 54 and 63% (p-value, 0.00) of men and women reported having far-sightedness, while 35% of men and 40.6% of women reported having near-sightedness (p-value, 0.00). In total, 33.5% of men and 38.6% of women reported having both near-sightedness and far-sightedness (p-value, 0.00). Of those who reported having either vision problems, 2.9% reported the use of visual assistive devices. Men had a higher assistive device use of 4.5% compared to 2.1% among women (p = 0.002). Age and household socio-economic status was positively associated with reporting vision problems and assistive device use, respectively.

    Conclusions: The results from this analysis showed that despite the high reporting of vision problems, only 2.9% reported using assistive devices. This outcome shows that there is a need to prevent vision problems and increase access to assistive devices among older people in the Kassena-Nankana district in Ghana.

  • 27.
    Al Bitar, Ghiath
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Diabetes and Edentulism: Analysis of WHO Study on global AGEing and adult health (SAGE) Wave 12015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 28.
    Al Mamun, Mohammad Feroz
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pokharel, Arpan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Reasons behind the use of tanning beds:: A Scoping Review2016Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]


    Tanning beds emit short, energetic and harmful rays, UV-A and UV-B which leads to various ocular and skin diseases; moreover, DNA damage and the initiation of carcinogenic changes are associated with regular use of it. Basal cell carcinoma and melanoma incidence rate have been rapidly increasing over a few decades due to unregulated consumption of solar bed. It has been classified as carcinogenic device and different organizations regularly advice for the prohibition of it. Despite the proven association of ocular and skin diseases and cancer from the large epidemiological data solar bed consumption is not degraded; furthermore, tanning bed has been developed as a culture in the modern western world. The exploration of tanning bed displayed that it is interconnected with the ancient sun worshippers, an advent of vitamin D and carbon arc lamps with quartz lens, heliotherapy clinics and to the modern sun stimulated indoor tanning. This scoping review provides a broad understanding of the reasons behind the popularity and the current consumption of indoor tanning bed.


    The aim of our study is to analyse and summarize the factors that contribute to the practice of indoor tanning beds in an overall population; furthermore, attitudes, perception, belief, behaviour and motivation factors of indoor tanners were undertaken to explore and find gaps in the existing literatures.


    By using a scoping review twenty articles both qualitative and quantitative were identified and selected from the Umeå University Library website by using only one database, “Web of Science TM Core Collection Studies (v.5.21)” during the months of March and April 2016.  Boolean logic was used to identify both qualitative and quantitative studies with keywords such as “Indoor tanning”, “Tanning bed”, “Qualitative Study”, “attitude”, “belief”, “behaviour”, “motivation” and “perception”. The relevant articles that were published and written only in English language and free to download a full copy of the articles through the Umeå University Library website and without any financial transactions and contacts with organizations and authors were included. In terms of population, our target study group is broad which includes both male and female population who are active and passive users of the tanning beds. The age of the participants in our study range from 11 years to 94 years.


    Seven themes are reported to be the main reasons behind the consumption of carcinogenic tanning bed. These are: - (1) Modern Healthism, (2) Influence from family and friends, (3) Social occasions and holidays, (4) Physical and Mental Gain, (5) Complex cognition, (6) Addiction and (7) Tactful marketing.  Modern healthism, tanning industries and salon’s tactful marketing help to set up image-based modern norms, attractive, healthy golden brown skin, in societal level influencing families and friends, which further develops indoor tanning as a culture and beautifying practice during special events like social occasions and holidays. The cognition regarding physical and mental gain perceived from an individual and societal perspective and contradictory findings from ongoing researches with respect to the hazards of solar beds create complex cognition among active and passive tanners, like ambivalence, cognitive dissonance, temporal discounting, rationalization and optimistic bias. However, in the adolescent phase, there is increasing consumption of the tanning beds which can be further explained by complex cognitive, the adolescent egocentrism. The complex cognition enhances the regular use of addictive tanning bed which further leads to dependence and skin cancers or the diseases of the eyes and the skin.

    Conclusions: Consumption of risky tanning bed has been developed as a culture or beauty norms that are still ingrained in the mind of tanners, i.e., golden brown tanned skin is attractive, which is created under the influence of modern healthism. The reasons behind the use of carcinogenic solar bed can be well explained by the concepts of cognitive science and psychology, i.e., ambivalence, adolescent egocentrism, cognitive dissonance, temporal discounting, rationalization, optimistic bias, and addiction. In order to tackle with solar bed dependence and its health related hazards, health workers should develop and implement promotive and preventive health programs which incorporate social norms and factors, tanner’s cognition and psychology. Policy makers and health actors should ban solar beds or avoid the use of it in the minors, i.e., under 18 years through embracing the evidence suggested by epidemiological studies.

  • 29.
    Alabi, Olusola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Exploring awareness and knowledge of tuberculosis spread among household members of tuberculosis patients in Nigeria2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 30.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Al Mandhari, Ahmed
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Are the resources adoptive for conducting team-based diabetes management clinics? An explorative study at primary health care centers in Muscat, Oman.2018In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, p. 1-28Article in journal (Refereed)
    Abstract [en]

    AimThe aim of this study is to explore the perceptions among primary health center staff concerning competencies, values, skills and resources related to team-based diabetes management and to describe the availability of needed resources for team-based approaches.

    BACKGROUND: The diabetes epidemic challenges services available at primary health care centers in the Middle East. Therefore, there is a demand for evaluation of the available resources and team-based diabetes management in relation to the National Diabetes Management Guidelines.

    METHOD: A cross-sectional study was conducted with 26 public primary health care centers in Muscat, the capital of Oman. Data were collected from manual and electronic resources as well as a questionnaire that was distributed to the physician-in-charge and diabetes management team members.FindingsThe study revealed significant differences between professional groups regarding how they perceived their own competencies, values and skills as well as available resources related to team-based diabetes management. The perceived competencies were high among all professions. The perceived team-related values and skills were also generally high but with overall lower recordings among the nurses. This pattern, along with the fact that very few nurses have specialized qualifications, is a barrier to providing team-based diabetes management. Participants indicated that there were sufficient laboratory resources; however, reported that pharmacological, technical and human resources were lacking. Further work should be done at public primary diabetes management clinics in order to fully implement team-based diabetes management.

  • 31. Alberts, Marianne
    et al.
    Dikotope, Sekgothe A
    Choma, Solomon R
    Masemola, Matshane L
    Modjadji, Sewela EP
    Mashinya, Felistas
    Burger, Sandra
    Cook, Ian
    Brits, Sanette J
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesberg, South Africa.
    Health & Demographic Surveillance System Profile: The Dikgale Health and Demographic Surveillance System.2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 5, p. 1565-1571Article in journal (Refereed)
  • 32. Aldrich, Rosemary
    et al.
    Mahoney, Mary
    Harris, Elizabeth
    Simpson, Sarah
    Stewart-Williams, Jenny
    Newcastle Institute of Public health, University of Newcastle, New South Wales, Australia.
    Building an equity focus in health impact assessment2005In: New South Wales Public Health Bulletin, ISSN 1034-7674, Vol. 16, no 7-8, p. 118-119Article in journal (Refereed)
  • 33. Aleksandrova, Krasimira
    et al.
    Jenab, Mazda
    Leitzmann, Michael
    Bueno-de-Mesquita, Bas
    Kaaks, Rudolf
    Trichopoulou, Antonia
    Bamia, Christina
    Lagiou, Pagona
    Rinaldi, Sabina
    Freisling, Heinz
    Carayol, Marion
    Pischon, Tobias
    Drogan, Dagmar
    Weiderpass, Elisabete
    Jakszyn, Paula
    Overvad, Kim
    Dahm, Christina C.
    Tjonneland, Anne
    Bouton-Ruault, Marie-Christine
    Kuehn, Tilman
    Peppa, Eleni
    Valanou, Elissavet
    La Vecchia, Carlo
    Palli, Domenico
    Panico, Salvatore
    Sacerdote, Carlotta
    Agnoli, Claudia
    Tumino, Rosario
    May, Anne
    van Vulpen, Jonna
    Borch, Kristin Benjaminsen
    Oyeyemi, Sunday Oluwafemi
    Ramon Quiros, J.
    Bonet, Catalina
    Sanchez, Maria-Jose
    Dorronsoro, Miren
    Navarro, Carmen
    Barricarte, Aurelio
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Key, Timothy J.
    Khaw, Kay-Tee
    Wareham, Nicholas
    Assi, Nada
    Ward, Heather A.
    Aune, Dagfinn
    Riboli, Elio
    Boeing, Heiner
    Physical activity, mediating factors and risk of colon cancer: insights into adiposity and circulating biomarkers from the EPIC cohort2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 6, p. 1823-1835Article in journal (Refereed)
    Abstract [en]

    There is convincing evidence that high physical activity lowers the risk of colon cancer; however, the underlying biological mechanisms remain largely unknown. We aimed to determine the extent to which body fatness and biomarkers of various biologically plausible pathways account for the association between physical activity and colon cancer. We conducted a nested case-control study in a cohort of 519 978 men and women aged 25 to 70 years followed from 1992 to 2003. A total of 713 incident colon cancer cases were matched, using risk-set sampling, to 713 controls on age, sex, study centre, fasting status and hormonal therapy use. The amount of total physical activity during the past year was expressed in metabolic equivalent of task [MET]-h/week. Anthropometric measurements and blood samples were collected at study baseline. High physical activity was associated with a lower risk of colon cancer: relative risk a parts per thousand<yen>91 MET-h/week vs < 91 MET-h/week = 0.75 [95% confidence interval (CI): 0.57 to 0.96]. In mediation analyses, this association was accounted for by waist circumference: proportion explained effect (PEE) = 17%; CI: 4% to 52%; and the biomarkers soluble leptin receptor (sOB-R): PEE = 15%; 95% CI: 1% to 50% and 5-hydroxyvitamin D (25[OH]D): PEE = 30%; 95% CI: 12% to 88%. In combination, these factors explained 45% (95% CI: 20% to 125%) of the association. Beyond waist circumference, sOB-R and 25[OH]D additionally explained 10% (95% CI: 1%; 56%) and 23% (95% CI: 6%; 111%) of the association, respectively. Promoting physical activity, particularly outdoors, and maintaining metabolic health and adequate vitamin D levels could represent a promising strategy for colon cancer prevention.

  • 34. Aleksandrova, Krasimira
    et al.
    Pischon, Tobias
    Jenab, Mazda
    Bueno-de-Mesquita, H Bas
    Fedirko, Veronika
    Norat, Teresa
    Romaguera, Dora
    Knüppel, Sven
    Boutron-Ruault, Marie-Christine
    Dossus, Laure
    Dartois, Laureen
    Kaaks, Rudolf
    Li, Kuanrong
    Tjønneland, Anne
    Overvad, Kim
    Quirós, José Ramón
    Buckland, Genevieve
    Sánchez, María José
    Dorronsoro, Miren
    Chirlaque, Maria-Dolores
    Barricarte, Aurelio
    Khaw, Kay-Tee
    Wareham, Nicholas J
    Bradbury, Kathryn E
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Palli, Domenico
    Krogh, Vittorio
    Tumino, Rosario
    Naccarati, Alessio
    Panico, Salvatore
    Siersema, Peter D
    Peeters, Petra HM
    Ljuslinder, Ingrid
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ericson, Ulrika
    Ohlsson, Bodil
    Weiderpass, Elisabete
    Skeie, Guri
    Borch, Kristin
    Rinaldi, Sabina
    Romieu, Isabelle
    Kong, Joyce
    Gunter, Marc J
    Ward, Heather A
    Riboli, Elio
    Boeing, Heiner
    Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study2014In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 12, no 1, p. 168-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors - healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. METHODS: In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. RESULTS: After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. CONCLUSIONS: Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.

  • 35. Aleman, J
    et al.
    Brännström, Inger
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Liljestrand, J
    Peña, R
    Persson, L A
    Steidinger, J
    Saving more neonates in hospital: an intervention towards a sustainable reduction in neonatal mortality in a Nicaraguan hospital1998In: Tropical doctor, ISSN 0049-4755, E-ISSN 1758-1133, Vol. 28, no 2, p. 88-92Article in journal (Refereed)
    Abstract [en]

    A process of change was initiated in a Nicaraguan regional hospital in order to achieve a sustainable reduction of early neonatal mortality. A series of organizational, educational and hygienic measures was introduced, involving all staff in antenatal care, delivery care and neonatal care. Neonatal mortality decreased from 56/1000 live births in 1985 to 11/1000 in 1993. A commission of maternal and child health, a weekly perinatal audit, the active involvement of all staff and dedicated work of key individuals, as well as national policy decisions, are considered important determinants of the process. Keeping neonatal mortality in focus through continuous analysis of care routines, and through external exchange of ideas is important in order to sustain improvements and to decrease further the mortality.

  • 36.
    Alemu, Andinet Worku
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, article id 5398Article in journal (Refereed)
    Abstract [en]

    Background: The antiretroviral treatment (ART) scale-up service has been a recent development in Ethiopia, but its impact on mortality has not been well investigated. The aim of this study was to assess the early survival outcome of the scale-up service by utilizing routine hospital data.

    Methods: All adult HIV/AIDS patients who started on antiretroviral treatment in Shashemene and Assela hospitals from January 1, 2006 to May 31, 2006 were included and followed up for 2 years. Data were extracted from standard patient medical registrations. Kaplan-Meier curves were used to estimate survival probability and the Cox proportional hazard model was applied to determine predictors of mortality. Two alterative assumptions (real case and worst case) were made in determining predictors of mortality.

    Results: The median age of patients was 33 years and 57% were female. Eighty-five percent had CD4 <200 cells/mu L with a median CD4 count of 103 cells/mu L. The median survival time was 104.4 weeks. A total of 28 (10.3%) deaths were observed during the 2-year period and 48 patients (18%) were lost to follow up. The majority of deaths occurred in the first 4 months of treatment. In multivariate analysis, 2-year survival was significantly associated with the clinical stage of the disease, baseline hemoglobin, and cotrimoxazole prophylaxis therapy (CPT) at or before ART initiation in both assumptions. The median CD4 count and body weight showed a marked improvement during the first 6 months of treatment, followed by stagnation thereafter.

    Conclusion: The study has shown an overall low mortality but a high loss to follow-up rate of the cohort. Advanced clinical stage, anemia, low body weight, and lack of CPT initiation were independent predictors of mortality - but not gender. CPT initiation should be encouraged in routine HIV care services, and patient retention mechanisms have to be strengthened. Stagnation in immunological and weight recovery after the first 6 months should be further investigated. The utilization of routine data should be encouraged in order to facilitate appropriate decision making.

  • 37. Alemu, Yihun Mulugeta
    et al.
    Awoke, Worku
    Wilder-Smith, Annalies
    Institute of Public Health, Heidelberg University, Heidelberg, Germany; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
    Determinants for tuberculosis in HIV-infected adults in Northwest Ethiopia: a multicentre case-control study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 4, article id e009058Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this study was to identify determinants for tuberculosis (TB) among HIV-infected adults in Northwest Ethiopia.

    DESIGN: Case-control study.

    SETTING: Three hospitals and 10 health centres in Northwest Ethiopia.

    PARTICIPANTS: A total of 446 individuals consented to participate in the study (150 cases and 296 controls). Cases were HIV-infected adults diagnosed with active TB, and controls were HIV-infected adults without active TB.

    MAIN OUTCOME MEASURE: The link between TB and determinants was assessed using logistic regression. Determinants were categorised as sociodemographic, host-related, clinical and environmental.

    RESULTS: Smoking (adjusted OR (AOR) 5.47; 95% CI 2.26 to 13.22), presence of a TB patient in the family (AOR 2.66; 95% CI 1.25 to 5.66), alcohol consumption (AOR 2.49; 95% CI 1.29 to 4.80) and chewing khat (AOR 2.22; 95% CI 1.11 to 4.41) were independent determinants for increased occurrence of TB. Highly active antiretroviral therapy (HAART) (AOR 0.25; 95% CI 0.13 to 0.51), isoniazid preventive therapy (IPT) (AOR 0.22; 95% CI 0.11 to 0.41) and cotrimoxazole preventive therapy (AOR 0.32; 95% CI 0.19 to 0.55) had a protective effect against TB.

    CONCLUSIONS: HIV-infected adults with substance abuse (tobacco smoking, khat chewing and alcohol) should be prioritised for TB screening. This study reaffirmed that HAART and IPT are some of the best strategies for reducing TB occurrence in HIV-infected adults. These findings provide impetus to intensify tracing of TB household contacts.

  • 38.
    Alenius, Gerd-Marie
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Reumatology.
    A Clinical and Genetic Study of Psoriatic Arthritis2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Psoriatic arthritis (PsA) is an inflammatory joint disease associated with psoriasis. PsA has a heterogeneous pattern, expressed by different manifestations such as mild mono-oligoarthritis or very severe, erosive and destructive polyarthritis. Measurable inflammatory activity is not always prominent. The aetiology is unknown but genetic factors are believed to be of importance. The pattern of inheritance is proposed to be polygenic. The aim of this study was to estimate the prevalence of joint and axial manifestations, characterise the disease in relation to inflammatory and genetic markers, and to identify disease susceptibility gene(s) for PsA in patients from northern Sweden.

    All patients from the city of Umeå (n=276), selected from a community and hospital based psoriasis register (n=1737) at the Dept of Dermatology, were invited to a prevalence study. Two hundred-two patients were examined and 97 (48%) had inflammatory manifestations such as peripheral arthritis, axial disease, undifferentiated spondylarthropathy (uSpA) and enthesopathies. Of the 67 patients (33 %) with peripheral arthritis and/or axial disease, 30 were not previously diagnosed.

    The association of clinical manifestations and potential markers of aggressive joint disease with HLA associations were analysed in 88 patients with PsA. We were not able to confirm findings of other groups reporting strong association with several HLA-antigens. The prevalence of HLA-B17, B37 and B62 was increased compared with controls, but the strongest predictive factors among our patients for an aggressive disease, in a multiple logistic analysis, were polyarthritic disease and distal interphalangeal engagement.

    In order to investigate for disease susceptibility genes, five genetic loci were analysed with microsatellites and single nucleotide polymorphisms in an association study of 120 patients with PsA. There was a significant association with the TNFB locus on chromosome 6p but not with any other loci examined; 1q21 (PSORS4), 3q21 (PSORS5), 8q24 and CTLA4. When stratifying for the TNFB alleles the association was confined to allele 123. In a subgroup of patients who were HLA-typed (n=83), we were not able to verify linkage disequilibrium with the TNFB allele 123 and the HLA antigens; B17, B27, B37, B62 or Cw*0602.

    The presence of renal abnormalities was evaluated as a manifestation of systemic inflammation in 73 patients with PsA. Renal abnormalities defined as decreased creatinine-clearance (≤ mean - 2SD) and/or urinary albumin >25 mg/24 h was found in 23% of the patients. The predictive factors for renal abnormalities was inflammatory activity (ESR > 25 mm/h and/or CRP >15 mg/L) indicating a systemic effect in some of the patients.

    In conclusion, we found high prevalence of inflammatory manifestations in patients with psoriasis. There was no strong association between PsA and HLA antigens and predictive factors for aggressive disease were polyarthritic disease and DIP joint engagement. The TNFB locus was associated with PsA and there were no linkage disequilibrium with the HLA antigens B17, B27, B62 or Cw*0602. There were evidence for systemic effects as renal abnormalities in patients with PsA and measurable inflammatory activity.

  • 39.
    Alers, Margret
    et al.
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands .
    Pepping, Tess
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
    Bor, Hans
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
    Verdonk, Petra
    Department of Medical Humanities, School of Medical Sciences, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands .
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lagro-Janssen, Antoine
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
    Speciality preferences in Dutch medical students influenced by their anticipation on family responsibilities2014In: Perspectives on Medical Eduction, ISSN 2212-277X, Vol. 3, no 6, p. 443-454Article in journal (Refereed)
    Abstract [en]

    Physician gender is associated with differences in the male-to-female ratio between specialities and with preferred working hours. We explored how graduating students’ sex or full-time or part-time preference influences their speciality choice, taking work-life issues into account. Graduating medical students at Radboud University Medical Centre, the Netherlands participated in a survey (2008–2012) on career considerations. Logistic regression tested the influence of sex or working hour preference on speciality choice and whether work-life issues mediate. Of the responding students (N = 1,050, response rate 83, 73.3 % women), men preferred full-time work, whereas women equally opted for part time. More men chose surgery, more women family medicine. A full-time preference was associated with a preference for surgery, internal medicine and neurology, a part-time preference with psychiatry and family medicine. Both male and female students anticipated that foremost the career of women will be negatively influenced by family life. A full-time preference was associated with an expectation of equality in career opportunities or with a less ambitious partner whose career would affect family life. This increased the likelihood of a choice for surgery and reduced the preference for family medicine among female students. Gender specifically plays an important role in female graduates’ speciality choice making, through considerations on career prospects and family responsibilities.

  • 40.
    Alfadel, Anas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Social Activity and Health: Studying Elderly Adults’ Perspective upon Social Life and Health in Northern Sweden2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: The importance social activities plays in the elderly adults’ health was the focus of many different studies on social isolation and elderly adults. Yet, not so many studies tried to catch how socially active elderly adults think about the correlation between social life and health.

    Methods: A qualitative methodology with inductive approach has been carried out in this study. Data was collected under a one-hour long focus group discussion in which five informants from the study population participated in. Data was then analyzed using thematic analysis.

    Results: A variety of social activity for elderly adults is to be found in a small village in north Sweden. At the same time, the results show that elderly adults acknowledge the importance of social activity to health and show awareness about a well functioning social life. Nonetheless, two points emphasized a new meaning for the connection between social activity and health: food as a social activity, and, social activities keep mind alerted.

    Conclusion: There is to be a remarkable awareness in elderly adults living in north Sweden about the importance of social activity for health and that a variety in social activities is to be found even in small village in the north of Sweden.

  • 41.
    Alfakir, Firas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    “The thorny path towards future life!!”: International students’ experiences and feelings of stress: a qualitative study in Umeå2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Mental health among international students is one of the most important topics that have been studied in different countries worldwide, but none was done in Sweden. This thesis will explore both mental health problems with focus on stress among internationally mobile students in Umeå and the causes behind these problems. The general aim of this study will be to focus on exploring the experiences and feelings of these students in Umeå regarding culture shock, seasonal effect, social support network and academic stress.

    Methods: A qualitative methodology was used for this study. In depth semi-structured interviews were done with 4 international students in Umeå University from both genders who have spent at least six months in this city without returning to their original countries and these students were selected from four different continents. They were interviewed in regard to their experiences and feelings toward the main stressors that they can face when moving to a new city. The data was analyzed using thematic analysis which consists of both the deductive approach using the theory of stress and coping and the inductive approach where the researcher gave the data the opportunity to express itself freely.

    Results: This section includes the outcomes of the thematic analysis that was carried out. The first inductive approach of analysis revealed one main theme cultural balance and previous experience (globalization), which discloses the cultural diversity, distance and balance perceived by the internationally mobile students from the four different continents when they compare between their home culture and the Swedish culture. And how previous knowledge about the Swedish culture (globalization) can play a role in reducing the culture shock effect. The Second deductive approach of analysis was done by applying the Stress and Cognitive theory of stress and coping to the codes, which revealed two additional main themes. The first one is Stages of culture shock, which was analyzed using the emotions obtained by applying the theory. It shows the different stages experienced by the international students. The second one is coping strategies and individual differences, which shows the different coping mechanisms used by the students from the four different continents.

    Conclusion: leaving your home to study abroad can be a stressful experience even if you have previous knowledge about the new country, which can result in developing some mental health problems. Seasonal differences in particular are one of the most difficult things for international students to deal with, especially in Umeå where winter can be long and dark. Culture shock, on the other hand, can be another stressful situation, where you need to understand its different dimensions like cultural distance, balance and differences. Also culture shock stages, and its related emotion and coping mechanisms should be studied well to be able to find solutions for it. Social support network and how it interacts with students’ mental health should also be taken into account when leaving your people back-home. Of course study performance should not be neglected also when we need to study mental health problems as studying is the first reason why international students wanted to travel. After exploring all these aspects in particular implications for practice can be implemented to reduce the effect of the negative side of moving to a new country.

  • 42.
    Alfredsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jeghannathan, Bhoomikumar
    Attitudes towards mental health and the integration of mental health services into primary health care: a cross-sectional survey among health-care workers in Lvea Em District, Cambodia2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1331579Article in journal (Refereed)
    Abstract [en]

    Background: Cambodia is a country where the resources for treating mental health disorders are far from sufficient. One strategy to narrow the treatment gap is to integrate mental health into primary health care (PHC). Understanding the knowledge and attitudes towards mental health integration that health-care workers have is important for assessing the challenges and opportunities when planning a potential integration project. Objective: The aim of this study was to assess these basic conditions in Lvea Em District, Cambodia. Design: A structured self-reporting questionnaire regarding attitudes and knowledge about mental health and its integration into PHC was collected from 75 health-care workers in Lvea Em District, Cambodia in October 2015. Firstly, descriptive analyses were carried out, and secondly, linear regression analyses to assess the relationship between attitudes and socio-demographic variables were conducted. Results: There was clear support towards integrating mental health services into PHC among these participants as 81.3% were interested in personally delivering mental health care at their units. Respondents who reported having received some kind of mental health-care training tended to have a more positive attitude towards mentally ill people (p = 0.005) and those who thought there was a high need for mental health care had a more favourable attitude towards the integration of mental health services (p = 0.007). Conclusions: The most important finding from this survey was the willingness and the acceptance of the need for integration of mental health care. This enhances the feasibility of integrating mental health services at the PHC level. Improving the competence of mental health care in these settings will likely help to reduce the treatment gap for mental, neurological and substance use disorders in Cambodia.

  • 43. Ali, Mohammed
    et al.
    Asefaw, Teklehaimanot
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Beyene, Hagos
    Pedersen, F Karup
    Helping northern Ethiopian communities reduce childhood mortality: population-based intervention trial2005In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 83, no 1, p. 27-33Article in journal (Refereed)
  • 44.
    Ali, Saeeda
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Is loneliness a risk factor for cardiovascular diseases in Indian adults aged 50 years and older?2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Loneliness has emerged as a psycho-social problem, particularly among older population in recent years. Many studies from different regions of India have shown considerable growth in the older population reporting feeling lonely. Recent attention to research demonstrating the association between loneliness and cardiovascular diseases (CVDs) has raised the profile, including in India, where CVD is one of the leading causes of death. This study aimed to assess the prevalence of loneliness and cardiovascular diseases among older adults aged 50 years and older in different demographic and socioeconomic groups, and explore the association between loneliness and CVDs.

    Methods: This cross-sectional study used data from the longitudinal Study on global AGEing and adult health in India in 2007, and included a total of 6,439 participants aged 50 years and older (3,241 men and 3,198 women). We used logistic regression analysis to assess the association between loneliness and CVDs, while controlling for confounding factors, such as age, gender, education, marital status, wealth, depressive symptoms, sleep, physical activity, smoking, and alcohol use. All analyses were stratified by gender.

    Results: Loneliness was more prevalent among women than men while prevalence of CVDs was higher in men than women. The regression analysis showed a positive association between loneliness and CVDs in both women and men. The univeriate analysis without adjusting for confounders showed that women had 58% higher odds of reporting CVDs (95% CI: 1.24 - 2.00 (p<0.001)) than women who did not report loneliness. The corresponding figure for men was 67% higher odds (95% CI: 1.34-2.08, p<0.001). In the adjusted analyses the association was attenuated, and loneliness was still a significant predictor of CVDs in women only (OR 1.37; 95% CI: 1.05 – 1.78, p<0.05).

    Conclusions: The current study reveals that loneliness was strongly associated with CVDs in older women in India while this association was not observed in men. Some of the factors controlled for in the analysis, such as age, wealth, depressive symptoms, and sleep are also significantly associated with CVDs in men and women while alcohol was significant only among men. Further studies using mediation analyses will allow better understanding about the true effects and mechanisms of these factors in influencing CVDs among older people. This information can help in developing psychosocial-related CVD prevention strategies, especially for women.

  • 45. Ali, Tazeen S
    et al.
    Asad, Nargis
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Krantz, Gunilla
    Intimate partner violence in urban Pakistan: prevalence, frequency, and risk factors2011In: International journal of women's health, ISSN 1179-1411, Vol. 3, p. 105-15Article in journal (Refereed)
    Abstract [en]

    Background: Intimate partner violence (IPV) is an important public health issue with severe adverse consequences. Population-based data on IPV from Muslim societies are scarce, and Pakistan is no exception. This study was conducted among women residing in urban Karachi, to estimate the prevalence and frequency of different forms of IPV and their associations with sociodemographic factors.

    Methods: This cross-sectional community-based study was conducted using a structured questionnaire developed by the World Health Organisation for research on violence. Community midwives conducted face-to-face interviews with 759 married women aged 25–60 years.

    Results: Self-reported past-year and lifetime prevalence of physical violence was 56.3 and 57.6%, respectively; the corresponding figures for sexual violence were 53.4% and 54.5%, and for psychological abuse were 81.8% and 83.6%. Violent incidents were mostly reported to have occurred on more than three occasions during the lifetime. Risk factors for physical violence related mainly to the husband, his low educational attainment, unskilled worker status, and five or more family members living in one household. For sexual violence, the risk factors were the respondent’s low educational attainment, low socioeconomic status of the family, and five or more family members in one household. For psychological violence, the risk factors were the husband being an unskilled worker and low socioeconomic status of the family.

    Conclusion: Repeated violence perpetrated by a husband towards his wife is an extremely common phenomenon in Karachi, Pakistan. Indifference to this type of violence against women stems from the attitude that IPV is a private matter, usually considered a justifiable response to misbehavior on the part of the wife. These findings point to serious violations of women’s rights and require the immediate attention of health professionals and policymakers.

  • 46. Ali, Tazeen S
    et al.
    Krantz, Gunilla
    Gul, Raisa
    Asad, Nargis
    Johansson, Eva
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Gender roles and their influence on life prospects for women in urban Karachi, Pakistan: a qualitative study2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 7448-Article in journal (Refereed)
    Abstract [en]

    Background: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women’s and men’s life prospects.

    Objective: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men’s and women’s life circumstances.

    Design: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.

    Findings: Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve women’s subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation.

    Conclusions: This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women’s empowerment.

  • 47. Ali, Tazeen S
    et al.
    Krantz, Gunilla
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Violence permeating daily life: a qualitative study investigating perspectives on violence among women in Karachi, Pakistan2012In: International Journal of Women's Health, ISSN 1179-1411, E-ISSN 1179-1411, Vol. 4, p. 577-585Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study explored how married women perceive situations which create family conflicts and lead to different forms of violence in urban Pakistan. In addition, it examines perceptions of consequences of violence, their adverse health effects, and how women resist violence within marital life.

    METHODS: Five focus group discussions were conducted with 28 women in Karachi. Purposive sampling, aiming for variety in age, employment status, education, and socioeconomic status, was employed. The focus group discussions were conducted in Urdu and translated into English. Manifest and latent content analysis were applied.

    RESULTS: One major theme emerged during the analysis, ie, family violence through the eyes of females. This theme was subdivided into three main categories. The first category, ie, situations provoking violence and their manifestations, elaborates on circumstances that provoke violence and situations that sustain violence. The second category, ie, actions and reactions to exposure to violence, describes consequences of ongoing violence within the family, including those that result in suicidal thoughts and actions. The final category, ie, resisting violence, describes how violence is avoided through women's awareness and actions.

    CONCLUSION: The current study highlights how female victims of abuse are trapped in a society where violence from a partner and family members is viewed as acceptable, where divorce is unavailable to the majority, and where societal support of women is limited. There is an urgent need to raise the subject of violence against women and tackle this human rights problem at all levels of society by targeting the individual, family, community, and societal levels concurrently.

  • 48. Ali, Tazeen S
    et al.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Krantz, Gunilla
    Intimate partner violence and mental health effects: a population-based study among married women in Karachi, Pakistan2013In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 20, no 1, p. 131-139Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Intimate partner violence (IPV) is recognized all over the world for its association with mental health problems in women. In Pakistan, such violence occurs commonly, but detailed information on mental health effects is scarce. The purpose of this study is to focused on married couples in urban Karachi to investigate mental health effects associated with physical, sexual and psychological violence perpetrated by husbands towards wives. Disclosure rates and health care-seeking behaviour were also investigated. METHOD: This cross-sectional study involved 759 women between the ages of 25 and 60 years, selected using a multi-stage random sampling technique. The women were interviewed by trained community midwives using a structured questionnaire. RESULTS: In the total population of women, mental symptoms were prevalent. Women subjected to any form of violence reported, however, considerably poorer mental health than unexposed women. A statistically significant difference for almost all of the studied health parameters persisted even after controlling for socio-demographic factors. The strongest associations were found for suicidal thoughts and physical violence (OR 4.41; 3.18-6.12), sexual abuse (OR 4.39; 3.17-6.07) and psychological abuse (OR 5.17; 3.28-8.15). The interviews revealed that only 27% of the women subjected to violence had disclosed this to anyone, in most cases to their parents. CONCLUSION: The findings in this study highlight that the violence women have to face contributes to the development of multiple forms of psychological stress and serious mental health problems. Women's restrictive life circumstances seriously hamper women's empowerment. Reliable health surveillance system and health care services are needed to serve abused women. Policy initiatives focused on IPV and gender inequality in Pakistan should be initiated.

  • 49. Alkema, Leontine
    et al.
    Chou, Doris
    Hogan, Daniel
    Zhang, Sanqian
    Moller, Ann-Beth
    Gemmill, Alison
    Fat, Doris Ma
    Boerma, Ties
    Temmerman, Marleen
    Mathers, Colin
    Say, Lale
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Witwatersrand, Johannesburg, South Africa.
    Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10017, p. 462-474Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030.

    METHODS: We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources.

    RESULTS: We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%.

    INTERPRETATION: Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths.

    FUNDING: National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

  • 50.
    Allard, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Enteric adenovirus type 41: genome organization and specific detection procedures1992Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Enteric adenoviruses (EAd) types 40 and 41 (Ad40 and Ad41) representing subgenus F, are primary pathogens of children being second only to rotaviruses as the most important cause of infantile diarrhea.

    The EAds differ from all other adenoviruses in their inability to grow in most conventional established cell lines and have been suggested to be deficient in some early gene functions since they could be complemented by Ad 5 early regions EIA and E1B. In order to search for differences that could explain its characteristic growth restriction, the early regions EIA and E1B of Ad41 (strain D389) were sequenced, analysed and compared with the corresponding regions of Adl2, Ad7, Ad2, and Ad4. As revealed by the analysis of Ad2, three major mRNAs of 9S, 12S and 13S are generated from region EIA. The EIA region of Ad41 encodes two mRNAs corresponding to the 12S and 13S mRNAs. Only the 13S mRNA is transcribed at detectable levels. This mRNA can be translated into a 251 aa putative protein that contains the three highly conserved domains found in all other human adenoviruses and shown to be responsible for many important regulatory functions during infection.

    The E1B region of Ad41 encodes three transcripts that correspond to 22S, 14S and 9S mRNA of Ad2. No equivalent to the 13S mRNA of Ad2 E1B is found. In addition the Ad41 14S mRNA exhibits an additional exon of 23 bp created by a donor and an acceptor splice sites not desribed for other adenovirus E1B sequences.

    Due to their growth restriction in conventional cultures, rapid diagnostic procedures developed for the enteric adenovirus infections have mainly been aimed at the detection of viral antigens or nucleic acids. This thesis also describes several procedures developed for the general detection of adenoviruses and specific detection of the enteric types in stools specimens. General and specific hybridization assays were developed by use of two BamHI clones obtained from the EIA region of Ad41. One- and two-step PCR procedures were also developed for the general detection of adenoviruses using primers corresponding to highly conserved sequences within the hexon gene. Subgenus F specific one- and two-step PCRs were developed by using primers located in the Ad41 E1B region.

    The one-step PCR systems were tested and validated against isolation in tissue culture, DNA restriction enzyme analysis and a commercial latex agglutination test in the study of 60 specimens obtained from children with rotavirus negative diarrhea. The asymptomatic fecal excretion of adenoviruses was evaluated by two-step PCR amplifications on samples from 50 healthy children, 50 healthy adults, and 50 adults suffering from diarrhea.

    Finally, a simplified procedure for detection, discrimination and typing of EAd was also designed by combining the one-step PCR amplification of the hexon region with the restriction of the 300 bp product.

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