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  • 1.
    Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Westerståhl, Maria
    Institutionen för laboratoriemedicin avd för klinisk fysiologi Karolinska institutet .
    Barnekow-Bergkvist, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jansson, Eva
    Institutionen för laboratoriemedicin avd för klinisk fysiologi Karolinska institutet .
    Hälsoresan till medelåldern2011In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, no 2, p. 4p. 40-43Article in journal (Other academic)
    Abstract [sv]

    Vad är viktigast för att få en god hälsa som vuxen? Sedan 1974 har vi följt samma personer från 16 års ålder in i medelåldern och studerat deras hälsa från flera olika synvinklar. Nu pågår den tredje mätomgången.

  • 2.
    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
  • 3.
    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
  • 4. 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)
  • 5.
    Acosta, Naydú
    et al.
    Universidad Industrial de Santander .
    Pollard, Jennifer
    National University of Colombia.
    Mosquera, Paola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Reveiz, Ludovic
    National University of Colombia.
    Equidad en el desarrollo de guias de practica clinica: [The concept of equity when developing clinical practice guidelines]2011In: Revista de Salud Pública, ISSN 0124-0064, Vol. 13, no 2, p. 327-38Article in journal (Refereed)
    Abstract [en]

    This systematic literature review sought to identify methodologies and technical strategies emphasising healthcare services and outcomes when incorporating the concept of equity into Clinical Practice Guidelines (CPG). 940 references were identified, of which 20 fulfilling the inclusion criteria were selected. While no reports were found describing or evaluating an explicit methodology for incorporating considerations of equity into CPG, some studies revealed related strategies or processes, summarised as follows: 1. Target population involvement during all phases of designing, implementing and evaluating CPG; 2. "Cultural capacity" seen as being necessary in CPGs' "cultural translation" for interventions to have less disparity regarding their application and results; 3. Considering psycho-social factors which could affect implementing CPG, and; 4. Considering system inequities so that any health intervention would also confront risks and obstacles to health care due to socioeconomic status. It was concluded that CPGs could be a potential route for promoting more equitable healthcare effects by standardising health interventions if, by incorporating some of the processes described above, they actively seek to avoid unjust differences in access to and/or the quality of the interventions that they prescribe.

  • 6. 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.

  • 7.
    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
  • 8.
    Adelphine, Ishimwe
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Road traffic injuries in Rwanda:: A study protocol of trend and prevalence in Kigali city.2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Road traffic injuries constitute the health burden all over the World. Every year more than a million people are killed and 50 million are injured as a result of road unsafety. The cost of dealing with associated consequences is even greater than many infectious diseases, since it runs to billions dollars every year. This issue is particularly alarming in the developing World, but African region is more affected than others continents.

    Rwanda is facing similar problems as other developing countries in terms of road traffic injuries. Apart from environment factors, vehicles conditions and human risky behaviours, the ignorance of road users is the major leading cause of many road traffic crashes. As many studies revealed, road accident is a preventable issue. Improvement of road safety by commitment of governments and population engagement, it is possible to save a significant number of lives.

    Objective: Since a decade of action for road safety has been launched by the World health organization in 2010, the government of Rwanda fixed a target of road fatality reduction of 50% by 2015. The aim of this study is to identify the change of road traffic accidents over a period of ten years (2005- 2015).

    Method: This write-up is a study protocol. A quantitative retrospective study involving secondary data analysis will be described. Information will be collected in the capital city of the Rwanda, since it has been identified as the most affected by road accidents. Data will be gathered from traffic Police records because it has the responsibility to collect all data related to traffic accidents in the country. Due to underreporting of some accidents, hospital records will be used to deal with that underestimation issue. Further later, data will be analysed and the estimation of the trend will be achieved by using multi linear regression. The trend analysis of change in number of deaths and injuries will be conducted. This information will be useful to localize where more effort is needed and how can be achieved. The result might be used by different organization in charge of transport safety, to improve countermeasures designed to tackle road accidents. 

  • 9. 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. 

  • 10. Agardh, Anette
    et al.
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Muriisa, Robert
    Östergren, Per-Olof
    Social capital and sexual behavior among Ugandan university students2010In: Global health action, ISSN 1654-9880, Vol. 3Article in journal (Refereed)
    Abstract [en]

    In general, social capital was associated with less risky sexual behavior in our sample. However, gender and role of religion modified the effect so that we can not assume that risky sexual behavior is automatically reduced by increasing social capital in a highly religious society. The findings indicate the importance of understanding the interplay between social capital, religious influence, and gender issues in HIV/AIDS preventive strategies in Uganda.

  • 11.
    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
  • 12.
    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
  • 13.
    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.

  • 14.
    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.

  • 15.
    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.

  • 16.
    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.

  • 17. 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.

  • 18.
    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
  • 19.
    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]

    Background:

    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.

    Aim:

    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.

     Method:

    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.

    Results:

    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.

  • 20.
    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
  • 21.
    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.

  • 22. 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)
  • 23.
    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.

  • 24.
    Alexander, Kailembo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Edentulism and associated factors among older adults in low-and middle-income countries2015Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
  • 25.
    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.

  • 26.
    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.

  • 27.
    Alfredsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Attitudes towards mental health and the integration of mental health service into primary health care: A cross-sectional survey among health care workers in Lvea Em District, Cambodia2015Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 28.
    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.

  • 29. 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.

  • 30. Allen, Naomi E
    et al.
    Roddam, Andrew W
    Sieri, Sabina
    Boeing, Heiner
    Jakobsen, Marianne Uhre
    Overvad, Kim
    Tjønneland, Anne
    Halkjær, Jytte
    Vineis, Paolo
    Contiero, Paolo
    Palli, Domenico
    Tumino, Rosario
    Mattiello, Amalia
    Kaaks, Rudolf
    Rohrmann, Sabine
    Trichopoulou, Antonia
    Zilis, Demosthenes
    Koumantaki, Yvoni
    Peeters, Petra H
    Bueno-de-Mesquita, H Bas
    Barricarte, Aurelio
    Rodríguez, Laudina
    Dorronsoro, Miren
    Sánchez, Maria-José
    Chirlaque, María Dolores
    Esquius, Laura
    Manjer, Jonas
    Wallström, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Bingham, Sheila
    Khaw, Kay-Tee
    Boffetta, Paolo
    Norat, Teresa
    Mouw, Traci
    Riboli, Elio
    A prospective analysis of the association between macronutrient intake and renal cell carcinoma in the European Prospective Investigation into Cancer and Nutrition.2009In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 125, no 4, p. 982-987Article in journal (Refereed)
    Abstract [en]

    Previous case-control studies have suggested that a high intake of animal foods and its associated nutrients are associated with an increased risk of renal cell carcinoma, although data from prospective studies are limited. We report here on the relationship between macronutrient intake and renal cell carcinoma incidence among 435,293 participants enrolled in the European Prospective Investigation into Cancer and Nutrition. Cox proportional hazard models were used to examine the association of dietary intake of fat, protein, carbohydrate, fiber and cholesterol and risk of renal cell carcinoma adjusted for age, sex, center, height, body mass index, physical activity, education, smoking, menopausal status, alcohol and energy intake. During an average 8.8 years of follow-up, 507 renal cell carcinoma cases occurred. Risk of renal cell carcinoma was not associated with macronutrient intake, including nutrients derived from animal sources. Our results indicate that macronutrient intake is not associated with risk of renal cell carcinoma in this cohort of European men and women. (c) 2009 UICC.

  • 31. Almquist, Ylva B
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Associations between social support and depressive symptoms: social causation or social selection-or both?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 84-89Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Numerous studies have demonstrated an association between social support and health, almost regardless of how social support and health have been conceptualised or measured. Even so, the issue of causality has not yet been sufficiently addressed. This issue is particularly challenging for mental health problems such as depressive symptoms. The aim of the present study is to longitudinally assess structural and functional aspects of social support in relation to depressive symptoms in men and women, through a series of competing causal models that, in contrast to many other statistical methods, allow for bi-directional effects.

    METHODS: Questionnaire data from the Northern Swedish Cohort (n = 1001) were utilised for the years 1995 (age 30) and 2007 (age 42). Associations were analysed by means of gender-specific structural equation modelling, with structural and functional support modelled separately.

    RESULTS: Both structural and functional support were associated with depressive symptoms at ages 30 and 42, for men and women alike. A higher level of support, particularly functional support, was associated with a decrease in depressive symptoms over time among men. Among women, there were bi-directional effects of social support and depressive symptoms over time.

    CONCLUSION: Concerning social support and health, the social causation hypothesis seems relevant for men whereas, for women, the associations appear to be more complex. We conclude that preventive and health promoting work may need to consider that the presence of depressive symptoms in itself impedes on women's capability to increase their levels of social support.

  • 32. Almquist, Ylva B.
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jackisch, J.
    Rajaleid, K.
    Westerlund, H.
    Hammarström, A.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 47-47Article in journal (Other academic)
    Abstract [en]

    Background: Adversity in the family of origin tends to translate into poor health development. Yet, the fact that this is not the always the case has been seen an indicator of resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status.

    Methods: The study was based on the Northern Swedish Cohort born in 1965 (n = 1,001). Measures of social and material adversity, health, and protective factors related to school, peers, and spare time, were derived from questionnaires distributed to the cohort members and their teachers at age 16. Self-rated health was measured at age 43. The main associations were examined by means of ordinal regression analysis, with the role of the protective factors being assessed through interaction analysis.

    Results: Social and material adversity in youth was associated with poorer self-rated health in midlife among males and females alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time – particularly in terms of being seen as having good educational and work prospects, as well as a high-quality spare time – appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health.

    Conclusions: There are several factors outside the context of the family that seemingly have the potential to buffer against the negative health consequences stemming from having experienced a disadvantaged upbringing. Initiatives targeted at increasing academic motivation and commitment as well as social capital and relationships in youth, may here be of particular relevance.

    Key messages:

    • While the experience of disadvantageous living conditions in adolescence tends to translate into poor health development across the life course, this is not always the case.
    • Advantages related to school, peers, and spare time have the potential of counteracting the negative health impact of an adverse family context.
  • 33.
    Almroth, Melody
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Music therapy and adolescents with emotional and behavioral disorders: A literature review on the effects of music therapy2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 34.
    Almroth, Melody
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Put on a Song and Feel a lot Better: The Perceived Influence of Music on the Well-Being of Healthy Young Adults2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 35. Ameh, Soter
    et al.
    Gomez-Olive, Francesc Xavier
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), Accra, Ghana.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), Accra, Ghana.
    Klipstein-Grobusch, Kerstin
    Relationships between structure, process and outcome to assess quality of integrated chronic disease management in a rural South African setting: applying a structural equation model2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, article id 229Article in journal (Refereed)
    Abstract [en]

    Background: South Africa faces a complex dual burden of chronic communicable and non-communicable diseases (NCDs). In response, the Integrated Chronic Disease Management (ICDM) model was initiated in primary health care (PHC) facilities in 2011 to leverage the HIV/ART programme to scale-up services for NCDs, achieve optimal patient health outcomes and improve the quality of medical care. However, little is known about the quality of care in the ICDM model. The objectives of this study were to: i) assess patients’ and operational managers’ satisfaction with the dimensions of ICDM services; and ii) evaluate the quality of care in the ICDM model using Avedis Donabedian’s theory of relationships between structure (resources), process (clinical activities) and outcome (desired result of healthcare) constructs as a measure of quality of care.

    Methods: A cross-sectional study was conducted in 2013 in seven PHC facilities in the Bushbuckridge municipality of Mpumalanga Province, north-east South Africa - an area underpinned by a robust Health and Demographic Surveillance System (HDSS). The patient satisfaction questionnaire (PSQ-18), with measures reflecting structure/process/outcome (SPO) constructs, was adapted and administered to 435 chronic disease patients and the operational managers of all seven PHC facilities. The adapted questionnaire contained 17 dimensions of care, including eight dimensions identified as priority areas in the ICDM model - critical drugs, equipment, referral, defaulter tracing, prepacking of medicines, clinic appointments, waiting time, and coherence. A structural equation model was fit to operationalise Donabedian’s theory, using unidirectional, mediation, and reciprocal pathways.

    Results: The mediation pathway showed that the relationships between structure, process and outcome represented quality systems in the ICDM model. Structure correlated with process (0.40) and outcome (0.75). Given structure, process correlated with outcome (0.88). Of the 17 dimensions of care in the ICDM model, three structure (equipment, critical drugs, accessibility), three process (professionalism, friendliness and attendance to patients) and three outcome (competence, confidence and coherence) dimensions reflected their intended constructs.

    Conclusion: Of the priority dimensions, referrals, defaulter tracing, prepacking of medicines, appointments, and patient waiting time did not reflect their intended constructs. Donabedian’s theoretical framework can be used to provide evidence of quality systems in the ICDM model.

  • 36. Ameh, Soter
    et al.
    Klipstein-Grobusch, Kerstin
    D'ambruoso, Lucia
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana.
    Gomez-Olive, Francesc Xavier
    Quality of integrated chronic disease care in rural South Africa: user and provider perspectives2017In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 32, no 2, p. 257-266Article in journal (Refereed)
    Abstract [en]

    The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model. In 2013, we conducted a case study of the seven PHC facilities in the rural Agincourt sub-district in northeast South Africa. Focus group discussions (n = 8) were used to obtain data from 56 purposively selected patients >= 18 years. In-depth interviews were conducted with operational managers of each facility and the sub-district health manager. Donabedian's structure, process and outcome theory for service quality evaluation underpinned the conceptual framework in this study. Qualitative data were analysed, with MAXQDA 2 software, to identify 17 a priori dimensions of care and unanticipated themes that emerged during the analysis. The manager and patient narratives showed the inadequacies in structure (malfunctioning blood pressure machines and staff shortage); process (irregular prepacking of drugs); and outcome (long waiting times). There was discordance between managers and patients regarding reasons for long patient waiting time which managers attributed to staff shortage and missed appointments, while patients ascribed it to late arrival of managers to the clinics. Patients reported anti-hypertension drug stock-outs (structure); sub-optimal defaulter-tracing (process); rigid clinic appointment system (process). Emerging themes showed that patients reported HIV stigmatisation in the community due to defaulter-tracing activities of home-based carers, while managers reported treatment of chronic diseases by traditional healers and reduced facility-related HIV stigma because HIV and NCD patients attended the same clinic. Leveraging elements of HIV programmes for NCDs, specifically hypertension management, is yet to be achieved in the study setting in part because of malfunctioning blood pressure machines and anti-hypertension drug stock-outs. This has implications for the nationwide scale up of the ICDM model in South Africa and planning of an integrated chronic disease care in other low-and middle-income countries.

  • 37. Ameh, Soter
    et al.
    Klipstein-Grobusch, Kerstin
    Musenge, Eustasius
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Witwatersrand, Sch Publ Hlth, Fac Hlth Sci, Med Res Council,Wits Univ Rural Publ Hlth, Johannesburg, South Africa ; Int Network Demog Evaluat Populat & Their Hlth De, Accra, Ghana ; Univ Witwatersrand, Sch Publ Hlth, Fac Hlth Sci, Hlth Transit Res Unit Agincourt, Johannesburg, South Africa.
    Tollman, Stephen
    Gomez-Olive, Francesc Xavier
    Effectiveness of an Integrated Approach to HIV and Hypertension Care in Rural South Africa: Controlled Interrupted Time-Series Analysis2017In: Journal of Acquired Immune Deficiency Syndromes, ISSN 1525-4135, E-ISSN 1944-7884, Vol. 75, no 4, p. 472-479Article in journal (Refereed)
    Abstract [en]

    Background: South Africa faces a dual burden of HIV/AIDS and noncommunicable diseases. In 2011, a pilot integrated chronic disease management (ICDM) model was introduced by the National Health Department into selected primary health care (PHC) facilities. The objective of this study was to assess the effectiveness of the ICDM model in controlling patients' CD4 counts (>350 cells/mm(3)) and blood pressure [BP (<140/90 mm Hg)] in PHC facilities in the Bushbuckridge municipality, South Africa. Methods: A controlled interrupted time-series study was conducted using the data from patients' clinical records collected multiple times before and after the ICDM model was initiated in PHC facilities in Bushbuckridge. Patients >18 years were recruited by proportionate sampling from the pilot (n = 435) and comparing (n = 443) PHC facilities from 2011 to 2013. Health outcomes for patients were retrieved from facility records for 30 months. We performed controlled segmented regression to model the monthly averages of individuals' propensity scores using autoregressive moving average model at 5% significance level. Results: The pilot facilities had 6% greater likelihood of controlling patients' CD4 counts than the comparison facilities (coefficient = 0.057; 95% confidence interval: 0.056 to 0.058; P < 0.001). Compared with the comparison facilities, the pilot facilities had 1.0% greater likelihood of controlling patients' BP (coefficient = 0.010; 95% confidence interval: 0.003 to 0.016; P = 0.002). Conclusions: Application of the model had a small effect in controlling patients' CD4 counts and BP, but showed no overall clinical benefit for the patients; hence, the need to more extensively leverage the HIV program for hypertension treatment.

  • 38.
    Amroussia, Nada
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    "Is the doctor God to punish me?!!": Childbirth experiences and self-perceptions of single mothers in Tunisia2016Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Worldwide, single mothers are considered a vulnerable group in the society. This vulnerability draws on multiple factors and it is reflected in different aspects of women's social, economic and health status depending on the context. In Tunisia, single mothers suffer from social stigmatization and socio-economic marginalization. There are few studies that have explored the social aspects of single motherhood in Tunisia, but, to the authors’ knowledge, the experiences of single mothers with the maternal health services facilities have not been explored yet. The general aim of this study is to explore the childbirth experiences of single mothers at the public health facilities in Tunisia.

    Methods: The thesis follows a qualitative design. In collaboration with non-governmental organizations in Tunisia, 11 single mothers were interviewed in regard to their experiences with maternal health care services and their perceptions of the attitudes of the health workers towards them. The interviews also addressed the barriers faced by these women in accessing adequate maternal health care services, and their self-perceptions as single mothers. The data was analyzed using an inductive thematic approach to generate codes. The development of themes was guided by a theoretical framework that connects the gender relational theory and the intersectional approach.

    Results: Three themes emerged during the data analysis. The first theme "Health systems disciplines single mothers" describes the relation between the single mothers and the maternal health care providers. The majority of the participants were subjected to discriminatory practices, neglect and even violence inflicted by the maternal health care providers. Few of the participants described positive childbirth experiences that are considered as signs of resistance. The second theme "If a woman makes a mistakes once. She has to pay for the rest of her life" reflects the self-perceptions of the participants as single mothers. The participants' self-perceptions are multifaceted: they are overwhelmed mothers living with a persistent feeling of guilt, and they are also challenging and determined mothers. The last theme "The trilogy of vulnerability" includes: the social stigmatization and the socio-economic marginalization experienced by the participants as single mothers, and the situation of the health system described as crumbling by the participants.

    Conclusion: The study highlights that childbirth experiences of single mothers are shaped by intersectional factors that go beyond the health system. Gender plays a major role in constructing these experiences while intersecting with other social structures. The participants had experienced disrespectful and discriminatory practices and even violence when they sought maternal health care services at the public health facilities in Tunisia. Those experiences reflect how the health system translate in its practices the discrimination and stigma culturally associated with single motherhood in this setting. Social discrimination and stigma did not only affect how single mother were treated during the childbirth, but also how they perceived themselves. Thus, ensuring women's right to dignified, respectful health care during childbirth requires tackling the underlying causes of women's marginalization and discrimination in many settings where women face the contingency of multiple social inequities.

  • 39.
    Amroussia, Nada
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Reproductive health policy in Tunisia (1994-2014): Impact on women's right to reproductive health and gender empowerment2015Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Tunisia was regarded as a pioneer in adopting a successful population policy in North Africa and the Middle East region. The Tunisian official family planning program started in 1966 with an objective of controlling population growth. After the International Conference on Population and Development (ICPD) in Cairo in 1994, there was a shift in the Tunisian population policy as the concept of reproductive health was introduced for the first time in national health programs and strategies.

    Methods: The thesis is a policy analysis of the reproductive health policy in Tunisia from a human rights based approach using the Health Rights of Women Assessment Instrument (HeRWAI). The analysis focuses on the impact of this policy on women’s right to reproductive health and gender empowerment.

    Results: The results revealed that Tunisia has started adopting laws promoting for reproductive rights since 1960s, in the form of the right to contraceptive use and the right to abortion. However, slow progress has been made since the ICPD conference in 1994. Furthermore,   significant limitations were found in the implementation of reproductive health policy in relation to women’s right to reproductive health: regional inequities in women’s access to reproductive health care services, discriminatory practices affecting single women and HIV patients, low quality of maternal care services and delay in the integration of the gender-based violence component into the reproductive health care services. The thesis also found that there was a lack of meaningful engagement in action to achieve gender equality in Tunisia. 

  • 40.
    Amroussia, Nada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hernandez, Alison
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Reproductive health policy in Tunisia: women's right to reproductive health and gender empowerment2016In: Health and Human Rights: An International Journal, ISSN 1079-0969, E-ISSN 2150-4113, Vol. 18, no 2, p. 183-194Article in journal (Refereed)
    Abstract [en]

    Although Tunisia is regarded as a pioneer in the Middle East and North Africa in terms of women's status and rights, including sexual and reproductive health and rights, evidence points to a number of persisting challenges. This article uses the Health Rights of Women Assessment Instrument (HeRWAI) to analyze Tunisia's reproductive health policy between 1994 and 2014. It explores the extent to which reproductive rights have been incorporated into the country's reproductive health policy, the gaps in the implementation of this policy, and the influence of this policy on gender empowerment. Our results reveal that progress has been slow in terms of incorporating reproductive rights into the national reproductive health policy. Furthermore, the implementation of this policy has fallen short, as demonstrated by regional inequities in the accessibility and availability of reproductive health services, the low quality of maternal health care services, and discriminatory practices. Finally, the government's lack of meaningful engagement in advancing gender empowerment stands in the way as the main challenge to gender equality in Tunisia.

  • 41.
    Amroussia, Nada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mosquera, Paola A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Explaining mental health inequalities in Northern Sweden: a decomposition analysis2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1305814Article in journal (Refereed)
    Abstract [en]

    Background: There has been a substantial increase of income inequalities in Sweden over the last 20 years, which also could be reflected in health inequalities, including mental health inequalities. Despite the growing body of literature focusing on health inequalities in Sweden, income-related inequalities in mental health have received little attention. Particularly scarce are research from Northern Sweden and examinations of the social determinants of health inequalities.

    Objectives: The present study seeks to provide evidence regarding inequalities in mental health in Northern Sweden. The specific aims were to (1) quantify the income-related inequality in mental health in Northern Sweden, and (2) determine the contribution of social determinants to the inequality.

    Methods: The study population comprised 25,646 participants of the 2014 Health on Equal Terms survey in the four northernmost counties of Sweden, aged 16 to 84 years old. Income-related inequalities in mental health were quantified by the concentration index and further decomposed by applying Wagstaff-type decomposition analysis.

    Results: The overall concentration index of mental health in Northern Sweden was −0.15 (95% CI: −0.17 to −0.13), indicating income inequalities in mental health disfavoring the less affluent population. The decomposition analysis results revealed that socio-economic conditions, including employment status (31%), income (22.6%), and cash margin (14%), made the largest contribution to the pro-rich inequalities in mental health. The second-largest contribution came from demographic factors, mainly age (11.3%) and gender (6%). Psychosocial factors were of smaller importance, with perceived discrimination (8%) and emotional support (3.4%) making moderate contributions to the health inequalities. 

    Conclusions: The present study demonstrates substantial income-related mental health inequalities in Northern Sweden, and provides insights into their underpinnings. These findings suggest that addressing the root causes is essential for promoting mental health equity in this region.

  • 42.
    Amroussia, Nada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hernandez, Alison
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Vives-Cases, Carmen
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    "Is the doctor God to punish me?!": An intersectional examination of disrespectful and abusive care during childbirth against single mothers in Tunisia2017In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 14, article id 32Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Disrespectful and abusive treatment during childbirth is a violation of women's right to dignified, respectful healthcare throughout pregnancy and childbirth. Although reports point out that marginalized groups in society such as single mothers are particularly vulnerable to abusive and disrespectful care, there is a lack of in-depth research exploring single mothers' encounters at the maternal healthcare facilities, especially in Tunisia. In Tunisia, single mothers are particularly vulnerable due to their social stigmatization and socio-economic marginalization. This study examines the self-perceptions and childbirth experiences of single mothers at the public healthcare facilities in Tunisia.

    METHODS: This study follows a qualitative design. Eleven single mothers were interviewed in regard to their experiences with maternal healthcare services and their perceptions of the attitudes of the health workers towards them. The interviews also addressed the barriers faced by the participants in accessing adequate maternal healthcare services, and their self-perceptions as single mothers. The data were analyzed using an inductive thematic approach guided by the feminist intersectional approach. Emergent codes were grouped into three final themes.

    RESULTS: Three themes emerged during the data analysis: 1) Experiencing disrespect and abuse, 2) Perceptions of regret and shame attributed to being a single mother, and 3) The triad of vulnerability: stigma, social challenges, and health system challenges. The study highlights that the childbirth experiences of single mothers are shaped by intersectional factors that go beyond the health system. Gender plays a major role in constructing these experiences while intersecting with other social structures. The participants had experienced disrespectful and discriminatory practices and even violence when they sought maternal healthcare services at the public healthcare facilities in Tunisia. Those experiences reflect not only the poor quality of maternal health services but also how health system practices translate the stigma culturally associated with single motherhood in this setting. Social stigma did not only affect how single mothers were treated during the childbirth, but also how they perceived themselves and how they perceived their care.

    CONCLUSION: Ensuring women's right to dignified, respectful healthcare during childbirth requires tackling the underlying causes of social inequalities leading to women's marginalization and discrimination.

  • 43.
    Andersen, C. D.
    et al.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Bennet, L.
    Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindblad, U.
    Department of Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lindholm, E.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Groop, L.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Worse glycaemic control in LADA patients than in those with type 2 diabetes, despite a longer time on insulin therapy2013In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 56, no 2, p. 252-258Article in journal (Refereed)
    Abstract [en]

    Our aim was to study whether glycaemic control differs between individuals with latent autoimmune diabetes in adults (LADA) and patients with type 2 diabetes, and whether it is influenced by time on insulin therapy. We performed a retrospective study of 372 patients with LADA (205 men and 167 women; median age 54 years, range 35-80 years) from Swedish cohorts from SkAyenne (n = 272) and Vasterbotten (n = 100). Age- and sex-matched patients with type 2 diabetes were included as controls. Data on the use of oral hypoglycaemic agents (OHAs), insulin and insulin-OHA combination therapy was retrieved from the medical records. Poor glycaemic control was defined as HbA(1c) a parts per thousand yen7.0% (a parts per thousand yen53 mmol/mol) at follow-up. The individuals with LADA and with type 2 diabetes were followed for an average of 107 months. LADA patients were leaner than type 2 diabetes patients at diagnosis (BMI 27.7 vs 31.0 kg/m(2); p < 0.001) and follow-up (BMI 27.9 vs 30.2 kg/m(2); p < 0.001). Patients with LADA had been treated with insulin for longer than those with type 2 diabetes (53.3 vs 28.8 months; p < 0.001). There was no significant difference between the patient groups with regard to poor glycaemic control at diagnosis, but more patients with LADA (67.8%) than type 2 diabetes patients (53.0%; p < 0.001) had poor glycaemic control at follow-up. Patients with LADA had worse glycaemic control at follow-up compared with participants with type 2 diabetes (OR = 1.8, 95% CI 1.2, 2.7), adjusted for age at diagnosis, HbA(1c), BMI at diagnosis, follow-up time and duration of insulin treatment. Individuals with LADA have worse glycaemic control than patients with type 2 diabetes despite a longer time on insulin therapy.

  • 44.
    Andersen Thulin, Elin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Exploring Maternal Mortality in Tigray, Ethiopia. - The obstacles faced by a region undergoing obstetric transition.2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 45. Andersson, Nirina
    et al.
    Carré, Helena
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Boman, Jens
    Nylander, Elisabet
    Gender differences in the well-being of patients diagnosed with Chlamydia trachomatis: a cross-sectional study.2018In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, article id sextrans-2017-053229Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We aimed to investigate how an infection with Chlamydia trachomatis (CT) influenced patients' well-being and whether there were differences due to gender, age or relationship status, in an effort to strengthen preventive measures and provide better healthcare for patients with CT.

    METHODS: Patients diagnosed with CT in the county of Västerbotten, Sweden, were asked to fill out a questionnaire about their feelings, thoughts and actions after CT diagnosis. The patients were also asked to fill in the validated questionnaires Hospital Anxiety and Depression Scale and Alcohol Use Disorder Identification Test. Between February 2015 and January 2017, 128 patients (74 women and 54 men) were included in the study.

    RESULTS: After being diagnosed with CT, men were generally less worried than women (P<0.001). Women worried more about not being able to have children (P<0.001) and about having other STIs (P=0.001) than men did. Men felt less angry (P=0.001), less bad (P<0.001), less dirty (P<0.001) and less embarrassed (P=0.011) than women did. Nineteen per cent of men and 48% of women reported symptoms of anxiety. The majority of both men (60%) and women (72%) had a risk consumption of alcohol.

    CONCLUSION: Women and men reacted differently when diagnosed with CT. Women worried more about complications and more often blamed themselves for being infected. Being aware of these gender differences may be important when planning preventive measures and during counselling of CT-infected patients. Persons working with patients with CT must also be aware of the high frequency of harmful alcohol consumption among their patients.

  • 46.
    Andusa Ambele, Carl
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Who takes care of our parents? Elderly care in Cameroon. A protocol study2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 47.
    Anh Huyen, Nguyen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Provider Payment Methods of healthcare service in Vietnam: a literature review2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

     Achieving access to basic health care for the entire population without risk of catastrophic expenditure and impoverishment is an important goal for Vietnam’s health system. Provider payment methods (PPM), which is an important component of purchasing and health financing, are powerful tools to promote the health system and achieve health policy objectives. However, the current PPM in Vietnam appears have drawbacks in both framework and arrangement. Reforms  of PPM and the health financing system are required.

    Objective

     The objective of this study is to identify the PPM mechanism in the health financing system of Vietnam, in order to provide scientific evidences for the reform process.

    Methods

     A literature review using the search terms “Vietnam “, “provider payment method”, “purchasing” and “health financing” is carried out in different databases:  Pubmed, Google Scholar, Science Direct, World Health Organization (WHO) and Word Bank (WB) library. The reference lists of included studies are also screeedn in the selecting process. Studies are included following criteria 1. Published from 1995 to March of 2015 2. Written in English and 3. Report, analyze PPM evolved in health financing system. Not only articles and papers, reports and books are also included to be reviewed.

    Results

      Among 78 papers, reports and books primarily, only 10 studies are eligible with 4 studies conducting assessment and 6 studies being reviews. About the structure of PPM, Vietnam operates a mixed system which consists of global budget, line item, fee-for-services (FFS)  and capitation.  FFS play the biggest role in the system but also receive the most critical assessments. Capitation, which has evolved since 2005, is far from the success found in other coountries. There are 2 purchaser contributed in system, Vietnam social security (VSS) and Ministry of health (MOH).  The suggestion for developing the mix of system of capitation and fee for services or transforming FFS to the capitation and case-based payment system are discussed.

    Conclusion

      There is a limited number of PPM in Vietnam and it is necessary to implement more empirical studies such as pilot study for different new scenarios of mixing PPM  as well as evaluation studies to find the best reform process in the future. 

  • 48.
    Anticona, Cynthia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundh, Thomas
    Alegre, Yuri
    Sebastian, Miguel San
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lead exposure in indigenous communities of the Amazon basin, Peru2011In: International journal of hygiene and environmental health (Print), ISSN 1438-4639, E-ISSN 1618-131X, Vol. 215, no 1, p. 59-63Article in journal (Refereed)
    Abstract [en]

    Since 2006, three studies have reported elevated levels of lead (Pb) among the indigenous population of the Corrientes river, in the Amazon basin of Peru. Due to the large evidence of environmental pollution related to oil exploitation in the area, this activity has been suggested as the source of exposure. This study aimed to evaluate Pb levels in the population and environment of two communities exposed and one community non-exposed to the oil exploitation activity. Blood lead levels (BLL) were determined by the instrument Leadcare. A comparison with the graphite furnace atomic absorption technique was performed in order to validate the Leadcare results. Environmental samples were analyzed by inductively coupled plasma atomic emission spectroscopy. Among 361 capillary samples, the mean BLL was 9.4μg/dl. Mean BLL of the communities exposed (n=171, x¯=9.5μg/dl) and non-exposed (n=190, x¯=9.2μg/dl) to the oil activity were not significantly different. Pb levels in environmental samples were below the maximum permissible levels. The sources of exposure could not be identified. Elevated levels of Pb in the oil-non-exposed community pointed out at other sources not yet clarified.

  • 49.
    Anticona, Cynthia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lead exposure among children from native communities of the Peruvian Amazon basin2012In: Revista panamericana de salud pùblica, ISSN 1020-4989, E-ISSN 1680-5348, Vol. 31, no 4, p. 296-302Article in journal (Refereed)
    Abstract [en]

    Objective. To assess potential risk factors associated with elevated blood lead levels (BLLs) among children in two communities from the Corrientes River basin in the Peruvian Amazon.

    Methods. Children aged 0-17 years were screened for BLLs, hemoglobin levels, and anthropometric measures. Dwelling, family, and child data were collected through a parental questionnaire. Statistical analysis included descriptive and bivariate analysis. Multiple linear and logistic regressions using generalized estimating equations were also conducted to determine associated risk factors. A map of each community was drawn to examine the spatial distribution of BLLs.

    Results. Of 208 children (88 from 23 households of the Peruanito community and 120 from 28 households of Santa Isabel), 27.4% had BLLs >= 10 mu g/dL. The geometric mean (+/- standard deviation) BLL was 8.7 +/- 4.0 mu g/dL (range 3.0-26.8 mu g/dL). In the total population, linear regression analysis indicated that age was positively associated with BLLs (P < 0.05). Logistic regression analysis showed that boys had 2.12 times greater odds of having BLLs >= 10 mu g/dL than girls (P < 0.05). Among the children 0-3 years, those whose mothers had BLLs >= 10 mu g/dL had 45.0% higher odds of presenting BLLs >= 10 mu g/dL than children whose mothers had BLLs < 10 mu g/dL (P < 0.05).

    Conclusions. Older age, male gender, and mothers' BLL >= 10 mu g/dL were the main risk factors for elevated BLLs. The higher risk in boys 7-17 years suggests that exposure could be related to specific activities in this group, such as fishing and hunting. Continuous monitoring of BLLs in the Corrientes River population is recommended.

  • 50.
    Anticona, Cynthia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bergdahl, Ingvar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sources and risk factors for lead exposure in indigenous children of the Peruvian Amazon, disentangling connections with oil activity2012In: International journal of occupational and environmental health, ISSN 1077-3525, E-ISSN 2049-3967, Vol. 18, no 4, p. 268-277Article in journal (Refereed)
    Abstract [en]

    Introduction: In the Corrientes river basin, Peruvian Amazon, lead exposure among indigenous communities was first reported in 2006. To address controversy regarding the main source of exposure, this study aimed to identify the sources and risk factors for lead exposure among children from the communities in question, and to clarify the potential relationship with oil activity.Methods: This cross-sectional study was conducted in six communities. Participants were children aged 0–17 years and their mothers. Data collection included blood lead levels (BLLs) and hemoglobin determination, a questionnaire on risk factors and environmental sampling. We used age-stratified multivariate regression models, with generalized estimating equation to account for correlation within households.Results: Twenty-seven percent of the children had BLLs ≧10 μg/dl. Mother's BLLs ≧10 μg/dl, playing and chewing lead scraps, fishing ≧three times/week, and living in highly oil-exposed communities increased the risk of having BLLs ≧10 μg/dl. Lead concentrations in sediment, soil, dust, and fish samples were below reference values.Conclusions: Mother's BLLs ≧10 μg/dl, playing and chewing lead scraps to manufacture fishing sinkers were the most important risk factors for children’s BLLs ≧10 μg/dl. The connection with oil activity appears to be through access to metal lead from the industry's wastes.

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