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  • 1. Abraha, Atakelti
    et al.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Kahsay, Asmelash
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
    The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case-control study2019In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.

  • 2.
    Al-Alawi, Kamila
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Team-based approach in the management of diabetes at primary health care level in Muscat, Oman: challenges and opportunities2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: The growth of type 2 diabetes is considered an alarming epidemic in Oman. The efficient team-based approach to diabetes management in primary health care is an essential component for providing ideal diabetic care. This thesis aimed to explore the current situation related to team-based management of type 2 diabetes in public Primary Health Care Centres (PHCCs) under the Ministry of Health (MOH) in Oman, including the various challenges associated with diabetes management and the most preferable Human Resources for Health (HRH) management mechanism, and to examine how this could be optimized from provider and patient perspectives.

    Materials and methods: The entire project was conducted in Muscat Governorate and was based on one quantitative and three qualitative studies. In the quantitative study, 26 public PHCCs were approached through cross-sectional study. The core diabetes management team recommended by the MOH for PHCCs in Oman was explored in terms of their competencies, values, skills, and resources related to the team-based approach to diabetes management. For the qualitative studies, five public purposely-selected PHCCs were approached. The diabetes consultations conducted by the core members and other supportive members involved in diabetes management were observed and later the Primary Health Care Providers (PHCPs) were interviewed. The different approaches explored challenges related to diabetes management and the most preferable HRH mechanism by PHCPs. Seven type 2 diabetes patients with different gender, employment status, and education were consequently interviewed to explore their perceptions towards the current diabetes management service and their opinions towards nurse-led clinics.

    Results: The survey provided significant and diverse perceptions of PHCPs towards their competencies, values, skills, and resources related to diabetes management. Physicians considered themselves to have better competencies than nurses and dieticians. Physicians also scored higher on team-related skills and values compared with health educators. In terms of team-related skills, the difference between physicians and nurses was statistically significant and showed that physicians perceived themselves to have better skills than nurses. Confusion about the leadership concept among PHCPs with a lack of pharmacological, technical, and human resources was also reported. The observations and interviews with PHCPs disclosed three different models of service delivery at diabetes management clinics. The challenges explored involved PHCCs’ infrastructure, nurses’ knowledge, skills, and non-availability of technical and pharmaceutical support. Other challenges that evolved into the community were cultural beliefs, traditions, health awareness, and public transportation. Complete implementation of task-sharing mechanisms within the team-based approach was selected by all PHCPs as the most preferable HRH mechanism. The selection was discussed in the context of positive outcomes, worries, and future requirements. The physicians stated that nurses’ weak contribution to the team within the selected mechanism could be the most significant aspect. Other members supported the task-sharing mechanism between physicians and nurses. However, type 2 diabetes patients’ non-acceptance of a service provided by the nurses created worries for the nurses. The interviews with type 2 diabetes patients disclosed positive perceptions towards the current diabetes management visits; however, opinions towards nurse-led clinics varied among the patients.

    Conclusions and recommendations: The team-based approach at diabetes management clinics in public PHCCs in Oman requires thoughtful attention. Diverse presence of the team members can form challenges during service delivery. Clear roles for team members must be outlined through a solid HRH management mechanism in the context of a sharp leadership concept. Nurse-led clinics are an important concept within the team; however, their implementation requires further investigation. The concept must involve clear understandings of independence and interdependence by the team members, who must be educated to provide a strong gain for team-based service delivery.

  • 3.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Al Mandhari, Ahmed
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, article id 18Article in journal (Refereed)
    Abstract [en]

    BackgroundThe literature has described several challenges related to the quality of diabetes management clinics in public primary health care centres in Oman. These clinics continue to face challenges due to the continuous growth of individuals diagnosed with type 2 diabetes. We sought to explore the challenges faced in these clinics and discuss opportunities for improvement in Oman.MethodsThis qualitative study was designed to include non-participant observations of diabetic patients and care providers during service provision at diabetes management clinics, as well as semi-structured interviews with care providers, at five purposively selected public primary health care centres. Care providers included physicians, nurses, dieticians, health educators, pharmacists, an assistant pharmacist, a psychologist, and a medical orderly. The data were analysed using qualitative content analysis.ResultsThe study disclosed three different models of service delivery at diabetes management clinics, which, to varying degrees, face challenges related to health centre infrastructure, technical and pharmaceutical support, and care providers' interests, knowledge, and skills. Challenges related to the community were also found in terms of cultural beliefs, traditions, health awareness, and public transportation.ConclusionThe challenges encountered in diabetes management clinics fall within two contexts: health care centres and community. Although many challenges exist, opportunities for improvement are available. However, improvements in the quality of diabetic clinics in primary health care centres might take time and require extensive involvement, shared responsibilities, and implications from the government, health care centres, and community.

  • 4.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Perceptions of type-two diabetes patients towards diabetes management visits at public primary health care centres with diverse opinions towards nurse-led clinics in Muscat, Oman: a pilot qualitative studyManuscript (preprint) (Other academic)
  • 5.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The question is not what we want; the question is, are we ready?: a qualitative study exploring primary health care providers`perceptions towards different human resources for health management mechanisms at diabetes management clinics in primary health care centres in Muscat, OmanManuscript (preprint) (Other academic)
  • 6. Alberto Diaz-Sanchez, Adrian
    et al.
    Corona-Gonzalez, Belkis
    Meli, Marina L.
    Obregon Alvarez, Dasiel
    Vega Canizares, Ernesto
    Fonseca Rodriguez, Osvaldo
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Centro Nacional de Sanidad Agropecuaria (CENSA), San José de las Lajas, Mayabeque, Cuba.
    Lobo Rivero, Evelyn
    Hofmann-Lehmann, Regina
    First molecular evidence of bovine hemoplasma species (Mycoplasma spp.) in water buffalo and dairy cattle herds in Cuba2019In: Parasites & Vectors, ISSN 1756-3305, E-ISSN 1756-3305, Vol. 12, article id 78Article in journal (Refereed)
    Abstract [en]

    Background: Hemotropic mycoplasmas (aka hemoplasmas) are small bacteria which cause infectious anemia in several mammalian species including humans. Information on hemoplasma infections in Cuban bovines remains scarce and no studies applying molecular methods have been performed so far. The aim of the present study was to utilize real-time PCR and sequence analysis to investigate dairy cattle and buffalo from Cuba for the presence of bovine hemoplasma species.

    Results: A total of 80 blood samples from 39 buffalo and 41 dairy cattle were investigated for the presence of Mycoplasma wenyonii and Candidatus Mycoplasma haemobos using two species-specific real-time TaqMan PCR assays. PCR results revealed overall 53 (66.2%; 95% CI: 55.3-75.7%) positive animals for M. wenyonii and 33 (41.2%; 95% CI: 31.1-52.2%) for Ca. M. haemobos; the latter were all co-infections with M. wenyonii. The sample prevalences were similar in cattle and buffalo. Based on the sequence analysis of the nearly full-length 16S rRNA gene from two cattle and two buffalo, the presence of M. wenyonii and Ca. M. haemobos was confirmed. Statistical analysis revealed that buffalo and cattle one year of age or older were more frequently infected with M. wenyonii or Ca. M. haemobos than younger animals. PCR-positivity was not associated with anemia; however, the infection stage was unknown (acute infection versus chronic carriers).

    Conclusions: The high occurrence of bovine hemoplasma infections in buffalo and dairy cattle may have a significant impact on Cuban livestock production. To the best of our knowledge, this is the first molecular evidence of bovine hemoplasma species infection in dairy cattle and buffalo from Cuba and the Caribbean.

  • 7.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Namatovu, Fredinah
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Annelie, Carlsson
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Preteen children’s health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 139Article in journal (Refereed)
    Abstract [en]

    Background: Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background.

    Methods: During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child’s country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups.

    Results: Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1–1.3) and more mood problems (OR: 1.35, 95% CI: 1.2–1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents’ occupation, however, children of parents with low or medium education levels reported less “mood problems” than those of parents with high education levels (OR: 0.65, 95% CI: 0.46–0.92) and (OR: 0.84, 95% CI: 0.73–0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14–2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08–6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations.

    Conclusion: More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.

  • 8. Baschieri, Angela
    et al.
    Gordeev, Vladimir S
    Akuze, Joseph
    Kwesiga, Doris
    Blencowe, Hannah
    Cousens, Simon
    Waiswa, Peter
    Fisker, Ane B
    Thysen, Sanne M
    Rodrigues, Amabelia
    Biks, Gashaw A
    Abebe, Solomon M
    Gelaye, Kassahun A
    Mengistu, Mezgebu Y
    Geremew, Bisrat M
    Delele, Tadesse G
    Tesega, Adane K
    Yitayew, Temesgen A
    Kasasa, Simon
    Galiwango, Edward
    Natukwatsa, Davis
    Kajungu, Dan
    Enuameh, Yeetey Ak
    Nettey, Obed E
    Dzabeng, Francis
    Amenga-Etego, Seeba
    Newton, Sam K
    Manu, Alexander A
    Tawiah, Charlotte
    Asante, Kwaku P
    Owusu-Agyei, Seth
    Alam, Nurul
    Haider, M M
    Alam, Sayed S
    Arnold, Fred
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Croft, Trevor N
    Herbst, Kobus
    Kishor, Sunita
    Serbanescu, Florina
    Lawn, Joy E
    "Every Newborn-INDEPTH" (EN-INDEPTH) study protocol for a randomised comparison of household survey modules for measuring stillbirths and neonatal deaths in five Health and Demographic Surveillance sites2019In: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 9, no 1, p. 1-15, article id 010901Article in journal (Refereed)
    Abstract [en]

    Background: Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths.

    Methods: This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken.

    Conclusions: This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes.

  • 9.
    Baxter, Rebecca
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Björk, Sabine
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Sköldunger, Anders
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Bergland, Ådel
    Winblad, Bengt
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing & Midwifery, La Trobe University, Melbourne, Australia.
    The Thriving of Older People Assessment Scale: Psychometric evaluation and short‐form development2019In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the psychometric properties and performance of the 32‐item Thriving of Older People Assessment Scale (TOPAS) and to explore reduction into a short‐form.

    Background: The 32‐item TOPAS has been used in studies of place‐related well‐being as a positive measure in long‐term care to assess nursing home resident thriving; however, item redundancy has not previously been explored.

    Design: Cross‐sectional.

    Method: Staff members completed the 32‐item TOPAS as proxy‐raters for a random sample of Swedish nursing home residents (N = 4,831) between November 2013 and September 2014. Reliability analysis, exploratory factor analysis and item response theory‐based analysis were undertaken. Items were systematically identified for reduction using statistical and theoretical analysis. Correlation testing, means comparison and model fit evaluation confirmed scale equivalence.

    Results: Psychometric properties of the 32‐item TOPAS were satisfactory and several items were identified for scale reduction. The proposed short‐form TOPAS exhibited a high level of internal consistency (α=0.90) and strong correlation (r=0.98) to the original scale, while also retaining diversity among items in terms of factor structure and item difficulties.

    Conclusion: The 32‐item and short‐form TOPAS' indicated sound validity and reliability to measure resident thriving in the nursing home context.

    Impact: There is a lack of positive life‐world measures for use in nursing homes. The short‐form TOPAS indicated sound validity and reliability to measure resident thriving, providing a feasible measure with enhanced functionality for use in aged care research, assessments and care planning for health promoting purposes in nursing homes.

  • 10.
    Björnebäck, Michaela
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Health care access for rural youths: a qualitative study in Northern Sweden2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 11.
    Blomfeldt, Marcus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Medical students’ views on and attitude towards prevention and health promotion in health care2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 12.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK; 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; Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa.
    Hussain-Alkhateeb, Laith
    D'Ambruoso, Lucia
    Clark, Samuel
    Davies, Justine
    Fottrell, Edward
    Bird, Jon
    Kabudula, Chodziwadziwa
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa; INDEPTH Network, Accra, Ghana.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa; INDEPTH Network, Accra, Ghana.
    Schiöler, Linus
    Petzold, Max
    An integrated approach to processing WHO-2016 verbal autopsy data: the InterVA-5 model2019In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 17, article id 102Article in journal (Refereed)
    Abstract [en]

    Background: Verbal autopsy is an increasingly important methodology for assigning causes to otherwise uncertified deaths, which amount to around 50% of global mortality and cause much uncertainty for health planning. The World Health Organization sets international standards for the structure of verbal autopsy interviews and for cause categories that can reasonably be derived from verbal autopsy data. In addition, computer models are needed to efficiently process large quantities of verbal autopsy interviews to assign causes of death in a standardised manner. Here, we present the InterVA-5 model, developed to align with the WHO-2016 verbal autopsy standard. This is a harmonising model that can process input data from WHO-2016, as well as earlier WHO-2012 and Tariff-2 formats, to generate standardised cause-specific mortality profiles for diverse contexts.

    The software development involved building on the earlier InterVA-4 model, and the expanded knowledge base required for InterVA-5 was informed by analyses from a training dataset drawn from the Population Health Metrics Research Collaboration verbal autopsy reference dataset, as well as expert input.

    Results: The new model was evaluated against a test dataset of 6130 cases from the Population Health Metrics Research Collaboration and 4009 cases from the Afghanistan National Mortality Survey dataset. Both of these sources contained around three quarters of the input items from the WHO-2016, WHO-2012 and Tariff-2 formats. Cause-specific mortality fractions across all applicable WHO cause categories were compared between causes assigned in participating tertiary hospitals and InterVA-5 in the test dataset, with concordance correlation coefficients of 0.92 for children and 0.86 for adults.

    The InterVA-5 model’s capacity to handle different input formats was evaluated in the Afghanistan dataset, with concordance correlation coefficients of 0.97 and 0.96 between the WHO-2016 and the WHO-2012 format for children and adults respectively, and 0.92 and 0.87 between the WHO-2016 and the Tariff-2 format respectively.

    Conclusions: Despite the inherent difficulties of determining “truth” in assigning cause of death, these findings suggest that the InterVA-5 model performs well and succeeds in harmonising across a range of input formats. As more primary data collected under WHO-2016 become available, it is likely that InterVA-5 will undergo minor re-versioning in the light of practical experience. The model is an important resource for measuring and evaluating cause-specific mortality globally.

  • 13.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nurturing Global Health Action through its first decade2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1569847Article in journal (Refereed)
  • 14.
    Byskov, Jens
    et al.
    University of Zambia.
    Maluka, Stephen A.
    University of Dar Es Salaam, Tanzania.
    Marchal, Bruno
    Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.
    Shayo, Elizabeth H.
    National Institute for Medical Research (NIMR), Dar Es Salaam, Tanzania.
    Blystad, Astrid
    Department of Global Health and Primary Care, University of Bergen, Norway.
    Bukachi, Salome
    Institute of Anthropology, Gender and African Studies University of Nairobi, Nairobi, Kenya.
    Zulu, Joseph M.
    School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
    Michelo, Charles
    School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Bloch, Paul
    Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, Gentofte, Denmark.
    A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals2019In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237Article in journal (Refereed)
    Abstract [en]

    Priority setting within health systems has not led to accountable, fair and sustainable solutions to improving population health. Providers, users and other stakeholders each have their own health and service priorities based on selected evidence, own values, expertise and preferences. Based on a historical account, this article analyses if contemporary health systems are appropriate to optimize population health within the framework of cross cutting targets of the Sustainable Development Goals (SDGs). We applied a scoping review approach to identify and review literature of scientific databases and other programmatic web and library-based documents on historical and contemporary health systems policies and strategies at the global level. Early literature supported the 1977 launching of the global target of Health for All by the year 2000. Reviewed literature was used to provide a historical overview of systems components of global health strategies through describing the conceptualizations of health determinants, user involvement and mechanisms of priority setting over time, and analysing the importance of historical developments on barriers and opportunities to accomplish the SDGs. Definitions, scope and application of health systems-associated priority setting fluctuated and main health determinants and user influence on global health systems and priority setting remained limited. In exploring reasons for the identified lack of SDG-associated health systems and priority setting processes, we discuss issues of accountability, vested interests, ethics and democratic legitimacy as conditional for future sustainability of population health. To accomplish the SDGs health systems must engage beyond their own sector boundary. New approaches to Health in All Policies and One Health may be conducive for scaling up more democratic and inclusive priority setting processes based on proper process guidelines from successful pilots. Sustainable development depends on population preferences supported by technical and managerial expertise.

  • 15.
    Bölenius, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lämås, Kristina
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Caring Sciences, Depart Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden..
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia..
    Perceptions of self-determination and quality of life among Swedish home care recipients - across-sectional study2019In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 142Article in journal (Refereed)
    Abstract [en]

    Background: It is acknowledged that preservation of self-determination is very important in order for older adults to experience good quality of life, but to what degree and in what areas people receiving help from home care service experience self-determination is unknown. Few studies have examined the perception of self-determination in relation to quality of life among older adults living at home with help from home care services. Thus, the aim of this study was to explore perceptions of self-determination among older adults living at home with the support of home care services, and to test whether older adults who perceive a higher degree of self-determination also feel they have a better quality of life.

    Methods: This cross-sectional study was conducted in one municipality in northern Sweden. A total of 134 older adults (≥ 65 years) were included. Data were collected by means of a survey including questionnaires about background characteristics, self-determination, and health-related quality of life. Descriptive statistics regarding background characteristics for groups with high and low self-determination respectively were presented and the differences between the groups were analyzed using the Chi-square test and the Mann-Whitney U test.

    Results: Our main finding shows that the majority of older adults with support from home care services experience self-determination in the dimensions use of time, and self-care. However, a wide variation was found in self-reported self-determination in all dimensions. Results also show that the group with higher self-reported self-determination also reported a greater degree of experienced quality of life in comparison with the group with lower self-reported self-determination.

    Conclusions: In line with earlier research, our results found a positive relation between self-determination and quality of life. The results are relevant for the care of older adults and indicate a need of further research. The results presented in this paper could serve as a guide when planning for improved self-determination among older adults in home care service.

  • 16. Coates, Matthew M.
    et al.
    Kamanda, Mamusu
    Kintuc, Alexander
    Arikpo, Iwara
    Chauque, Alberto
    Mengesha, Melkamu Merid
    Price, Alison J.
    Sifuna, Peter
    Wamukoya, Marylene
    Sacoor, Charfudin N.
    Ogwang, Sheila
    Assefa, Nega
    Crampin, Amelia C.
    Macete, Eusebio, V
    Kyobutungi, Catherine
    Meremikwu, Martin M.
    Otieno, Walter
    Adjaye-Gbewonyo, Kafui
    Marx, Andrew
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sankoh, Osman
    Bukhman, Gene
    A comparison of all-cause and cause-specific mortality by household socioeconomic status across seven INDEPTH network health and demographic surveillance systems in sub-Saharan Africa2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1608013Article in journal (Refereed)
    Abstract [en]

    Background: Understanding socioeconomic disparities in all-cause and cause-specific mortality can help inform prevention and treatment strategies.

    Objectives: To quantify cause-specific mortality rates by socioeconomic status across seven health and demographic surveillance systems (HDSS) in five countries (Ethiopia, Kenya, Malawi, Mozambique, and Nigeria) in the INDEPTH Network in sub-Saharan Africa.

    Methods: We linked demographic residence data with household survey data containing living standards and education information we used to create a poverty index. Person-years lived and deaths between 2003 and 2016 (periods varied by HDSS) were stratified in each HDSS by age, sex, year, and number of deprivations on the poverty index (0-8). Causes of death were assigned to each death using the InterVA-4 model based on responses to verbal autopsy questionnaires. We estimated rate ratios between socioeconomic groups (2-4 and 5-8 deprivations on our poverty index compared to 0-2 deprivations) for specific causes of death and calculated life expectancy for the deprivation groups.

    Results: Our pooled data contained almost 3.5 million person-years of observation and 25,038 deaths. All-cause mortality rates were higher among people in households with 5-8 deprivations on our poverty index compared to 0-2 deprivations, controlling for age, sex, and year (rate ratios ranged 1.42 to 2.06 across HDSS sites). The poorest group had consistently higher death rates in communicable, maternal, neonatal, and nutritional conditions (rate ratios ranged 1.34-4.05) and for non-communicable diseases in several sites (1.14-1.93). The disparities in mortality between 5-8 deprivation groups and 0-2 deprivation groups led to lower life expectancy in the higher-deprivation groups by six years in all sites and more than 10 years in five sites.

    Conclusions: We show large disparities in mortality on the basis of socioeconomic status across seven HDSS in sub-Saharan Africa due to disparities in communicable disease mortality and from non-communicable diseases in some sites. Life expectancy gaps between socioeconomic groups within sites were similar to the gaps between high-income and lower-middle-income countries. Prevention and treatment efforts can benefit from understanding subpopulations facing higher mortality from specific conditions.

  • 17.
    Coronado, Liani
    et al.
    Centro Nacional de Sanidad Agropecuaria (CENSA), OIE Collaborating Centre for Diagnosis and Risk Analysis of the Caribbean Region, La Habana 32700, Cuba.
    Rios, Liliam
    University of New Brunswick, Reiman Cancer Research Laboratory, Faculty of Medicine, Saint John, NB, E2L 4L5 Canada.
    Frías, María Teresa
    Centro Nacional de Sanidad Agropecuaria (CENSA), OIE Collaborating Centre for Diagnosis and Risk Analysis of the Caribbean Region, La Habana 32700, Cuba.
    Amarán, Laymara
    National Laboratory for Veterinary Diagnostic (NLVD), Avenida 51 No. 33 222, Arroyo Arenas, La Lisa, La Habana, Cuba.
    Naranjo, Paula
    Veterinary Medicine Institute, Havana, Cuba.
    Percedo, María Irian
    Centro Nacional de Sanidad Agropecuaria (CENSA), OIE Collaborating Centre for Diagnosis and Risk Analysis of the Caribbean Region, La Habana 32700, Cuba.
    Perera, Carmen Laura
    Centro Nacional de Sanidad Agropecuaria (CENSA), OIE Collaborating Centre for Diagnosis and Risk Analysis of the Caribbean Region, La Habana 32700, Cuba.
    Prieto, Felix
    National Laboratory for Veterinary Diagnostic (NLVD), Avenida 51 No. 33 222, Arroyo Arenas, La Lisa, La Habana, Cuba.
    Fonseca-Rodriguez, Osvaldo
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Perez, Lester J
    University of Illinois, College of Veterinary Science, Department of Clinical Veterinary Medicine, Urbana, Illinois, 61802 United States.
    Positive selection pressure on E2 protein of classical swine fever virus drives variations in virulence, pathogenesis and antigenicity: implication for epidemiological surveillance in endemic areas: Variability of positive selected strain of classical swine fever virus2019In: Transboundary and Emerging Diseases, ISSN 1865-1674, E-ISSN 1865-1682Article in journal (Refereed)
    Abstract [en]

    Classical swine fever (CSF), caused by CSF virus (CSFV), is considered one of the most important infectious diseases with devasting consequences for the pig industry. Recent reports describe the emergence of new CSFV-strains resulting from the action of positive selection pressure, due mainly to the bottleneck effect generated by ineffective vaccination. Even though a decrease in the genetic diversity of the positive selected CSFV-strains has been observed by several research groups, there is little information about the effect of this selective force on the virulence degree, antigenicity and pathogenicity of this type of strains. Hence, the aim of the current study was to determine the effect of the positive selection pressure on these three parameters of CSFV-strains, emerged as result of the bottleneck effects induced by unproper vaccination in a CSF-endemic area. Moreover, the effect of the positive selected strains on the epidemiological surveillance system was assessed. By the combination of in vitro, in vivo and immunoinformatic approaches we revealed that the action of the positive selection pressure induces a decrease in virulence and alteration in pathogenicity and antigenicity. However, we also noted that the evolutionary process of CSFV, especially in segregated microenvironments, could contribute to the gain-fitness event, restoring the highly virulent pattern of the circulating strains. Besides, we denoted that the presence of low virulent strains selected by bottleneck effect after inefficient vaccination can lead to a relevant challenge for the epidemiological surveillance of CSF, contributing to under-reports of the disease, favoring the perpetuation of the virus in the field. In this study B-cell and CTL epitopes on the E2 3D-structure model were also identified. Thus, the current study provides novel and significant insights into variation in virulence, pathogenesis and antigenicity experienced by CSFV strains after the positive selection pressure effect.

  • 18. Draper, Catherine E.
    et al.
    Tomaz, Simone A.
    Jones, Rachel A.
    Hinkley, Trina
    Twine, Rhian
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Norris, Shane A.
    Cross-sectional associations of physical activity and gross motor proficiency with adiposity in South African children of pre-school age2019In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 22, no 4, p. 614-623Article in journal (Refereed)
    Abstract [en]

    Objective: The study aimed to investigate the relationship between physical activity, gross motor skills and adiposity in South African children of pm-school age.

    Design: Cross-sectional study.

    Setting: High-income urban, and low-income urban and rural settings in South Africa.

    Participants: Children (3-6 years old, n 268) were recruited from urban high-income (n 46), urban low-income (n 91) and rural low-income (n 122) settings. Height and weight were measured to calculate the main outcome variables: BMI and BMI-for-age Z-score (BAZ). Height-for-age and weight-for-age Z-scores were also calculated. Actigraph GT3X+ accelerometers were used to objectively measure physical activity; the Test of Gross Motor Development (Version 2) was used to assess gross motor skills.

    Results: More children were overweight/obese and had a higher BAZ from urban low-income settings compared with urban high-income settings and rural low-income settings. Being less physically active was associated with thinness, but not overweight/obesity. Time spent in physical activity at moderate and vigorous intensities was positively associated with BMI and BAZ. Gross motor proficiency was not associated with adiposity in this sample.

    Conclusions: The findings of this research highlight the need for obesity prevention particularly in urban low-income settings, as well as the need to take into consideration the complexity of the relationship between adiposity, physical activity and gross motor skills in South African pre-school children.

  • 19. Dubouis, Ghislain
    et al.
    Sovacool, Benjamin
    Aall, Carlo
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Barbier, Carine
    Herrmann, Alina
    Bruyère, Sébastien
    Andersson, Camilla
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Sköld, Bore
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nadaud, Franck
    Dorner, Florian
    Moberg, Karen Richardsen
    Ceron, Jean Paul
    Fischer, Helen
    Amelung, Dorothee
    Baltruszewicz, Marta
    Fischer, Jeremy
    Benevise, Françoise
    Valerie, Valérie R
    Sauerborn, Rainer
    It starts at home? Climate policies targeting household consumption and behavioral decisions are key to low-carbon futures2019In: Energy Research & Social Science, ISSN 2214-6296, E-ISSN 2214-6326, Vol. 52, p. 144-158Article in journal (Refereed)
    Abstract [en]

    Through their consumption behavior, households are responsible for 72% of global greenhouse gas emissions. Thus, they are key actors in reaching the 1.5°C goal under the Paris Agreement. However, the possible contribution and position of households in climate policies is neither well understood, nor do households receive sufficiently high priority in current climate policy strategies. This paper investigates how behavioral change can achieve a substantial reduction in greenhouse gas emissions in European high-income countries. It uses theoretical thinking and some core results from the HOPE research project, which investigated household preferences for reducing emissions in four European cities in France, Germany, Norway and Sweden. The paper makes five major points: First, car and plane mobility, meat and dairy consumption, as well as heating are the most dominant components of household footprints. Second, household living situations (demographics, size of home) greatly influence the household potential to reduce their footprint, even more than country or city location. Third, household decisions can be sequential and temporally dynamic, shifting through different phases such as childhood, adulthood, and illness. Fourth, short term voluntary efforts will not be sufficient by themselves to achieve the drastic reductions needed to achieve the 1.5°C goal; instead, households need a regulatory framework supporting their behavioral changes. Fifth, there is a mismatch between the roles and responsibilities conveyed by current climate policies and household perceptions of responsibility. We then conclude with further recommendations for research and policy.

  • 20. Edem, Idara J.
    et al.
    Dare, Anna J.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    D'Ambruoso, Lucia
    Kahn, Kathleen
    Leather, Andy J. M.
    Tollman, Stephen
    Whitaker, John
    Davies, Justine
    External injuries, trauma and avoidable deaths in Agincourt, South Africa: a retrospective observational and qualitative study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 6, article id e027576Article in journal (Refereed)
    Abstract [en]

    Objective: Injury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies.

    Setting: Agincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa.

    Participants: Agincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals.

    Methods: A literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the ‘three delays framework’ (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs—a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care.

    Results: Using VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40%) avoidable EIDs and 78 (30%) avoidable trauma deaths (41% of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61%) and trauma deaths (59%), followed by delay in seeking care (24% and 23%) and in reaching care (15% and 18%). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems.

    Conclusions: A substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.

  • 21.
    Eid, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Biomedical Sciences Research, Faculty of Medicine, San Simon University, Cochabamba, Bolivia.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Pulkki-Brännström, Anni-Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    "Cheaper and better": an economic analysis of changing first line treatment for cutaneous leishmaniasis in BoliviaManuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: Cutaneous leishmaniasis (CL) is endemic in Bolivia, mostly affecting poor people in rainforest areas. The current first-line treatment consists of systemic pentavalent antimonials (SPA) for 20 days and is paid for by the Ministry of Health (MoH). Long periods of drug shortages, a lack of conditions to deliver treatment safely, treatment interruption are challenges to implementation. Intralesional pentavalent antimonials (ILPA) are an alternative to SPA. This study aims to compare the cost of ILPA and SPA, and to estimate the health and economic impacts of changing the first-line treatment for CL in an endemic area of Bolivia.

    Methods: The cost per patient treated was estimated for SPA and ILPA from the perspectives of the MoH and society. The quantity and unit costs of medications, staff time, transportation and loss of production were obtained through a health facility survey (N=12), official documents and key informants. A one-way sensitivity analysis was conducted on key parameters to evaluate the robustness of the results. The annual number of patients treated and the budget impact of switching to ILPA as the first-line treatment were estimated under different scenarios of increasing treatment utilization using previous estimates of the extent of underreporting. Costs were reported in 2016 international dollars (1 INT$ = 3.10 BOB).

    Results: Treating CL using ILPA was associated with a cost saving of $248 per patient treated from the MoH perspective, and $688 per patient treated from the societal perspective. ILPA was cost-saving even under a hypothetical increase of 80% in the number of cases treated. Switching first-line treatment would allow two-and-a-half times the current number of patients to be treated, while maintaining the current budget.

    Conclusions: The results of this study support a shift to ILPA as the first-line treatment for CL in Bolivia and possibly in other South American countries.

  • 22.
    Eid Rodríguez, Daniel V.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The rough journey to access health care: the case of leishmaniasis in the Bolivian rainforest2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Leishmaniasis is a parasitic infectious disease transmitted by vectors that cause three main clinical syndromes: cutaneous (CL), mucosal (ML), and visceral (VL). Since VL is not relevant to this thesis, only CL and ML will be further discussed. Leishmaniasis is present in 98 countries, with more than 350 million people at risk of infection. Leishmaniasis disproportionately affects poor countries and, in particular, remote areas where health services are weaker. Bolivia, a lower-middle-income country, is the fifth country with more cases in Latin America, and case detection and management is the main control strategy of the National Leishmaniasis Control Programme (NLCP). The NLCP provides free treatment to patients, which consists of systemic pentavalent antimonials (SPA) for 20 days. This treatment is highly toxic for patients and costly for the government, resulting in long periods of shortage of the drug. A good alternative to SPA is the use of intralesional pentavalent antimonials (ILPA), which are safer and have similar efficacy to SPA in treating CL. Case detection and management depend on a well-structured health-care system, and the primary level of care is responsible for this task in Bolivian endemic areas. It is well known that health-care access for leishmaniasis patients is limited but the extent and the determinant factors of this problem are unknown. The aim of this thesis is to assess health-care access among patients with leishmaniasis in a Bolivian rainforest rural area, addressing four specific questions: Who is most vulnerable to CL?; What is the extent of their lack of access to health care?; How do the dimensions of access and the quality of care influence health-care utilization in a context of vulnerability?; and how can a change in NLCP policy related to the treatment of CL improve the level of access to health care?

    Methods: This thesis is based on four studies that use quantitative and qualitative methods. Data collection was conducted through surveys, in-depth interviews and revision of official documents. Sub-study 1 was based on a cross-sectional study conducted in two communities of Cochabamba and assessed risk factors for CL using multivariate analysis. Sub-study 2 used the method of capture−recapture to assess the level of under-reporting of the national register for the period of 2013−2014,  using Chapman’s formula. Sub-study 3 was conducted through in-depth interviews applied to 14 participants, using thematic analysis. Sub-study 4 was an economic evaluation that used data from surveys with physicians, official documents and key informants and compared the costs of systemic pentavalent antimonials (SPA) and intralesional pentavalent antimonials (ILPA) from the perspective of the Ministry of Health (MoH) and society. Additionally, a budget impact analysis of the implementation of ILPA in hypothetical scenarios of increasing level of demand was carried out.

    Main findings: Sub-study 1 showed that gender/sex was the only statistically significant factor associated with CL, with men being the most affected group. Other classical factors, such as animal ownership, house materials and protective measures were, however, not related to CL. Sub-study 2 revealed a high level of under-reporting (73%) of CL in the study area, and this under-reporting was higher among men compared to women. Sub-study 3 showed that the lack of availability, accessibility, affordability and quality of care were the main factors that limited the access to care of CL and ML patients. In sub-study 4, the economic analysis pointed out that the use of ILPA was cost-saving for the MoH and society, and the budget analysis confirmed that the implementation of ILPA as first-line treatment was not only cost-saving for the MoH, but it would also increase the number of patients accessing the treatment.

    Conclusions: The predominance of a sylvatic pattern of transmission, with men as the most affected group, demands new approaches to prevention related to occupational activities. The NLCP policy related to case management has been essential to reducing economic barriers for patients with leishmaniasis; however, there are still a considerable amount of cases who do not have access to the treatment. Lacko f health services, equipment and drugs, as well as difficulties in reaching health services, the high costs of seeking health care and the low quality of care are important factors that must be addressed to fulfil the right to health care for these patients. Finally, new therapeutic alternatives, such as ILPA, must be considered to reduce problems of affordability, adherence, as well as side effects to the treatment. This information can be used to develop targeted interventions aimed at increasing the access to health care of people with leishmaniasis in the rainforest of Bolivia.

  • 23. Ekstrand, Joakim
    et al.
    Petersson, Pia
    Westergren, Albert
    Sahlén, Klas-Göran
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Preventiva hembesök till seniorer - har vi råd att inte satsa?2019In: Svensk geriatrik, no 1, p. 24-27Article in journal (Other (popular science, discussion, etc.))
  • 24. Escolar-Pujolar, Antonio
    et al.
    Córdoba Doña, Juan Antonio
    Goicolea Julían, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Jesús Rodríguez, Gabriel
    Santos Sánchez, Vanesa
    Mayoral Sánchez, Eduardo
    Aguilar Diosdado, Manuel
    El efecto del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus en Andalucía2018In: Endocrinología, Diabetes y Nutrición, ISSN 2530-0180, Vol. 65, no 1, p. 21-29Article in journal (Refereed)
    Abstract [en]

    Objetivos: Evaluar el efecto modificador del estado civil sobre las desigualdades sociales y de género en la mortalidad por diabetes mellitus (DM) en Andalucía.

    Material y métodos: Estudio transversal a partir de la Cohorte Censal 2001 de Andalucía. Se estudiaron defunciones por DM entre 2002 y 2013 según nivel de estudios y estado civil. Se calcularon tasas de mortalidad ajustadas por edad (TA) y razones de tasas de mortalidad (RTM) mediante modelos de regresión de Poisson, controladas por otras variables sociodemográficas. Se evaluó el efecto modificador del estado civil incorporando a los modelos un término de interacción. Todos los análisis se realizaron separadamente para hombres y mujeres.

    Resultados: Sobre un total de 4.229.791 sujetos se registraron 18.158 muertes por DM (10.635 mujeres y 7.523 hombres). A medida que disminuye el nivel educativo aumenta el riesgo de muerte. El estado civil modifica la desigualdad social en la mortalidad por DM de forma diferente en cada sexo. Las mujeres viudas y separadas/divorciadas con menor nivel de estudios presentan las mayores RTM: 5,1 (IC 95%: 3,6-7,3) y 5,6 (IC 95%: 3,6-8,5), respectivamente, mientras que los hombres solteros tienen la RTM más elevada: 3,1 (IC 95%: 2,7-3,6).

    Conclusiones: El nivel de estudios es un determinante fundamental de la mortalidad por DM en ambos sexos; su relevancia es mayor entre las mujeres, mientras que en los hombres también el estado civil es un factor clave. Para abordar las desigualdades en la mortalidad nuestros resultados sugieren que el énfasis actual en los factores individuales y el autocuidado debería extenderse hacia intervenciones sobre la familia, la comunidad y los contextos sociales más cercanos a los pacientes.

  • 25. Estalella, Itziar
    et al.
    San Millán, Jaione
    Trincado, María José
    Maquibar, Amaia
    Martínez-Indart, Lorea
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay2019In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Late-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm.

    OBJECTIVE: The aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain.

    METHODS: The intervention was designed to promote parents' education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n=212) and an intervention group (n=161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups.

    RESULTS: Infants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p=0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p=0.009).

    CONCLUSION: The intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.

  • 26.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Cultural parenting programmes could play an important role in helping immigrants adapt to their host countries2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 8, p. 1491-1491Article in journal (Other academic)
  • 27.
    Eurenius, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Richter Sundberg, Linda
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Vaezghasemi, Masoud
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Social-emotional problems among three-year-olds differ based on the child's gender and custody arrangement2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 6, p. 1087-1095Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to investigate mental health with respect to social-emotional problems among three-year-olds in relation to their gender, custody arrangements and place of residence.

    METHODS: A cross-sectional population-based design was used, encompassing 7,179 three-year-olds in northern Sweden during the period 2014-2017 from the regional Salut Register. Descriptive and comparative analyses were performed based on parents' responses on the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), supplemented with items on gender, custody arrangement and place of residence.

    RESULTS: Parental-reported social-emotional problems were found in almost 10% of the children. Boys were reported to have more problems (12.3%) than girls (5.6%) (p<0.001). Parents were most concerned about children's eating habits and interactions at mealtimes. Parents not living together reported more problems among their children than those living together (p<0.001). When stratifying by custody arrangement, girls in rural areas living alternately with each parent had more problems compared to those in urban areas (p<0.008).

    CONCLUSION: Gender and custody arrangements appear to be important factors for social-emotional problems among three-year-olds. Thus, such conditions should receive attention during preschool age, preferably by a systematic preventive strategy within Child Health Care.

  • 28. Fearon, Elizabeth
    et al.
    Wiggins, Richard D.
    Pettifor, Audrey E.
    MacPhail, Catherine
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of 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; INDEPTH Network, Accra, Ghana.
    Selin, Amanda
    Gomez-Olive, F. Xavier
    Hargreaves, James R.
    Friendships Among Young South African Women, Sexual Behaviours and Connections to Sexual Partners (HPTN 068)2019In: Aids and Behavior, ISSN 1090-7165, E-ISSN 1573-3254, Vol. 23, no 6, p. 1471-1483Article in journal (Refereed)
    Abstract [en]

    Friends could be influential on young women's sexual health via influences on sexual behaviours and as connections to sexual partners, but are understudied in sub-Saharan Africa. We cross-sectionally surveyed 2326 13-20year-old young women eligible for grades 8-11 in rural South Africa about their sexual behaviour and up to three sexual partners. Participants each described five specific but unidentified friends and the relationships between them in an egocentric' network analysis design. We used logistic regression to investigate associations between friendship characteristics and participants' reports of ever having had sex (n=2326) and recent condom use (n=457). We used linear regression with random effects by participant to investigate friendship characteristics and age differences with sexual partners (n=633 participants, 1051 partners). We found that it was common for friends to introduce young women to those who later became sexual partners, and having older friends was associated with having older sexual partners, (increase of 0.37years per friend at least 1year older, 95% CI 0.21-0.52, adjusted). Young women were more likely to report ever having had sex when more friends were perceived to be sexually active (adjusted OR 1.85, 95% CI 1.72-2.01 per friend) and when they discussed sex, condoms and HIV with friends. Perception of friends' condom use was not associated with participants' reported condom use. While this study is preliminary and unique in this population and further research should be conducted, social connections between friends and sexual partners and perceptions of friend sexual behaviours could be considered in the design of sexual health interventions for young women in South Africa.

  • 29.
    Fonseca Rodriguez, Osvaldo
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Häggström Lundevaller, Erling
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Sheridan, Scott C
    Department of Geography, Kent State University, Kent, OH 4242, USA.
    Schumann, Barbara
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Association between Weather Types based on the Spatial Synoptic Classification and All-Cause Mortality in Sweden, 1991⁻20142019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 10, article id 1696Article in journal (Refereed)
    Abstract [en]

    Much is known about the adverse health impact of high and low temperatures. The Spatial Synoptic Classification is a useful tool for assessing weather effects on health because it considers the combined effect of meteorological factors rather than temperature only. The aim of this study was to assess the association between oppressive weather types and daily total mortality in Sweden. Time-series Poisson regression with distributed lags was used to assess the relationship between oppressive weather (Dry Polar, Dry Tropical, Moist Polar, and Moist Tropical) and daily deaths over 14 days in the extended summer (May to September), and 28 days during the extended winter (November to March), from 1991 to 2014. Days not classified as oppressive weather served as the reference category. We computed relative risks with 95% confidence intervals, adjusting for trends and seasonality. Results of the southern (Skåne and Stockholm) and northern (Jämtland and Västerbotten) locations were pooled using meta-analysis for regional-level estimates. Analyses were performed using the dlnm and mvmeta packages in R. During summer, in the South, the Moist Tropical and Dry Tropical weather types increased the mortality at lag 0 through lag 3 and lag 6, respectively. Moist Polar weather was associated with mortality at longer lags. In the North, Dry Tropical weather increased the mortality at shorter lags. During winter, in the South, Dry Polar and Moist Polar weather increased mortality from lag 6 to lag 10 and from lag 19 to lag 26, respectively. No effect of oppressive weather was found in the North. The effect of oppressive weather types in Sweden varies across seasons and regions. In the North, a small study sample reduces precision of estimates, while in the South, the effect of oppressive weather types is more evident in both seasons.

  • 30.
    Fonseca-Rodríguez, Osvaldo
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Pinheiro Júnior, José Wilton
    Department of Veterinary Medicine, Federal Rural University of Pernambuco, Recife, PE, Brazil.
    Aparecido Mota, Rinaldo
    Department of Veterinary Medicine, Federal Rural University of Pernambuco, Recife, PE, Brazil.
    Spatiotemporal Analysis of Glanders in Brazil2019In: Journal of Equine Veterinary Science, ISSN 0737-0806, E-ISSN 1542-7412, Vol. 78, p. 14-19Article in journal (Refereed)
    Abstract [en]

    In Brazil, glanders remains a serious problem, with the obligatory sacrifice of disease-positive animals without compensation. Each year, glanders cases are reported in several regions of the country, causing severe economic losses and trade restrictions. The present study describes and discusses the occurrence of glanders foci in Brazil during a 12-year period from 2005 to 2016. The highest frequency of reported affected holdings during the study period was in the northeast region. Moreover, during this period, the disease incidence in Brazil showed an overall increasing tendency. The number of affected holdings significantly increased during the last four years of the period, and more cases were noted during the months of May and June. Spatiotemporally, there are four high-risk glanders clusters: (1) cluster A (relative risk [RR = 6.51, P < .0001) involved the northeast region from March 2008 to February 2014; (2) cluster B (RR = 17.37, P < .0001) involved a southeast region state from March 2013 to June 2015; (3) cluster C (RR = 6.92, P < .0001) involved the states in the midwest, southeast, and south regions of Brazil from March 2015 to May 2016; and (4) cluster D (RR = 19.07, P < .0001) involved a north region state from October 2015 to April 2016. Only two states of the north region (Acre and Amapá) did not experience glanders during the study period.

  • 31.
    Fors, Ronny
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Ortodontics.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Persson, Maurits
    Umeå University, Faculty of Medicine, Department of Odontology, Ortodontics.
    Nickel allergy in relation to piercing and orthodontic appliances: a population study2012In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 67, no 6, p. 342-350Article in journal (Refereed)
    Abstract [en]

    Background. Studies have shown conflicting results on the association between nickel exposure from orthodontic appliances and nickel sensitization.

    Objectives & Method. In a cross-sectional study, we investigated the association between nickel sensitization and exposure to orthodontic appliances and piercings. 4376 adolescents were patch tested following a questionnaire asking for earlier piercing and orthodontic treatment. Exposure to orthodontic appliances was verified in dental records.

    Results. Questionnaire data demonstrated a reduced risk of nickel sensitization when orthodontic treatment preceded piercing (OR 0.46; CI 0.27–0.78). Data from dental records demonstrated similar results (OR 0.61, CI 0.36–1.02), but statistical significance was lost when adjusting for background factors. Exposure to full, fixed appliances with NiTi-containing alloys (OR 0.31, CI 0.10–0.98) as well as a pooled ‘high nickel-releasing’ appliance group (OR 0.56, CI 0.32–0.97) prior to piercing was associated with a significantly reduced risk of nickel sensitization.

    Conclusion. High nickel-containing orthodontic appliances preceding piercing reduces the risk of nickel sensitization by a factor 1.5–2. The risk reduction is associated with estimated nickel release of the appliance and length of treatment. Sex, age at piercing and number of piercings are also important risk indicators. Research on the role of dental materials in the development of immunological tolerance is needed.

  • 32. Fritzell, S.
    et al.
    Trygg, Nadja
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Public Health Agency of Sweden, Solna, Sweden.
    Busch, H.
    Bremberg, S.
    Inequalities in determinants and mental health in Sweden: results from a governmental initiative2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 124-124Article in journal (Other academic)
    Abstract [en]

    Mental health is an increasing concern in all European countries. Social inequalities may appear both in the distribution of mental health and the social and economic consequences. In 2016, the government commissioned The Public Health Agency of Sweden (PHAS) to increase knowledge on socioeconomic determinants of mental health problems. The present study addresses the social distribution of mental health problems and what mediates this.

    Drawing on patient registry data of the population from 2014 and a national survey representative of the population aged 16-84, years 2013-2016 (n = 155339) we analyze how mental health is distributed in social groups and what determinants mediate poor mental health. Outcomes include psychiatric in- and outpatient care (numbers and cases/1000), and for self-reported measures (ie. GHQ, stress, anxiety) odds ratios (OR) from multivariate logistic regression, adjusting for social and economic determinants.

    Preliminary results show that most outcomes in self-reported poor mental health and psychiatric diagnoses were more common among women. Social patterns differed between diagnoses.

    Among working ages in- and outpatient care, low educated showed fourfold increased risk of psychotic disorders, while neurotic stress related disorders showed a doubled risk among low educated. Care for any mental disorder (excluding dementia) was more common among lower educated men and women aged 65+ but had a reverse social gradient. In analyses modelling the risk of poor mental health (GHQ12), controlling for background-, social and economic factors in particular financial strain (OR 2.42, CI 2.11-2.77) mediated poor mental health among women 25-64.

    An educational gradient was found in most mental health outcomes with more pronounced gradient in more severe outcomes. Patterns differ by age groups, social group, and outcome. Results will be used to inform practitioners and policy makers at national and regional level to decrease inequalities in mental health.

    Key messages:

    • Social inequalities in mental health and its’ determinants are found in most age groups, and most outcomes studied.

    • Focusing on living conditions, particularly economic strain is essential for achieving equity in mental health.

  • 33. Fritzell, S.
    et al.
    Trygg, Nadja
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Public Health Agency of Sweden, Solna, Sweden.
    Busch, H.
    Bremberg, S.
    Scoping the evidence on mental health inequalities and underlying determinants in Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 316-316Article in journal (Other academic)
    Abstract [en]

    Mental health is an increasing concern in all European countries. Social inequalities may appear in both the distribution of mental health and the social and economic consequences. In 2016, the government commissioned The Public Health Agency of Sweden (PHAS) to increase the knowledge on mental health inequalities and their underlying determinants. In all, 18 research projects were initiated within different universities in Sweden and PHAS.

    Research questions addressed dimensions of inequality such as age, gender, SES, sexual orientation and disability. PHAS involved researchers from the fields of social medicine, epidemiology and economics to explore all levels of social determinants, different mechanisms, interacting forces of inequalities and consequences of disease. Evidence from scoping literature reviews were coupled with analyses of Swedish data on a range of outcomes; from positive mental health to in-patient care.

    Preliminary results have been discussed in joint workshops and show social inequalities in mental health in all age groups in Sweden, including small children, with a more pronounced gradient in severe outcomes. Generally, the results points towards policy actions focusing girls and women, low income earners, those experiencing financial strain, hbtq persons and persons with disability. Also, the interaction of different dimensions of inequality need consideration.

    The project is a collaboration between PHAS and a range of research disciplines all joining to discuss mental health and inequalities. Though challenging as interpretations may differ due to field of research, overall it has allowed for a broad approach and joint learning as experts have collaborated. This is a step towards understanding country specific determinants of mental health inequalities. Combined, the results make up a knowledge base that will guide policy makers and practitioners to develop efficient policies and practices in order to decrease inequalities in mental health.

    Key messages:

    • Combining evidence from international literature with context specific secondary data analyses improves its local relevance.

    • Collaboration between research fields enables a more comprehensive basis for decision making.

  • 34.
    Furberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Anticona Huaynate, Cynthia
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Schumann, Barbara
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Post-infectious fatigue following Puumala virus infection2019In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, p. 1-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Puumala virus infection or nephropathia epidemica (NE) is common in northern Sweden. NE causes haemorrhagic fever with renal syndrome. Most patients make a full recovery, but a convalescent phase with fatigue has been reported. Although post-infectious fatigue has been demonstrated for other viral infections, it is not well studied in relation to NE. This study assessed recovery time and levels of fatigue in former NE patients, as compared to the general population.

    METHODS: NE patients diagnosed in northern Sweden between 2007 and 2011, together with a comparison sample from the general population, answered a questionnaire on demographic and health-related factors, including the Fatigue Severity Scale (FSS), and characteristics of NE infection. Self-reported recovery time was assessed, and fatigue levels were compared across the two groups by multiple linear regression, stratified by gender.

    RESULTS: In total, 1132 NE patients and 915 comparison group subjects participated. Time to complete recovery was reported to exceed 3 months for 47% and 6 months for 32% of the NE patients. Recovery time differed by gender and age. NE patients had significantly higher FSS scores than the comparison group. Differences were greater among women than men, and adjustments for current illness, body mass index, smoking and current residence only slightly modified the estimates.

    CONCLUSIONS: Individuals with previous NE infection show higher fatigue scores than non-infected individuals, even 5 years following the infection. Full recovery takes half a year or longer for a substantial proportion of former NE patients.

  • 35.
    Gaitonde, Rakhal
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Indian Institute of Technology – Madras, Centre of Technology and Policy, Chennai, India.
    Oxman, Andrew D
    Okebukola, Peter O
    Rada, Gabriel
    Interventions to reduce corruption in the health sector2016In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 8, article id CD008856Article, review/survey (Refereed)
    Abstract [en]

    Background: Corruption is the abuse or complicity in abuse, of public or private position, power or authority to benefit oneself, a group, an organisation or others close to oneself; where the benefits may be financial, material or non-material. It is wide-spread in the health sector and represents a major problem.

    Objectives: Our primary objective was to systematically summarise empirical evidence of the effects of strategies to reduce corruption in the health sector. Our secondary objective was to describe the range of strategies that have been tried and to guide future evaluations of promising strategies for which there is insufficient evidence.

    Search methods: We searched 14 electronic databases up to January 2014, including: CENTRAL; MEDLINE; EMBASE; sociological, economic, political and other health databases; Human Resources Abstracts up to November 2010; Euroethics up to August 2015; and PubMed alerts from January 2014 to June 2016. We searched another 23 websites and online databases for grey literature up to August 2015, including the World Bank, the International Monetary Fund, the U4 Anti-Corruption Resource Centre, Transparency International, healthcare anti-fraud association websites and trial registries. We conducted citation searches in Science Citation Index and Google Scholar, and searched PubMed for related articles up to August 2015. We contacted corruption researchers in December 2015, and screened reference lists of articles up to May 2016.

    Selection criteria: For the primary analysis, we included randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies that evaluated the effects of an intervention to reduce corruption in the health sector. For the secondary analysis, we included case studies that clearly described an intervention to reduce corruption in the health sector, addressed either our primary or secondary objective, and stated the methods that the study authors used to collect and analyse data.

    Data collection and analysis: One review author extracted data from the included studies and a second review author checked the extracted data against the reports of the included studies. We undertook a structured synthesis of the findings. We constructed a results table and 'Summaries of findings' tables. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence.

    Main results: No studies met the inclusion criteria of the primary analysis. We included nine studies that met the inclusion criteria for the secondary analysis. One study found that a package of interventions coordinated by the US Department of Health and Human Services and Department of Justice recovered a large amount of money and resulted in hundreds of new cases and convictions each year (high certainty of the evidence). Another study from the USA found that establishment of an independent agency to investigate and enforce efforts against overbilling might lead to a small reduction in overbilling, but the certainty of this evidence was very low. A third study from India suggested that the impacts of coordinated efforts to reduce corruption through increased detection and enforcement are dependent on continued political support and that they can be limited by a dysfunctional judicial system (very low certainty of the evidence). One study in South Korea and two in the USA evaluated increased efforts to investigate and punish corruption in clinics and hospitals without establishing an independent agency to coordinate these efforts. It is unclear whether these were effective because the evidence is of very low certainty. One study from Kyrgyzstan suggested that increased transparency and accountability for co-payments together with reduction of incentives for demanding informal payments may reduce informal payments (low certainty of the evidence). One study from Germany suggested that guidelines that prohibit hospital doctors from accepting any form of benefits from the pharmaceutical industry may improve doctors' attitudes about the influence of pharmaceutical companies on their choice of medicines (low certainty of the evidence). A study in the USA, evaluated the effects of introducing a law that required pharmaceutical companies to report the gifts they gave to healthcare workers. Another study in the USA evaluated the effects of a variety of internal control mechanisms used by community health centres to stop corruption. The effects of these strategies is unclear because the evidence was of very low certainty.

    Authors' conclusions: There is a paucity of evidence regarding how best to reduce corruption. Promising interventions include improvements in the detection and punishment of corruption, especially efforts that are coordinated by an independent agency. Other promising interventions include guidelines that prohibit doctors from accepting benefits from the pharmaceutical industry, internal control practices in community health centres, and increased transparency and accountability for co-payments combined with reduced incentives for informal payments. The extent to which increased transparency alone reduces corruption is uncertain. There is a need to monitor and evaluate the impacts of all interventions to reduce corruption, including their potential adverse effects.

  • 36. Geldsetzer, Pascal
    et al.
    Vaikath, Maria
    Wagner, Ryan
    Rohr, Julia K.
    Montana, Livia
    Gomez-Olive, Francesc X.
    Rosenberg, Molly S.
    Manne-Goehler, Jennifer
    Mateen, Farrah J.
    Payne, Collin F.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Salomon, Joshua A.
    Gaziano, Thomas A.
    Baernighausen, Till
    Berkman, Lisa F.
    Depressive Symptoms and Their Relation to Age and Chronic Diseases Among Middle-Aged and Older Adults in Rural South Africa2019In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 74, no 6, p. 957-963Article in journal (Refereed)
    Abstract [en]

    Background: Understanding how depression is associated with chronic conditions and sociodemographic characteristics can inform the design and effective targeting of depression screening and care interventions. In this study, we present some of the first evidence from sub-Saharan Africa on the association between depressive symptoms and a range of chronic conditions (diabetes, HIV, hypertension, and obesity) as well as sociodemographic characteristics. Methods: A questionnaire was administered to a population-based simple random sample of 5,059 adults aged 40 years and older in Agincourt, South Africa. Depressive symptoms were measured using a modified version of the eight-item Center for Epidemiological Studies-Depression screening tool. Diabetes was assessed using a capillary blood glucose measurement and HIV using a dried blood spot. Results: 17.0% (95% confidence interval: 15.9%-18.1%) of participants had at least three depressive symptoms. None of the chronic conditions were significantly associated with depressive symptoms in multivariable regressions. Older age was the strongest correlate of depressive symptoms with those aged 80 years and older having on average 0.63 (95% confidence interval: 0.40-0.86; p<.001) more depressive symptoms than those aged 40-49 years. Household wealth quintile and education were not significant correlates. Conclusions: This study provides some evidence that the positive associations of depression with diabetes, HIV, hypertension, and obesity that are commonly reported in high-income settings might not exist in rural South Africa. Our finding that increasing age is strongly associated with depressive symptoms suggests that there is a particularly high need for depression screening and treatment among the elderly adults in rural South Africa.

  • 37.
    Granberg Sandlund, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Diamant, Anna
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Granåsen, Gabriel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Salzer, Jonatan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Effectiveness of care in acute dizziness presentations2019In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 276, no 9, p. 2389-2396Article in journal (Refereed)
    Abstract [en]

    Purpose: This study aims to evaluate whether a management algorithm has improved the effectiveness of care for dizzy patients at Umea University Hospital.

    Methods: This was an interventional study using medical records to collect data for acute dizziness presentations before (period 1, 2012-2014) and after (period 2, 2016-2017) the implementation of a management algorithm. Outcomes were changes in a set of pre-defined effectiveness markers and health economic effects.

    Results: Total n = 2126 and n = 1487 acute dizziness presentations were identified in period 1 and 2, respectively. Baseline characteristics were similar. The proportion of patients undergoing Dix-Hallpike testing increased, 20.8% [95% confidence interval (CI) 18.8-23.0%] vs. 37.7% (95% CI 35.2-40.2%), as did BPPV diagnoses, 7.6% (95% CI 6.6-8.8%) vs. 15.3% (95% CI 13.6-17.3%). Hospitalization became less common, 61.5% (95% CI 59.4-63.6%) vs. 47.6% (95% CI 45.1-50.2%). The proportion undergoing any neuroradiological investigation decreased, 44.8% (95% CI 42.7-47.0%) vs. 36.3% (95% CI 33.8-38.7%) with a shift from CT to MRI, with unchanged sensitivity for diagnosing cerebrovascular causes. The average cost for the care of one dizzy patient decreased from $2561 during period 1 to $1808 during period 2.

    Conclusions: This study shows that the implementation of a management algorithm for dizzy patients was associated with improved effectiveness of care.

  • 38. Granbom, Marianne
    et al.
    Szanton, Sarah
    Gitlin, Laura N.
    Paulsson, Ulrika
    Zingmark, Magnus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ageing in the right place: a prototype of a web-based housing counselling intervention for later life2019In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014Article in journal (Refereed)
    Abstract [en]

    Background: Despite a strong desire among most older adults to age in place, there are few widely available services to support planning and preparing for one's future housing needs. Objective: To develop a prototype of a web-based housing counselling intervention for use in later life, by employing a user-centred design. Material and Methods: As the first step in intervention development, we employed a development process based on research circle methodology. Nine older adults participated in three sessions. Findings from literature reviews, a meeting with a technology and design panel (n = 6) and interviews with representatives of nonprofit organizations, companies, and municipalities (n = 7) served as discussion points. Result: An on-paper prototype was derived, composed of the THINK, LEARN and ACT module reflecting different stages of the decision-making process. Each module addressed preferences, health, home and social and financial resources. Key design features and theoretical underpinnings were included.

  • 39.
    Hansson, Jonas
    et al.
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ghazinour, Mehdi
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University. Umeå University, Faculty of Social Sciences, Department of Social Work.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University. Umeå University, Faculty of Social Sciences, Department of Social Work.
    The Swedish Police Service's deportations of unaccompanied, asylum-seeking refugee children: The role of coping and general mental health2017In: Cogent Psychology, ISSN 2331-1908, Vol. 4, no 1, article id 1355629Article in journal (Refereed)
    Abstract [en]

    The number of unaccompanied, asylum-seeking refugee children (UARC) coming to Sweden has increased 100 times during the last ten years. If children do not voluntarily return, the police are responsible for deportation. This study aims to describe police officers’ coping in the deportation of UARC and to investigate the associations between coping and general mental health in relation to the deportation of UARC among police officers by considering sociodemographic variables. Validity and reliability analyses were conducted for the use of the Ways of Coping Questionnaire (WOCQ) in the context of UARC. Mental health was assessed using the General Health Questionnaire 12 (GHQ-12). The GHQ-12 was the outcome (dependent variable), and the experience of deportations of UARC, the WOCQ and sociodemographic variables were the independent variables. A 5-factor structure with some important similarities and differences to the original version was confirmed. This study shows that the police officers utilize different coping strategies in the same complex situations during the deportation of UARC. The use of escape-avoidance and self-control increased the likelihood of psychological disturbance, whereas positive reappraisal had a protective effect. This research also demonstrates that coping strategies have a moderating effect on general mental health in police officers’ work with the deportations of UARC. 

  • 40. Herrmann, A.
    et al.
    Amelung, D.
    Fischer, H.
    Wilkinson, P.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Barbier, C.
    Dubois, G.
    Aall, C.
    Sauerborn, R.
    Promoting health under the Paris Climate Agreement: results from a European mixed-methods study2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 170-170Article in journal (Other academic)
  • 41.
    Hitimana, Regis
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Krantz, Gunilla
    Nzayirambaho, Manasse
    Semasaka Sengoma, Jean Paul
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Pulkki-Brännström, Anni-Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Incremental cost and health gains of the 2016 WHO antenatal care recommendations for Rwanda: results from expert elicitation2019In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 17, article id 36Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: High-quality evidence of effectiveness and cost-effectiveness is rarely available and relevant for health policy decisions in low-resource settings. In such situations, innovative approaches are needed to generate locally relevant evidence. This study aims to inform decision-making on antenatal care (ANC) recommendations in Rwanda by estimating the incremental cost-effectiveness of the recent (2016) WHO antenatal care recommendations compared to current practice in Rwanda.

    METHODS: Two health outcome scenarios (optimistic, pessimistic) in terms of expected maternal and perinatal mortality reduction were constructed using expert elicitation with gynaecologists/obstetricians currently practicing in Rwanda. Three costing scenarios were constructed from the societal perspective over a 1-year period. The two main inputs to the cost analyses were a Monte Carlo simulation of the distribution of ANC attendance for a hypothetical cohort of 373,679 women and unit cost estimation of the new recommendations using data from a recent primary costing study of current ANC practice in Rwanda. Results were reported in 2015 USD and compared with the 2015 Rwandan per-capita gross domestic product (US$ 697).

    RESULTS: Incremental health gains were estimated as 162,509 life-years saved (LYS) in the optimistic scenario and 65,366 LYS in the pessimistic scenario. Incremental cost ranged between $5.8 and $11 million (an increase of 42% and 79%, respectively, compared to current practice) across the costing scenarios. In the optimistic outcome scenario, incremental cost per LYS ranged between $36 (for low ANC attendance) and $67 (high ANC attendance), while in the pessimistic outcome scenario, it ranged between $90 (low ANC attendance) and $168 (high ANC attendance) per LYS. Incremental cost effectiveness was below the GDP-based thresholds in all six scenarios.

    DISCUSSION: Implementing the new WHO ANC recommendations in Rwanda would likely be very cost-effective; however, the additional resource requirements are substantial. This study demonstrates how expert elicitation combined with other data can provide an affordable source of locally relevant evidence for health policy decisions in low-resource settings.

  • 42. Hove, Jennifer
    et al.
    D'Ambruoso, Lucia
    Mabetha, Denny
    van der Merwe, Maria
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Kahn, Kathleen
    Khosa, Sonto
    Witter, Sophie
    Twine, Rhian
    'Water is life': developing community participation for clean water in rural South Africa2019In: BMJ Global Health, ISSN 2059-7908, Vol. 4, no 3, article id e001377Article in journal (Refereed)
    Abstract [en]

    Background South Africa is a semiarid country where 5 million people, mainly in rural areas, lack access to water. Despite legislative and policy commitments to the right to water, cooperative governance and public participation, many authorities lack the means to engage with and respond to community needs. The objectives were to develop local knowledge on health priorities in a rural province as part of a programme developing community evidence for policy and planning. Methods We engaged 24 participants across three villages in the Agincourt Health and Socio-Demographic Surveillance System and codesigned the study. This paper reports on lack of clean, safe water, which was nominated in one village (n=8 participants) and in which women of reproductive age were nominated as a group whose voices are excluded from attention to the issue. On this basis, additional participants were recruited (n=8). We then held a series of consensus-building workshops to develop accounts of the problem and actions to address it using Photovoice to document lived realities. Thematic analysis of narrative and visual data was performed. Results Repeated and prolonged periods when piped water is unavailable were reported, as was unreliable infrastructure, inadequate service delivery, empty reservoirs and poor supply exacerbated by droughts. Interconnected social, behavioural and health impacts were documented combined with lack of understanding, cooperation and trust between communities and authorities. There was unanimity among participants for taps in houses as an overarching goal and strategies to build an evidence base for planning and advocacy were developed. Conclusion In this setting, there is willingness among community stakeholders to improve water security and there are existing community assemblies to support this. Health and Socio-Demographic Surveillance Systems provide important opportunities to routinely connect communities to resource management and service delivery. Developing learning platforms with government and non-government organisations may offer a means to enable more effective public participation in decentralised water governance.

  • 43. Hussain-Alkhateeb, Laith
    et al.
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Institute for Global Health, University College London, London, UK.
    Petzold, Max
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. INDEPTH Network, Accra, Ghana; Medical Research Council, Johannesburg, South Africa; Medical Research Council, Johannesburg, South Africa; 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.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council, Johannesburg, South Africa; 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.
    Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-9, article id 28302Article in journal (Refereed)
    Abstract [en]

    Background: Understanding how lay people perceive the causes of mortality and their associated risk factors is important for public health. In resource-limited settings, where verbal autopsy (VA) is used as the most expedient method of determining cause of death, it is important to understand how pre-existing concepts of cause of death among VA-informants may influence their VA-responses and the consequential impact on cause of death assessment. This study describes the agreement between VA-derived causes of death and informant-perceived causes and associated influential factors, which also reflects lay health literacy in this setting. Method: Using 20 years of VA data (n = 11,228) from the Agincourt Health and Demographic Surveillance System (HDSS) site in rural South Africa, we explored the agreement between the causes of death perceived by the VA-informants and those assigned by the automated Inter-VA tool. Kappa statistics and concordance correlation coefficients were applied to measure agreement at individual and population levels, respectively. Multivariable regression models were used to explore factors associated with recognised lay perceptions of causes of mortality. Results: Agreement between informant-perceived and VA-derived causes of death at the individual level was limited, but varied substantially by cause of death. However, agreement at the population level, comparing cause-specific mortality fractions was higher, with the notable exception of bewitchment as a cause. More recent deaths, those in adults aged 15-49 years, deaths outside the home, and those associated with external causes showed higher concordance with InterVA. Conclusion: Overall, informant perception of causes of death was limited, but depended on informant characteristics and causes of death, and to some extent involved non-biomedical constructs. Understanding discordance between perceived and recognised causes of death is important for public health planning; low community understanding of causes of death may be detrimental to public health. These findings also illustrate the importance of using rigorous and standardised VA methods rather than relying on informants' reported causes of death.

  • 44.
    Ivarsson, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Richter Sundberg, Linda
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Socioemotionell förmåga hos treåringar: Resultat från en befolkningsbaserad studie i Västerbottens län2019Report (Other academic)
    Abstract [sv]

    Det övergripande målet för svensk barnhälsovård är att främja barns hälsa, trygghet och utveckling samt ge stöd i föräldraskapet. Barn i Sverige är i hög grad fysiskt friska i internationell jämförelse, men det finns indikationer på att den psykiska ohälsan har ökat hos barn och ungdomar under de senaste decennierna. Kunskapen om förekomst av, och bakomliggande faktorer, till psykisk ohälsa hos förskolebarn är dock otillräcklig. Syftet med denna studie är därför att undersöka treåringars socioemotionella förmåga med avseende på könsskillnader och boende i stad eller på landsbygd i Västerbottens län.

    Förskolebarns psykiska hälsa undersöks systematiskt

    I denna studie har instrumentet Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) använts för att undersöka föräldrars rapporterade socioemotionella förmåga hos treåringar. ASQ:SE 36-månadersversion delas rutinmässigt ut till föräldrar inför treårsbesöket på barnavårdscentraler i Västerbottens län sedan 2013. ASQ:SE är ursprungligen utvecklat i USA och mäter barns socioemotionella förmåga inom sju domäner: självreglering, följsamhet, kommunikation, adaptiv förmåga, autonomi, affekt och social interaktion. Socioemotionell förmåga i treårsåldern är exempelvis förmåga till samspel med vuxna och jämnåriga samt förmåga att med stöd av förälder reglera egna känslor. Betydande avvikelser i den socioemotionella förmågan vid denna ålder kan tyda på att barnet har en sårbarhet som kan leda till fortsatta och ibland mer allvarliga socioemotionella problem.

    Generellt god psykisk hälsa men fler problem bland pojkar

    Svaren från majoriteten av föräldrarna indikerar god socioemotionell förmåga hos barnen, dock hade nästan en av tio treåringar föräldrarapporterade socioemotionella problem, med ASQ:SE-poäng över gränsvärdet 59. Problemen var dubbelt så vanliga bland pojkar (12 procent) som bland flickor (6 procent) (p <0,001). Det fanns inga signifikanta skillnader i socioemotionell förmåga mellan barn bosatta i städer i jämförelse med barn bosatta på landsbygden. Skillnaderna mellan könen var dock kvarstående oberoende av geografisk hemvist. Domänerna autonomi och följsamhet innehöll de frågor för vilka flest föräldrar rapporterade svårigheter, detta gällde för både pojkar och flickor.

    Slutsats

    Studien har ökat förståelsen för socioemotionell förmåga hos treåringar i Sverige. Den förstärker vikten av att identifiera problem i tidig ålder och att beakta könsskillnader. Redan i förskoleåldern bör socioemotionell förmåga uppmärksammas, helst genom en systematisk strategi inom barnhälsovården

  • 45.
    Jerdén, Lars
    et al.
    Högskolan Dalarna, Jakobsgårdarnas akademiska vårdcentral, Borlänge.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Läkaren har en nyckelroll i vårdarbetet med levnadsvanor2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, article id FF4SArticle in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Updated Swedish National Guidelines on prevention and lifestyle habits: physicians' role

    The recently updated Swedish National Guidelines on prevention and lifestyle habits (tobacco use, hazardous use of alcohol, insufficient physical activity and unhealthy eating habits) emphasize the importance of supporting lifestyle changes among risk individuals, such as already affected by disease, carriers of risk factors that increase the risk of disease, and people with social vulnerability. More measures targeting youth are included, as well as measures to avoid smoking and alcohol use prior to surgery. Physicians have a key role in implementation of the new guidelines, as a great majority of patients who attend healthcare and discuss lifestyle habits do so with a physician.

  • 46.
    Joffer, Junia
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Center for Clinical Research Dalarna-Uppsala University, Nissers väg 3, SE-791 82 Falun, Sweden.
    Flacking, Renee
    Bergström, Erik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Randell, Eva
    Jerdén, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Center for Clinical Research Dalarna-Uppsala University, Nissers väg 3, SE-791 82 Falun, Sweden; School of Education, Health and Social Studies, Dalarna University, SE-791 88 Falun, Sweden.
    Self-rated health, subjective social status in school and socioeconomic status in adolescents: a cross-sectional study2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 785Article in journal (Refereed)
    Abstract [en]

    Background: Social position, traditionally measured by objective data on socioeconomic status (SES), is linked to health status in adults. In adolescents, the association is more uncertain and there are some studies suggesting that subjective social status (SSS) might be more adequate in relation to health. This study aimed to examine associations between SSS in school, SES and self-rated health (SRH) in adolescent boys and girls.

    Methods: A descriptive cross-sectional research design with quantitative survey data was used. The study involved 705 Swedish adolescents in upper secondary school (17–18-year-olds). SRH was measured with a single-item question and SSS by a question where adolescents were asked to assess their social position within their school. Formal education level of the parents was used as a proxy for objective SES. Univariable and multivariable ordinal regression analyses were conducted to assess the associations between SRH and SSS in school and SES.

    Results: In the multivariable analysis, SSS in school was positively associated with SRH, whereas no significant association between SES and SRH was found. The proportion of adolescents with high SRH increased with higher steps on the SSS ladder. Significant gender differences were found in that boys rated their SRH and SSS in school higher than girls did.

    Conclusions: The study shows that self-rated health in adolescents is related to perceived social position in school. Subjective social status in school seems to be a useful health-related measure of social position in adolescents.

  • 47.
    Johansson, Katarina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nordyke, Katrina
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Celiac Dietary Adherence Test simplifies Determining Adherence to a Gluten-Free Diet in Swedish Adolescents2019In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801Article in journal (Refereed)
    Abstract [en]

    Objectives: The aims of the study were to ascertain whether the Celiac Dietary Adherence Test (CDAT) could contribute in determining adherence to a gluten-free diet in celiac disease patients and to evaluate the diet adherence and well-being of a study population five years after a celiac disease screening known as “Exploring the Iceberg of Celiacs in Sweden”.

    Methods: Through the screening, 90 adolescents (born 1997) were diagnosed with biopsy-proven celiac disease at twelve-years of age. Of them, 70 (78%) came to a five-year follow-up where anti–tissue transglutaminase antibodies 2 (TG2-IgA) was tested and a questionnaire was filled in, including CDAT, which consists of seven questions related to adherence. Non-parametrical tests were utilized to determine associations between adherence measures.

    Results: Among the adolescents, 86% were adherent to a gluten-free diet five years after screening, 38% reported their general well-being as excellent, 50% very well, and 12% well. Statistically significant associations were seen between TG2-IgA and the CDAT score (p=0.033), and the self-reported adherence question and the CDAT score (p < 0.001).

    Conclusions: The screening-detected adolescents reported a high level of well-being and adherence to a gluten-free diet five years after screening. We conclude that the CDAT can be used in clinical practice as an estimation of adherence to a gluten-free diet. It would be most suitable to use in conjunction with currently used adherence measures, but can also be used as a stand-alone method when others are not accessible.

  • 48.
    Jonsson, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rural-urban differences in health among youth in northern Sweden: an outcome-wide epidemiological approach2019In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 78, article id 1640015Article in journal (Refereed)
    Abstract [en]

    The aim of this research was to contribute knowledge about rural-urban differences in health among young northern Swedish women and men. This study was based on the 2014 "Health on Equal Terms" survey, distributed in the four northernmost counties of Sweden, with complementary information on areas of residence classified as rural, semi-urban and urban from total population registers. The analytical sample included 2,691 individuals who were selected using a probabilistic sampling method. Prevalence ratios were calculated in multivariable log-binomial regression analyses to measure the association between place of residence and nine outcomes covering three health dimensions (general, mental and lifestyle behaviours). The results indicated that daily smoking and being overweight were more common, while feelings of stress and psychological distress were less prevalent, among youths in rural as compared to urban areas. After including covariates, this pattern appeared stronger for young women, although the direction of the results also applied to young men, albeit without revealing significant differences. In conclusion, the findings from this study indicate that for youths - particularly young women - the rural setting may imply an increased risk of poor general health and lifestyle behaviours, while simultaneously playing a partially protective role for mental health.

  • 49.
    Jonzon, Robert
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Folkhälsomyndigheten.
    Health assessments of asylum seekers within the Swedish healthcare system: a study of the interface between control and care, and how structure and procedures may influence access and coverage2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Despite lack of evidence, there is a common notion that diseases are brought along with migrants, and thus a threat to people in the host country. In Sweden asylum seekers are to be offered a health assessment (HA), but national statistics show that the coverage is less than 50%. It has been assumed that asylum seekers do not want to attend, but this research data instead indicate structural barriers.

    Objectives: To explore to what extent the Swedish healthcare system provides optimal conditions for asylum seekers to access the HA and how the HA could meet their own perceived health needs, as well as society’s demand on detecting contagious diseases, from a public health perspective.

    Methods: This research project adopted a mixed method approach. A quantitative cross-sectional design was applied where different questionnaires were used, targeting administrators and healthcare professionals as well as former asylum seekers. In addition a qualitative, interpretative and descriptive research approach was applied, guided by grounded theory. Individual interviews were carried out among former asylum seekers.

    Results: This research revealed that there is no coherent national system for the HAs on asylum seekers in Sweden. The structures, organizations, procedures and outcomes vary significantly between the 21 counties, and the reasons for the low coverage seemed multifold. The former asylum seekers stated feelings of ambiguity and mistrust due to lack of information on the purpose of the HA and how it might influence their asylum application. Poor communication was identified as one of several barriers to access healthcare. The attitude was positive to the HA as such, but it was considered to be just a communicable disease control, without focus on their own perceived health needs, thus an imbalance between control and care.

    Conclusions: Although being an important contribution, the HA does not suffice to fulfill the right to health of asylum seekers, due to shortcomings regarding accessibility and acceptability of the information, procedures and services that it includes.

  • 50.
    Karhina, Kateryna
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ghazinour, Mehdi
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University.
    Ng, Nawi
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    What determines gender inequalities in social capital in Ukraine?2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8, article id 100383Article in journal (Other academic)
    Abstract [en]

    Background

    Social capital is a social determinant of health that has an impact on equity and well-being. It may be unequally distributed among any population. The aims of this study are to investigate the distribution of different forms of social capital between men and women in Ukraine and analyse how potential gender inequalities in social capital might be explained and understood in the Ukrainian context.

    Method

    The national representative cross-sectional data from the European Social Survey (wave 6) was used with a sample of 1377 women and 797 men. Seven outcomes that represent cognitive and structural social capital were constructed i.e. institutional trust, generalised trust, reciprocity, safety, as well as bonding, bridging and linking forms. Multivariate logistic regression and post-regression Fairlies decompositions were used for the analyses.

    Results

    There are several findings that resulted from the analyses i), access to institutional trust, linking and bridging social capital is very limited; ii), the odds for almost all forms of social capital (besides safety) are lower for men; iii), feeling about income and age explain most of the gender differences and act positively, as well as offsetting the differences.

    Conclusion

    Social capital is unequally distributed between different population groups. Some forms of social capital have a stronger buffering effect on women than on men in Ukraine. Reducing gender and income inequalities would probably influence the distribution of social capital within the society.

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