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  • 1.
    Abdelhay, Amro Gaber
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Antibiotic misuse in Egypt from the community pharmacists' perspective.: A study protocol.2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction/Background: Antibiotic resistance (AR) has become a danger threats to all countries and regions in the world. Decreased effectiveness of antibiotics in treating some infections due to antibiotic resistance is leading to more suffering for patients, increased treatment costs, increased days of hospitalization as well as increasing morbidity and mortality. In order to tackle AR, a much more responsible use of antibiotics is needed including avoidance of overuse, overprescribing and any other type of inappropriate use of antibiotics. Egypt is one of the countries with high rate of antibiotic misuse- In the study that this study protocol is outlining, the reasons for misuse will be explored from the community pharmacists’ perspectives in order to suggest possible solutions.

    Objective: The general objective is to study factors contributing to antibiotic misuse in Egypt from the perspective of community pharmacists.

    Method: A cross sectional study will be conducted using structured questionnaire. Answers will be collected from community pharmacists in Fayoum governorate in Egypt whereafter data analysis will be done.

    Study work plan: It is intended that the study period altogether will be six months.

  • 2. Abraha, Atakelti
    et al.
    Myléus, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. 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 universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. 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 study2019Ingår i: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, s. 1-11Artikel i tidskrift (Refereegranskat)
    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.

  • 3.
    Aden, Jamila Ahmed
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Faculty of Medicine and Health Sciences, East Africa University, Bosaso, Puntland State of Somalia, Somalia; Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Ahmed, Hinda Jama
    Östergren, Per-Olof
    Causes and contributing factors of maternal mortality in Bosaso District Somalia. A retrospective study of 30 cases using a Verbal Autopsy proach2019Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, nr 1, artikel-id 1672314Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Somali women suffer from one of the highest maternal mortality rates in the world. Somalia characterises a specific low-income country situation with a mix of newly urbanized and nomadic culture combined with a frail health care infrastructure set in a post-conflict era. Very little is known about the effects that these contextual factors can have on maternal mortality.

    Objectives: To explore and describe causes and contributing factors concerning maternal deaths in the Bosaso District, Puntland State of Somalia.

    Methods: Data was collected using an adapted Verbal Autopsy tool. In 2017 30 cases of maternal deaths occurring in 2016 in the Bosaso District were reviewed. Information was assessed by three independent reviewers who classified the cause of death and the contributing factors. The Three Delay Model was employed to identify socio-cultural and economic and health system factors that may have contributed to these maternal deaths.

    Results: Direct obstetric deaths accounted for 28 cases. Among these, haemorrhage was the leading cause, followed by eclampsia, sepsis and obstructed labour. Two cases were indirect obstetric deaths, caused by anaemia. All three types of delay were frequent among the studied cases. Delay in deciding to seek care was found in 25 cases, delay in reaching care in 22 cases and delay in receiving health care in 24 cases. Lack of knowledge, money, transportation, poor access and availability of adequate services, as well as substandard management by health care providers, were all underlying the delays.

    Conclusion: A comprehensive intervention programme is needed in order to decrease maternal mortality among Somali women. Such a programme must include health education, improved referral systems and strategic upgrading of care services.

  • 4.
    Al-Alawi, Kamila
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Team-based approach in the management of diabetes at primary health care level in Muscat, Oman: challenges and opportunities2019Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

  • 5.
    Al-Alawi, Kamila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Al Mandhari, Ahmed
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study2019Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, artikel-id 18Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Al-Alawi, Kamila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    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 studyManuskript (preprint) (Övrigt vetenskapligt)
  • 7.
    Al-Alawi, Kamila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    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, OmanManuskript (preprint) (Övrigt vetenskapligt)
  • 8. Alberto Diaz-Sanchez, Adrian
    et al.
    Corona-Gonzalez, Belkis
    Meli, Marina L.
    Obregon Alvarez, Dasiel
    Vega Canizares, Ernesto
    Fonseca Rodriguez, Osvaldo
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (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 Cuba2019Ingår i: Parasites & Vectors, ISSN 1756-3305, E-ISSN 1756-3305, Vol. 12, artikel-id 78Artikel i tidskrift (Refereegranskat)
    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.

  • 9.
    Andersson, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    von Wachenfeldt Väppling, Anna
    de Jong, Anna
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Adherence to adjuvant endocrine therapy after breast cancer in Sweden 2008-2010: a nationwide survey2019Ingår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 37, nr 15, s. 523-523Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: In estrogen receptor (ER) positive early breast cancer (EBC) adjuvant endocrine therapy (AET) is crucial to reduce recurrence and mortality. Previous studies have shown that adherence to AET is lower than expected and could negatively affect outcome. Since the year of 2000, BC patients in Sweden are treated in accordance to national guidelines. Treatment is offered at a low cost for the patient. The aim of the study was to estimate the adherence to AET in Sweden by regions and age groups. Methods: Women with a first primary EBC diagnosis 2008-2010 were identified through the Swedish Cancer Registry (SCR). Individual tumour and treatment data were retrieved from the Swedish National Breast Cancer Registry (SNBCR). Patients with ER negative tumours, small tumours (≤ 10 mm) and metastatic disease was excluded from the study since there were no indication to AET. Likewise, were individuals with AET registered to be administered by a third part excluded. Dispensed treatment from pharmacies was obtained through the Swedish Prescription Registry and medication possession rate (MPR) was calculated as number of dispensed doses divided by treatment duration in days. Good adherence to treatment in a patient was set at MPR ≥ 80 %. Adherence was calculated for 3 and 5 years. Results: Twenty-one thousand sixteen (21 016) individuals with a first primary BC between 2008 and 2010 was identified through SCR of which 20 596 were registered in the SNBCR. A total of 10 176 met the inclusion criteria in the study. Adherence after 3 years was 88.0 % and after 5 years 82.5 %. Adherence differed between regions in Sweden and was positively associated with age at diagnosis between 41-74 years. Urban areas had a lower adherence than rural areas (80.7 % vs 83.6 %; p= <0.001). Conclusions: Adherence to AET in Sweden was good, although there were differences by age and urban and rural areas. Further studies are needed to identify factors affecting differences in adherence, with the purpose of initiate actions to increase adherence to AET in ER positive EBC patients.

  • 10.
    Anyango, Cartrine
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    “I am their youth clinic”: - perceptions and attitudes towards Swedish youth clinics from the perspective of African immigrant parents2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Good health for young people is essential for they are both the present and the hope of tomorrow’s generation. Despite youth being in general a healthy period, young people are also in the high end of experiencing negative health outcomes including sexual and reproductive health. Parent-young people communication play a great role in shaping their sexual and reproductive health and decisions. Many studies have targeted youth clinics from different perspectives, but none from the perspective of immigrant parents with African origin. Thus, the aim of this study was to explore the perceptions and attitudes towards the Swedish youth clinic services from the perspective of the African immigrant parents.

    Methods: A qualitative study design was selected using semi-structured interviews with African immigrant parents in a medium sized city in northern Sweden. A semi structured interview guide with open ended questions was utilized following an emergent design. Four parents were interviewed. The interviews were recorded and later transcribed verbatim. Data was analysed inductively using qualitative content analysis.

    Results: Overall, the participants had mixed feelings about the youth clinics and services in almost all aspects. Parents acknowledged, appreciated, but on the other hand feared, the youth clinics which they perceived as providing too much freedom and openness regarding sexual and reproductive services and communication. Parents perceived culture and religion as playing a pivotal role in shaping parent-young people communication and sources of sexual and reproductive health information.

    Conclusion: This study shows that parents’ role could influence young people in accessing sexual and reproductive services. Parent-young people communication skills need to be improved by programs aimed at building parents’ skills through training. Due to the dilemma on cultural safe services depicted, a follow-up study to explore the perceptions from the perspective of the young people with African background in Sweden, is recommended.

  • 11.
    Assarsson, Rebecka
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nationell jämställdhet i relation till självmordstankar hos ungdomar i låg- och medelinkomstländer2018Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 12.
    Assarsson, Rebecka
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Petersen, Solveig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Högberg, Björn
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Strandh, Mattias
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Center for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Johansson, Klara
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Gender inequality and adolescent suicide ideation across Africa, Asia, the South Pacific and Latin America: a cross-sectional study based on the Global School Health Survey (GSHS)2019Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, artikel-id 1663619Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Suicide ideation is a health issue affecting adolescents worldwide. There are significant variations in suicide ideation between countries and genders, which have not been fully explained. Research is especially lacking in countries outside Europe and North America. Gender equality has been shown to matter in other aspects of adolescent mental health, such as life satisfaction, but has not been researched in relation to suicide ideation at national level.

    Objective: To investigate how national gender inequality is related to self-reported suicide ideation among adolescents, and whether this association differs between boys and girls.

    Methods: This is a cross-national, cross-sectional study using individual survey data from the Global School-based Student Health Survey, a survey in Africa, Asia, Latin America and the South Pacific, developed and supported by among others the WHO and the CDC; connecting this to national data: the gender inequality index from the UNDP; controlling for GDP per capita and secondary school enrolment. The data was analysed using a multilevel logistic regression method and included 149,306 students from 37 countries.

    Results: Higher national gender inequality, as measured by the gender inequality index, was significantly associated with a higher likelihood of suicide ideation in both girls and boys (odds ratio: 1.38 p-value: 0.015), but for girls and both sexes this was only after adjusting for selection bias due to secondary school enrolment (as well as GDP/capita). Interaction models showed that this association was stronger in boys than in girls.

    Conclusions: National gender inequality seems to be associated with higher levels of suicide ideation among adolescents in mainly low- and middle-income countries, especially among boys.

  • 13.
    Baldeh, Samba N
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Impact of cooking fuels and other factors on acute respiratory infection among children under-fives in The Gambia2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Solid fuels still stand as the most widely major source of energy for cooking globally, more than half of the population in the world are using solid fuels for the preparation of their daily meals. About 2.4 billion of the population depend on biomass (wood, animal dung, crop wastes) and o.6 billion on coal. Epidemiologically the hazard associated with the exposure to indoor air pollution generated as result of the used of biomass fuels may account for about two million deaths in developing countries and 4% of the global burden of disease. This study aims to find out the impact of cooking fuels and other factors on acute respiratory infection among children under five in The Gambia.

    Methods: Data from the nationally representative Gambia demographic and health survey was used to select all children less than five years old. The number of under five children was 8088 and after exclusion due to missing data and those who didn’t answer the questions, the unweighted children (n= 7605) and the weighted number of children was 7266. The outcome measure was acute respiratory infection and the exposure variables is cooking fuels. The other factors that were captures in the study were child age, gender, mother’s education, household wealth quintile and residence. In the analysis, descriptive statistics was used to estimate the frequencies and distribution of each of the variable. Logistic regression and chi squares test were also used in the analysis to investigate the relation between cooking fuels and acute respiratory infection.

    Results: The finding of this study shows that more than three quarter (80%) of the children belong to household that used wood/straw as their main source of cooking fuels while the remaining use other fuels. Before adjusting for other variables cooking fuels was not significant but after adjusting for residence a decrease risk of ARI was observed in the household that used wood compared to charcoal (adjusted OR = 0.71 0.52 -0 .97). In this study there was no significant association between cooking fuels and acute respiratory infection. It was also noticed that children whose mothers are educated were more likely to suffered from ARI compared to those belonging to mothers with no education and the same trends was observed for mother’s occupation.

    Conclusion: There is no association reported between the types of cooking fuel and ARI in The Gambia. This and other study that use similar approaches and did not find any association. However, majority of studies were able to establish association with ARI. Other factors like gender of the child, mother’s education, mother’s occupation predicted a significant association with ARI. There is need for more further research since many studies around the world are reporting increase risk of ARI among those who are using cooking fuels.

  • 14.
    Balwiire, Davis
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    DOES MATERNAL POSTPARTUM DEPRESSION AFFECT EARLY CHILD DEVELOPMENT?: A study protocol for a prospective cohort study in rural Uganda2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Mothers in Uganda and all over the world are at risk to postpartum depression due to diverse factors present in their communities. Approximately 10% to 15% suffer from postpartum depression with its prevalence at 6.1% in Uganda. It has adverse effects on mothers and their families with severe consequences. Depressed mothers loose interest in most aspects of their life including their children who are strongly dependent on them, leading to serious neglect. This may affect the children’s development.

    Aims: The aim of this study protocol is to examine if maternal postpartum depression affects child development amongst one-year olds in rural Uganda.

    Methods: It will be a prospective cohort study and a quantitative approach will be used with structured questionnaires for data collection that’s maternal postpartum depression status and socio demography data, and the child’s development. Mother’s postpartum depression will be assessed first at 2 months after birth. Secondly their children’s development will be measured and assessed at 6 months and at 12 months in the one-year follow-up period. A sample of 114 mother-infant pairs is required and quantitative statistical methods will be used for data analyzes.

    Expected Outcomes: This study will generate scientific knowledge on the effects of postpartum depression on child development in a rural setting of a developing country. The findings will identify which children are at most risk of having development issues. Lastly, the findings could be used to formulate appropriate strategies and interventions to combat depression and its effects on child development.

  • 15.
    Baroudi, Mazen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Petersen, Solveig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Namatovu, Fredinah
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Annelie, Carlsson
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Preteen children’s health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups2019Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, artikel-id 139Artikel i tidskrift (Refereegranskat)
    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.

  • 16. 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 universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    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 sites2019Ingår i: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 9, nr 1, s. 1-15, artikel-id 010901Artikel i tidskrift (Refereegranskat)
    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.

  • 17.
    Baxter, Rebecca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Björk, Sabine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Sköldunger, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sjögren, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.
    Bergland, Ådel
    Winblad, Bengt
    Edvardsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Nursing & Midwifery, La Trobe University, Melbourne, Australia.
    The thriving of older people assessment scale: Psychometric evaluation and short‐form development2019Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648Artikel i tidskrift (Refereegranskat)
    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.

  • 18.
    Bergman, Joakim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Svenningsson, A.
    Liv, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Burman, J.
    Poor correlation between protein levels in different CNS compartments in patients with progressive MS2019Ingår i: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 25, s. 432-433Artikel i tidskrift (Övrigt vetenskapligt)
  • 19.
    Björnebäck, Michaela
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Health care access for rural youths: a qualitative study in Northern Sweden2018Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 20.
    Blomfeldt, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Medical students’ views on and attitude towards prevention and health promotion in health care2018Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 21.
    Blomstedt, Yulia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Research Unit Medicine-Geriatric Clinic, Skellefteå County Hospital, SE-931 86 Skellefteå, Sweden..
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al2019Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, nr 1, artikel-id 1095Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An evaluation of Vasterbotten Intervention Programme (VIP) was recently conducted by San Sebastian et al. (BMC Public Health 19:202, 2019). Evaluation of health care interventions of this kind require 1) an understanding of both the design and the nature of the intervention, 2) correct definition of the target population, and 3) careful choice of the appropriate evaluation method. In this correspondence, we review the approach used by San Sebastian et al. as relates to these three criteria. Within this framework, we suggest important explanations for why the conclusions drawn by these authors contradict a large body of research on the effectiveness of the VIP.

  • 22.
    Blåhed, Hanna
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Politics and health outcomes in Sweden: Does voter turnout influence health? A path analysis approach2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Previous studies on politics and health heavily stems from research by Navarro et al and Mackenbach et al. Their findings have shown that political traditions have influenced implementation of health-policies differently, which have had impacts on health outcomes. While previous authors have approached the subject of politics and health by studying political traditions, I wished to examine whether political participation in the shape of voter turnout, had any influence on health. Thus, the objective of this study was to examine if voter turnout was associated to health, and if the labour market, welfare state and the level of socioeconomic inequalities mediated this possible relationship, in the context of Sweden.

    Methods: Aggregated data on county level (in total 21) was used to perform the analysis. Variables used included voter turnout, unemployment, non-eligibility to enter upper secondary school, trust towards health care, the Gini coefficient and the regional GDP per capita. The health outcomes included heart attack rate, overweight and psychosocial distress prevalence. The data was collected between the years of 2014-2018, and retrieved from Statistics Sweden, the Swedish National Agency for Education, the Swedish Association of Local Authorities and Regions, the Public Health Agency of Sweden and the National Board of Health and Welfare. Path analysis, a form of structural equation modelling, was applied and direct, indirect and total effects were calculated in order to establish relationships.

    Results: No relationship was found between voter turnout and health outcomes in the final model. However, associations were observed between unemployment and heart attack both in the female (b = -0.43, p = 0.027) and male population (b = -0.39, p = 0.043). Lack of education, in terms of non-eligibility to enter upper secondary school, was correlated to heart attack among women (b =0.63, p = 0.004) as well as among men (b = 0.65, p = 0.002). Both unemployment and lack of education were mediated by Gini and GDP. Gini and heart attack among women was directly correlated (b =-0.44, p = 0.011), likewise for men (b = -0.48, p = 0.003). Gini was also related to overweight among women (b =-0.50, p = 0.041). GDP showed an association between heart attack among the female (b =-0.40, p = 0.008) and the male population (b = -039, p = 0.006), respectively. Lastly, an observed negative correlation between GDP and overweight in men was detected (b =-0.26, p = 0.001).

    Conclusion: This study concluded that health outcomes are not directly linked to political participation, in terms of voter turnout. Instead, the analysed health outcomes seemed to be mainly associated with unemployment, lack of education, and socioeconomic and income inequalities. Surprisingly, the results showed that unemployment seemed to decrease heart attack among both women and men. However, as lack of education increased, heart attack among women and men increased. It was also unexpected that high income inequalities (Gini) seemed to decrease heart attack among both women and men, as well among overweight women. Further research including sub-analysis, confounders and specific variables is required in order to confirm, or not, these findings.

  • 23.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Correlation between noncommunicable disease mortality in people aged 30-69 years and those aged 70-89 years2019Ingår i: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 97, nr 9, s. 589-596Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate whether the key metric for monitoring progress towards sustainable development goal target 3.4 that is measuring premature noncommunicable disease mortality (deaths among people aged 30-69 years), is ageist.

    Methods: To examine the relationship between premature noncommunicable disease mortality and noncommunicable disease mortality in older people, a database of mortality rates for cardiovascular disease, cancer, chronic obstructive pulmonary disease and diabetes in people aged 30 to 69 years and 70 to 89 years was compiled using estimates from the Global Burden of Disease Study 2017. The data covered 195 countries, six time-points and both sexes, giving 2340 instances. The World Health Organization's (WHO's) life-table method for the premature noncommunicable disease mortality metric was applied to the data.

    Findings: There was a strong correlation between noncommunicable disease mortality patterns in the premature and older age groups, which suggests that measuring premature noncommunicable disease mortality is informative about such mortality in later life. Neither time nor geographical location had a substantial effect on this correlation. However, there were female-to-male differences in age-specific probabilities of death due to noncommunicable disease, implying that noncommunicable disease mortality should be assessed using a sex-disaggregated approach.

    Conclusion: As the established WHO metric for premature noncommunicable disease mortality was predictive of noncommunicable disease mortality in older people, the metric should not be construed as ageist Focusing resources on measuring premature noncommunicable disease mortality will be appropriate, particularly in settings without universal civil death registration. This approach should not prejudice the provision of health services throughout the life-course.

  • 24.
    Byass, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. 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 universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa; INDEPTH Network, Accra, Ghana.
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. 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 model2019Ingår i: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 17, artikel-id 102Artikel i tidskrift (Refereegranskat)
    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.

  • 25.
    Byass, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nurturing Global Health Action through its first decade2019Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, nr 1, artikel-id 1569847Artikel i tidskrift (Refereegranskat)
  • 26.
    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 universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    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 Goals2019Ingår i: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237Artikel i tidskrift (Refereegranskat)
    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.

  • 27.
    Bölenius, Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lämås, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Division of Caring Sciences, Depart Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden..
    Lindkvist, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Edvardsson, David
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. 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 study2019Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, artikel-id 142Artikel i tidskrift (Refereegranskat)
    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.

  • 28. Capasso, Ariadna
    et al.
    Ompad, Danielle C.
    Vieira, Dorice L.
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Tozan, Yesim
    Incidence of Guillain-Barre Syndrome (GBS) in Latin America and the Caribbean before and during the 2015-2016 Zika virus epidemic: A systematic review and meta-analysis2019Ingår i: PLoS Neglected Tropical Diseases, ISSN 1935-2727, E-ISSN 1935-2735, Vol. 13, nr 8, artikel-id e0007622Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: A severe neurological disorder, Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis. Enhanced surveillance of GBS in Latin America and the Caribbean (LAC) following the 2015–2016 Zika virus (ZIKV) epidemic presents an opportunity to estimate, for the first time, the regional incidence of GBS.

    Methods and findings: For this systematic review and meta-analysis, we searched nine scientific databases and grey literature from January 1, 1980 to October 1, 2018. Sources with primary data on incident GBS cases in LAC within a well-defined population and timeframe, published in English, Spanish, Portuguese, or French, were included. We calculated the annual GBS incidence rates (IRs) and 95% confidence intervals (CIs) for each source based on published data. Following an assessment of heterogeneity, we used random-effects meta-analysis to calculate the pooled annual IR of GBS. The study is registered with PROSPERO, number CRD42018086659. Of the 6568 initial citation hits, 31 were eligible for inclusion. Background annual GBS IRs in Latin America ranged from 0.40 in Brazil to 2.12/100,000 in Chile. The pooled annual IR in the Caribbean was 1.64 (95% CI 1.29–2.12, I2<0.01, p = 0.44). During the ZIKV epidemic, GBS IRs ranged from 0.62 in Mexico to 9.35/100,000 in Martinique. GBS increased 2.6 (95% CI 2.3–2.9) times during ZIKV and 1.9 (95% CI 1.1–3.4) times during chikungunya outbreaks over background rates. A limitation of this review is that the studies included employed different methodologies to find and ascertain cases of GBS, which could contribute to IR heterogeneity. In addition, it is important to consider that data on GBS are lacking for many countries in the region.

    Conclusions: Background IRs of GBS appear to peak during arboviral disease outbreaks. The current review contributes to an understanding of the epidemiology of GBS in the LAC region, which can inform healthcare system planning and preparedness, particularly during arboviral epidemics.

  • 29.
    Cheik, Aung Khun
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Is women empowerment important for maternal health care seeking practice in Myanmar?: A cross sectional study2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Women in low and middle-income countries are often vulnerable in their sexual and reproductive health. Women empowerment has been highlighted in many studies as important for better sexual and reproductive health outcomes. However, even if many studies have examined the relationship between women empowerment and maternal health care seeking practice in the developing world, this issue rarely has been studied in the context of Myanmar. The aim of this research thus is to examine the association between women empowerment and skilled birth attendance in Myanmar.

    Methods: In this study, data comes from the cross-sectional Myanmar Demographic and Health Survey carried out in 2015-2016, which is a nationally representative survey covering demographic and health-related characteristics in Myanmar. The analytical sample included 3,617 women aged 15-49 years who had given birth in last five years, selecting from a total number of 12,885 women aged 15-49 years. The ability for women to decide jointly with partner or independently over health care utilization was used as an indicator of women empowerment while delivery care by skilled birth attendant was used as a measure of maternal health care seeking practice. Odds Ratio was used in logistic regression analyses to study the association between indicator of women empowerment and skilled birth attendance in Myanmar.

    Results: Results from the univariate logistic regression indicated that women with higher levels of empowerment had a 1.62 times (95% CI=1.27-2.06) higher odds of having skilled birth attendance, compared to women with less empowerment. After adjusting for potential confounders such as women and partner education, women age group, area of residence, in a multivariate logistic regression analysis, the results still showed that women with higher levels of empowerment had a 1.44 times (95% CI=1.11-1.87) higher odds of having skilled birth attendance, compared to women with less empowerment.

    Conclusion: Our findings suggest that women empowerment might be important to obtain birth attendance from a skilled professional in Myanmar. This result remained even after controlling for known social- and sociodemographic characteristic. Policies and health promotion programs working to expand the utilization of skilled birth attendants should consider women empowerment as a potentially important factor. For example, school education about association of womeniiiempowerment and maternal health outcome would be bargained investment for future generation.

  • 30.
    Cholponkulova, Asel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Job Insecurity effects on health: EQ-5D based survey on health-related quality of life2018Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Due to the rising financialization of the global economy in the recent decades (including Sweden’s 3 financial crises in 1992, 2000 and 2008) job insecurity is increasing even for highly educated groups and high-income countries.

    Aim: to measure how job insecurity is associated with health-related quality of life, with a focus on the effect on subgroups, divided by age, gender, education, marital status and previous health.

    Methods: Health effects were measured by a cross-sectional survey among 967 respondents (38.7% response rate), aged 20-64, who were registered in Sweden. Questionnaire included demographic background (age, education, marital status), health status, job-insecurity exposure, and EQ-D5 instrument with 5 dimensions of health-related quality of life: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. Statistical analysis was done by multiple logistic regression.

    Results: of the 967 respondents 808 were included into analysis. The individuals with job insecurity had significantly higher problems with usual activities (OR= 2.78, CI= 1.47-5.28, p = 0.002), anxiety and depression (OR 2.36, CI= 1.52-3.66, p= 0.000), and pain and discomfort (OR= 1.67, CI= 1.06-2.61, p= 0.024). In stratified results, poorer health was found for groups of women, middle aged, primary school graduates, living with a partner, and with previous bad health.

    Conclusion: Results show that physical and especially mental health are both affected negatively by job insecurity. Research considerations: further country level and cross-country comparative research, with labor policies, unemployment insurance coverage, level of financialization, level of voter financial literacy, could help to explain wide differences in previous results (especially between US, Germany and Sweden), and to shape better integrated labor, health, fiscal and monetary policy.

  • 31. 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 universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    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 Africa2019Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, nr 1, artikel-id 1608013Artikel i tidskrift (Refereegranskat)
    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.

  • 32.
    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 universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    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 virus2019Ingår i: Transboundary and Emerging Diseases, ISSN 1865-1674, E-ISSN 1865-1682Artikel i tidskrift (Refereegranskat)
    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.

  • 33. Draper, Catherine E.
    et al.
    Tomaz, Simone A.
    Jones, Rachel A.
    Hinkley, Trina
    Twine, Rhian
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. 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 age2019Ingår i: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 22, nr 4, s. 614-623Artikel i tidskrift (Refereegranskat)
    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.

  • 34. Dubouis, Ghislain
    et al.
    Sovacool, Benjamin
    Aall, Carlo
    Nilsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Barbier, Carine
    Herrmann, Alina
    Bruyère, Sébastien
    Andersson, Camilla
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Sköld, Bore
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    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 futures2019Ingår i: Energy Research & Social Science, ISSN 2214-6296, E-ISSN 2214-6326, Vol. 52, s. 144-158Artikel i tidskrift (Refereegranskat)
    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.

  • 35. Edem, Idara J.
    et al.
    Dare, Anna J.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. 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 study2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 6, artikel-id e027576Artikel i tidskrift (Refereegranskat)
    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.

  • 36.
    Eid, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Biomedical Sciences Research, Faculty of Medicine, San Simon University, Cochabamba, Bolivia.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Pulkki-Brännström, Anni-Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    "Cheaper and better": an economic analysis of changing first line treatment for cutaneous leishmaniasis in BoliviaManuskript (preprint) (Övrigt vetenskapligt)
    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.

  • 37.
    Eid Rodríguez, Daniel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Biomedical Sciences Research, Faculty of Medicine, San Simon University, Cochabamba, Bolivia.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Pulkki-Brännström, Anni-Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    "Cheaper and better": Societal cost savings and budget impact of changing from systemic to intralesional pentavalent antimonials as the first-line treatment for cutaneous leishmaniasis in Bolivia2019Ingår i: PLoS Neglected Tropical Diseases, ISSN 1935-2727, E-ISSN 1935-2735, Vol. 13, nr 11, artikel-id e0007788Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Cutaneous leishmaniasis (CL), endemic in Bolivia, mostly affects 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 and a lack of safe conditions to deliver treatment 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 a Bolivian endemic area.

    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. Costs were reported in 2017 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. Switching first-line treatment to ILPA while maintaining the current budget would allow two-and-a-half times the current number of patients to be treated. ILPA remained cost-saving compared to SPA in the sensitivity analysis.

    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.

  • 38.
    Eid Rodríguez, Daniel V.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The rough journey to access health care: the case of leishmaniasis in the Bolivian rainforest2019Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

  • 39. Ekstrand, Joakim
    et al.
    Petersson, Pia
    Westergren, Albert
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Preventiva hembesök till seniorer - har vi råd att inte satsa?2019Ingår i: Svensk geriatrik, nr 1, s. 24-27Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 40.
    Eriksson, Malin
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lindgren, Urban
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för geografi.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The effect of neighbourhood social capital on child injuries: a gender-stratified analysis2019Ingår i: Health & Place, Vol. 60, artikel-id 102205Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We designed a longitudinal retrospective cohort study to analyse the associations between neighbourhood social capital and child injures. Register data from the Umeå Simsam Lab in Sweden was used to measure child injuries and demographic and socioeconomic factors at individual, household and neighbourhood level. A social capital score from a previous survey was used to measure neighbourhood social capital. We conducted a three-level multilevel negative binomial regression analysis, with children (level 1, N = 77,193) nested within households (level 2, N = 10,465), and households nested within neighbourhoods (level 3, N = 49). The incidence rate of child injuries was lower in high social capital neighbourhoods. When controlling for factors at individual, household and neighbourhood levels, living in a high social capital neighbourhood was protective of injuries among girls, but not among boys. Promoting social capital in local neighbourhoods could be seen as a prevention strategy for injuries among girls.

  • 41. Escolar-Pujolar, Antonio
    et al.
    Córdoba Doña, Juan Antonio
    Goicolea Julían, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    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 Andalucía2018Ingår i: Endocrinología, Diabetes y Nutrición, ISSN 2530-0180, Vol. 65, nr 1, s. 21-29Artikel i tidskrift (Refereegranskat)
    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.

  • 42. Estalella, Itziar
    et al.
    San Millán, Jaione
    Trincado, María José
    Maquibar, Amaia
    Martínez-Indart, Lorea
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay2019Ingår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Artikel i tidskrift (Refereegranskat)
    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.

  • 43.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cultural parenting programmes could play an important role in helping immigrants adapt to their host countries2019Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, nr 8, s. 1491-1491Artikel i tidskrift (Övrigt vetenskapligt)
  • 44.
    Eurenius, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Richter Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Vaezghasemi, Masoud
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social-emotional problems among three-year-olds differ based on the child's gender and custody arrangement2019Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, nr 6, s. 1087-1095Artikel i tidskrift (Refereegranskat)
    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.

  • 45. Fearon, Elizabeth
    et al.
    Wiggins, Richard D.
    Pettifor, Audrey E.
    MacPhail, Catherine
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. 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)2019Ingår i: Aids and Behavior, ISSN 1090-7165, E-ISSN 1573-3254, Vol. 23, nr 6, s. 1471-1483Artikel i tidskrift (Refereegranskat)
    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.

  • 46.
    Fonseca Rodriguez, Osvaldo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Häggström Lundevaller, Erling
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Sheridan, Scott C
    Department of Geography, Kent State University, Kent, OH 4242, USA.
    Schumann, Barbara
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Association between Weather Types based on the Spatial Synoptic Classification and All-Cause Mortality in Sweden, 1991⁻20142019Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, nr 10, artikel-id 1696Artikel i tidskrift (Refereegranskat)
    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.

  • 47.
    Fonseca-Rodríguez, Osvaldo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    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 Brazil2019Ingår i: Journal of Equine Veterinary Science, ISSN 0737-0806, E-ISSN 1542-7412, Vol. 78, s. 14-19Artikel i tidskrift (Refereegranskat)
    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.

  • 48.
    Fors, Ronny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Ortodonti.
    Stenberg, Berndt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Persson, Maurits
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Ortodonti.
    Nickel allergy in relation to piercing and orthodontic appliances: a population study2012Ingår i: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 67, nr 6, s. 342-350Artikel i tidskrift (Refereegranskat)
    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.

  • 49. Fritzell, S.
    et al.
    Trygg, Nadja
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Public Health Agency of Sweden, Solna, Sweden.
    Busch, H.
    Bremberg, S.
    Inequalities in determinants and mental health in Sweden: results from a governmental initiative2018Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, s. 124-124Artikel i tidskrift (Övrigt vetenskapligt)
    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.

  • 50. Fritzell, S.
    et al.
    Trygg, Nadja
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Public Health Agency of Sweden, Solna, Sweden.
    Busch, H.
    Bremberg, S.
    Scoping the evidence on mental health inequalities and underlying determinants in Sweden2018Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, s. 316-316Artikel i tidskrift (Övrigt vetenskapligt)
    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.

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