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  • 1.
    Blomstedt, Yulia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlén, Klas Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nilsson, Ingeborg
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Brändström, Anders
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Elderly care in Swedish welfare state: implications of the population ageing2013Inngår i: Global aging issues and policies: understanding the importance of comprehending and studying the aging process / [ed] Yushi Li, Springfield: Charles C. Thomas Publisher Ltd., 2013, s. 226-244Kapittel i bok, del av antologi (Fagfellevurdert)
  • 2.
    Daerga, Laila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Edin-Liljegren, A
    Dahlgren, L
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lack of trust in health and social services among reindeer herding Sami in SwedenInngår i: Artikkel i tidsskrift (Fagfellevurdert)
  • 3. Dalmar, Abdirisak Ahmed
    et al.
    Hussein, Abdullahi Sheik
    Walhad, Said Ahmed
    Ibrahim, Abdirashid Omer
    Abdi, Abshir Ali
    Ali, Mohamed Khalid
    Ereg, Derie Ismail
    Egal, Khadra Ali
    Shirwa, Abdulkadir Mohamed
    Aden, Mohamed Hussain
    Yusuf, Marian Warsame
    Abdi, Yakoub Aden
    Freij, Lennart
    Johansson, Annika
    Mohamud, Khalif Bile
    Abdulkadir, Yusuf
    Emmelin, Maria
    Eriksen, Jaran
    Erlandsson, Kerstin
    Gustafsson, Lars L.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Klingberg-Allvin, Marie
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Källestål, Carina
    Målqvist, Mats
    Osman, Fatumo
    Persson, Lars-Åke
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Rebuilding research capacity in fragile states: the case of a Somali-Swedish global health initiative2017Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, nr 1, artikkel-id 1348693Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.

  • 4. Edin-Liljegren, A
    et al.
    Daerga, Laila
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Jacobsson, L
    Psychosocial perspectives on working conditions among reindeer herding Sami in SwedenInngår i: Artikkel i tidsskrift (Fagfellevurdert)
  • 5.
    Edin-Liljegren, Anette
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Västerbottens läns landsting.
    Daerga, Laila
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Västerbottens läns landsting.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Institutionen för omvårdnad.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Psychosocial Perspectives on Working Conditions among Men and Women in Reindeer Breeding in Sweden2017Inngår i: Journal of Northern Studies, ISSN 1654-5915, Vol. 11, nr 2, s. 31-47Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this project was to describe the work organisation in the Sami communities and in reindeer-herding work and to explore the range of female duties and compare how men and women experience their psychosocial working conditions. Design: A kind of intervention study was performed by means of a questionnaire sent out to 200 individuals from seven Sami communities. Questions were asked about work organisation, communication, personal relations, solitary work, support, participation and appreciation from colleagues and women's tasks. Meetings and discussions were held about what was perceived as being important in the life of the Sami communities. Notes from 16 group discussions were written down and analysed according to themes of topics relating to how men and women in the Sami communities experience their lives. Results: Communication and relations were described as being inadequate and some respondents experienced a heavy workload. The women reported more troubled relations, less participation in decision-making and less appreciation from colleagues. Positive issues reported were the Sami identity and a strong connection to the reindeer and to nature. Conclusions: This study indicates a need for a more systematic study of the psychosocial work conditions in the Sami communities in Sweden. Measures should be taken to develop the organisation of work, e.g. through developing communication strategies and conflict management, which has been requested by several Sami communities.

  • 6.
    Edin-Liljegren, Anette
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Daerga, Laila
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Reindeer-herding Sami experiences of seeking care in the mainstream society2016Inngår i: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 75, nr 33200Artikkel i tidsskrift (Fagfellevurdert)
  • 7.
    Hoi, Le Van
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Tien, Nguyen Thi Kim
    Tien, Nguyen Van
    Dung, Dao Van
    Chuc, Nguyen Thi Kim
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlen, Klas Göran
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS). Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Willingness to use and pay for options of care for community dwelling older people in rural Vietnam2012Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, s. 36-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The proportion of people in Vietnam who are 60 years and over has increased rapidly. The emigration of young people and impact of other socioeconomic changes leave more elderly on their own and with less family support. This study assesses the willingness to use and pay for different models of care for community-dwelling elderly in rural Vietnam.

    Methods: In 2007, people aged 60 and older and their family representatives, living in 2,240 households, were randomly selected from the FilaBavi Demographic Surveillance Site. They were interviewed using structured questionnaires to assess dependence in activities of daily living (ADLs), willingness to use and to pay for day care centres, mobile care teams, and nursing centres. Respondent socioeconomic characteristics were extracted from the FilaBavi repeated census. Percentages of those willing to use models and the average amount (with 95% confidence intervals) they are willing to pay were estimated. Multivariate analyses were performed to measure the relationship of willingness to use services with ADL index and socioeconomic factors. Four focus group discussions were conducted to explore people's perspectives on the use of services. The first discussion group was with the elderly. The second discussion group was with their household members. Two other discussion groups included community association representatives, one at the communal level and another at the village level.

    Results: Use of mobile team care is the most requested service. The fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than do the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require that services be free-of-charge is two to three times higher than the proportion willing to pay full cost. Households are willing to pay more than the elderly for day care and nursing centres. The elderly are more willing to pay for mobile teams than are their households. Age group, sex, literacy, marital status, living arrangement, living area, working status, poverty, household wealth and dependence in ADLs are factors related to willingness to use services.

    Conclusions: Community-centric elderly care will be used and partly paid for by individuals if it is provided by the government or associations. Capacity building for health professional networks and informal caregivers is essential for developing formal care models. Additional support is needed for the most vulnerable elderly to access services.

  • 8.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Johansson, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Mohamud, Khalif Bile
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Freij, Lennart
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Dalmar, Abdirisak Ahmed
    Ibrahim, Abdirashid Omer
    Hagi, Abdisamad Abikar
    Abdi, Abshir Ali
    Hussein, Abdullahi Sheik
    Shirwa, Abdulkadir Mohamed
    Warsame, Amina
    Ereg, Derie Ismail
    Aden, Mohamed Hussain
    Qasim, Maryan
    Ali, Mohamed Khalid
    Elmi, Abdullahi
    Afrah, Abdullahi Warsame
    Sabtiye, Faduma Omar
    Guled, Fatuma Ege
    Ahmed, Hinda Jama
    Mohamed, Halima
    Tinay, Halima Ali
    Mohamud, Kadigia Ali
    Yusuf, Mariam Warsame
    Omar, Mayeh
    Abdi, Yakoub Aden
    Abdulkadir, Yusuf
    Johansson, Annika
    Kulane, Asli Ali
    Schumann, Barbara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Essen, Birgitta
    Kalengayi, Faustine Nkulu
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Norder, Helene
    Schröders, Julia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Erlandsson, Kerstin
    Edin, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Gustafsson, Lars L.
    Persson, Lars-Ake
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Emmelin, Maria
    Hasselberg, Marie
    Klingberg, Marie
    Preet, Raman
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hogberg, Ulf
    Sjostrom, Urban
    Omar, Saif
    Healing the health system after civil unrest2015Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, s. 1-4Artikkel i tidsskrift (Annet vitenskapelig)
  • 9. Kobayashi, H.
    et al.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Distributed resources and care choice: formulation through the capability approach2016Konferansepaper (Fagfellevurdert)
  • 10.
    Lindholm, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Löfgren, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Meili, Kaspar
    Nygren, Lennart
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Pulkki-Brännström, Anni-Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nytt sätt att mäta livskvalitet öppnar för effektivare insatser2018Inngår i: Dagens samhälle, ISSN 1652-6511, nr 31, s. 26-26Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 11.
    Löfgren, Curt
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ming, HV
    Thanh, NX
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Catastrophic Health Expenditure and Impoverishment among the Elderly Households in Vietnam.Inngår i: Artikkel i tidsskrift (Fagfellevurdert)
  • 12.
    Moshi, Haleluya
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Faculty of Rehabilitation Medicine, Physiotherapy Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Traumatic spinal cord injury in the north-east Tanzania: describing incidence, etiology and clinical outcomes retrospectively2017Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, nr 1, artikkel-id 1355604Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Causes, magnitude and consequences of traumatic spinal cord injury depend largely on geography, infrastructure, socioeconomic and cultural activities of a given region. There is a scarcity of literature on profile of traumatic spinal cord injury to inform prevention and rehabilitation of this health condition in African rural settings, particularly Tanzania. Objective: To describe the incidence, etiology and clinical outcomes of traumatic spinal cord injury and issues related to retrospective study in underdeveloped setting.

    Methods: Records for patients with traumatic spinal cord injury for five consecutive years (2010–2014) were obtained retrospectively from the admission wards and health records archives of the Kilimanjaro Christian Medical Center. Sociodemographic, cause, complications and patients’ condition on discharge were recorded and analyzed descriptively.

    Results: The admission books in the wards registered 288 new traumatic spinal cord injury cases from January 2010 to December 2014. Of the 288 cases registered in the books, 224 were males and 64 females with mean age 39.1(39.1 ± 16.3) years and the majority of individuals 196(68.1%) were aged between 16 and 45 years. A search of the hospital archives provided 213 full patient records in which the leading cause of injury was falls 104(48.8%) followed by road traffic accidents 73(34.3%). Cervical 81(39.9%) and lumbar 71(34.74%) spinal levels were the most affected. The annual incidence for the Kilimanjaro region (population 1,640,087) was estimated at more than 26 persons per million population. The most docu- mented complications were pressure ulcers 42(19.7%), respiratory complications 32(15.0%) and multiple complications 28(13.1%). The mean length of hospital stay was 64.2 ± 54.3 days and the mortality rate was 24.4%.

    Conclusion: Prevention of traumatic spinal cord injury in North-east Tanzania should consider falls (particularly from height) as the leading cause, targeting male teenagers and young adults. Pressure ulcers, respiratory complications, in-hospital mortality and availability of wheelchairs should be addressed. 

  • 13.
    Moshi, Haleluya
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Kilimanjaro Cristian Medical University College, Moshi, Tanzania.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Anthea, Rhoda
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Coping Resources for Persons With Traumatic Spinal Cord Injury in A Tanzania Rural Area2018Inngår i: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 10, nr 5, s. 138-153Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Persons with traumatic spinal cord injury (TSCI) in Tanzanian rural settings face a variety of geographical and socioeconomic challenges that make life almost impossible for them. However, some have managed to live relatively long lives despite these difficult conditions. This study aimed at exploring secrets behind successful lives of persons with TSCI in typical resource-constrained rural Tanzanian settings.

    METHODS: A modified constructivist grounded theory was employed for the analysis of data from 10 individuals who have lived between 7 and 28 years with TSCI in typical Tanzanian rural area. The 10 were purposively selected from 15 interviews that were conducted in 2011. The analysis followed the constructivist approach in which data was first open and axial coded, prior to categories being constructed. The categories were frequently reviewed in light of the available literature to determine the over-arching core category that described or connected the rest.

    RESULTS: Nine categories (identified as internal and external coping resources) were constructed. The internal coping resources were: secured in God, increase in awareness on health risk, problem-solving skills and social skills. External coping resources were: having a reliable family, varying support from the community, a matter of possession and left without means for mobility. Acceptance was later identified as a core category that determines identification and utilization of the rest of the coping resources.

    CONCLUSION: Persons with traumatic spinal cord injury can survive for a relatively long time despite the hostile environment. Coping with these environments requires the employment of various coping resources, acceptance being the most important.

  • 14.
    Moshi, Haleluya
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Incidence of traumatic spinal cord injury and prevalence of medical complications among hospitalized patients at Kilimanjaro: a one year prospective studyManuskript (preprint) (Annet vitenskapelig)
  • 15.
    Moshi, Haleluya
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Quality of life of persons with traumatic spinal cord injury in rural Kilimanjaro, Tanzania: a community surveyManuskript (preprint) (Annet vitenskapelig)
  • 16.
    Norström, Fredrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Waenerlund, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nygren, Rebecka
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Brydsten, Anna
    Stockholms universitet.
    Does unemployment contribute to poorer health-related quality of life among Swedish adults?2019Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, artikkel-id 457Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Previous studies have shown that unemployment has negative impacts on various aspects of health. However, little is known about the effect of unemployment on health-related quality of life. Our aim was to examine how unemployment impacts upon health-related quality of life among Swedish adults, and to investigate these effects on population subgroups defined by education level, marital status, previous health, and gender.

    METHODS: As part of a cross-sectional study, a questionnaire was sent to 2500 randomly selected individuals aged 20 to 64 years living in Sweden in 2016. The questionnaire included the EuroQol 5 dimensions (EQ-5D) instrument and was answered by 967 individuals (39%). Quality-adjusted life year (QALY) scores were derived from the EQ-5D responses. Of the respondents, 113 were unemployed and 724 were employed. We used inverse probability-weighted propensity scores in our analyses to estimate a risk difference. Gender, age, education level, marital status, and previous health were used as covariates in our analyses.

    RESULTS: There was a statistically significant lower QALY score by 0.096 points for the unemployed compared to the employed. There were also statistically significant more problems due to unemployment for usual activities (6.6% more), anxiety/depression (23.6% more), and EQ-5D's Visual Analogue Scale (7.5 point lower score). Grouped analyses indicated a larger negative health effect from becoming unemployed for men, those who are married, and young individuals.

    CONCLUSIONS: In our study, we show that the health deterioration from unemployment is likely to be large, as our estimated effect implies an almost 10% worse health (in absolute terms) from being unemployed compared to being employed. This further highlights that unemployment is a public health problem that needs more focus. Our study also raises further demands for determining for whom unemployment has the most negative effects and thus suggesting groups of individuals who are in greatest need for labor market measures.

  • 17.
    Rocklöv, Joacim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Bao Giang, Kim
    Van Minh, Hoang
    Ebi, Kristie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Univ Washington, Sch Publ Hlth, Seattle, WA 98195 USA.
    Nilsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Local research evidence for public health interventions against climate change in Vietnam2014Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, artikkel-id 26552Artikkel i tidsskrift (Fagfellevurdert)
  • 18.
    Sahlen, Klas Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Löfgren, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hellner, Britt Mari
    IMS, Institutet för metodutveckling i socialt arbete, Socialstyrelsen.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Preventive home visits to older people are cost-effective2008Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, s. 265-271Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: There is ongoing debate over the effectiveness of preventive home visits (PHVs) for the elderly. A municipality in the north of Sweden carried out a controlled trial of such visits. Healthy seniors aged 75 years and over received two PHVs per year over 2 years. The aim of this study was to do a cost utility analysis of the intervention.

    Methods: The intervention group (n=196) was compared with a control group (n=346), and a cost utility analysis was performed. The analysis was carried out with three different time perspectives. Data were sourced from official documents and medical and social records.

    Results: From a societal perspective, using a time period of 4 years, the analysis of PHVs to healthy seniors showed net savings. When including estimated future costs for health and elderly care during gained life years, the result changed from a net saving to a cost of Euro 200,000. A lifetime perspective also resulted in net savings if the costs of future health and elderly care were not included in the analysis. In this case, the total costs rose to approximately Euro 900,000. The cost could also be expressed as Euro 14,200 per quality-adjusted life year gained if future costs for elderly care and healthcare were included.

    Conclusions: PHVs represent a cost-effective intervention in this setting. The costs are justified by the outcomes.

  • 19.
    Sahlen, Klas Göran Sahlen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hellner, Britt Mari
    IMS, Institutet för metodutveckling i socialt arbete, Socialstyrelsen.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Preventive home visits postpone mortality: a controlled trial with time-limited results2006Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 6, nr 220Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There is a debate on whether preventive home visits to older people have any impact. This study was undertaken to investigate whether preventive home visits by professional health workers to older persons can postpone mortality in a Swedish context.

    Method: A controlled trial in a small community in the north of Sweden. Participants are healthy pensioners aged 75 years and over. 196 pensioners were selected as the intervention group and 346 as the control group. The intervention, two visits per year, lasted two years.

    Results: During the intervention, mortality was 27 per 1000 in the intervention group and 48 per 1000 in the control group. The incidence rate ratio for the control group IR2000–2001 was 1,79 (95%CI = 0,94–3,40). Analysing the data with an "on treatment approach" gave a significant result, 2,31 (95%CI = 1,07–5,02) After the trial the difference between the groups disappeared.

    Conclusion: Preventive home visits in a healthy older population can postpone mortality in a Swedish context if they are carried out by professional health-workers in a structured way. When the home visit programme ended the effect on mortality disappeared. These findings are dependent on contextual factors that make it difficult to form general policy recommendations.

  • 20.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Implementering av verksamhet med förebyggande hembesök:: Nordmalings kommun - primärvården i Nordmaling2005Rapport (Annet (populærvitenskap, debatt, mm))
  • 21.
    Sahlen, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Brännström, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    A cost-effectiveness study of person-centered integrated heart failure and palliative home care: based on a randomized controlled trial2016Inngår i: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 30, nr 3, s. 296-302Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion.

    Aim: To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care.

    Design: A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients’ responses to the EQ-5D quality of life instrument.

    Setting/participants: Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital.

    Results: EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs.

    Conclusion: The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.

  • 22.
    Sahlen, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Health coaching to promote healthier lifestyle among older people at moderate risk for cardiovascular diseases, diabetes and depression: a study protocol for a randomized controlled trial in Sweden2013Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, nr 199Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The challenge of an aging population in the society makes it important to find strategies to promote health for all. The aim of this study is to evaluate if repeated health coaching in terms of motivational interviewing, and an offer of wide range of activities, will contribute to positive lifestyle modifications and health among persons aged 60-75 years, with moderately elevated risk for cardiovascular disease (CVD), diabetes, or mild depression.

    METHODS/DESIGN: Men and women between 60 and 75 are recruited in four regions in Sweden if they fulfill one or more of the four inclusion criteria.•Current reading of blood pressure (140-159/90-99) without medication.•Current reading of blood sugar (Hba1c 42-52 mmol/mol) without medication.•A current waist-circumference of ≥94 cm for men and ≥80 for women.•A minor/mild depression (12-20 points) according to Montgomery-Åsberg Depression Rating Scale without medication.Individuals with a worse result than inclusion criteria are treated according to regular guidelines at the PHCs and therefore not included. Exclusion criteria for the study are dementia, mental illness or other condition deemed unsuitable for participation.All participants fill out a questionnaire at baseline, and at the 6-, 12- and 18-month follow-ups containing questions on demographic characteristics, social life, HRQoL, lifestyle habits, general health/medication, self-rated mental health, and sense of coherence. At the 12-month follow-up, the health coach will give each participant a second questionnaire to capture attitudes and perceptions related to health coaching and venues/activities offered.Qualitative data will be collected twice to obtain a deeper understanding of perceptions and attitudes related to health and lifestyle/lifestyle modifications. A health economic assessment will be performed. Individual costs for health care utilisation will be collected and QALY-scores will be estimated.

    DISCUSSION: Several drawbacks can be identified when conducting research in real life. However, many of the identified problems can diminish the positive results of the intervention and if the intervention shows positive effects they might be underestimated.

  • 23.
    Sahlen, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Löfgren, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Brodin, Håkan
    FHI, Folkhälsoinstitutet.
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Measuring the value of old people’s production: ideas based on diariesInngår i: Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective:

    Productive capacity is usually not valued for seniors who have retired. However, some seniors produce much more than we expect. In this diary-study senior activities are identified and value mechanisms are suggested. One question raised is if it is possible to scale up this diary study into a larger representative study.

    Method:

    Diaries kept for one week were collected among 23 seniors in the north of Sweden. They were analysed with a Grounded theory approach; an interplay between ideas and empirical data.

     Result:

    Some productive senior activities must be valued as opportunity cost of time and others must be valued with replacement cost. In order to make the choice among these principally different methods the societal entitlement is important. When the societal entitlement does not exist the first method must be used and when it exists the latter must be used. 

    Conclusion:

    An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. Questions addressing senior production must be adjusted to the type of production. In order to understand senior production, degrees of free choice to conduct an activity, as well as describing health-related quality of life, are important.

  • 24.
    Sahlen, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Löfgren, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Brodin, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Measuring the value of older people's production: a diary study2012Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 12, s. 4-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The productive capacity of retired people is usually not valued. However, some retirees produce much more than we might expect. This diary-based study identifies the activities of older people, and suggests some value mechanisms. One question raised is whether it is possible to scale up this diary study into a larger representative study. Methods: Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data. Results: Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used. Conclusions: An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life.

  • 25.
    Sahlén, Klas Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hellner, Britt Mari
    IMS, Institutet för Metodutveckling i Socialt arbete.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dahlgren, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Preventive home visits improve Swedish seniors´ coping strategies and healthInngår i: Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Preventive home visits (PHVs) promote health in old age.  Research indicates that PHVs have a positive health effect on mortality, admissions to institutions, and falls.  To understand how seniors perceive PHVs and how they cope with everyday life when PHVs have ended, five individual research interviews were conducted with seniors aged 79 – 88 years. Seniors with a low degree of control over their daily life appeared to gain more from PHVs than other seniors. To help seniors to increase control seems essential if they are to lead an independent and healthy life. PHVs can contribute to positive health development by improving seniors’ sense of control over their everyday lives and processing the used coping strategies. It is important that home visitors understand how the different coping strategies used by seniors affect health.

  • 26.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    An ounce of prevention is worth a pound of cure: preventive home visits among healthy seniors2009Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The aim of this thesis is to contribute to existing knowledge. If the knowledge is not useful in building society it has limited value. In order to be a tool for decision-makers, Preventive Home Visits (PHVs) are described and discussed according to a realist synthesis approach. The premise of this approach is that a single trial cannot tell the whole story and that understanding theoutcome pattern is much more important than seeking regularities in results across different trials. In order to understand the o utcome pattern, the PHV strategy in Nordmaling is examined against other trials and scientific work, and also in grey literature such as reports and workingpapers.

    An increasing population of seniors means that resources for health and elderly care are being scrutinised in order to achieve the best possible health for the money invested. PHVs represent one strategy that attempts to promote health among independent seniors. This thesis is a multidisciplinary study aiming to gain knowledge about the effects of PHVs and to understand the mechanisms of importance when implementing this particular strategy. The point of departure is a study conducted in Nordmaling in the north of Sweden among healthy seniors aged 75 years and over.

    The study, conducted as a controlled trial during 2000 and 2001, showed a decrease in mortality as well as the utilisation of care, and an improvement in indicators of perceived health. Cost analyses showed significant savings for the municipality following a reduction in the use of home help. These and other savings combined with costs of the intervention were related to saved life years and used to conduct health economic analyses. Medical and social records from the primary health centre and the municipality, along with official registers provided information for modelling health economic analyses from a lifetime perspective. Results showed that the costs of PHVs were less than 10 000 Euros per gained life year, against an acceptable level of cost effectiveness of 50 000 Euros. Using a shorter time perspective, the result was even more favourable for PHVs. It was evident that the time window used in the analyses, the normative choice of including future healthcare costs or not, and how to handle the value of the seniors’ production were important factors in determining the results.

    Two years after the trial, in-depth interviews were conducted with 5 seniors who had experienced PHVs, in order to gain understanding of the outcome of the PHV trial in Nordmaling.

    Participants were selected with respect to their health and how they responded to advice given during the PHV trial. Grounded Theory was used to analyse the interviews. Seniors who used autonomous coping strategies in everyday life gained less from PHVs than other seniors. All participants could benefit from PHVs, but in order for these to be successful it was important for the home visitor to be professional and to understand how the different coping strategies of seniors worked.

    Taken together, the different aspects of this study raised normative questions that are discussed in this thesis. One, whether the production of seniors has any monetary value in health economic analyses conducted from a societal perspective, was addressed in a smaller diary study where 23 seniors were asked to keep a diary in order to identify everything they did over a oneweek period. It was evident that most of the respondents “produced” a lot, however the production of seniors is rarely taken into account in health economic analyses. The concept of “senior production” includes both the market value of what seniors do, as well as the value of what society can avoid doing if the seniors are independent and healthy.

  • 27.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för regionalvetenskap (CERUM).
    Hälsa På-projektet: Effekter av förebyggande hembesök hos pigga pensionärer i Nordmaling2002Rapport (Annet vitenskapelig)
  • 28.
    Sahlén, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Isaksson, Ulf
    Östlund, Ulrika
    Lämås, Kristina
    Lindgren, Britt Marie
    Enarsson, Per
    Juthberg, Christina
    Isaksson, Rose Marie
    Hajdarevic, Senada
    Saveman, Brittinger
    Nursing research in Sweden2014Inngår i: The Japanese Journal of Nursing Research, ISSN 0022-8370, Vol. 47, nr 2, s. 126-133Artikkel i tidsskrift (Fagfellevurdert)
  • 29.
    Sahlén, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Östlund, Ulrika
    Lämås, Kristina
    Lindgren, Britt Marie
    Enarsson, Per
    Juthberg, Christina
    Isaksson, Rose Marie
    Hajdarevic, Senada
    Saveman, Brittinger
    Nursing research in Sweden II2014Inngår i: The Japanese Journal of Nursing Research, ISSN 0022-8370, Vol. 47, nr 3, s. 234-240Artikkel i tidsskrift (Fagfellevurdert)
  • 30.
    Sahlén, Klas-Göran
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Löfgren, Curt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Är det lönsamt med prevention efter 65?: Ålders betydelse i hälsoekonomiska utvärderingsmetoder: förebyggande hembesök i Nordmaling2006Rapport (Annet (populærvitenskap, debatt, mm))
  • 31. Van Minh, Hoang
    et al.
    Tuan Anh, Tran
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Bao Giang, Kim
    Trang, Le Quynh
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nilsson, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Primary healthcare system capacities for responding to storm and flood-related health problems: a case study from a rural district in central Vietnam2014Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, artikkel-id 23007Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: As a tropical depression in the East Sea, Vietnam is greatly affected by climate change and natural disasters. Knowledge of the current capacity of the primary healthcare system in Vietnam to respond to health issues associated with storms and floods is very important for policy making in the country. However, there has been little scientific research in this area. OBJECTIVE: This research was to assess primary healthcare system capacities in a rural district in central Vietnam to respond to such health issues. DESIGN: This was a cross-sectional descriptive study using quantitative and qualitative approaches. Quantitative methods used self-administered questionnaires. Qualitative methods (in-depth interviews and focus groups discussions) were used to broaden understanding of the quantitative material and to get additional information on actions taken. RESULTS: 1) Service delivery: Medical emergency services, especially surgical operations and referral systems, were not always available during the storm and flood seasons. 2) Governance: District emergency plans focus largely on disaster response rather than prevention. The plans did not clearly define the role of primary healthcare and had no clear information on the coordination mechanism among different sectors and organizations. 3) Financing: The budget for prevention and control of flood and storm activities was limited and had no specific items for healthcare activities. Only a little additional funding was available, but the procedures to get this funding were usually time-consuming. 4) Human resources: Medical rescue teams were established, but there were no epidemiologists or environmental health specialists to take care of epidemiological issues. Training on prevention and control of climate change and disaster-related health issues did not meet actual needs. 5) Information and research: Data that can be used for planning and management (including population and epidemiological data) were largely lacking. The district lacked a disease early-warning system. 6) Medical products and technology: Emergency treatment protocols were not available in every studied health facility. CONCLUSIONS: The primary care system capacity in rural Vietnam is inadequate for responding to storm and flood-related health problems in terms of preventive and treatment healthcare. Developing clear facility preparedness plans, which detail standard operating procedures during floods and identify specific job descriptions, would strengthen responses to future floods. Health facilities should have contingency funds available for emergency response in the event of storms and floods. Health facilities should ensure that standard protocols exist in order to improve responses in the event of floods. Introduction of a computerized health information system would accelerate information and data processing. National and local policies need to be strengthened and developed in a way that transfers into action in local rural communities.

  • 32.
    Zingmark, Magnus
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Community Care Administration, Municipality of Östersund, 83182 Östersund, Sweden.
    Nilsson, Ingeborg
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sahlén, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Cost effectiveness of an intervention focused on reducing bathing disability2017Inngår i: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 14, nr 3, s. 233-241Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The onset of bathing disability among older people is critical for a decline in functioning and has implications for both the individuals’ quality of life and societal costs. The aim of this study was to evaluate longterm cost effectiveness of an intervention targeting bathing disability among older people. For hypothetical cohorts of community-dwelling older people with bathing disability, transitions between states of dependency and death were modelled over 8 years including societal costs. A five-state Markov model based on states of dependency was used to evaluate Quality-adjusted life years (QALYs) and costs from a societal perspective. An intervention group was compared with a no intervention control group. The intervention focused on promoting safe and independent performance of bathing-related tasks. The intervention effect, based on previously published trials, was applied in the model as a 1.4 increased probability of recovery during the first year. Over the full follow-up period, the intervention resulted in QALY gains and reduced societal cost. After 8 years, the intervention resulted in 0.052 QALYs gained and reduced societal costs by €2410 per person. In comparison to the intervention cost, the intervention effect was a more important factor for the magnitude of QALY gains and long-term societal costs. The intervention cost had only minor impact on societal costs. The conclusion was that an intervention targeting bathing disability among older people presents a cost-effective use of resources and leads to both QALY gains and reduced societal costs over 8 years.

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