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  • 151.
    Alabi, Olusola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Exploring awareness and knowledge of tuberculosis spread among household members of tuberculosis patients in Nigeria2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 152.
    Al-Alawi, Kamila
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Team-based approach in the management of diabetes at primary health care level in Muscat, Oman: challenges and opportunities2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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  • 153.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Al Mandhari, Ahmed
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study2019In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 19, article id 18Article in journal (Refereed)
    Abstract [en]

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

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  • 154.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Perceptions of type-two diabetes patients towards diabetes management visits at public primary health care centres with diverse opinions towards nurse-led clinics in Muscat, Oman: a pilot qualitative studyManuscript (preprint) (Other academic)
  • 155.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The question is not what we want; the question is, are we ready?: a qualitative study exploring primary health care providers`perceptions towards different human resources for health management mechanisms at diabetes management clinics in primary health care centres in Muscat, OmanManuscript (preprint) (Other academic)
  • 156.
    Al-Alawi, Kamila
    et al.
    Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    “Yes to discuss different models of care between primary care physicians and diabetes-practice nurses, but not to complete implementation yet”: Explorative qualitative study at diabetes clinics in primary health care centres in Muscat, Oman2020In: International Journal of Healthcare, ISSN 2377-7338, Vol. 6, no 1, p. 72-80Article in journal (Refereed)
    Abstract [en]

    Background: Globally, many models of care through which the way health services are delivered have been adopted withinteam-based primary health care. Although these models have aimed to solve some of the health care challenges related tophysician’s shortages in clinics and further acceptance of non-physician-led clinics, their application is usually determined by arange of factors, such as preparedness of the health care providers, preparedness of patients and support from higher authorities.

    Objective: The study was designed to explore health care providers’ perceptions for changes in models of care in diabetes clinicsat primary health care in Muscat, Oman.

    Methods: A total of 27 semi-structured interviews were conducted with health care providers involved in diabetes clinics atfive purposively selected primary health care centres in Muscat. The interviewees included the core members of the diabetesmanagement team and other supportive members available at the centres, and were of mixed genders, nationalities and professions.Qualitative thematic analysis was applied.

    Results: The analysis resulted in one main theme, which captured positive responses towards task-sharing model, but revealedworries and requirements for complete implementation. Nurses’ competences and diabetic patients’ acceptance were among themain concerns. Health care providers revealed that for complete implementation of the model, nurses’ involvement in the teamcould be improved through updating their knowledge and through the provision of support from higher authorities, while diabeticpatients’ acceptance could be improved through understanding of their perceived knowledge towards the model which couldpromote nurse-led clinics.

    Conclusion: Task-sharing within the discussed possibilities could provide many positive outcomes and a rewarding future fordiabetes clinics at primary health care centres. Omani culture could play a role in its implementation; therefore, if successfulimplementation is desired, carefully considered steps must be applied by the government and the community

  • 157.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Al Mandhari, Ahmed
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Are the resources adoptive for conducting team-based diabetes management clinics?: An explorative study at primary health care centers in Muscat, Oman2018In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 20, p. 1-28, article id E3Article in journal (Refereed)
    Abstract [en]

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

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

    METHOD: A cross-sectional study was conducted with 26 public primary health care centers in Muscat, the capital of Oman. Data were collected from manual and electronic resources as well as a questionnaire that was distributed to the physician-in-charge and diabetes management team members.

    FINDINGS: The study revealed significant differences between professional groups regarding how they perceived their own competencies, values and skills as well as available resources related to team-based diabetes management. The perceived competencies were high among all professions. The perceived team-related values and skills were also generally high but with overall lower recordings among the nurses. This pattern, along with the fact that very few nurses have specialized qualifications, is a barrier to providing team-based diabetes management. Participants indicated that there were sufficient laboratory resources; however, reported that pharmacological, technical and human resources were lacking. Further work should be done at public primary diabetes management clinics in order to fully implement team-based diabetes management.

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  • 158.
    Alaniemi, Niclas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Nilsson Landén, Oskar
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Hur skiljer sig kroppens akuta fysiologiska responser vid två olika modaliteter av stegrade intervaller?: Cykel och uppresningar från stol, en pilotstudie.2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion / bakgrund

    Högintensiva intervaller är en tidseffektiv träningsform, som har potential att ge flera positiva hälsoeffekter. Det finns dock en del svårigheter vid genomförandet av högintensiva intervaller avseende hur intensitetsnivån regleras. Dessutom genomförs dessa intervaller oftast på träningscyklar, och det finns därför kunskapsluckor vad gäller genomförandet i form av andra träningsmodaliteter, som bland annat uppresningar från stol. Syftet med den här studien var att undersöka skillnader i akuta fysiologiska responser vid stegrade arbetsprov av de två olika träningsmodaliteterna cykel respektive uppresningar från stol. 

    Metod 

    I studien deltog 10 träningsvana individer i åldersintervallet 20-30 år. Fem kvinnor och fem män. Vardera deltagare genomförde två olika stegrande arbetsprov i form av uppresningar från stol respektive cykel. Vid genomförandet fick deltagarna skatta sin upplevda ansträngning respektive bentrötthet. Även hjärtfrekvens registrerades. Effektutvecklingen för respektive arbetsprov uppmättes. Deltagarna fick dessutom genomföra test av isometrisk benstyrka både före och efter respektive arbetsprov. Skillnader mellan dessa modaliteter avseende dessa akuta responser analyserades sedan med hjälp av Wilcoxon signed-rank test. 

    Resultat 

    Resultatet påvisade signifikanta skillnader mellan modaliteterna avseende hjärtfrekvens, skattad ansträngning samt skattad bentrötthet vid effektutveckling = 300 watt, där högre värden uppnåddes vid cykel. Vid brytpunkten för arbetsproverna, d.v.s. där deltagarna skattade Borg RPE 17, uppmättes signifikanta skillnader i uppnådd hjärtfrekvens samt uppnådd effektutveckling, med en högre hjärtfrekvens vid cykel och en högre effektutveckling vid uppresningar från stol. 

    Slutsats / konklusion 

    Resultatet indikerade att uppresningar från stol var mindre ansträngande att genomföra i jämförelse med cykel. De mätvärden som registrerades i samband med intervallerna, utvecklades dock i liknande takt under de stegrade arbetsproverna, vilket antyder att modaliteterna har potential att styras. 

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  • 159.
    Alao, Jonathan Afamefuna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    “If Education is expensive, ignorance is more expensive.”: A Qualitative study Exploring the Knowledge, Attitudes, and Beliefs of Diabetes Mellitus by the Staff of Nigeria Baptist Seminary, Ogbomosho, Nigeria.2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Diabetes is rapidly increasing worldwide, and in Africa, the prevalence rate is also rapidly increasing. Nigeria has the highest prevalence of Diabetes in Africa. Although the rate of diabetes has been underrepresented because of the traditional and religious influence over the beliefs and the perspective of the people towards diabetes; as well as the inadequate knowledge of the people has affected the management, diagnosis, and prevention of diabetes.

    The study aimed to explore the knowledge, attitudes, and beliefs of diabetes mellitus by the staff of Nigerian Baptist Theological Seminary, Ogbomosho, Nigeria.

    Methods: The qualitative research method was used in the study. The Snowball technique was used to recruit participants, The responses in interview sessions from 5 staff in various offices as lecturers, administrative staff, and service workers, were interpreted using thematic analysis. The themes that were identified and the sub-themes helped in interpreting the result of the study.

    The results show that the participants had some, but limited knowledge about diabetes. There were significant misconceptions that Diabetes could be treated by eating bitter leaves, the disease was perceived as severe, and Education was seen as very important. Secondly, the participants demonstrated a negative attitude towards diabetes, indicating that it is stigmatized. Diabetes was also considered to be a disease of the rich. Thirdly, the participants expressed that diabetes should be treated with care through exercise, right eating habits, and adhering to the doctor's instructions.

    Conclusion: The study identifies that diabetes by the participants is commonly associated with increased sugar [literally sweet food] and carbohydrate in the body. The knowledge level of the staff was poor [they were not aware of any other type of diabetes or about insulin]. The attitude towards diabetes was negative [DM was seen as a problem of the rich, and the stigmatization of diabetes is in relation to beliefs and negative perceptions of diabetes]. The staff’s belief about the management of diabetes or the diabetic was that they are being poorly managed, as it was observed that people may know good practices such as going for medical checkups but don’t necessarily practice it.

  • 160. Alaridah, Nader
    et al.
    Hallbäck, Erika Tång
    Tångrot, Jeanette
    Umeå University, Faculty of Medicine, Department of Molecular Biology (Faculty of Medicine). National Bioinformatics Infrastructure Sweden (NBIS), SciLifeLab, Computational Life Science Cluster, Umeå University, Umeå, Sweden.
    Winqvistz, Niclas
    Sturegard, Erik
    Floren-Johanssons, Kerstin
    Jonsson, Bodil
    Tenland, Erik
    Welinder-Olssons, Christina
    Medstrand, Patrik
    Kaijser, Bertil
    Godaly, Gabriela
    Transmission dynamics study of tuberculosis isolates with whole genome sequencing in southern Sweden2019In: Scientific Reports, E-ISSN 2045-2322, Vol. 9, article id 4931Article in journal (Refereed)
    Abstract [en]

    Epidemiological contact tracing complemented with genotyping of clinical Mycobacterium tuberculosis isolates is important for understanding disease transmission. In Sweden, tuberculosis (TB) is mostly reported in migrant and homeless where epidemiologic contact tracing could pose a problem. This study compared epidemiologic linking with genotyping in a low burden country. Mycobacterium tuberculosis isolates (n = 93) collected at Scania University Hospital in Southern Sweden were analysed with the standard genotyping method mycobacterial interspersed repetitive units-variable number tandem repeats (MIRU-VNTR) and the results were compared with whole genome sequencing (WGS). Using a maximum of twelve single nucleotide polymorphisms (SNPs) as the upper threshold of genomic relatedness noted among hosts, we identified 18 clusters with WGS comprising 52 patients with overall pairwise genetic maximum distances ranging from zero to nine SNPs. MIRU-VNTR and WGS clustered the same isolates, although the distribution differed depending on MIRU-VNTR limitations. Both genotyping techniques identified clusters where epidemiologic linking was insufficient, although WGS had higher correlation with epidemiologic data. To summarize, WGS provided better resolution of transmission than MIRU-VNTR in a setting with low TB incidence. WGS predicted epidemiologic links better which could consolidate and correct the epidemiologically linked cases, avoiding thus false clustering.

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  • 161.
    Alasalmi, Hanna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Spirometry in medical surveillance of asbestosis and silicosis: Sensitivity, specificity and predictive values2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 162.
    Alastalo, Pihla
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Mörfelt, Isabella
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Arbetsterapeutiska interventioner i förskole- och skolmiljö för barn med autismspektrumtillstånd: En litteraturstudie2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Autismspektrumtillstånd (AST) sammanfattar olika diagnoser som innebär svårigheter inom social interaktion, kommunikation och föreställningsförmåga. Barn med AST ställs inför många utmaningar i förskole- och skolmiljö och är i behov av anpassningar och stöd i sina studier. Syftet med denna litteraturstudie var att beskriva arbetsterapeutiska interventioner i förskole- och skolmiljö för barn med autismspektrumtillstånd. En beskrivande litteraturöversikt genomfördes genom att granska vetenskapliga artiklar. Litteraturstudiens resultat omfattar nio vetenskapliga artiklar publicerade mellan åren 2006-2012 och beskriver arbetsterapeutiska interventioner för barn mellan tre och tjugo år med diagnos inom AST. Analysen av de utvalda studierna resulterade i tre kategorier: Kompensatoriska interventioner för att möjliggöra delaktighet i klassrummet, Interventioner riktade mot träning av sociala färdigheter och Interventioner riktade mot modifiering av beteenden. För att öka barnens kommunikation och sociala interaktion med omvärlden kan till exempel rollspel, yoga och interventioner med djur vara till hjälp. Kompensatoriska interventioner som bollstolar och tyngdvästar kan utgöra ett stöd för vissa barn men för andra barn påverkas koncentrationsförmågan negativt. Arbetsterapeutiska interventioner har potential att underlätta skolsituationen för barn och unga vuxna med AST. Det finns ett behov av att utveckla arbetsterapeutiska interventioner och undersöka dess effekter.

     

     

    Sökord: arbetsterapi, elev, åtgärd, autismspektrum, klassrum

  • 163.
    Albahrani, Mohammed
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Minority Stress Model Utilization to Assess Mental Health Outcomes Among Transgender Youth: A scoping review2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 164. Alberts, Marianne
    et al.
    Dikotope, Sekgothe A
    Choma, Solomon R
    Masemola, Matshane L
    Modjadji, Sewela EP
    Mashinya, Felistas
    Burger, Sandra
    Cook, Ian
    Brits, Sanette J
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesberg, South Africa.
    Health & Demographic Surveillance System Profile: The Dikgale Health and Demographic Surveillance System.2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 5, p. 1565-1571Article in journal (Refereed)
  • 165.
    Albertsson, Sandra
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Juntunen, Martin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Styrketräningsadaption: Aminosyrafördelning och intracellulär signalering2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Muscle mass regulation is responsive to a variety of stimuli, whereas amino acids and resistance exercise are two major regulators. Protein accretion occurs when the rate of protein synthesis exceeds the rate of protein degradation. It has long been recognized that both amino acid and resistance exercise effect protein synthesis and protein degradation, although the effect of varying distribution of amino acids remain unknown. The intracellular pathways by which protein synthesis are activated is complex. The purpose of this essay is to elucidate if there exist any scientific rationale to spread the amino acid intake over the day, with the purpose to maximize muscle protein accretion in response to resistance exercise. Furthermore , we intend to describe how amino acids and resistance exercise effect the molecular pathways that regulate protein synthesis, with the main focus on pathways that activate and are activated by mTOR.

    Studies that examine acute effects on protein synthesis or protein balance after resistance exercise and amino acid intake support the notion that there may be an advantage to spread the amino acid intake over the day, since the synthetic response to amino acids are transient. However, studies examining the effect of different meal frequencies on protein accretion and /or training results fail to support this notion. Both amino acids and resistance exercise seems to independently activate the intracellular pathways that regulate protein synthesis, with the effect being greatest when both are combined. The regulation also seems to be dependent on exercise intensity and volume, age of test subjects, contraction type and muscle fiber type. Furthermore, some researchers have found correlations between activation of these pathways and resistance exercise-induced muscle gain and strength gain.

  • 166.
    Albinsson, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nordlander, Anna-Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sjuksköterskors upplevelser och erfarenheter av samtal med äldre personer som vårdas i livets slutskede2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background. Ensuring good care in the end of life is a multifaceted task. Focus often tends to be of pharmacological orientation and mostly on relieving physical symptoms such as pain.For a person-centered care based on a holistic view, the nurse's communication with the patient is also important.The aim of this study was to describe the nurses' experiences of communicating with elderly people cared for in the end of life.Design. This study has a qualitative descriptive design and is based on interviews.Method. A total of ten nurses participated in semistructured interviews at the beginning of the year of 2017. The material was analyzed with qualitative content analysis.Findings. Eight categories emerged during analysis. The result shows that late insight and denial approach to end of life are perceived as obstructing circumstances for communication. A number of other impeding considerations such as lack of time, language barriers, lack of knowledge and experience, as well as relatives' presence are also described in this study. The nurse's closeness in a neutral relationship, the patient's ability of acceptance and the nurse's balance between professionalism and trustworthy commitment, appear on the other hand as supportive conditions for communication. A united palliative focus around the patient creates better opportunities for communication and support to adaption and acceptance in the final stage of life.Conclusions. The result shows that trustful communication is found meaningful both for the patient and for the nurse. The nurse finds that the connection to the patient through the communication is an important and necessary basis when creating a person-centered care. The communication consequently need to be highlighted as a self-evident and prioritized part in the care of the elderly person at the end of life.

  • 167. Albrecht, E. C.
    et al.
    Kaelin, Vera C.
    Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
    Rigau, B. L.
    Dooling-Litfin, J. K.
    Scully, E. A.
    Murphy, N. J.
    McManus, B. M.
    Khetani, M. A.
    Pilot implementation of an electronic patient-reported outcome measure for planning and monitoring participation-focused care in early intervention2020In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 20, no 1, article id 199Article in journal (Refereed)
    Abstract [en]

    Background: Family-centered care is a valued approach to improving child and family outcomes in early intervention (EI), yet there is need to implement interventions that support information exchange for shared decision-making when planning and monitoring EI care. This study aims at estimating the feasibility, acceptability, and value of implementing the Young Children’s Participation and Environment Measure (YC-PEM), a valid electronic patient-reported outcome (e-PRO) that is designed to support family engagement when planning care and monitoring outcomes of care.

    Methods: Data were gathered from caregivers (N = 139) that were enrolled in a Phase 1 trial of the YC-PEM e-PRO as implemented within 1 month of their child’s next EI evaluation of progress. YC-PEM e-PRO feasibility was estimated according to enrollment and completion rates, and mean completion time. Chi-square tests were used to examine parent perceptions of YC-PEM e-PRO acceptability by caregiver education and family income. Caregiver feedback via open-ended responses were content coded to inform intervention and protocol optimizations. YC-PEM e-PRO value was estimated via composite and item-level scores to capture the extent of participation difficulty in home and community activities, and common areas of need regarding caregivers desired change in their child’s participation.

    Results: Feasibility of implementing the YC-PEM e-PRO in routine EI care was mixed, as evidenced by low enrollment rates (21.0–29.2%), a high completion rate (85.3%), and limited missing data (80.6% of completed cases contained no missing data). More than half of the participants reported that the completion of the YC-PEM e-PRO was at least somewhat helpful, regardless of family income or caregiver education, providing support for its acceptability. As for its value, the YC-PEM e-PRO results were viewed by 64% of caregivers, whose desire for change most often pertained to the child’s participation in non-discretionary activities at home and structured activities in the community.

    Conclusions: Results may support the implementation of YC-PEM e-PRO as a feasible, acceptable, and valued option for engaging families in planning the child’s EI care. Results also inform select intervention and protocol optimizations prior to undertaking a multi-site pragmatic trial of its effectiveness on family engagement and shared decision-making within an EI clinical workflow.

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  • 168.
    Alcala, Karine
    et al.
    International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, 150 Cours Albert Thomas, Lyon, France.
    Mariosa, Daniela
    International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, 150 Cours Albert Thomas, Lyon, France.
    Smith-Byrne, Karl
    Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, United Kingdom.
    Nasrollahzadeh Nesheli, Dariush
    International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, 150 Cours Albert Thomas, Lyon, France.
    Carreras-Torres, Robert
    Group of Digestive Diseases and Microbiota, Institut d'Investigació Biomèdica de Girona-IDIBGI, Salt, Spain.
    Ardanaz Aicua, Eva
    Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
    Bondonno, Nicola P
    Danish Cancer Society Research Center, Copenhagen, Denmark; School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, Australia; Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
    Bonet, Catalina
    Unit of Nutrition and Cancer, Catalan Institute of Oncology, ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute-(IDIBELL), l'Hospitalet de Llobregat, Barcelona, Spain.
    Brunström, Mattias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Bueno-De-Mesquita, Bas
    Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
    Chirlaque, María-Dolores
    CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain.
    Christakoudi, Sofia
    Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, St Mary's Campus, London, United Kingdom; MRC Centre for Transplantation, King's College London, London, United Kingdom.
    Heath, Alicia K
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Kaaks, Rudolf
    Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Katzke, Verena
    Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Krogh, Vittorio
    Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Milan, Italy.
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Martin, Richard M
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
    May, Anne
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
    Melander, Olle
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden.
    Palli, Domenico
    Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
    Rodriguez-Barranco, Miguel
    Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain; Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain.
    Sacerdote, Carlotta
    Unit of Cancer Epidemiology, Cittàdella Salute e della Scienza University-Hospital, Turin, Italy.
    Stocks, Tanja
    Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
    Tjønneland, Anne
    Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Travis, Ruth C.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Vermeulen, Roel
    Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands.
    Chanock, Stephen
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, MD, Bethesda, United States.
    Purdue, Mark
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, MD, Bethesda, United States.
    Weiderpass, Elisabete
    International Agency for Research on Cancer (IARC/WHO), Lyon, France.
    Muller, David
    Imperial College London, London, United Kingdom.
    Brennan, Paul
    International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, 150 Cours Albert Thomas, Lyon, France.
    Johansson, Mattias
    International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, 150 Cours Albert Thomas, Lyon, France.
    The relationship between blood pressure and risk of renal cell carcinoma2022In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 51, no 4, p. 1317-1327Article in journal (Refereed)
    Abstract [en]

    Background: The relation between blood pressure and kidney cancer risk is well established but complex and different study designs have reported discrepant findings on the relative importance of diastolic blood pressure (DBP) and systolic blood pressure (SBP). In this study, we sought to describe the temporal relation between diastolic and SBP with renal cell carcinoma (RCC) risk in detail. Methods: Our study involved two prospective cohorts: the European Prospective Investigation into Cancer and Nutrition study and UK Biobank, including >700 000 participants and 1692 incident RCC cases. Risk analyses were conducted using flexible parametric survival models for DBP and SBP both separately as well as with mutuality adjustment and then adjustment for extended risk factors. We also carried out univariable and multivariable Mendelian randomization (MR) analyses (DBP: ninstruments = 251, SBP: ninstruments = 213) to complement the analyses of measured DBP and SBP. Results: In the univariable analysis, we observed clear positive associations with RCC risk for both diastolic and SBP when measured ≥5 years before diagnosis and suggestive evidence for a stronger risk association in the year leading up to diagnosis. In mutually adjusted analysis, the long-term risk association of DBP remained, with a hazard ratio (HR) per standard deviation increment 10 years before diagnosis (HR10y) of 1.20 (95% CI: 1.10-1.30), whereas the association of SBP was attenuated (HR10y: 1.00, 95% CI: 0.91-1.10). In the complementary multivariable MR analysis, we observed an odds ratio for a 1-SD increment (ORsd) of 1.34 (95% CI: 1.08-1.67) for genetically predicted DBP and 0.70 (95% CI: 0.56-0.88) for genetically predicted SBP. Conclusion: The results of this observational and MR study are consistent with an important role of DBP in RCC aetiology. The relation between SBP and RCC risk was less clear but does not appear to be independent of DBP.

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  • 169.
    Aldin, Z.
    et al.
    Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Diss, J.K.
    Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Mahmood, H.
    Imaging Department, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea and Westminster Hospital, Chelsea, London, United Kingdom.
    Sadik, T.
    Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Basra, H.
    Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Ahmed, M.
    Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Danawi, Z.
    Department of Trauma and Orthopaedics, Southend University Hospital, Southend, Essex, United Kingdom.
    Gul, A.
    Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, United Kingdom.
    Sayed-Noor, A.S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Clinical Sciences Department, College of Medicine, University of Sharjah, United Arab Emirates.
    Long-term effectiveness of transforaminal anterolateral approach CT-guided cervical epidural steroid injections for cervical radiculopathy treatment2024In: Clinical Radiology, ISSN 0009-9260, E-ISSN 1365-229XArticle in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the long-term clinical effectiveness of computed tomography (CT)-guided transforaminal cervical epidural steroid injection using an anterolateral approach for the treatment of cervical radiculopathy (CR) using well-established robust clinical scoring systems for neck pain and neck disability. Despite its widespread use, evidence to support the long-term benefit of routine cervical epidural steroid injection is currently very limited.

    Materials and methods: This study included 113 patients with magnetic resonance imaging (MRI)-confirmed CR who underwent a steroid injection at a single cervical level via a unilateral transforaminal anterolateral approach. Pain was assessed quantitatively at pre-injection, 15 minutes post-injection, 1 month, 3 months, and at 1 year. Neck disability was assessed using the Oswestry Neck Disability Index (NDI) at pre-injection, 1 month, 3 months, and 1 year time points.

    Results: Eighty patients completed the study. Sixty per cent reported reduced neck pain (mean pain reduction, 55%), which was clinically significant in 45% cases. Furthermore, 66% reported an improvement in neck disability (mean improvement, 51%), which was clinically significant for 56% patients. Clinically significant good outcomes in both neck pain and neck disability were evident from as early as 1-month, and importantly, were independent both of pre-treatment CR characteristics (including severity of pre-injection neck pain or disability) and of findings on pre-injection MRI imaging.

    Conclusion: Transforaminal anterolateral approach CT-guided epidural steroid injection resulted in a clinically significant long-term improvement in both neck pain and disability for half of the present cohort of patients with unilateral single-level CR. This improvement was independent of the severity of the initial symptoms and pre-injection MRI findings.

  • 170. Aldrich, Rosemary
    et al.
    Mahoney, Mary
    Harris, Elizabeth
    Simpson, Sarah
    Stewart-Williams, Jenny
    Newcastle Institute of Public health, University of Newcastle, New South Wales, Australia.
    Building an equity focus in health impact assessment2005In: New South Wales Public Health Bulletin, ISSN 1034-7674, Vol. 16, no 7-8, p. 118-119Article in journal (Refereed)
  • 171.
    Aledahl, Adam
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Följs riktlinjerna för remittering till MRT vid ländryggssmärta?2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Today there is no indication that medical personnel in Sweden follow guidelines for remittance to MRI in the field of lumbar pain. This information is necessary to ensure that the patient receives adequate diagnostic examination and assessment.

    Aims: Study referrals to evaluate whether the referral question was included within the framework of current guidelines, and to investigate the relationship between gender, age, duration of symptoms and the followed guidelines, and if the guidelines provide greater correspondence between questions and answers in the MRI referrals.

    Methods: Retrospective study in which all referrals to low back MRI in Västerbotten County Council in 2016 were examined. Referrals and referral responses were reviewed and encoded during January-July 2018. Data regarding age, gender, followed guidelines, symptom duration, mentioned patoanatomic issue (PAD) in referral and if PAD was identified was collected. To describe the relationship between sex, age, duration of symptoms and followed guidelines, logistic regression was made. To describe the differences between the number of PAD’s in referrals which current guidelines are followed and not followed, a chi square test was made.

    Results: 62% of the total 1459 included referrals followed current guidelines. There was a significant positive relationship between age and compliance with guidelines (p≤0.001). There was also a significant positive correlation between subacute pain (p<0.05), chronic pain (p≤0.001) and pain >5 years and compliance with the guidelines (p<0.05). There is no correlation between gender and followed guidelines.

    Conclusion: 38% of the referrals did not follow the current guidelines. There is no correlation between gender, but a positive correlation between followed guidelines, increased age and longer periods of pain.

  • 172. Aleksandrova, Krasimira
    et al.
    Bamia, Christina
    Drogan, Dagmar
    Lagiou, Pagona
    Trichopoulou, Antonia
    Jenab, Mazda
    Fedirko, Veronika
    Romieu, Isabelle
    Bueno-de-Mesquita, H. Bas
    Pischon, Tobias
    Tsilidis, Kostas
    Overvad, Kim
    Tjønneland, Anne
    Bouton-Ruault, Marie-Christine
    Dossus, Laure
    Racine, Antoine
    Kaaks, Rudolf
    Kuehn, Tilman
    Tsironis, Christos
    Papatesta, Eleni-Maria
    Saitakis, George
    Palli, Domenico
    Panico, Salvatore
    Grioni, Sara
    Tumino, Rosario
    Vineis, Paolo
    Peeters, Petra H.
    Weiderpass, Elisabete
    Lukic, Marko
    Braaten, Tonje
    Ramon Quiros, J.
    Lujan-Barroso, Leila
    Sanchez, Mara-Jose
    Chilarque, Maria-Dolores
    Ardanas, Eva
    Dorronsoro, Miren
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Wallström, Peter
    Ohlsson, Bodil
    Bradbury, Kathryn E.
    Khaw, Kay-Tee
    Wareham, Nick
    Stepien, Magdalena
    Duarte-Salles, Talita
    Assi, Nada
    Murphy, Neil
    Gunter, Marc J.
    Riboli, Elio
    Boeing, Heiner
    Trichopoulos, Dimitrios
    The association of coffee intake with liver cancer risk is mediated by biomarkers of inflammation and hepatocellular injury: data from the European Prospective Investigation into Cancer and Nutrition2015In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 102, no 6, p. 1498-1508Article in journal (Refereed)
    Abstract [en]

    Background: Higher coffee intake has been purportedly related to a lower risk of liver cancer. However, it remains unclear whether this association may be accounted for by specific biological mechanisms. Objective: We aimed to evaluate the potential mediating roles of inflammatory, metabolic, liver injury, and iron metabolism biomarkers on the association between coffee intake and the primary form of liver cancer-hepatocellular carcinoma (HCC). Design: We conducted a prospective nested case-control study within the European Prospective Investigation into Cancer and Nutrition among 125 incident HCC cases matched to 250 controls using an incidence-density sampling procedure. The association of coffee intake with HCC risk was evaluated by using multivariable-adjusted conditional logistic regression that accounted for smoking, alcohol consumption, hepatitis infection, and other established liver cancer risk factors. The mediating effects of 21 biomarkers were evaluated on the basis of percentage changes and associated 95% CIs in the estimated regression coefficients of models with and without adjustment for biomarkers individually and in combination. Results: The multivariable-adjusted RR of having >= 4 cups (600mL) coffee/d compared with <2 cups (300 mL)/d was 0.25 (95% CI: 0.11, 0.62; P-trend = 0.006). A statistically significant attenuation of the association between coffee intake and HCC risk and thereby suspected mediation was confirmed for the inflammatory biomarker IL-6 and for the biomarkers of hepatocellular injury glutamate dehydrogenase, alanine aminotransferase, aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and total bilirubin, which-in combination-attenuated the regression coefficients by 72% (95% CI: 7%, 239%). Of the investigated biomarkers, IL-6, AST, and GGT produced the highest change in the regression coefficients: 40%, 56%, and 60%, respectively. Conclusion: These data suggest that the inverse association of coffee intake with HCC risk was partly accounted for by biomarkers of inflammation and hepatocellular injury.

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  • 173. Aleksandrova, Krasimira
    et al.
    Drogan, Dagmar
    Boeing, Heiner
    Jenab, Mazda
    Bas Bueno-de-Mesquita, H
    Jansen, Eugene
    van Duijnhoven, Fränzel J B
    Rinaldi, Sabina
    Fedirko, Veronika
    Romieu, Isabelle
    Kaaks, Rudolf
    Riboli, Elio
    Gunter, Marc J
    Romaguera, Dora
    Westhpal, Sabine
    Overvad, Kim
    Tjønneland, Anne
    Halkjaer, Jytte
    Boutron-Ruault, Marie-Christine
    Clavel-Chapelon, Françoise
    Lukanova, Annekatrin
    Trichopoulou, Antonia
    Trichopoulos, Dimitrios
    Vidalis, Pavlos
    Panico, Salvatore
    Agnoli, Claudia
    Palli, Domenico
    Tumino, Rosario
    Vineis, Paolo
    Buckland, Genevieve
    Sánchez-Cruz, José-Juan
    Dorronsoro, Miren
    Díaz, María José Tormo
    Barricarte, Aurelio
    Ramon Quiros, J
    Peeters, Petra H
    May, Anne M
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Palmqvist, Richard
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Crowe, Francesca L
    Khaw, Kay-Tee
    Wareham, Nickolas
    Pischon, Tobias
    Adiposity, mediating biomarkers and risk of colon cancer in the European prospective investigation into cancer and nutrition study2014In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 134, no 3, p. 612-621Article in journal (Refereed)
    Abstract [en]

    Adiposity is a risk factor for colon cancer, but underlying mechanisms are not well understood. We evaluated the extent to which 11 biomarkers with inflammatory and metabolic actions mediate the association of adiposity measures, waist circumference (WC) and body mass index (BMI), with colon cancer in men and women. We analyzed data from a prospective nested case-control study among 662 incident colon cancer cases matched within risk sets to 662 controls. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. The percent effect change and corresponding CIs were estimated after adjusting for biomarkers shown to be associated with colon cancer risk. After multivariable adjustment, WC was associated with colon cancer risk in men (top vs. bottom tertile RR 1.68, 95% CI 1.06-2.65; ptrend  = 0.02) and in women (RR 1.67, 95% CI 1.09-2.56; ptrend  = 0.03). BMI was associated with risk only in men. The association of WC with colon cancer was accounted mostly for by three biomarkers, high-density lipoprotein cholesterol, non-high-molecular-weight adiponectin and soluble leptin receptor, which in combination explained 46% (95% CI 37-57%) of the association in men and 50% (95% CI 40-65%) of the association in women. Similar results were observed for the associations with BMI in men. These data suggest that alterations in levels of these metabolic biomarkers may represent a primary mechanism of action in the relation of adiposity with colon cancer. Further studies are warranted to determine whether altering their concentrations may reduce colon cancer risk.

  • 174. Aleksandrova, Krasimira
    et al.
    Jenab, Mazda
    Leitzmann, Michael
    Bueno-de-Mesquita, Bas
    Kaaks, Rudolf
    Trichopoulou, Antonia
    Bamia, Christina
    Lagiou, Pagona
    Rinaldi, Sabina
    Freisling, Heinz
    Carayol, Marion
    Pischon, Tobias
    Drogan, Dagmar
    Weiderpass, Elisabete
    Jakszyn, Paula
    Overvad, Kim
    Dahm, Christina C.
    Tjonneland, Anne
    Bouton-Ruault, Marie-Christine
    Kuehn, Tilman
    Peppa, Eleni
    Valanou, Elissavet
    La Vecchia, Carlo
    Palli, Domenico
    Panico, Salvatore
    Sacerdote, Carlotta
    Agnoli, Claudia
    Tumino, Rosario
    May, Anne
    van Vulpen, Jonna
    Borch, Kristin Benjaminsen
    Oyeyemi, Sunday Oluwafemi
    Ramon Quiros, J.
    Bonet, Catalina
    Sanchez, Maria-Jose
    Dorronsoro, Miren
    Navarro, Carmen
    Barricarte, Aurelio
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Key, Timothy J.
    Khaw, Kay-Tee
    Wareham, Nicholas
    Assi, Nada
    Ward, Heather A.
    Aune, Dagfinn
    Riboli, Elio
    Boeing, Heiner
    Physical activity, mediating factors and risk of colon cancer: insights into adiposity and circulating biomarkers from the EPIC cohort2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 6, p. 1823-1835Article in journal (Refereed)
    Abstract [en]

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

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

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

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  • 176. Aleksandrova, Krasimira
    et al.
    Reichmann, Robin
    Kaaks, Rudolf
    Jenab, Mazda
    Bueno-de-Mesquita, H. Bas
    Dahm, Christina C.
    Eriksen, Anne Kirstine
    Tjonneland, Anne
    Artaud, Fanny
    Boutron-Ruault, Marie-Christine
    Severi, Gianluca
    Husing, Anika
    Trichopoulou, Antonia
    Karakatsani, Anna
    Peppa, Eleni
    Panico, Salvatore
    Masala, Giovanna
    Grioni, Sara
    Sacerdote, Carlotta
    Tumino, Rosario
    Elias, Sjoerd G.
    May, Anne M.
    Borch, Kristin B.
    Sandanger, Torkjel M.
    Skeie, Guri
    Sanchez, Maria-Jose
    Huerta, Jose Maria
    Sala, Nuria
    Gurrea, Aurelio Barricarte
    Quiros, Jose Ramon
    Amiano, Pilar
    Berntsson, Jonna
    Drake, Isabel
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Harlid, Sophia
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Key, Tim
    Weiderpass, Elisabete
    Aglago, Elom K.
    Cross, Amanda J.
    Tsilidis, Konstantinos K.
    Riboli, Elio
    Gunter, Marc J.
    Development and validation of a lifestyle-based model for colorectal cancer risk prediction: the LiFeCRC score2021In: BMC Medicine, E-ISSN 1741-7015, Vol. 19, no 1, article id 1Article in journal (Refereed)
    Abstract [en]

    Background: Nutrition and lifestyle have been long established as risk factors for colorectal cancer (CRC). Modifiable lifestyle behaviours bear potential to minimize long-term CRC risk; however, translation of lifestyle information into individualized CRC risk assessment has not been implemented. Lifestyle-based risk models may aid the identification of high-risk individuals, guide referral to screening and motivate behaviour change. We therefore developed and validated a lifestyle-based CRC risk prediction algorithm in an asymptomatic European population.

    Methods: The model was based on data from 255,482 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study aged 19 to 70 years who were free of cancer at study baseline (1992–2000) and were followed up to 31 September 2010. The model was validated in a sample comprising 74,403 participants selected among five EPIC centres. Over a median follow-up time of 15 years, there were 3645 and 981 colorectal cancer cases in the derivation and validation samples, respectively. Variable selection algorithms in Cox proportional hazard regression and random survival forest (RSF) were used to identify the best predictors among plausible predictor variables. Measures of discrimination and calibration were calculated in derivation and validation samples. To facilitate model communication, a nomogram and a web-based application were developed.

    Results: The final selection model included age, waist circumference, height, smoking, alcohol consumption, physical activity, vegetables, dairy products, processed meat, and sugar and confectionary. The risk score demonstrated good discrimination overall and in sex-specific models. Harrell’s C-index was 0.710 in the derivation cohort and 0.714 in the validation cohort. The model was well calibrated and showed strong agreement between predicted and observed risk. Random survival forest analysis suggested high model robustness. Beyond age, lifestyle data led to improved model performance overall (continuous net reclassification improvement = 0.307 (95% CI 0.264–0.352)), and especially for young individuals below 45 years (continuous net reclassification improvement = 0.364 (95% CI 0.084–0.575)).

    Conclusions: LiFeCRC score based on age and lifestyle data accurately identifies individuals at risk for incident colorectal cancer in European populations and could contribute to improved prevention through motivating lifestyle change at an individual level.

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

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

  • 178.
    Alemayehu, Asebe Abreham
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Is a Two Component-Dimeticone Cost effective over the standard treatment: A Markov Modelling of Tungiasis Treatment in Sub-Saharan Africa2021Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Tungiasis is a neglected tropical disease caused by infestation of an ectoparasite from the genus Tunga. It is associated with severe morbidity and impaired quality of life. Recently, the Two component Dimeticone found effective in killing sandfleas more than the standard treatment with potassium permanganate and Vaseline. The aim of the study was to assess the cost-effectiveness of the Two-component Dimeticone against the standard treatment among children in the age group of 5-9 in Sub-Saharan Africa region using a decision analysis approach with a health care perspective.

    Method: A four-state Markov model with a cycle duration of one month and a cycle length of 5 years was constructed. The health care perspective was employed to estimate the costs and benefits. The study simulated 100, 000 children at the age of 5 years and followed them until the end of age 9 in the Sub-Saharan Africa region. The discount rate of 5% was used for both benefits and costs. The Incremental cost-effectiveness ratio was calculated, and a one-way sensitivity analysis was performed to assess the uncertainty of parameters.

    Results: The Two-component Dimeticone dominated the standard treatment with the discounted incremental cost-effectiveness ratio (ICER) of 280.8USD. The discounted health gain was 0.1 more QALYs per person with an associated saved discounted cost of 309,358USD. The model was insensitive to the one-way sensitive analysis.

    Conclusion: This study concludes that the Two-component Dimeticone is likely cost-effective and cost saving drug for Tungiasis infested children in the age group 5-9 in the Sub-Saharan Africa compared to the standard treatment.

  • 179.
    Alemayehu, Asebe Abreham
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Study Protocol on Exploring How Women Articulate Their Experience of Violence and Perceive Facilitators and Barriers to Disclose the Violence at One-stop Centres in Ethiopia2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 180.
    Alemu, Andinet Worku
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia2010In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, article id 5398Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

    DESIGN: Case-control study.

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

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

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

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

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

  • 182.
    Alenius, Gerd-Marie
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Reumatology.
    A Clinical and Genetic Study of Psoriatic Arthritis2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

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

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  • 183. Alenius, Lisa Smeds
    et al.
    Lindqvist, Rikard
    Ball, Jane E.
    Sharp, Lena
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Tishelman, Carol
    Between a rock and a hard place: Registered nurses' accounts of their work situation in cancer care in Swedish acute care hospitals2020In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 47, article id 101778Article in journal (Refereed)
    Abstract [en]

    Purpose: Hospital organizational features related to registered nurses' (RNs') practice environment are often studied using quantitative measures. These are however unable to capture nuances of experiences of the practice environment from the perspective of individual RNs. The aim of this study is therefore to investigate individual RNs' experiences of their work situation in cancer care in Swedish acute care hospitals.

    Methods: This study is based on a qualitative framework analysis of data derived from an open-ended question by 200 RNs working in specialized or general cancer care hospital units, who responded to the Swedish RN4CAST survey on nurse work environment. Antonovsky's salutogenic concepts "meaningfulness", "comprehensibility", and "manageability" were applied post-analysis to support interpretation of results.

    Results: RNs describe a tension between expectations to uphold safe, high quality care, and working in an environment where they are unable to influence conditions for care delivery. A lacking sense of agency, on individual and collective levels, points to organizational factors impeding RNs' use of their competence in clinical decision-making and in governing practice within their professional scope.

    Conclusions: RNs in this study appear to experience work situations which, while often described as meaningful, generally appear neither comprehensible nor manageable. The lack of an individual and collective sense of agency found here could potentially erode RNs' sense of meaningfulness and readiness to invest in their work.

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  • 184.
    Alers, Margret
    et al.
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands .
    Pepping, Tess
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
    Bor, Hans
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
    Verdonk, Petra
    Department of Medical Humanities, School of Medical Sciences, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands .
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lagro-Janssen, Antoine
    Unit Gender and Women’s Health, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.
    Speciality preferences in Dutch medical students influenced by their anticipation on family responsibilities2014In: Perspectives on Medical Eduction, ISSN 2212-277X, Vol. 3, no 6, p. 443-454Article in journal (Refereed)
    Abstract [en]

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

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  • 185.
    Alessandra, Ingargiola
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food, Nutrition and Culinary Science.
    Pua, Övergaard
    Umeå University, Faculty of Social Sciences, Department of Food, Nutrition and Culinary Science.
    Elevers upplevelser av hur hälsoperspektiv kopplat till MAT tas upp i hem- och konsumentkunskap2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNING 

    Bakgrund Hem- och konsumentkunskap (HKK) är ett viktigt skolämne som syftar till att ge elever nödvändiga verktyg för att bli medvetna konsumenter. Livsmedelsverkets nya kostråd innebär att äta mer mat från växtriket och mindre från djurriket, att äta lagom mycket och att röra på sig. Flera studier om hem- och konsumentkunskapsundervisning visar att majoriteten av eleverna prioriterar smak framför hälsa samt att ungdomar under tonåren är mycket lättpåverkade av sina kamrater, reklam och förändringar i samhället. Ungdomars ohälsosamma matvanor beskrivs utgöra en av de största riskfaktorerna för sjuklighet i Sverige idag. Skolan med dess hem- och konsumentkunskapsundervisning har således möjlighet att främja hälsosamma matvanor.

    Syfte Syftet med uppsatsen var att utforska elevers upplevelser av hälsoperspektivet kopplat till mat i undervisningen i hem- och konsumentkunskap.

    Metod I studien har en kvalitativ forskningsmetod använts. Elva semistrukturerade intervjuer av elever i årskurs 9 har genomförts. Intervjumaterialet transkriberades, bröts ner i meningsenheter och kodades. Sedan delades materialet i subkategorier och kategorier vilka användes i resultatanalysen.

    Resultat Analysen resulterade i fem kategorier som byggdes upp av elva subkategorier. Kategorierna handlade om hälsa och livsstil, hantering av livsmedel, hur maten påverkar kropp och hälsa, vad det innebär att göra hälsosamma val samt elevers önskan av variation och tydlighet i undervisningen.

    Slutsats Eleverna visade sig ha svårigheter med att omvandla hälsokunskap till handling i vardagslivet. De behöver praktiska och konkreta övningar för att göra hälsosamma val i vardagen så att inte smak, kompisinflytande och ohälsosamma matvanor prioriteras före reflektion av hälsosam livsstil. Rekommendationen blir att läraren behöver vara mer tydlig och hälsoperspektivet behöver genomsyra undervisningen genom att visa på vad som är hälsosamt och inte. Detta medför att HKK-läraren behöver ha goda kunskaper om ämnet hälsa för att kunna förmedla detta på ett intressant och varierande sätt för eleverna.

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  • 186.
    Alex, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Feministiska perspektiv på omvårdnad - finns det?1998In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 75, no 1-2, p. 57-61Article in journal (Other (popular science, discussion, etc.))
  • 187.
    Alex, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Resilience among old Sami women2016In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 36, p. 1738-1756Article in journal (Refereed)
    Abstract [en]

    There is lack of research on old indigenous women’s experiences. The aim of thisstudy was to explore how old women narrate their experiences of wellbeing andlack of wellbeing using the salutogenetic concept of resilience. Interviews fromnine old Sami women were analysed according to grounded theory with the followingthemes identified: contributing to resilience and wellbeing built up from the categoriesfeeling connected, feeling independent and creating meaning; andcontributing to lack of lack of resilience and wellbeing built up from the categoryexperiencing lack of connectedness. The old Sami women’s narratives showedthat they were to a high extent resilient and experienced wellbeing. They felt bothconnected and independent and they were able to create meaning of being anold Sami woman. Having access to economic and cultural capital were for the oldSami women valuable for experiencing resilience. Lack of resilience was expressedas experiences of discrimination, lack of connectedness and living on the borderof the dominant society. Analysis of the Sami women’s narratives can give wider perspectiveson women’s health and deepen the perspectives on human resilience andincrease the understanding of minority groups in a multicultural world.

  • 188.
    Alex, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Experiences of Well-Being Among Sami and Roma Women in a Swedish Context2013In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 34, no 8, p. 707-726Article in journal (Refereed)
    Abstract [en]

    Our aim was to explore the experiences of well-being and lack of well-being among middle-aged and older women belonging to two national minority groups in Sweden. Interviews from nine older Sami women and four middle-aged Roma women were analyzed using grounded theory with the following categories identified: contributing to well-being (with the subcategories belonging to a healthy family, being spiritual, cultural norms as health promoting, and having had a life of one's own); and contributing to lack of well-being (with the subcategories living subordinate to the dominant society, living in a hierarchical family, and living in the shadow of tuberculosis.)

  • 189.
    Alex, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Wikberg, A
    Feministisk kritik av kurslitteratur inom ämnet professionell omvårdnad1994In: Omvårdaren, ISSN 0280-4123, no 2, p. 24-27Article in journal (Other (popular science, discussion, etc.))
  • 190.
    Alexandersson, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Påverkas rehabiliteringen av att patienter som genomgår en total knäplastiksoperation opereras i blodtomt fält och i så  fall hur? .: Enrandomiserad kontrollerad studie2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: År 2011genomfördes 12 048 primära totala knäartroplastiker (TKA) i Sverige. Av dessa opererades 90 96 iblodtomt fält (BTF) och10 96 i icke BTF. För att åstadkomma ett bladtomt fält används en blodtrycksmanschett pä låret, trycket kan variera mellan olika kliniker. Effekten av trycket mot hud, muskler, nerver och lodkärl kan orsaka neuromuskulära skador som kan leda tillpost-operativ svaghet i quadriceps.

    Syfte:Att se om rehabiliteringsresultatet päskyndades ochförbättrades av att patienterna inte opereradesiblodtomt fält.

    Metod: 37 patienter med knäartros randomiserades till cementerad TKA i blodtomt fält respektive icke blodtomt fält Aktiv knäflexion, smärta, svullnad, quadricepsfunktion och timed up and go (TUG) mättes före ochupp till tre månader post-operativt.

    Resultat: ANCOVA visade ingen effekt på knäflexion dag trepost-operativt mellan grupperna. Inte heller något av de övriga utfallsmåtten visade en signifikant skillnad post­ operativt. Gruppen med BTF hade tendens till mindre smärta dag tre post-operativt och det fanns ingen signifikant skillnad avseende extra morfinkonsumtion utöver ordinarie dos.

    Konklusion:Operation av TKAiblodtomt fält påverkade inte knäflexion men ytterligare studier med fler deltagare behövs för att säkert kunna säga om rehabiliteringen påverkas av operation i blodtomt fält.

  • 191.
    Alfadel, Anas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Social Activity and Health: Studying Elderly Adults’ Perspective upon Social Life and Health in Northern Sweden2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

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

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

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

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

  • 192.
    Alfakir, Firas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    “The thorny path towards future life!!”: International students’ experiences and feelings of stress: a qualitative study in Umeå2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

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

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

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

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

  • 193.
    Alfredson, Hakan
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). ISEH, UCLH, London, UK.
    Persistent pain in the Achilles midportion?: Consider the plantaris tendon as a possible culprit!2017In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 51, no 10, p. 833-834Article, review/survey (Refereed)
  • 194.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. Alfredson Tendon Clinic Inc., Umeå, Sweden; Pure Sports Medicine, London, England.
    Achilles and patellar tendon operations performed in local anestesia2018In: American journal of Anesthesiology and Pain medicine, ISSN 2640-5377, Vol. 1, no 1, p. 001-002Article in journal (Refereed)
    Abstract [en]

    From 20 years of research on innervation patterns and pain mechanisms in chronic painful Achilles and patellar tendinopathy, we have learned that the nerves are located outside the affected tendon. With this background we use local anestetics in combination with Adrenaline when these patients are surgical treated. We have now more than 15 years of experience in treating Achilles tendinopathy, and 10 years of experience in treating patellar tendinopaty, in local anesthesia alone. I will present the scientific background and practi-cal techniques to use local anesthesia for treatment of chronic painful Achilles and patellar tendinopathy.

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  • 195.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Can specific treatment prevent progressive tendon degeneration?2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 4, p. 334-Article in journal (Refereed)
    Abstract [en]

    Background Tendon degeneration is generally believed to be irreversible.

    Objective To use ultrasound to study the Achilles midportion tendon structure and thickness before and after treatment of chronic painful tendinosis.

    Design Prospective study.

    Patients and interventions Middle aged patients on varying activity levels, having midportion chronic Achilles tendinosis, were followed with ultrasound examinations before and after treatment with eccentric training, sclerosing polidocanol injections and surgical scraping.

    Outcome measurements Tendon thickness and structure.

    Results 89 patients successfully treated (pain-free during tendon loading) with eccentric training (n=22), sclerosing polidocanol injections (n=38) and surgical scraping (n=29), had a significantly thinner Achilles midportion and a more normal tendon structure, after compared to before, treatment.

    Conclusion For the Achilles midportion, tendon degeneration might not be irreversible. The findings indicate a possible regeneration potential.

  • 196.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Eccentric calf muscle training: the story2010In: Sportverletzung, Sportschaden, ISSN 0932-0555, E-ISSN 1439-1236, Vol. 24, no 4, p. 188-189Article in journal (Refereed)
  • 197.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. 2Institute of Sport, Exercise and Health, University College London Hospitals, London, UK.
    Low recurrence rate after mini surgery outside the tendon combined with short rehabilitation in patients with midportion Achilles tendinopathy2016In: Open Access Journal of Sports Medicine, E-ISSN 1179-1543, Vol. 7, p. 51-54Article in journal (Refereed)
    Abstract [en]

    Background: There is a general opinion that a structured and specific rehabilitation is needed after treatment of midportion Achilles tendinopathy to minimize recurrence of the condition. There is sparse knowledge about the recurrence rates in large patient materials after specific treatments for midportion Achilles tendinopathy.

    Aim: This study aimed to investigate the recurrence rates in a large number of patients with chronic painful midportion Achilles tendinopathy that had been surgically treated with the ultrasound (US) and Doppler (DP)-guided mini-surgical scraping technique. Postoperatively, a relatively simple rehabilitation protocol, including a range of movement exercises and gradually increased walking and biking before allowing free activity, was used.

    Materials and methods: From a database, information about the recurrence rates after US + DP-guided mini-surgical scraping, performed by a single surgeon on 519 tendons with US + DP-verified chronic painful midportion Achilles tendinopathy, was obtained.

    Results: Recurrence of painful midportion Achilles tendinopathy was found in 26 of 519 (5%) operated tendons, 13 from women and 13 from men. In 13 tendons, a close by located plantaris tendon was extirpated during the reoperation.

    Conclusion: In this large material on patients treated with US + DP-guided mini-surgical scraping for midportion Achilles tendinopathy, there were few recurrences, although only a simple and nonspecific rehabilitation protocol was used.

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  • 198.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Midportion Achilles tendinosis and the plantaris tendon2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 13, p. 1023-1025Article in journal (Refereed)
    Abstract [en]

    Objectives: When re-operating patients with midportion Achilles tendinosis, having had a poor effect of ultrasound (US) and Doppler-guided scraping, the author found the involvement of the plantaris tendon to be a likely reason for the poor result. The aim of this study was to investigate the occurrence of a plantaris tendon in close relation to the Achilles tendon in consecutive patients with midportion Achilles tendinosis undergoing treatment with US and Doppler-guided scraping.

    Material and methods: This study includes 73 consecutive tendons with chronic painful midportion Achilles tendinosis, where US+Doppler examination showed thickening, irregular tendon structure, hypo-echoic regions, and localised high blood flow outside and inside the ventral Achilles midportion. The tendons were treated with US+Doppler-guided scraping, via a medial incision. If there was a plantaris tendon located in close relation to the medial Achilles, it was extirpated.

    Results: An invaginated, or ‘close by located’, enlarged plantaris tendon was found in 58 of 73 (80%) tendons. Preliminary clinical results of the combined procedure, US + Doppler-guided surgical scraping and extirpation of the plantaris tendon, are very promising.

    Conclusions: A thickened plantaris tendon located in close relation to the medial Achilles seems common in patients with chronic painful midportion tendinosis. The role of the plantaris tendon in midportion Achilles tendinosis needs to be further evaluated and should be kept in mind when treating this condition.

  • 199.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine.
    Reply to the letter from Dr. Karsten Knobloch regarding our article "Sclerosing injections to treat midportion Achilles tendinosis: a randomized controlled study evaluating two different concentrations of polidocanol"2009In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 17, no 1, p. 113-114Article in journal (Other academic)
  • 200.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine. National Institute for Working Life, University of Umeå , 901 87, Umeå, Sweden .
    Strategies in treatment of tendon overuse injury. The chronic painful tendon.2006In: European Journal of Sport Science, ISSN 1746-1391, E-ISSN 1536-7290, Vol. 6, no 2, p. 81-85Article in journal (Refereed)
    Abstract [en]

    The etiology and pathogenesis to chronic tendon pain is unknown, and treatment is known to be difficult. Treatment is often based on opinions and not findings in scientific studies. Recent research, using the intra-tendinous microdialysis technique, has shown that in chronic painful Achilles-, patellar-, and extensor carpi radialis brevis (ECRB) tendons, there were no signs (normal Prostaglandin-2 levels) of a so-called chemical inflammation. Furthermore, in biopsies from chronic painful Achilles tendons, pro-inflammatory cytokines were not up-regulated, again showing the absence of an intra-tendinous inflammation. Consequently, if the purpose is to treat a chemical inflammation, there is no science backing up for treatment of theses conditions with anti-inflammatory agents (NSAIDs, corticosteroidal injections). Interestingly, Substance-P (SP) and Calcitonin Gene Regulated Peptide (CGRP) nerves have been demonstrated in close relation to vessels in biopsies from these chronic painful tendons, indicating the existence of a possible so-called neurogenic inflammation. Using ultrasonography (US) + color Doppler (CD), and immunhistochemical analyses of biopsies, a vasculo/neural (SP- and CGRP-nerves) ingrowth in the chronic painful tendinosis tendon, but not in the pain-free normal tendon, has recently been found. A specially designed treatment, using US- and CD-guided injections of the sclerosing agent Polidocanol, targeting the neovessels outside the tendon, has in pilot studies on chronic painful Achilles-, and patellar tendons been shown to cure the tendon pain in the majority of patients. A recent randomized double-blind study, verified the importance of injecting the sclerosing substance Polidocanol.

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