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  • 201.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Ultrasound and Doppler-guided mini-surgery to treat midportion Achilles tendinosis: results of a large material and a randomised study comparing two scraping techniques.2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 407-410Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Treatment based on ultrasound (US) and colour Doppler (CD) findings in midportion Achilles tendinosis has shown promising results. In a randomised study on a small patient material, similar short-term clinical results were demonstrated with surgery outside the tendon and sclerosing polidocanol injections, but surgical treatment led to a faster return to activity.

    OBJECTIVE: To evaluate the clinical results of US and CD-guided mini-surgery (scraping) outside the ventral tendon in a larger patient material and, in a randomised study, compare two different techniques for surgical scraping.

    MATERIAL AND METHODS: 103 patients (66 men, 37 women), mean age 43 years (range 24-77), with midportion tendinosis in 125 Achilles tendons were included. Patients from a large group (88 tendons), and a randomised study (37 tendons), were in local anaesthesia treated with a US and CD-guided new surgical approach outside the ventral tendon. All patients in the large group, and one arm of the randomised study, were treated open with a scalpel, while the other arm of the randomised study were treated percutaneously. Pain during Achilles tendon loading activity (Visual Analogue Scale (VAS)), and satisfaction with treatment, were evaluated.

    RESULTS: Before surgery, the mean VAS was 73. After surgery (follow-up mean 18 months, range 6-33), the mean VAS was 3 in 111 tendons (89%) from satisfied patients back in full Achilles tendon loading activity. In the randomised study, there were no significant differences in the results between open treatment with a scalpel and percutaneous treatment with a needle.

    CONCLUSIONS: US and CD-guided scraping show good short-term results in midportion Achilles tendinosis.

  • 202.
    Alfredson, Håkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Where to now with Achilles tendon treatment?2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 386-386Article in journal (Refereed)
  • 203.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Sports Medicine.
    Masci, Lorenzo
    Institute of Sports Exercise and Health, University College Hospital London, London, United Kingdom; Sports & Exercise Medicine, Queen Mary University of London, London, United Kingdom.
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Private Orthopaedic Spine Center, Würzburg, Germany.
    Is There a Relationship Between Quadriceps Tendinopathy and Suprapatellar Plica? An Observational Case Series2022In: International Medical Case Reports Journal, E-ISSN 1179-142X, Vol. 15, p. 81-84Article in journal (Refereed)
    Abstract [en]

    Purpose: Chronic painful quadriceps tendinopathy is a relatively rare condition known to be difficult to manage. Conservative management is first-line treatment and if that fails open intra-tendinous revision surgery followed by a long rehabilitation period is used. There is sparse research on etiology and new treatment methods. This observational study aimed to evaluate the intra-articular findings in patients with chronic painful quadriceps tendinopathy resistant to conservative management.

    Patients and Methods: Seven male athletes (mean age 33 years, range 22–40) suffering from chronic painful quadriceps tendinopathy in altogether 10 tendons, not responding to conservative management including heavy strength training, were included. Clinical examination and ultrasound scanning were used for diagnosis. Arthroscopy was used for evaluation of the inside of the knee.

    Results: In all 10 knees, there were obliterating major plica formations in the suprapatellar pouch.

    Conclusion: Obliterating plica formations in the suprapatellar pouch may be involved in the aetiology and pathology in quadriceps tendinopathy.

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  • 204.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Sports Medicine. Institute of Sports Exercise and Health, University College Hospital London, London, United Kingdom.
    Masci, Lorenzo
    Institute of Sports Exercise and Health, University College Hospital London, London, United Kingdom; Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom.
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Private Orthopaedic Spine Center Dr. Alfen, Würzburg, Germany.
    Sharp pain in a normal Achilles tendon of a professional female football player was related to a plantaris tendon in a rare position: a case report2021In: Journal of Medical Case Reports, E-ISSN 1752-1947, Vol. 15, no 1, article id 513Article in journal (Refereed)
    Abstract [en]

    Background: Plantaris tendinopathy and plantaris-associated Achilles tendinopathy can be responsible for chronic pain in the Achilles tendon midportion, often accompanied by medial tenderness. As conservative treatments are less successful for this patient group, proper diagnosis is important for decision making. This report presents a case with plantaris tendinopathy in a rare (superficial) location.

    Case presentation: This article describes a pain history and treatment timeline of a professional Swedish female soccer player (32 years old, Northern European ethnicity, white) who suffered from sharp pain in the Achilles tendon midportion and tenderness on the medial and superficial side for about 2 years. Conservative treatments, including eccentric exercises, were not successful and, to some extent, even caused additional irritation in that region. Ultrasound showed a wide and thick plantaris tendon located on the superficial side of the Achilles tendon midportion. The patient was surgically treated with local removal of the plantaris tendon. After surgery there was a relatively quick (4–6 weeks) rehabilitation, with immediate weight bearing, gradual increased loading, and return to running activities after 4 weeks. At follow-up at 8 weeks, the patient was running and had not experienced any further episodes of sharp pain during change of direction or sprinting.

    Conclusions: The plantaris tendon should be considered as a possible source of Achilles tendon pain. This case study demonstrates that the plantaris tendon can be found in unexpected (superficial) positions and needs to be carefully visualized during clinical and imaging examinations.

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  • 205.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. ISEH, UCLH, London, UK; Pure Sports Medicine Clinic, London, UK.
    Masci, Lorenzo
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Surgical plantaris tendon removal for patients with plantaris tendon-related pain only and a normal Achilles tendon: a case series2018In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 4, no 1, article id e000462Article in journal (Refereed)
    Abstract [en]

    Objectives: Surgical removal of the plantaris tendon can cure plantaris-associated Achilles tendinopathy, a condition in which Achilles and plantaris tendinopathy coexist. However, rare cases with plantaris tendinopathy alone are often misdiagnosed due to a normal Achilles tendon.

    Design and setting: Prospective case series study at one centre.

    Participants: Ten consecutive patients (9 men and one woman, mean age 35 years, range 19–67) with plantaris tendon-related pain alone in altogether 13 tendons were included. All had had a long duration (median 10 months, range 3 months to 10 years) of pain symptoms on the medial side of the Achilles tendon mid-portion. Preoperative ultrasound showed thickened plantaris tendon but a normal Achilles tendon.

    Interventions: Operative treatment consisting of ultrasound-guided excision of the plantaris tendon.

    Primary and secondary outcome measures: Scores from Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A)were taken preoperatively and postoperatively (median duration 10 months). Patient satisfaction and time until full return to sports activity level was asked by a questionnaire.

    Results: The VISA-A scores increased from 61 (range 45–81) preoperatively to 97 (range 94–100) postoperatively (p<0.01). Follow-up results at 10 months (range 7–72 months) on 9/10 patients showed full satisfaction and return to their preinjury sports or recreational activity

    Conclusion: The plantaris tendon should be kept in mind when evaluating painful conditions in the Achilles tendon region, especially when no Achilles tendinopathy is present. Excision of the plantaris tendon via a minor surgical procedure in local anaesthesia results in a good outcome.

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  • 206.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Sports Medicine. Institute of Sports, Exercise and Health, University College Hospital, London, UK.
    Masci, Lorenzo
    Department of Sports and Exercise Medicine, Queen Mary University, London, United Kingdom.
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Research Unit, Orthopaedic Spine Center, Dr. Alfen, Würzburg, Germany.
    Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: A case series2021In: BMJ Open Sport and Exercise Medicine, ISSN 2055-7647, Vol. 7, no 1, article id e000979Article in journal (Refereed)
    Abstract [en]

    Objectives: Chronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.

    Methods: Ninety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24-64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.

    Results: In 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.

    Conclusion: Plantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.

    Level of evidence: IV case series.

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  • 207.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Masci, Lorenzo
    Öhberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Partial midportion Achilles tendon ruptures: new sonographic findings helpful for diagnosis.2011In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 45, no 5, p. 429-432Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Partial Achilles tendon ruptures are not always easy to diagnose. A history including a sudden onset of pain, and/or relative weakness in plantar flexion force, are indicators. The most loaded side of the Achilles tendon is the dorsal side (skin side). OBJECTIVE: To evaluate the ultrasound (US) and Doppler (CD) findings in patients with a suspected partial rupture in the Achilles tendon. Material and METHODS: Seventeen patients (16 men and 1 woman) with a mean age of 36 years (range 23-71) were examined clinically and by US+CD because of midportion Achilles tendon pain. There was an acute onset in 14/17 patients, and all had painful weakness during tendon loading activity. RESULTS: In all patients the US examination showed a partial Achilles tendon rupture, presented as a disrupted dorsal (skin side) tendon line and an irregular tendon structure mainly located in the dorsal and mid-tendon. The size of the rupture varied from 1/3 to 2/3 of the tendon thickness. In the dorsal part of the tendon, corresponding to the region with disrupted tendon line and irregular structure, CD examination showed high blood flow-most often of a longitudinal character. Six of the patients were surgically treated, and macroscopical examination verified the ultrasound findings, showing disruption on the dorsal side, and a partial rupture in the dorsal and mid- tendon. CONCLUSIONS: Ultrasound and Doppler examination can be helpful tools to diagnose partial midportion Achilles tendon ruptures. The characteristic findings of a disrupted dorsal tendon line, and high blood flow in the structurally abnormal dorsal tendon, indicate a partial rupture.

  • 208.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine. ISEH, UCLH, London, UK; Pure Sports Medicine Clinic, London, UK.
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Dr Alfen, Orthopedic Spine Center, 97080 Würzburg, Germany.
    Clinical presentation and surgical management of chronic Achilles tendon disorders: a retrospective observation on a set of consecutive patients being operated by the same orthopedic surgeon2018In: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 24, no 6, p. 490-494Article in journal (Refereed)
    Abstract [en]

    Background: Non-invasive treatment is not always successful in patients with Achilles tendon disorders, and surgical treatment is instituted as the next step. There is sparse knowledge about the diagnoses, pain levels before surgery, surgically confirmed pathologies and postoperative complications in large patient groups.

    Aims: To study the diagnoses, pain scores before surgery, macroscopic surgical findings and postoperative complications in a series of patients treated for Achilles disorders.

    Material and methods: One surgeon operated on 771 Achilles tendons of 481 men and 290 women during a 10-year period. The clinically and ultrasound confirmed diagnoses, pre-operative pain and functional scores (Visual Analogue Scale, VAS, range 0-100; Victorian Institute Sports Tendon Assessment - Achilles questionnaire, VISA-A), macroscopic findings during surgery and postoperative complications, were retrospectively collected from a database.

    Results: Clinically, by ultrasound and during surgery midportion Achilles tendinopathy was confirmed in 519 (67%) patients, 41% of them had a thickened plantaris tendon located close the Achilles tendon. Partial midportion rupture was found in 31 (4%) patients, chronic midportion rupture in 12 (2%) patients and insertional Achilles tendinopathy, including superficial and retro-calcaneal bursitis, Haglund deformity, distal Achilles tendinopathy, plantaris tendon pathology, and bone spurs, in 209 (27%) patients. The mean pre-operative pain scores for midportion Achilles tendinopathy were 73 (VAS) and 45 (VISA-A), and for insertional Achilles tendinopathy 77 (VAS) and 39 (VISA-A). For midportion Achilles tendinopathy there were 14 (3%), and for insertional Achilles tendinopathy 10 (5%), postoperative complications.

    Conclusions: Patients presenting high pain scores from midportion Achilles tendinopathy were the most common. Plantaris tendon involvement is a frequent observation. For insertional Achilles tendinopathy the combination of pathology in the subcutaneous and retrocalcaneal bursa, a Haglund deformity and distal Achilles tendinopathy/tendinosis was most frequent. 

  • 209.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Unilateral surgical treatment for patients with midportion Achilles tendinopathy may result in bilateral recovery2014In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 48, no 19, p. 1421-1424Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Bilateral midportion Achilles tendinopathy/tendinosis is not unusual, and treatment of both sides is often carried out. Experiments in animals suggest of the potential involvement of central neuronal mechanisms in Achilles tendinosis. OBJECTIVES: To evaluate the outcome of surgery for Achilles tendinopathy. METHODS: This observational study included 13 patients (7 men and 6 women, mean age 53 years) with a long duration (6-120 months) of chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery. Follow-ups were conducted and the primary outcome was pain by visual analogue scale. In an additional part of the study, specimens from Achilles and plantaris tendons in three patients with bilateral Achilles tendinosis were examined. RESULTS: Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2 of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. Morphologically, it was found that there were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally. CONCLUSION: Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy.

  • 210.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Tol, Johannes
    Sports Medicine Physician Aspetar Qatar Orthopaedic and Sports Medicine Hosptial Doha, Qatar.
    de-Vos, Robert-Jan
    Erasmus Medical Centre and The Hague Medical Centre Rotterdam, The Netherlands.
    Chronic pain in the Achilles tendon2013In: Aspetar Sports Medicine Journal, Vol. 2, no 1, p. 18-22Article in journal (Other academic)
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  • 211.
    Alfredson, Håkan
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Sports Medicine. Capio Ortho Center Skåne, Malmö, Sweden.
    Waldén, Markus
    Capio Ortho Center Skåne, Malmö, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Roberts, David
    Capio Ortho Center Skåne, Malmö, Sweden.
    Spang, Christoph
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Department of Sports Science, University of Würzburg, Sanderring, Germany.
    Combined midportion achilles and plantaris tendinopathy: a 1-year follow-up study after ultrasound and color-doppler-guided walant surgery in a private setting in Southern Sweden2023In: Medicina, ISSN 1010-660X, E-ISSN 1648-9144, Vol. 59, no 3, article id 438Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: Chronic painful midportion Achilles combined with plantaris tendinopathy can be a troublesome condition to treat. The objective was to prospectively follow patients subjected to ultrasound (US)- and color doppler (CD)-guided wide awake, local anesthetic, no-tourniquet (WALANT) surgery in a private setting.

    Material and Methods: Twenty-six Swedish patients (17 men and 9 women, mean age 50 years (range 29-62)) and eight international male patients (mean age of 38 years (range 25-71)) with combined midportion Achilles and plantaris tendinopathy in 45 tendons altogether were included. All patients had had >6 months of pain and had tried non-surgical treatment with eccentric training, without effect. US + CD-guided surgical scraping of the ventral Achilles tendon and plantaris removal under local anesthesia was performed on all patients. A 4-6-week rehabilitation protocol with an immediate full-weight-bearing tendon loading regime was used. The VISA-A score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation.

    Results: At the 1-year follow-up, 32/34 patients (43 tendons) were satisfied with the treatment result and had returned to their pre-injury Achilles tendon loading activity. There were two dropouts (two tendons). For the Swedish patients, the mean VISA-A score increased from 34 (0-64) before surgery to 93 (61-100) after surgery (p < 0.001). There were two complications, one wound rupture and one superficial skin infection.

    Conclusions: For patients suffering from painful midportion Achilles tendinopathy and plantaris tendinopathy, US + CD-guided surgical Achilles tendon scraping and plantaris tendon removal showed a high satisfaction rate and good functional results 1 year after surgery.

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  • 212.
    Alfredsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jeghannathan, Bhoomikumar
    Attitudes towards mental health and the integration of mental health services into primary health care: a cross-sectional survey among health-care workers in Lvea Em District, Cambodia2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1331579Article in journal (Refereed)
    Abstract [en]

    Background: Cambodia is a country where the resources for treating mental health disorders are far from sufficient. One strategy to narrow the treatment gap is to integrate mental health into primary health care (PHC). Understanding the knowledge and attitudes towards mental health integration that health-care workers have is important for assessing the challenges and opportunities when planning a potential integration project. Objective: The aim of this study was to assess these basic conditions in Lvea Em District, Cambodia. Design: A structured self-reporting questionnaire regarding attitudes and knowledge about mental health and its integration into PHC was collected from 75 health-care workers in Lvea Em District, Cambodia in October 2015. Firstly, descriptive analyses were carried out, and secondly, linear regression analyses to assess the relationship between attitudes and socio-demographic variables were conducted. Results: There was clear support towards integrating mental health services into PHC among these participants as 81.3% were interested in personally delivering mental health care at their units. Respondents who reported having received some kind of mental health-care training tended to have a more positive attitude towards mentally ill people (p = 0.005) and those who thought there was a high need for mental health care had a more favourable attitude towards the integration of mental health services (p = 0.007). Conclusions: The most important finding from this survey was the willingness and the acceptance of the need for integration of mental health care. This enhances the feasibility of integrating mental health services at the PHC level. Improving the competence of mental health care in these settings will likely help to reduce the treatment gap for mental, neurological and substance use disorders in Cambodia.

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  • 213.
    Alfvén, Tobias
    et al.
    Institutionen för global folkhälsa, Karolinska institutet; Sachsska barn- och ungdomssjukhuset, Stockholm.
    Ekman, Anna-Theresia
    Institutionen för global folkhälsa, Karolinska institutet; S:t Görans sjukhus, Stockholm.
    Awil, Hana
    ST-läkare i allmänmedicin, Mora.
    Holmer, Hampus
    Institutionen för global folkhälsa, Karolinska institutet, Stockholm; Duke Global Health Institute, USA.
    Mia Ekström, Anna
    Institutionen för global folkhälsa, Karolinska institutet; Tema infektion och inflammation, Karolinska universitetssjukhuset, Stockholm.
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Agardh, Anette
    Socialmedicin och global hälsa, Lunds universitet.
    Frielingsdorf Lundqvist, Helena
    Flyktingmedicinskt centrum, Norrköping; Centrum för social och affektiv neurovetenskap, Linköpings universitet.
    Agenda 2030 och målen för en hållbar utveckling angår oss alla: [The 2030 Agenda for Sustainable Development - an important opportunity to improve global health]2020In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, article id 20037Article in journal (Refereed)
    Abstract [en]

    The 2030 Agenda for Sustainable Development and its seventeen Sustainable Development Goals were adopted by the United Nations General Assembly in 2015. It is a bold agenda for global social, environmental and economic development, with human health as a central theme. Even though substantial improvements in health have been achieved during the last decades, every year over 5 million children die, mostly from preventable causes, and 300 000 women die in conjunction with childbirth. Premature deaths from non-communicable diseases are increasing, and our ability to treat infections is under threat through widespread anti-microbial resistance. Climate change is recognized as the biggest threat to health in our time. When the world now starts to plan for how society and our health systems should be reorganized after the COVID-19 pandemic the 2030 Agenda could and should play a central role. In this context, Agenda 2030 provides an ambitious roadmap for development, with its emphasis on collaboration across borders and disciplines. The agenda is achievable but reaching its goals will require strong commitment at all levels and societal change on a large scale.

  • 214. Alghadir, A. H.
    et al.
    Anwer, S.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology. Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia ; Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
    Al-Eisa, E. S.
    Effect of quadriceps and hamstrings muscle cooling on standing balance in healthy young men2017In: Journal of Musculoskeletal and Neuronal Interactions - JMNI, ISSN 1108-7161, Vol. 17, no 3, p. 176-182Article in journal (Refereed)
    Abstract [en]

    Objective: The present study compared the effect of quadriceps and hamstring muscle cooling on standing balance in healthy young men.

    Methods: Thirty healthy young men (18-30 years) participated in the study. The participants were randomly assigned to three groups (n=10 each): quadriceps cooling (QC), hamstring cooling (HC), or control group (no cooling). Participants in the QC and HC groups received 20 minutes of cooling using a cold pack (gel pack), placed on the anterior thigh (from the apex of the patella to the mid-thigh) and the posterior thigh (from the base of the popliteal fossa to the mid-thigh), respectively. Balance score including unilateral stance was measured at baseline and immediately after the application of the cold pack.

    Results: No significant difference in the balance score was noted in any group after the application of the cold pack (p>0.05). Similarly, no significant differences in post-test balance score were noted among the three groups (p>0.05).

    Conclusions: Cooling of the quadriceps and hamstring muscles has no immediate effect on standing balance in healthy young men. However, longitudinal studies are warranted to investigate the long-term effects of cooling these muscles on standing balance.

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  • 215. Alghadir, A. H.
    et al.
    Anwer, S.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology. Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
    Iqbal, Z. A.
    Effect of localised vibration on muscle strength in healthy adults: a systematic review2018In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 104, no 1, p. 18-24Article, review/survey (Refereed)
    Abstract [en]

    Objective To investigate the effects of local vibration on muscle strength in healthy adults.

    Data sources The electronic databases PubMed, CINAHL, Scopus and Web of Science were searched using a combination of the following keywords: vibration, vibration therapy, power, maximal voluntary contraction, performance, rate of force development and vibratory exercise. In addition, the Medical Subject Headings 'vibration', 'strength' and 'exercise' were used. The bibliographical search was limited to articles published in English.

    Study selection Trials that evaluated the effect of localised vibration on muscle strength in healthy humans were included.

    Data extraction Two independent evaluators verified the quality of the selected studies using the PEDro Scale and the Cochrane Collaboration's tool for assessing the risk of bias. Muscle strength was calculated for each intervention.

    Results In total, 29 full-text studies were assessed for eligibility. Eighteen studies did not match the inclusion criteria, and were excluded. The 11 studies included in this review had an average PEDro score of 5.36/10. Most of the studies reported significant improvements in muscle strength after the application of local vibration. There was considerable variation in the vibration training parameters and target muscle location.

    Conclusions The use of local vibration on the target muscle can enhance muscle strength in healthy adults. Further well-designed controlled studies are required to confirm the effect of local vibration training on muscle strength. 

  • 216. Alghadir, Ahmad
    et al.
    Aly, Farag
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology.
    Sex-Based Differences in Lung Functions of Saudi Adults2012In: Journal of Physical Therapy Science, ISSN 0915-5287, Vol. 24, no 1, p. 5-9Article in journal (Refereed)
    Abstract [en]

    [Background] Sex-based differences in lung function are known. [Purpose] To investigate sex-based differences in ventilatory function among Saudi adults, anti to relate it to their level of physical activity. [Subjects and Methods] Seventy healthy Saudi adult subjects (35 males and 35 females) participated in this study. Measurements of forced vital capacity (FVC), forced expiratory volume in one second (FEVI). FEVI/FVC%, and maximal voluntary ventilation (MVV) were made. In addition, physical activity scores (MET-minutes/week) were measured using the International Physical Activity Questionnaire (IPAQ). [Results] The studied parameters were significantly higher for males than for females. The female values were significantly lower even after the male values were adjusted to compensate for gender-based anatomical and physiological differences in lung capacity. The MET-minutes/week was significantly higher for males than for females, but it was not significantly correlated with the pulmonary function parameters of either gender. [Conclusions] There are sex-based differences in lung function parameters of Saudi adults, with higher values for males. This difference in lung function tests between the genders is greater than the known anatomical and physiological differences in the respiratory systems of males and females. Saudi males are more physically active than females but no significant correlation between pulmonary function parameters and physical activity score was found for either gender.

  • 217. Alghadir, Ahmad H.
    et al.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology. Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia.
    Iqbal, Zaheen A.
    Experiences of Overseas Trained Physical Therapists Working in Saudi Arabia: An Observational Study2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 10, article id 3406Article in journal (Refereed)
    Abstract [en]

    Background: Health professionals, including physical therapists (PTs), are known to migrate for better jobs, as well as for personal and professional development. However, this involves risks of maladjustment, discrimination, and exploitation. We conducted this study to investigate the experiences of overseas trained PTs in Saudi Arabia (SA) and their perceptions about physical therapy practice and problems regarding the profession in the country.

    Methods: A questionnaire and accompanying explanation of the study was sent to 175 members of the Saudi Physical Therapy Association (SPTA) working in SA who had been trained outside SA and had a minimum of one year of work experience before moving to SA.

    Results: One hundred and fifty (86%) respondents completed the questionnaire. Among the respondents, the majority had more than five years of work experience after moving to SA. While 54% of the respondents reported that they were satisfied with their work experiences in SA, the remaining respondents reported their dissatisfaction for various reasons.

    Conclusions: With the increase in aged population and rise in disability, the need for PTs has simultaneously increased in the health care sector around the world, including in SA. Until PTs of local origin are ready to fill the requirements, the services of PTs from other countries will be required in SA. Although the majority of respondents reported having positive work experiences in SA, the negative aspects and challenges faced by PTs in SA have also been highlighted in this study. These problems need to be addressed in order to promote the development of a better and more holistic approach to patient care.

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  • 218. Alghadir, Ahmad H.
    et al.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology. Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
    Iqbal, Zaheen A.
    Al-Eisa, Einas S.
    Effect of voluntary teeth clenching and sitting posture on maximal static force of limb muscles2019In: Journal of Sports Medicine and Physical Fitness, ISSN 0022-4707, E-ISSN 1827-1928, Vol. 59, no 5, p. 774-778Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: People clench their teeth to activate facial, neck and abdominal muscles when they need to generate heavy muscle force against large resistance like lifting heavy objects, in order to gain possible ergogenic advantage. These are termed as remote voluntary contractions. Aim of this study was to evaluate the effect of voluntary teeth clenching on maximal voluntary contraction of extensors and flexors of the knee, shoulder and elbow joints of the dominant side during slouch and unsupported upright sitting.

    METHODS: One hundred healthy young male adults (mean age 23.3 years) participated in this study. Maximal voluntary contraction was measured using a hand-held dynamometer.

    RESULTS: Jaw clenching caused different ergogenic effect during slouch versus unsupported sitting postures. The data revealed that during unsupported upright sitting, the effect of jaw clenching consistently results in larger maximal voluntary contraction of both extensor and flexor muscles of all the three studied joints. However, during slouch sitting, only the maximal voluntary contraction of extensors of elbow and flexors of knee were larger with clenched teeth position.

    CONCLUSIONS: Jaw clenching can affect the maximal voluntary contraction of limb muscles which is sitting posture dependent. Jaw clenching can consistently facilitate certain muscles of the upper and lower limbs to generate greater force production during upright sitting.

  • 219. Alghadir, Ahmad
    et al.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology. King Saud Univ, Coll Appl Med Sci, Rehabil Res Chair, POB 10219, Riyadh 11433, Saudi Arabia.
    Iqbal, Zaheen A.
    Effect of upright and slouch sitting postures and voluntary teeth clenching on hand grip strength in young male adults2017In: Journal of Back and Musculoskeletal Rehabilitation, ISSN 1053-8127, E-ISSN 1878-6324, Vol. 30, no 5, p. 961-965Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Estimation of handgrip strength (HGS) is routinely used by clinicians and epidemiologists for objective assessment of functional status of hand and upper extremity. It is also used as an indirect indicator of overall physical strength and health status in variety of clinical situations and chronic general medical conditions. OBJECTIVE: The present study was conducted to examine the effects of upright and slouch sitting postures and voluntary teeth clenching on hand grip strength in healthy young male subjects. METHODS: One hundred healthy young males (aged 18-30 years) participated in this study. The HGS was measured using a commercially available dynamometer for the dominant hand. The HGS was measured during four test conditions; (a) slouch sitting without teeth contact, (b) slouch sitting with teeth clenching, (c) upright sitting without teeth contact, and (d) upright sitting with teeth clenching. RESULTS: The HGS values were significantly higher during slouch than upright sitting posture, both during similar and opposite teeth related conditions (p < 0.001). Teeth clenching had no effect on the in HGS values during slouch or upright sitting posture (P > 0.05). CONCLUSIONS: As compared to upright sitting, higher HGS values can be obtained during slouch sitting in young healthy males. Teeth clenching does not affect the HGS values during slouch or upright sitting posture.

  • 220. Alghadir, Ahmad
    et al.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology.
    Iqbal, Zaheen A.
    Work-related musculoskeletal disorders among dental professionals in Saudi Arabia2015In: Journal of Physical Therapy Science, ISSN 0915-5287, Vol. 27, no 4, p. 1107-1112Article in journal (Refereed)
    Abstract [en]

    [Purpose] Musculoskeletal disorders are common causes of work-related disability in different professions involving the frequent practice of lifting, stooping, twisting, prolonged sitting, or standing. The dental profession is one such profession. Our aim was to determine the prevalence of work-related musculoskeletal disorders among dental professionals in Saudi Arabia, the factors associated with them, and their consequences and to propose preventive measures for them.

    [Subjects and Methods] A self-administered online questionnaire was sent to 225 members of the Saudi Dental Association. It included questions on demographic and professional characteristics, general medical history, and history of work-related musculoskeletal disorders before and after joining the dental profession.

    [Results] The questionnaire was completed by 65% of the respondents. Among them 85% reported that they had developed some pain due to work after joining the dental profession, and 42% reported that they were suffering pain at the time of the survey. Besides lower back, shoulder, and neck regions, the hands, upper back, and other regions like the elbows, buttocks, thighs, leg, and feet were areas in which they pain.

    [Conclusion] The prevalence of work-related musculoskeletal disorders among dental professionals in Saudi Arabia is high, affecting their daily activities, sometimes even forcing them to change their work setting. Age, gender, specialty of work, work setting, number of contact hours with patients, etc., were all found to be related to their work-related pain. We need to emphasize the role of ergonomics, counseling, proper techniques of patient handling, etc., during the training of dental professionals so that they can work efficiently.

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  • 221. Alghadir, Ahmad
    et al.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology. King Saud Univ, Coll Appl Med Sci, Dept Rehabil Sci, Riyadh, Saudi Arabia.
    Iqbal, Zaheen Ahmed
    Anwer, Shahnawaz
    Physical therapy education in Saudi Arabia2015In: Journal of Physical Therapy Science, ISSN 0915-5287, Vol. 27, no 5, p. 1621-1623Article in journal (Refereed)
    Abstract [en]

    [Purpose] To review the physical therapy educational program model, professional curriculum, and gender representation at major universities, as well as the quality and scope of physical therapy practice in Saudi Arabia. [Methods] Information regarding course curriculum, gender representation, and the quality and scope of physical therapy practice was collected from six universities in Saudi Arabia, the Saudi Physical Therapy Association, and the Saudi Health Commission. [Results] The first bachelor's degree course of physical therapy was started in Saudi Arabia more than 30 years ago. In the last 10 years, the number of universities offering a bachelor's degree in physical therapy has risen from 6 to 16, of which 14 are governmental and two are private. The 5- to 6 year bachelor's degree program in physiotherapy includes an internship and preparatory prerequisite courses. Postgraduate study in physical therapy was introduced in 2000. Most universities offer segregated physical therapy courses for male and female students. [Conclusion] The enrollment of students in physical therapy programs in Saudi Arabia is gradually increasing. There are many opportunities to extend the scope of practice and contribute to the health needs of the Arab population and international communities.

  • 222. Alghadir, Ahmad
    et al.
    Zafar, Hamayun
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia.
    Iqbal, Zaheen
    Al-Eisa, Einas
    Effect of sitting postures and shoulder position on the cervicocephalic kinesthesia in healthy young males2016In: Somatosensory & motor research, ISSN 0899-0220, E-ISSN 1369-1651, Vol. 33, no 2, p. 93-98Article in journal (Refereed)
    Abstract [en]

    Information about head orientation, position, and movement with respect to the trunk relies on the visual, vestibular, extensive muscular, and articular proprioceptive system of the neck. Various factors can affect proprioception since it is the function of afferent integration, and tuning of muscular and articular receptors. Pain, muscle fatigue, and joint position have been shown to affect proprioceptive capacity. Thus, it can be speculated that changes in body posture can alter the neck proprioception. This study was undertaken to investigate the effect of body posture on cervicocephalic kinesthetic sense in healthy subjects. Cervicocephalic kinesthetic sensibility was measured by the kinesthetic sensibility test in healthy young adults while in (a) habitual slouched sitting position with arms hanging by the side (SS), (b) habitual slouched sitting position with arms unloaded (supported) (SS-AS), and (c) upright sitting position with arms hanging by the side (US) during maximum and 30 degree right, left rotations, flexion, and extension. Thirty healthy male adults (mean age 27.83; SD 3.41) volunteered for this study. The least mean error was found for the SS-AS position (0.48; SD 0.24), followed by SS (0.60; SD 0.43) and US (0.96; SD 0.71), respectively. For all test conditions, there was significant difference in mean absolute error while head repositioning from maximum and 30 degree rotation during SS and SS-AS positions (p<0.05). In conclusion, body posture can affect the proprioception function of the neck. Supporting the upper extremities in such a way that their weight is unloaded, which leads to reduction in the tension between the neck and shoulder girdle, can improve cervicocephalic kinesthetic sense in both the horizontal and vertical planes. The findings of this study can be implemented in people who have to do repeated arm and neck movements, by using ergonomically effective chairs with proper arm supports. This might help in prevention and treatment of neck pain.

  • 223.
    Algotsson, Elin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Undersökningar med magnetkamera av fullgångna och prematura barn: En litteraturstudie om risker och patientsäkerhet2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: MRI is a relatively safe diagnostic method with non-ionizing radiation used, as is not the case in conventional radiography. Despite this there are still risks to take into account, some common to all patients. For neonates, premature and full-term, these risks differ, and thereby also affect the neonatal staff and the radiographer's ability to meet the child's special need of patient safety. Purpose: This study aims to describe specific risk factors that affect patient safety during examination with MRI, regarding the full term and preterm neonatal child. Method: scientific articles were searched in PubMed, Cinahl and Medline, eight quantitative articles were selected for quality review. Results: After analysis of these eight articles, four categories were recognized and distinguished; image quality, hypothermia, low oxygen saturation, and anesthetics. The results also showed that the use of an MR-compatible incubator further impacted patient safety positively. Conclusion: Image quality, hypothermia, low oxygen saturation and anesthetics are specific risk factors that need to take into account when considering the patient safety in preterm and full-term neonates.

    Keywords: magnetic resonance imaging, infant premature, patient safety

  • 224. Ali, Mohammed
    et al.
    Asefaw, Teklehaimanot
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Beyene, Hagos
    Pedersen, F Karup
    Helping northern Ethiopian communities reduce childhood mortality: population-based intervention trial2005In: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 83, no 1, p. 27-33Article in journal (Refereed)
  • 225.
    Ali, Mohammed Hassan
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The need for research and evidence-based practice amongst health professionals in Somalia: The case of “The Training of Trainers' program” in research methodology.2019Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 226.
    Ali, Saeeda
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Is loneliness a risk factor for cardiovascular diseases in Indian adults aged 50 years and older?2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Loneliness has emerged as a psycho-social problem, particularly among older population in recent years. Many studies from different regions of India have shown considerable growth in the older population reporting feeling lonely. Recent attention to research demonstrating the association between loneliness and cardiovascular diseases (CVDs) has raised the profile, including in India, where CVD is one of the leading causes of death. This study aimed to assess the prevalence of loneliness and cardiovascular diseases among older adults aged 50 years and older in different demographic and socioeconomic groups, and explore the association between loneliness and CVDs.

    Methods: This cross-sectional study used data from the longitudinal Study on global AGEing and adult health in India in 2007, and included a total of 6,439 participants aged 50 years and older (3,241 men and 3,198 women). We used logistic regression analysis to assess the association between loneliness and CVDs, while controlling for confounding factors, such as age, gender, education, marital status, wealth, depressive symptoms, sleep, physical activity, smoking, and alcohol use. All analyses were stratified by gender.

    Results: Loneliness was more prevalent among women than men while prevalence of CVDs was higher in men than women. The regression analysis showed a positive association between loneliness and CVDs in both women and men. The univeriate analysis without adjusting for confounders showed that women had 58% higher odds of reporting CVDs (95% CI: 1.24 - 2.00 (p<0.001)) than women who did not report loneliness. The corresponding figure for men was 67% higher odds (95% CI: 1.34-2.08, p<0.001). In the adjusted analyses the association was attenuated, and loneliness was still a significant predictor of CVDs in women only (OR 1.37; 95% CI: 1.05 – 1.78, p<0.05).

    Conclusions: The current study reveals that loneliness was strongly associated with CVDs in older women in India while this association was not observed in men. Some of the factors controlled for in the analysis, such as age, wealth, depressive symptoms, and sleep are also significantly associated with CVDs in men and women while alcohol was significant only among men. Further studies using mediation analyses will allow better understanding about the true effects and mechanisms of these factors in influencing CVDs among older people. This information can help in developing psychosocial-related CVD prevention strategies, especially for women.

  • 227.
    Ali, Saeeda
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    “Marry them off quickly and get the responsibility over”: A qualitative study of exploring perceptions of child marriage among Rohingya refugees in Cox’s Bazar camps, Bangladesh; Grounded theory approach2019Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Child marriage, early marriage, or marriage of minors is a widely recognized as a harmful and discriminatory act violating human rights. Any marriage where one or both partners are under 18 years of age is considered child marriage. It is generally thought that child marriage occurs in girls, but boys also could be exposed to such an issue. Poverty, illiteracy, cultural and religious factors contribute to the rise in child marriage worldwide. In addition, its impacts affect multiple levels of the country, such as disempowerment and neglection of the individual, spread of inequality, and increase in child and maternal mortalities. Child marriage was also been seen in refuge contexts, as in Rohingya refugees living in Cox’s Bazar refugee camps in Bangladesh. Yet, there is lack of in-depth research examining the perception of this particular group on child marriage. This thesis aims to discover families’ perceptions of child marriage in “unstable” contexts. Also, the study explores the reason behind parents marrying their children off in exceptionally young age, and searches for ways to reduce child marriage in refugees.

    Method: The study used qualitative design. It engaged 26 Rohingya informants from Cox’s Bazar camps in in-depth interviews to gather data on their views related to child marriage. 12 male and 14 female parents arriving the camps from 2000 to 2018 were included. Data collection and analysis followed a grounded theory approach. All the emerged codes from the transcribed data went through diverse levels of clustering; selective coding, theoretical or sub-categories, main categories, and the final core category.

    Result: Five categories that emerged from the data were; fulfilment of family needs, parental obligations, judgement based on fearful thoughts, twistable child protection law, and beyond parent’s desire. The core category “perceptions on child marriage act in the middle of acceptance and rejection” was seen to linked with the categories in terms of whether parents accept the act or not, child marriage is a widespread practice among Rohingya families.

    Conclusion: Child marriage is found to be a deeply-rooted tradition among Rohingya families. It was viewed mostly as a fulfilment of a need, a religious and cultural obligation, a mean of protection, and an undesirable act at the same time. In order to change the views in Rohingya communities, religious leaders along with families must be engaged in the long-term interventions of child marriage eradication.

  • 228.
    Ali, Sebat Abdulkadir
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Prevalence and predictors of smoking in Northern Sweden: A population-based cross-sectional study.2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 229. Ali, Tazeen S
    et al.
    Asad, Nargis
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Krantz, Gunilla
    Intimate partner violence in urban Pakistan: prevalence, frequency, and risk factors2011In: International Journal of Women's Health, E-ISSN 1179-1411, Vol. 3, p. 105-15Article in journal (Refereed)
    Abstract [en]

    Background: Intimate partner violence (IPV) is an important public health issue with severe adverse consequences. Population-based data on IPV from Muslim societies are scarce, and Pakistan is no exception. This study was conducted among women residing in urban Karachi, to estimate the prevalence and frequency of different forms of IPV and their associations with sociodemographic factors.

    Methods: This cross-sectional community-based study was conducted using a structured questionnaire developed by the World Health Organisation for research on violence. Community midwives conducted face-to-face interviews with 759 married women aged 25–60 years.

    Results: Self-reported past-year and lifetime prevalence of physical violence was 56.3 and 57.6%, respectively; the corresponding figures for sexual violence were 53.4% and 54.5%, and for psychological abuse were 81.8% and 83.6%. Violent incidents were mostly reported to have occurred on more than three occasions during the lifetime. Risk factors for physical violence related mainly to the husband, his low educational attainment, unskilled worker status, and five or more family members living in one household. For sexual violence, the risk factors were the respondent’s low educational attainment, low socioeconomic status of the family, and five or more family members in one household. For psychological violence, the risk factors were the husband being an unskilled worker and low socioeconomic status of the family.

    Conclusion: Repeated violence perpetrated by a husband towards his wife is an extremely common phenomenon in Karachi, Pakistan. Indifference to this type of violence against women stems from the attitude that IPV is a private matter, usually considered a justifiable response to misbehavior on the part of the wife. These findings point to serious violations of women’s rights and require the immediate attention of health professionals and policymakers.

  • 230. Ali, Tazeen S
    et al.
    Krantz, Gunilla
    Gul, Raisa
    Asad, Nargis
    Johansson, Eva
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Gender roles and their influence on life prospects for women in urban Karachi, Pakistan: a qualitative study2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, p. 7448-Article in journal (Refereed)
    Abstract [en]

    Background: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women’s and men’s life prospects.

    Objective: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men’s and women’s life circumstances.

    Design: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.

    Findings: Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve women’s subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation.

    Conclusions: This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women’s empowerment.

  • 231. Ali, Tazeen S
    et al.
    Krantz, Gunilla
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Violence permeating daily life: a qualitative study investigating perspectives on violence among women in Karachi, Pakistan2012In: International Journal of Women's Health, E-ISSN 1179-1411, Vol. 4, p. 577-585Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study explored how married women perceive situations which create family conflicts and lead to different forms of violence in urban Pakistan. In addition, it examines perceptions of consequences of violence, their adverse health effects, and how women resist violence within marital life.

    METHODS: Five focus group discussions were conducted with 28 women in Karachi. Purposive sampling, aiming for variety in age, employment status, education, and socioeconomic status, was employed. The focus group discussions were conducted in Urdu and translated into English. Manifest and latent content analysis were applied.

    RESULTS: One major theme emerged during the analysis, ie, family violence through the eyes of females. This theme was subdivided into three main categories. The first category, ie, situations provoking violence and their manifestations, elaborates on circumstances that provoke violence and situations that sustain violence. The second category, ie, actions and reactions to exposure to violence, describes consequences of ongoing violence within the family, including those that result in suicidal thoughts and actions. The final category, ie, resisting violence, describes how violence is avoided through women's awareness and actions.

    CONCLUSION: The current study highlights how female victims of abuse are trapped in a society where violence from a partner and family members is viewed as acceptable, where divorce is unavailable to the majority, and where societal support of women is limited. There is an urgent need to raise the subject of violence against women and tackle this human rights problem at all levels of society by targeting the individual, family, community, and societal levels concurrently.

  • 232. Ali, Tazeen S
    et al.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Krantz, Gunilla
    Intimate partner violence and mental health effects: a population-based study among married women in Karachi, Pakistan2013In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 20, no 1, p. 131-139Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Intimate partner violence (IPV) is recognized all over the world for its association with mental health problems in women. In Pakistan, such violence occurs commonly, but detailed information on mental health effects is scarce. The purpose of this study is to focused on married couples in urban Karachi to investigate mental health effects associated with physical, sexual and psychological violence perpetrated by husbands towards wives. Disclosure rates and health care-seeking behaviour were also investigated. METHOD: This cross-sectional study involved 759 women between the ages of 25 and 60 years, selected using a multi-stage random sampling technique. The women were interviewed by trained community midwives using a structured questionnaire. RESULTS: In the total population of women, mental symptoms were prevalent. Women subjected to any form of violence reported, however, considerably poorer mental health than unexposed women. A statistically significant difference for almost all of the studied health parameters persisted even after controlling for socio-demographic factors. The strongest associations were found for suicidal thoughts and physical violence (OR 4.41; 3.18-6.12), sexual abuse (OR 4.39; 3.17-6.07) and psychological abuse (OR 5.17; 3.28-8.15). The interviews revealed that only 27% of the women subjected to violence had disclosed this to anyone, in most cases to their parents. CONCLUSION: The findings in this study highlight that the violence women have to face contributes to the development of multiple forms of psychological stress and serious mental health problems. Women's restrictive life circumstances seriously hamper women's empowerment. Reliable health surveillance system and health care services are needed to serve abused women. Policy initiatives focused on IPV and gender inequality in Pakistan should be initiated.

  • 233.
    Ali, Winifred
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The role of psychoeducation in reducing the burden of care for relatives of patients with schizophrenia: A scoping review.2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    It is known that the role of caregiving is burdensome for relatives of people living with schizophrenia. Psychoeducation has been proven to improve this burden of caregiving for relatives of patients living with schizophrenia, however, the extent of its application in clinical settings is unknown.

    The purpose of this scoping review was to discover the role of psychoeducation in reducing the burden of care for relatives of schizophrenic patients. The review was done using the PRISMA-ScR guideline and, PubMed was used as the only search engine. Articles were eligible if the intervention was psychoeducation, the focus was on relatives and, the outcome was related to the burden of care.

    23 articles published between 2003 to February 2022 are included in this review. The majority of the articles compared psychoeducation to standard care. A bulk of the studies originated from Asia and, most caregivers were female. The findings from most of the studies are consistent with the fact that psychoeducation improves the burden of care and other negative outcomes for caregivers of people living with schizophrenia. Literature lacked studies from Africa and the perspective of spouses of people living with schizophrenia.

    There is a need for psychoeducation to be tailored toward the requirements of female caregivers and the continuous integration of psychoeducation in routine clinical settings for relatives of people living with schizophrenia.

  • 234.
    Alizadeh, Neda
    et al.
    School of Occupational Therapy, Dalhousie University, Halifax, Canada.
    Packer, Tanya
    Umeå University, Faculty of Medicine, Department of Nursing. School of Health Administration, Dalhousie University, Halifax, Canada.
    Chen, Yu-Ting
    Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan.
    Alnasery, Yaser
    School of Occupational Therapy, Dalhousie University, Halifax, Canada; College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
    What we know about fatigue self-management programs for people living with chronic conditions: a scoping review2023In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 114, article id 107866Article, review/survey (Refereed)
    Abstract [en]

    Objective: The significant impact of fatigue on the lives of patients with chronic conditions has demanded a response. One response has been the development and testing of self-management programs. Little is known about what these programs have in common or how they differ. This scoping review compared the key components of fatigue self-management programs.

    Methods: Scoping review methodology was employed. Databases of CINAHL, Academic Search Premier, PsycINFO, Cochrane and Medline were searched to identify relevant sources. Results: Included fatigue programs were compared using a three-component framework: 1) self-management strategies; 2) active patient participation; and 3) self-management support. Although all programs included some aspects of these components, the extent varied with only a few domains of these components found across all programs.

    Conclusion: The three self-management components employed in this study showed potential benefits in identifying similarities and differences across fatigue programs with comparable and distinct underlying theories. This three-component framework could facilitate identification of domains associated with positive outcomes. Practice implications: It is essential that authors of programs provide detailed descriptions to enable inter-program comparison. The three-component framework chosen for this review was capable of describing and comparing fatigue self-management programs, paving the way for more effective interventions.

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  • 235.
    Aljaberi, Musheer A.
    et al.
    Faculty of Medicine & Health Sciences, Taiz University, Taiz, Yemen; Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
    Alsalahi, Abdulsamad
    Department of Pharmacology, Faculty of Pharmacy, Sana’a University, Sana’a, Yemen.
    Juni, Muhamad Hanafiah
    Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
    Noman, Sarah
    Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
    Al-Tammemi, Ala'a B.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary; Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
    Hamat, Rukman Awang
    Department of Medical Microbiology, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
    Efficacy of interventional programs in reducing acculturative stress and enhancing adjustment of international students to the new host educational environment: a systematic review and meta-analysis2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 15, article id 7765Article, review/survey (Refereed)
    Abstract [en]

    This review aimed to systematically outline and meta-analyze the efficacy of psychoeduca-tional, cultural orientation, socio-cultural, and peer-pairing programs in reducing acculturative stress and enhancing adjustment among international students worldwide. The consulted databases were PubMed, Scopus, Web of Science, ScienceDirect, EBSCO, and ProQuest. Eligibility criteria allowed the inclusion of randomized controlled trials (RCTs) and quasi-experimental trials without applying lan-guage, country, publication type or time restrictions. The quality of the eligible studies was appraised by the RoB2 tool of Cochrane for RCTs and JBI critical appraisal tools for quasi-experimental trials. Data items were collected based on PICO acronym by two investigators and reviewed for accuracy by a third one. The evidence was narratively synthesized and validated by proceeding with a random model meta-analysis using Cochrane RevMan software(Version 5.4). The quality of the pooled evidence from meta-analysis was assessed using the tool of GRADE. Out of 29,975 retrieved records, 14 studies (six RCTs and eight quasi-experimental trials) were included. The psychoeducational program significantly reduced acculturative stress and enhanced adjustment. In contrast, cultural orientation and peer-pairing programs significantly enhanced adjustment, but could not reduce acculturative stress. In meta-analysis, acculturative stress was significantly reduced in the psychoe-ducational intervention versus controls [overall pooled size effect = −3.89 (95% CI: −5.42, −2.53) at p < 0.001]. Similarly, adjustment was significantly enhanced in the psychoeducation and sociocultural interventions versus control [overall pooled size effect = 3.10 (95% CI: 2.35, 3.85) at p <0.001]. In conclusion, the psychoeducational program demonstrated superior efficacy in reducing accultur-ative stress and enhancing adjustment compared to the other interventional programs. However, socio-cultural programs have still been effective in enhancing adjustment. This systematic review is registered in PROSPERO (CRD42018104211).

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  • 236. Aljuaid, Mohammed
    et al.
    Elmontsri, Mustafa
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Rawaf, Salman
    Majeed, Azeem
    Psychometric evaluation of the Arabic language person-centred climate questionnairestaff version2018In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 26, no 4, p. 449-456Article in journal (Refereed)
    Abstract [en]

    AimTo evaluate the psychometric properties of the Arabic language person-centred climate questionnairestaff version. BackgroundThere have been increasing calls for a person-centred rather than a disease-centred approach to health care. A limited number of tools measure the extent to which care is delivered in a person-centred manner, and none of these tools have been validated for us in Arab settings. MethodThe validated form of the person-centred climate questionnairestaff version was translated into Arabic and distributed to 152 health care staff in teaching and non-teaching hospitals in Saudi Arabia. Statistical estimates of validity and reliability were used for psychometric evaluation. ResultsItems on the Arabic form of the person-centred climate questionnairestaff version had high reliability (Cronbach's alpha .98). Cronbach's alpha values for the three sub-scales (safety, everydayness and community), were .96, .97 and .95 respectively. Internal consistency was also high and measures of validity were very good. ConclusionArabic form of the person-centred climate questionnairestaff version provides a valid and reliable way to measure the degree of perceived person-centredness. Implications for nursing managementThe tool can be used for comparing levels of person-centredness between wards, units, and public and private hospitals. The tool can also be used to measure the extent of person-centredness in health care settings in other Arab countries.

  • 237.
    Alkass, Petra
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Fritidsaktiviteter som främjar delaktighet i vardagen för barn och ungdomar med Cerebral Pares: En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Cerebral pares (CP) är en neurologisk sjukdom som drabbar den omogna hjärnan tidigt i livet. Denna typ av skada påverkar i stort individens delaktighet i aktivitet. Detta kan leda till ett begränsat liv. Delaktighet är en viktig faktor för att bibehålla en god hälsa. Det handlar om att kunna delta, ingå, och involveras i olika livssituationer. Syftet är att sammanställa befintlig forskning avseende delaktighet i fritidsaktivitet och upplevelsen av delaktighet hos barn med Cerbral Pares. Metod: En litteraturstudie grundad på åtta kvalitativa och kvantitativa artiklar. Artiklarna hämtades från databaserna PubMed, CINAHL och Academic Search Elite, publicerade mellan år 2006-2016 och deras resultat sammanställdes i huvudrubriker. Resultat: Deltagarna som deltog i fritidsaktiviteter upplevde en stor glädje till sin aktivitet och föredrar att involvera sig i informella aktiviteter. Diskussion: Deltagarna fick en positiv inställning till att delta i fritidsaktiviteter som utmynnar motivation och intresse men det är lågt forskat inom detta område vilket gör resultatet svårt att generalisera.

  • 238.
    Al-Kassas, Anneli
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Gustafsson, Tove
    Umeå University, Faculty of Medicine, Department of Nursing.
    Kvinnors erfarenheter av återhämtning efter hjärtinfarkt: En litteraturstudie2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
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  • 239. Alkema, Leontine
    et al.
    Chou, Doris
    Hogan, Daniel
    Zhang, Sanqian
    Moller, Ann-Beth
    Gemmill, Alison
    Fat, Doris Ma
    Boerma, Ties
    Temmerman, Marleen
    Mathers, Colin
    Say, Lale
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Witwatersrand, Johannesburg, South Africa.
    Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10017, p. 462-474Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030.

    METHODS: We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources.

    RESULTS: We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%.

    INTERPRETATION: Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths.

    FUNDING: National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

  • 240.
    Alkhed, Ann-Kristin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Har konditionsträning positiv effekt på hjärntrötthet, kognitiva förmågor och dynamisk balans under gång hos personer med förvärvad hjänskada?: En Single-Subject Experimental Design studie2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background and aim: People with acquired brain injury often have problems with fatigue, cognition and dynamic balance during walking. The aim of this study was to evaluate if aerobic exercise had positive effects on fatigue, cognition and dynamic balance during walking for persons with acquired brain injury

     

    Method: Single subject experimental design, A-B-design was used. The three participants were between 18-70 years, have had the injury for at least two years, had participated in a group rehabilitation program and had at least 4 on the Fatigue Severity Scale (FSS). They cycled 30 minutes, twice a week during twelve weeks on 70-80 % of maximum heart rate. The intervention consisted of warm-up and four intervals with recovery in-between. The exertion level had to be between 12 and 15 on the Rating of Percieved Exertion-scale. Other outcome measures that were used were FSS, Flanker, N-back, Stroop test and Dynamic Gait Index (DGI). Descriptive statistics, visual analysis and 2SD method were used.

     

    Results: The cognition improved for all three participants. The results showed no improvement in DGI but in FSS for one participant.

     

    Conclusion: Aerobic exercise could be used in the physical and cognitive rehabilitation for patients with acquired brain injury but seemingly has no positive effects on fatigue or dynamic balance during walking.

  • 241.
    Allard, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Enteric adenovirus type 41: genome organization and specific detection procedures1992Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Enteric adenoviruses (EAd) types 40 and 41 (Ad40 and Ad41) representing subgenus F, are primary pathogens of children being second only to rotaviruses as the most important cause of infantile diarrhea.

    The EAds differ from all other adenoviruses in their inability to grow in most conventional established cell lines and have been suggested to be deficient in some early gene functions since they could be complemented by Ad 5 early regions EIA and E1B. In order to search for differences that could explain its characteristic growth restriction, the early regions EIA and E1B of Ad41 (strain D389) were sequenced, analysed and compared with the corresponding regions of Adl2, Ad7, Ad2, and Ad4. As revealed by the analysis of Ad2, three major mRNAs of 9S, 12S and 13S are generated from region EIA. The EIA region of Ad41 encodes two mRNAs corresponding to the 12S and 13S mRNAs. Only the 13S mRNA is transcribed at detectable levels. This mRNA can be translated into a 251 aa putative protein that contains the three highly conserved domains found in all other human adenoviruses and shown to be responsible for many important regulatory functions during infection.

    The E1B region of Ad41 encodes three transcripts that correspond to 22S, 14S and 9S mRNA of Ad2. No equivalent to the 13S mRNA of Ad2 E1B is found. In addition the Ad41 14S mRNA exhibits an additional exon of 23 bp created by a donor and an acceptor splice sites not desribed for other adenovirus E1B sequences.

    Due to their growth restriction in conventional cultures, rapid diagnostic procedures developed for the enteric adenovirus infections have mainly been aimed at the detection of viral antigens or nucleic acids. This thesis also describes several procedures developed for the general detection of adenoviruses and specific detection of the enteric types in stools specimens. General and specific hybridization assays were developed by use of two BamHI clones obtained from the EIA region of Ad41. One- and two-step PCR procedures were also developed for the general detection of adenoviruses using primers corresponding to highly conserved sequences within the hexon gene. Subgenus F specific one- and two-step PCRs were developed by using primers located in the Ad41 E1B region.

    The one-step PCR systems were tested and validated against isolation in tissue culture, DNA restriction enzyme analysis and a commercial latex agglutination test in the study of 60 specimens obtained from children with rotavirus negative diarrhea. The asymptomatic fecal excretion of adenoviruses was evaluated by two-step PCR amplifications on samples from 50 healthy children, 50 healthy adults, and 50 adults suffering from diarrhea.

    Finally, a simplified procedure for detection, discrimination and typing of EAd was also designed by combining the one-step PCR amplification of the hexon region with the restriction of the 300 bp product.

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  • 242.
    Allebeck, Peter
    et al.
    Department of Global Public Health, Karolinska Institutet, Sweden..
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Fifty years of Nordic social medicine and public health: snapshots of a journal2022In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 7, p. 827-830Article in journal (Refereed)
    Abstract [en]

    We revied articles published in the Scandinavian Journal of Public Health in a 50 years perspective. Papers reflect development of public health research, policy and debate over the years. Several papers describe early phases of Nordic population based studies that came to have major importance.

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  • 243.
    Allerstrand, Linda
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Upplevelser och erfarenheter av arbetsterapeutisk gruppbehandling inom psykiatrisk öppenvård2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Människor med lindrig kognitiv funktionsnedsättning upplever ofta svårigheter i vardagliga aktiviteter. De kan ha problem med minne, uppmärksamhet och problemlösning. Trots att de utför sina dagliga aktiviteter oberoende av stöd gör de fler misstag och tar längre tid på sig. En psykiatrisk öppenvårdsmottagning i norra Sverige startade 2014 en arbetsterapeutisk gruppbehandling för klienter med milda kognitiva funktionsnedsättningar och aktivitetsbegränsningar. I behandlingen får deltagarna möjlighet att identifiera och prioritera aktivitetsproblem. Syftet med studien var att belysa klienters upplevelser och erfarenheter av arbetsterapeutisk gruppbehandling inom psykiatrisk öppenvård. För att svara på syftet valdes en kvalitativ ansats med metoden innehållsanalys. Tidigare deltagare som hade fullgjort sin behandling och hade uppsatta mål under behandlingen identifierades via den psykiatriska öppenvårdsenheten. Analysen utgjordes av åtta semistrukturerade intervjuer och resulterade i totalt fem underkategorier och två huvudkategorier. Första huvudkategorin ”en vilja till förändring genom gruppbehandlingsprocessen” handlar om upplevelsen om de sociala fördelarna av att delta i en grupp och vad som krävs för att skapa en hållbar rutin. Andra huvudkategorin ”strukturlös gruppbehandling” handlar om upplevelsen av bristande struktur och oorganiserade grupptillfällen. Slutsatsen är att deltagarna upplevde positiva fördelar med att delta i gruppbehandling och att utbytet sinsemellan i gruppen bidrog till att komma till rätta med deltagarnas aktivitetsbegränsningar. Deltagarna beskrev att den sociala träningen som grupptillfällena erbjöd var värdefull och atmosfären i gruppen var stöttande. Upplevelsen av ostrukturerade grupptillfällen och hög frånvaro bland gruppdeltagarna beskrevs öka det kaos som deltagarna önskade kontrollera.

  • 244.
    Allfors, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Engström, Kristina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    En samtida validering av självtesten i appen MinBalans: En jämförelse mot kraftplatta2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Vid Umeå universitet är applikationen MinBalans under utveckling. Det är ett självtest för äldre personer för att på egen hand kunna utvärdera balansförmåga och funktionella benstyrka. Självtestet har tidigare jämförts mot kliniska tester men ej mot Gold standard (kraftplatta).

    Syfte: Syftet med denna samtida valideringsstudie är att undersöka sambandet mellan variabler uppmätta med appen MinBalans och kraftplatta i ett balans- och ett uppresningstest. Ett ytterligare syfte är att undersöka vilka variabler som tydligast åtskiljer resultaten mellan yngre och äldre testdeltagare.

    Metod: Variabler beräknade från appen jämfördes med motsvarande variabler uppmätta med kraftplattan. Tio äldre och tio yngre deltagare utförde ett balanstest bestående av två delar, fötter ihop och semitandem, samt ett uppresningstest.

    Resultat: I balanstestet fötter ihop korrelerade 4 av 12 variabler och i semitandem 10 av 12. I jämförelsen mellan yngre och äldre deltagares resultat visades signifikant skillnad för 3 av 12 variabler i testet fötter ihop för mobilappen och 1 av 12 för kraftplattan. I jämförelsen i semitandem visades signifikant skillnad för 6 av 12 variabler för mobilappen och 8 av 12 för kraftplattan. Variabeln Power visar på väldigt hög korrelation i uppresningstestet samt en signifikant skillnad i jämförelsen.

    Slutsats: Tre variabler i balanstestet och variabeln Power i uppresningstestet visade på god validitet och skulle kunna utvärderas vidare i fortsatt utveckling av appen MinBalans. Mobiltelefonens placering och kroppsmassans påverkan på resultatet kan studeras vidare för att öka appens validitet. För att ytterligare öka validiteten behövs vidare forskning på ett större urval.

  • 245.
    Allo, Heba
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Paju, Victor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Styrketränande unga män: - en strävan mot respekterad manlighet2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Styrketräningen är mer än enbart det fysiska utförandet eftersom sociala normer har en inverkan på unga styrketränande mäns förhållningssätt till sin kropp. Det finns en idealbild av manlighet på gym som fysioterapeuter bör vara medvetna om.

    Syfte: Syftet är att utifrån ett maskulinitetsperspektiv undersöka vilken inställning unga styrketränande män mellan tonår och ung vuxenhet har till kropp och styrketräning.

    Metod: Studien baseras på kvalitativa intervjuer med fyra styrketränande unga män och en nyckelperson. Intervjuguiderna som används är semistrukturerade och analysmetoden Grounded Theory.

    Resultat: De kategorier som framkommer vid dataanalysen formar gemensamt kärnkategorin ”Upprätthålla respekterad manlighet genom styrketräning”. De fem kategorier som samlar underkategorierna är: Den obrydda mannen, Den odödliga mannen, Den presterande mannen, Den muskulösa mannen och Den sårbara mannen.

    Konklusion: Styrketräning handlar inte enbart om styrka och utseende utan även om manlighet, respekt och värdighet. Styrketräning kan väljas för dess stämpel som manlig aktivitet – således finns en djupare innebörd med styrketräningen. Det kan vara viktig att känna till för fysioterapeuter som möter unga styrketränande män i rehabiliteringssammanhang. Området är outforskat inom fysioterapi. Mer forskning fordras därför för att öka förståelsen om unga styrketränande män i dagens samhälle.

  • 246.
    Allwell-Brown, Gbemisola
    et al.
    Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
    Hussain-Alkhateeb, Laith
    Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sewe, Maquins
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Kitutu, Freddy Eric
    Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden; Sustainable Pharmaceutical Systems (SPS) Unit, Department of Pharmacy, School of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda.
    Strömdahl, Susanne
    Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Mårtensson, Andreas
    Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
    Johansson, Emily White
    Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.
    Determinants of trends in reported antibiotic use among sick children under five years of age across low-income and middle-income countries in 2005–17: A systematic analysis of user characteristics based on 132 national surveys from 73 countries2021In: International Journal of Infectious Diseases, ISSN 1201-9712, E-ISSN 1878-3511, Vol. 108, p. 473-482Article in journal (Refereed)
    Abstract [en]

    Objectives: This study aimed to analyze any reported antibiotic use for children aged <5 years with fever, diarrhea or cough with fast or difficult breathing (outcome) from low-income and middle-income countries (LMICs) during 2005–2017 by user characteristics: rural/urban residence, maternal education, household wealth, and healthcare source visited.

    Methods: Based on 132 demographic and health surveys and multiple indicator cluster surveys from 73 LMICs, the outcome by user characteristics for all country-years was estimated using a hierarchical Bayesian linear regression model.

    Results: Across LMICs during 2005–2017, the greatest relative increases in the outcome occurred in rural areas, poorest quintiles and least educated populations, particularly in low-income countries and South-East Asia. In low-income countries, rural areas had a 72% relative increase from 17.8% (Uncertainty Interval (UI): 5.2%–44.9%) in 2005 to 30.6% (11.7%–62.1%) in 2017, compared to a 29% relative increase in urban areas from 27.1% (8.7%–58.2%) in 2005 to 34.9% (13.3%–67.3%) in 2017. Despite these increases, the outcome was consistently highest in urban areas, wealthiest quintiles, and populations with the highest maternal education.

    Conclusion: These estimates suggest that the increasing reported antibiotic use for sick children aged <5 years in LMICs during 2005–2017 was driven by gains among groups often underserved by formal health services.

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  • 247.
    Alm, Emelie
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Fellbrink, Tove
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Gymnasieungdomars stillasittande och fysiska aktivitet under skolstängning orsakat av Covid-19: En enkätundersökning2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Den 11 mars 2020 klassades viruset Covid-19 som en pandemi. För att bromsa smittspridningen beslutade regeringen att stänga gymnasieskolorna runt om i Sverige och övergå till fjärr- och distansundervisning. Flertal idrottsföreningar har inte heller kunnat bedriva sin verksamhet på grund av pandemin. Trots att restriktionerna har varit nödvändiga för att minska smittspridningen kan det ge konsekvenser på ungdomars och unga vuxnas rörelsevanor. 

    Syfte: Studera förekomst av stillasittande och fysisk aktivitet hos gymnasieungdomar i Västerbottens inland till följd av skolstängningen orsakat av Covid-19.

    Metod: Undersökningen utfördes bland 86 gymnasieelever (16–20 år) i Västerbottens inland. En webbenkät med 23 frågor skickades ut till tre gymnasieskolor i olika kommuner. Enkäten var tillgänglig mellan 2 februari och 16 februari 2021. Deskriptiv analys, Chi2-test och Man Whitney U användes för att analysera och jämföra data. 

    Resultat: I denna studie ansåg 81,4 % av eleverna att deras stillasittande hade ökat och 55,8 % ansåg att deras fysiska aktivitet minskat under pandemin. Totalt var det 55,8 % som inte uppnådde FYSS rekommendationer under Covid-19. Unga vuxna (18–20 år) och unga kvinnor visade en viss tendens att vara mindre fysiskt aktiva i jämförelse med ungdomar (16–17 år). Resultatet generade ingen statistisk signifikant skillnad avseende fysisk aktivitet och stillasittande mellan unga kvinnor och unga män. Valet av fysisk aktivitet förändrades under pandemin i jämförelse med innan. 

    Konklusion: Resultatet visar en negativ påverkan på stillasittande och fysisk aktivitet hos ungdomar och unga vuxna i Västerbottens inland på grund av pandemin. Detta skulle kunna leda till ökade hälsorisker hos ungdomar och unga vuxna i Västerbottens inland. Detta resultat kan vägleda insatser för att främja gymnasieelevers hälsa till följd av pandemin. Fortsatt forskning krävs då pandemin är pågående. 

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  • 248.
    Alm, Petter
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Evaluation of Physiological Characters in Mixed Martial Arts Athletes2012Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Introduction: MMA is a relatively new sport and is a mixture of many different martial arts. Currently, studies on the physiological characters of MMA athletes are very limited. The present study is mainly interested in evaluation of MMA athletes with respect to the aerobic and anaerobic capacity.

    Method and materials: 5 male pro MMA athletes were recruited for the study. VO2max and anaerobic threshold measured with different methods were evaluated on treadmill and arm cycle. Muscle strength and power was evaluated through measurement of squat jump, counter movement jump, counter movement jump with arm swing, maximum clean, maximum deadlift and maximum reps of vertical sit-ups. Body composition including bone mineral density, muscle mass and fat mass were also measured.  All the above measurements were performed twice with one year in between. Personal competition records expressed as percentage of win in total competition during the past year or the whole years before each test occasion were also calculated. 

    Result: except for a lower relative VO2max (both on treadmill and arm cycle) and [La] 0min after treadmill test, none of the measurements on absolute VO2max, anaerobic thresholdor body composition showed significant difference in values between the two test occasions. A tendency of decrease in muscle strength/power was observed in the second occasion, where the lower squat jump (cm) and counter movement jump with arm swing (cm/kg) were significant.

    Conclusion: the MMA athletes have reached their physiological capacity needed for the sport or did not prioritized their strength and conditioning training high enough to improve them further.

  • 249.
    Alm, Petter
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Yu, Ji-Guo
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
    Physiological characters in mixed martial arts2013In: American Journal of Sports Science, ISSN 2330-8540, Vol. 1, no 2, p. 12-17Article in journal (Refereed)
    Abstract [en]

    Mixed martial arts (MMA) is a relatively new sport and is a mixture of many different martial arts. Currently, study on the physiological characters in the sport is very limited. The present study evaluated the physiological characters in 5 active male MMA athletes at two occasions with one year between. Aerobic- and anaerobic capacity were estimated through measurement of VO2max and anaerobic threshold using both treadmill running and arm cycling. Muscle strength was evaluated through series measurements. Body composition and personal competition records were also examined. The subjects presented above average aerobic capacity, but rather high anaerobic capacity and threshold levels compared with other similar sports. No significant difference in VO2max, anaerobic threshold or body composition was observed between the two test occasions, despite a decreased tendency in muscle strength/power in the second test compared to the first. The results were interpreted to indicate either the MMA athletes had reached the physiological requirements for MMA or the one year physical training was inefficient in further improving the parameters.                                              

  • 250.
    Almanza-Aguilera, Enrique
    et al.
    Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
    Guiñón-Fort, Daniel
    Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
    Perez-Cornago, Aurora
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Martínez-Huélamo, Miriam
    Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Nutrition and Food Safety Research Institute (INSA), Food Innovation Network (XIA), Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
    Andrés-Lacueva, Cristina
    Biomarkers and Nutrimetabolomics Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Nutrition and Food Safety Research Institute (INSA), Food Innovation Network (XIA), Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
    Tjønneland, Anne
    Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Eriksen, Anne Kirstine
    Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
    Katzke, Verena
    Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Bajracharya, Rashmita
    Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Schulze, Matthias B.
    Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
    Masala, Giovanna
    Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network—ISPRO, Florence, Italy.
    Oliverio, Andreina
    Hyblean Association for Epidemiological Research (AIRE-ONLUS), Ragusa, Italy.
    Tumino, Rosario
    Hyblean Association for Epidemiological Research (AIRE-ONLUS), Ragusa, Italy.
    Manfredi, Luca
    Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.
    Lasheras, Cristina
    Functional Biology Department, University of Oviedo, Oviedo, Spain.
    Crous-Bou, Marta
    Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
    Sánchez, Maria-José
    Granada Cancer Registry, Andalusian School of Public Health (EASP), Instituto de Investigación Biosanitaria Ibs. GRANADA, University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria Ibs. GRANADA, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
    Amiano, Pilar
    Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; Epidemiology of Chronic and Communicable Diseases Group, BioGipuzkoa Health Research Institute, San Sebastian, Spain.
    Colorado-Yohar, Sandra M.
    Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain; Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia.
    Guevara, Marcela
    Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Navarra Public Health Institute, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
    Sonestedt, Emily
    Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Bjartell, Anders
    Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Thysell, Elin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Weiderpass, Elisabete
    International Agency for Research on Cancer (IARC/WHO), Lyon, France.
    Aune, Dagfinn
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department of Nutrition, Oslo New University College, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
    Aglago, Elom K.
    Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Travis, Ruth C.
    Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
    Zamora-Ros, Raul
    Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
    Intake of the total, classes, and subclasses of (poly)phenols and risk of prostate cancer: a prospective analysis of the EPIC study2023In: Cancers, ISSN 2072-6694, Vol. 15, no 16, article id 4067Article in journal (Refereed)
    Abstract [en]

    Existing epidemiological evidence regarding the potential role of (poly)phenol intake in prostate cancer (PCa) risk is scarce and, in the case of flavonoids, it has been suggested that their intake may increase PCa risk. We investigated the associations between the intake of the total and individual classes and subclasses of (poly)phenols and the risk of PCa, including clinically relevant subtypes. The European Prospective Investigation into Cancer and Nutrition (EPIC) cohort included 131,425 adult men from seven European countries. (Poly)phenol intake at baseline was assessed by combining validated center/country-specific dietary questionnaires and the Phenol-Explorer database. Multivariable-adjusted Cox proportional hazards models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI). In total, 6939 incident PCa cases (including 3501 low-grade and 710 high-grade, 2446 localized and 1268 advanced, and 914 fatal Pca cases) were identified during a mean follow-up of 14 years. No associations were observed between the total intake of (poly)phenols and the risk of PCa, either overall (HRlog2 = 0.99, 95% CI 0.94–1.04) or according to PCa subtype. Null associations were also found between all classes (phenolic acids, flavonoids, lignans, and stilbenes) and subclasses of (poly)phenol intake and the risk of PCa, overall and according to PCa subtype. The results of the current large prospective cohort study do not support any association between (poly)phenol intake and PCa incidence.

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