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  • 201.
    Hurtig, Anna-Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    The People's Health Movement: what is it and should we care?2005Inngår i: Scand J Public Health, ISSN 1403-4948, Vol. 33, nr 3, s. 236-8Artikkel i tidsskrift (Fagfellevurdert)
  • 202.
    Hyder, SM Ziyaddin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Anemia and iron deficiency in women: impact of iron supplementation during pregnancy in rural Bangladesh2002Doktoravhandling, med artikler (Annet vitenskapelig)
  • 203.
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    [No way back?]2007Inngår i: Lakartidningen, ISSN 0023-7205, Vol. 104, nr 9, s. 692-Artikkel i tidsskrift (Annet vitenskapelig)
  • 204.
    Hörnsten, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandström, Herbert
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Allmänmedicin.
    Improvements in HbA1c remain after 5 years--a follow up of an educational intervention focusing on patients' personal understandings of type 2 diabetes2008Inngår i: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 81, nr 1, s. 50-5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This paper reports a 5-year follow-up from a study aimed at evaluating whether an intervention which focused on patients’ personal understanding of their illness was more effective than conventional diabetes care with regard to metabolic control among patients with type 2 diabetes mellitus (DM2). The study was conducted within Swedish primary health care and included 102 patients (mean age 63 years). At clinic level they were randomised into control or intervention groups. The intervention directed at patients consisted of ten two-hour group sessions over 9 months, focusing on patients’ own needs and questions. The mean HbA1c at baseline was 5.71% (S.D. 0.76) in the intervention group and 5.78% (S.D. 0.71) in the control group. At the 5-year follow-up, the mean HbA1c in the intervention group still was 5.71% (S.D. 0.85) while among the controls it had increased to 7.08% (S.D. 1.71). The adjusted difference was 1.37 (p < 0.0001). Treatment upgrade, BMI, total cholesterol, HDL, LDL and triglycerides at baseline did not influence the difference in HbA1c. These findings indicate that group sessions in patients with DM2 focusing on patients’ personal understanding of their illness are more effective than conventional diabetes care with regard to metabolic control.

  • 205.
    Isaksson, Joakim
    et al.
    Umeå universitet, Samhällsvetenskaplig fakultet, Socialt arbete.
    Lindqvist, Rafael
    Göteborgs universitet, Institutionen för Socialt arbete .
    Bergström, Erik
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Mellan normalitet och avvikelse: om skolans insatser för barn och ungdomar i behov av särskilt stöd2007Inngår i: Funktionshinder, kultur och samhälle, Lund: Studentlitteratur , 2007, s. 147-169Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 206.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Celiac disease - is there a dietary prevention?2004Inngår i: Proceedings of the 18th meeting of the working group on Prolamin analysis and toxicity, 2004, s. 165-171Konferansepaper (Annet vitenskapelig)
  • 207.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    On the multifactorial aetiology of coeliac disease2001Inngår i: Scandinavian Journal of Nutrition/Näringsforskning, Vol. 45, s. 184-185Artikkel i tidsskrift (Annet vitenskapelig)
  • 208.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    On the multifactorial etiology of celiac disease2001Doktoravhandling, med artikler (Annet vitenskapelig)
  • 209.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    The incidence of celiac disease in the county of Västerbotten reported to the European multicenter study1992Inngår i: Common food intolerance I: Epidemiology of Coeliac Disease, Karger, Basel , 1992Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 210.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    The Swedish epidemic of coeliac disease explored using an epidemiological approach--some lessons to be learnt.2005Inngår i: Best Pract Res Clin Gastroenterol, ISSN 1521-6918, Vol. 19, nr 3, s. 425-40Artikkel i tidsskrift (Fagfellevurdert)
  • 211.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hernell, O
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    On the multifactorial aetiology of coeliac disease2004Inngår i: Annales Nestlé, Vol. 62, s. 107-18Artikkel i tidsskrift (Annet vitenskapelig)
  • 212.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Utredning av celiaki. Minskat antal barn får diagnosen celiaki.1998Inngår i: Små & Stora Nyheter, Vol. 2, s. 14-15Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 213.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, L A
    Children born in the summer have increased risk for coeliac disease.2003Inngår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 57, nr 1, s. 36-39Artikkel i tidsskrift (Fagfellevurdert)
  • 214.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Persson, LÅ
    Celiaki - en ny folksjukdom?1994Inngår i: Vår Föda, Vol. 46, s. 481-485Artikkel i tidsskrift (Annet vitenskapelig)
  • 215.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, Lars Ake
    Breast-feeding protects against celiac disease.2002Inngår i: Am J Clin Nutr, ISSN 0002-9165, Vol. 75, nr 5, s. 914-21Artikkel i tidsskrift (Fagfellevurdert)
  • 216.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Myléus, Anna
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Wall, Stig
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Towards preventing celiac disease - an epidemiological approach.2008Inngår i: Frontiers in Celiac Disease, Basel: Karger , 2008, 12, s. 198-209Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 217.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, L A
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Does breast-feeding affect the risk for coeliac disease?2000Inngår i: Adv Exp Med Biol, ISSN 0065-2598, Vol. 478, s. 139-49Artikkel i tidsskrift (Fagfellevurdert)
  • 218.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, L A
    Juto, P
    Peltonen, M
    Suhr, O
    Hernell, O
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    High prevalence of undiagnosed coeliac disease in adults: a Swedish population-based study.1999Inngår i: J Intern Med, ISSN 0954-6820, Vol. 245, nr 1, s. 63-8Artikkel i tidsskrift (Fagfellevurdert)
  • 219.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, L A
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Ascher, H
    Cavell, B
    Danielsson, L
    Dannaeus, A
    Lindberg, T
    Lindquist, B
    Stenhammar, L
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Epidemic of coeliac disease in Swedish children.2000Inngår i: Acta Paediatr, ISSN 0803-5253, Vol. 89, nr 2, s. 165-71Artikkel i tidsskrift (Fagfellevurdert)
  • 220.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, L A
    Stenhammar, L
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Is prevention of coeliac disease possible?2000Inngår i: Acta Paediatr, ISSN 0803-5253, Vol. 89, nr 6, s. 749-50Artikkel i tidsskrift (Annet vitenskapelig)
  • 221.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, Lars Ake
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    The Swedish coeliac disease epidemic with a prevailing twofold higher risk in girls compared to boys may reflect gender specific risk factors.2003Inngår i: Eur J Epidemiol, ISSN 0393-2990, Vol. 18, nr 7, s. 677-84Artikkel i tidsskrift (Fagfellevurdert)
  • 222.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, LÅ
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Primary prevention of coeliac disease by favourable infant feeding practices2003Inngår i: Primary prevention of celiac disease – the utopia of the next millennium?, AIC Press, Pisa , 2003, s. 43-60Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 223.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Economic crisis, unemployment and public health2009Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, nr 8, s. 783-784Artikkel i tidsskrift (Fagfellevurdert)
  • 224.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Professurer och professorer i socialmedicin i Sverige2004Inngår i: Socialmedicinsk tidskrift, Vol. 81, s. 202-6Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 225.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Socialmedicinen - en pånyttfödd 30-pring2006Inngår i: Socialmedicinsk tidskrift, Vol. 83, s. 93-94Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 226.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    The population as patient: on public health work.2004Inngår i: Scand J Public Health, ISSN 1403-4948, Vol. 32, nr 6, s. 401-2Artikkel i tidsskrift (Annet vitenskapelig)
  • 227.
    Janlert, Urban
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Which theory is best? Explanatory models of the relationship between unemployment and health.2009Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 9, nr 235Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A number of different models have been used in order to explain the links between unemployment and ill-health. The objective of this study was to test different proposed models in an empirical setting. METHODS: A cohort of school-leavers consisting of more than 1000 persons was followed for 14 years up to the age of 30. They have repeatedly been asked questions that could be used to operationalise different proposed models as well as health outcomes. Seven different models explaining the health effect of unemployment were identified: an economic deprivation model, a lack of control model as well as a locus of control model, a stress model, a social support model, a work involvement model and a model of latent functions. Health outcomes used were somatic symptoms, depressive symptoms, self-perceived health and nervous problems. Statistical tests included bivariate correlations and logistic regression. RESULTS: Most of the models correlated fairly well with unemployment measures. The capacity of the models to explain the connection between unemployment and ill-health varied, however. The model of latent functions was most successful, followed by the economic deprivation model. The social support and the control models were also fairly good. The work involvement scale and the stress model demonstrated the smallest explanatory power. CONCLUSION: Studies comparing different explanatory models in the field are rare. Few models apply a multidisciplinary approach. In view of the findings, it should be possible to develop multidisciplinary and better models to explain the links between unemployment and health in more detail.

    Fulltekst (pdf)
    Which theory is best? Explanatory models of the relationship between unemployment and health
  • 228. Janson, C
    et al.
    Norbäck, D
    Omenaas, E
    Gislason, T
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Jögi, R
    Lindberg, E
    Gunnbjörnsdottir, M
    Norrman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Wentzel-Larsen, T
    Svanes, C
    Jensen, E J
    Torén, K
    Insomnia is more common among subjects living in damp buildings.2005Inngår i: Occup Environ Med, ISSN 1470-7926, Vol. 62, nr 2, s. 113-8Artikkel i tidsskrift (Fagfellevurdert)
  • 229.
    Jerdén, Lars
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Health-promoting health services: personal health documents and empowerment2007Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    In 2003, the Swedish Parliament adopted a national public health policy that included the domain - “A more health-promoting health service”. Strategies and tools are needed in the work to reorient health services. Personal health documents are documents concerning a person’s health, and are owned by the individual. Several studies that have evaluated such documents indicate that they could be of interest in health-promotion work. However, there is insufficient knowledge concerning personal health documents that target adolescents, and little is known about the feasibility of such documents in a Swedish cultural context. The concept of empowerment is gaining increased interest for health services, but the associations between empowerment, self-rated health and health behaviour are sparsely studied.

    The overall aim of the thesis is to explore a strategy - empowerment - and a tool - personal health documents - that might facilitate the work of the public health goal of a health-promoting health service. Specific aims are to examine the feasibility of using personal health documents in health promotion; to examine professionals’ experiences of working with health promotion and personal health documents; to examine the association between personal health documents and self-reported health behaviour change; and to examine the perception of empowerment in relation to self-rated health and health behaviour among adolescents.

    Two personal health documents that targeted adults and adolescents were developed and evaluated. Distribution to adults in different settings was compared in a cross-sectional study (n = 1 306). Adolescents received the document in school, and surveys were performed at baseline and after one year (n = 339). Practical use and attitudes by document owners were studied by questionnaires. Teachers (n = 69) answered a questionnaire, and community health nurses were interviewed (n = 12). The interviews also explored nurses’ experiences of working with health promotion in general, and were analysed by qualitative methodology. Adolescents’ empowerment was examined by a questionnaire (n = 1 046).

    Most participants reported reading in the documents; writing in the documents varied between 16% (distribution in occupational health) and 87% (adolescents). The health document was perceived as useful by 35% of the adolescents. Factors significantly related to personal usefulness were being born outside Sweden, experiencing fair treatment by teachers, being a non-smoker and having a positive school experience. Community health nurses were striving for a balance of being a doer of practical, disease-oriented tasks and a health-promotion communicator. The structural organisation in health care centres was important for their work with health promotion and the health document. Teachers were generally in favour of continued work with the document. In different settings, between 10% and 26% of adults reported changes in their health situations as a result of reading the booklet. Self-reported changes in health situations were less likely using postal distribution, and there were no significant differences between the other types of distribution. Adolescents with low empowerment scores reported poorer self-rated health and more risk-taking behaviours such as smoking and binge drinking.

    To conclude, personal health documents are feasible to use in different settings. Health promotion in health services needs active support from leaders as well as adequate support systems. Findings suggest that personal health documents can be tools for promoting self-reported lifestyle changes among adults in different settings. There is a close relation among adolescents between low empowerment in the domain of health, low self-rated health and health behaviours such as binge drinking and smoking.

    Fulltekst (pdf)
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  • 230.
    Jerdén, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Bildt-Ström, Pia
    Burell, Gunilla
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Bergström, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Personal health documents in school health education: a feasibility study2007Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, nr 6, s. 662-665Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To examine the feasibility of a school intervention using a personal health document adapted for adolescents. Methods: The health document was developed in close cooperation with groups of adolescents and tested among seventh-grade students at two junior high schools (n=339). The document was presented to the students by their regular teachers. For evaluation, an adolescent questionnaire was used at baseline and after one year. Results: After one year, 87% of adolescents reported having written in the health document, and 77% reported having had classes with discussions on subjects in the document. The health document was perceived as useful by 35% of the adolescents. Factors significantly related to personal usefulness were being born outside Sweden, experiencing fair treatment by teachers, being a non-smoker, and having a positive school experience. Conclusions: Implementation of a personal health document in junior high-school health education was feasible and well accepted.

  • 231.
    Jerdén, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Burell, Gunilla
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Bergström, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Empowerment: a key to a better understanding of adolescent health?2008Inngår i: International journal of child and adolescent health, ISSN 1939-5930, Vol. 1, nr 1, s. 61-68Artikkel i tidsskrift (Fagfellevurdert)
  • 232.
    Jerdén, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hillervik, Charlotte
    Hansson, Ann-Christin
    Flacking, Renée
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Experiences of Swedish community health nurses working with health promotion and a patient-held record2006Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, nr 4, s. 448-454Artikkel i tidsskrift (Fagfellevurdert)
  • 233.
    Jerdén, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Cost-effectiveness of a personal health document in different distribution settings2008Inngår i: Health promotion journal of Australia, ISSN 1036-1073, Vol. 19, nr 2, s. 125-131Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim was to compare the cost-effectiveness of different ways to distribute a personal health document that was primarily aimed at supporting behaviour change. Personal health documents have been widely used in health-promoting efforts but their effective use is rather sparsely studied. METHODS: Four types of distribution were tested in Sweden: primary health care centres (n=418); work site meetings (n=164); at an occupational health examination (n=279); by mail (n=445). Participant behaviour changes were measured by a questionnaire. Cost calculations were made based on the results of the study. RESULTS: Between 10% and 26% of participants reported behaviour changes as a result of reading the booklet. A change in health situation was less likely using postal distribution. There were no significant differences between the other types of distribution. Cost-effective distribution at work sites and in occupational health was superior to distribution in primary health care when direct costs were used. Distribution at work sites was the least cost-effective when indirect costs, i.e. productivity losses of participants, were included. CONCLUSIONS: Cost-effectiveness analyses support distribution of personal health documents in occupational health. In primary health care, high training costs in combination with low distribution rates might be problematic. Providing information during distribution at work sites is time-consuming and might therefore be a problem if productivity losses are taken into account.

  • 234.
    Jerdén, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Epidemiologi och folkhälsovetenskap.
    Does a patient-held health record give rise to lifestyle changes? A study in clinical practice.2004Inngår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 21, nr 6, s. 651-653Artikkel i tidsskrift (Fagfellevurdert)
  • 235.
    Johansson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Emerging perspectives on tuberculosis and gender in Vietnam2000Doktoravhandling, med artikler (Annet vitenskapelig)
  • 236.
    Johansson, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindqvist, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    Eriksson, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    A survey of teenager unnatural deaths in northern Sweden 1981-20002005Inngår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 37, nr 2, s. 253-258Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures.

    SETTING: The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden.

    MATERIAL AND METHODS: All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present.

    RESULTS: Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time.

    CONCLUSIONS: Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.

  • 237. Johansson, Pia M
    et al.
    Tillgren, Per E
    Guldbrandsson, Karin A
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    A model for cost-effectiveness analyses of smoking cessation interventions applied to a Quit-and-Win contest for mothers of small children.2005Inngår i: Scand J Public Health, ISSN 1403-4948, Vol. 33, nr 5, s. 343-52Artikkel i tidsskrift (Fagfellevurdert)
  • 238.
    Jonsson, Bertil
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Stenlund, Hans
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Björnstig, Ulf
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi.
    Backset-stationary and during car driving.2008Inngår i: Traffic injury prevention, ISSN 1538-957X, Vol. 9, nr 6, s. 568-573Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: The aim of the study was to measure and analyze backset, defined as the horizontal distance between the back of the occupant's head and a point located on the ventral/top aspect of the sewn rim of the head restraint, with the car stationary and during driving, in the driver's position in a modern car. METHODS: A population of 65 subjects, 35 males and 30 females, was studied in a Volvo V70 car, model year 2007. The subjects were studied in the driver's position, in a self-selected posture. Stationary backset was measured with the technique described by Jonsson et al. (2007) and backset during driving with video analysis. Descriptive data were calculated, and variability and correlation analyses were performed. A t-test was used to test differences of means. Significance level was set to 0.05. RESULTS: In comparison to stationary backset, mean backset during driving was 43 mm greater in males and 41 mm greater in females. Driving backset was 44 mm larger in males than in females. Driving backset was moderately correlated (0.37-0.43) to stature, seated height, and seat back angle in males and moderately correlated (0.44-0.52) to hip width, waist circumference, and weight in females. The overall intraclass correlation coefficient for backset during driving was 0.81 (CI: 0.75-0.86). CONCLUSIONS: These results may be of use in designing future updates of test protocols/routines for geometric backset, such as RCAR and RCAR-IIWPG.

  • 239.
    Jonsson, Bertil
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi. Kirurgi.
    Stenlund, Hans
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Svensson, Mats Y
    Björnstig, Ulf
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Kirurgi. Kirurgi.
    Backset and cervical retraction capacity among occupants in a modern car.2007Inngår i: Traffic Inj Prev, ISSN 1538-9588, Vol. 8, nr 1, s. 87-93Artikkel i tidsskrift (Fagfellevurdert)
  • 240.
    Jonsson, Bertil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Svensson, Mats Y
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Seat adjustment: capacity and repeatability among occupants in a modern car2008Inngår i: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 51, nr 2, s. 232-241Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Families in the Western world have a car and several family members share the same car. In this study, 154 participants have adjusted a driver's seat three times. The primary objective was to study intrapersonal repeatability and intraclass correlation (ICC) on seat; length adjustment, backrest angle, seat front edge and seat rear edge adjustment, related to participant age, sex, stature and weight. Length adjustment has the best intrapersonal repeatability within two repetitions, 49 mm and ICC-value 0.87. Females and younger participants (age < 40 years) adjust seats generally more accurately. Females adjust the seat 41 mm more forward, 120 mm compared to men 79 mm counted from 0-starting position. Females sit with more upright seat backrests, 46 degree compared to 43 degrees for males counted from 0-starting position. Females sit higher than males in both the frontal and rear part of the seat cushion.

  • 241.
    Jonsson, Håkan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Bordás, Pál
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Wallin, Hans
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Service screening with mammography in Northern Sweden: effects on breast cancer mortality - an update.2007Inngår i: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 14, nr 2, s. 87-93Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To study the effectiveness of service screening with mammography in Northern Sweden.

    SETTING: Two counties which invited women aged 40-74 years to service screening with mammography were compared with two counties where service screening started 5-7 years later. There were 109,000 and 77,000 women in the study and control counties, respectively.

    METHODS: Cohorts in the study group were defined to include only breast cancer cases diagnosed after their first invitation to screening. Two outcome measures for breast cancer mortality were used; excess mortality and underlying cause of death (UCD). Detection mode was used to estimate the efficacy of screening for those women who actually attended screening. The cohorts were followed for 11 years.

    RESULTS: The relative rate (RR) of breast cancer death as excess mortality and UCD for women aged 40-74 years invited to screening, compared with women not yet invited, was 0.70 (95% confidence interval [CI] 0.56-0.87) and 0.74 (95% CI 0.62-0.88), respectively. The largest effect was seen in women aged 40-49 years (RR = 0.64 and RR = 0.62 for excess mortality and UCD, respectively). RR in age 40-74 years for women actually screened was 0.65 (95% CI 0.51-0.84) and 0.70 (95% CI 0.57-0.86) for excess mortality and UCD, respectively. The number of women needed to screen to save one life was 912 after 11 years of follow-up.

    CONCLUSIONS: This study confirms previous findings in the earlier follow-up and indicates a long-term reduction of breast cancer mortality by 26-30%. The efficacy among those who actually attended screening was about 5% larger.

  • 242.
    Joshi, Himanshu
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Do early infectious episodes contribute to the risk of celiac disease?2006Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
    Abstract [en]

    Background: Celiac disease, a permanent gluten sensitive enteropathy, is the most common genetic disorder, although largely underestimated public health problem worldwide. The wide spectrum of its multifaceted manifestations is a continuum representing the outcome of a complex interplay of genetic and environmental factors with immunological processes suggesting its multifactorial etiopathogenesis and also involves the risk of malignancy. Despite of the new insights gained by recent advances in knowledge, etiopathogenesis still remains to be elucidated completely. Investigating the Swedish epidemic of CD by epidemiological approach has revealed the possible associations of CD with some environmental factors. Emphasizing the significance of events in early infancy in view of current CD aetiopathogenesis concepts and with relevance to the unique pattern of CD incidence trends in Swedish children, early infectious episodes emerge as seemingly important clue in etiology of CD. This study investigates the possible contribution to the risk from early infectious episodes to development of Celiac disease.

    Objectives: This study aims to investigate possible contribution by early infectious episodes to the risk of development of celiac disease and discusses the findings in view of current concepts of CD aetiopathogenesis.

    Methods: Literature-review. A review of available knowledge from studies in the aetiopathogenesis of celiac disease was done to understand the possible association with environmental factors, in particular role of infectious episodes. Study-design and data-analysis: Data from a Swedish population-based incident case-referent study with 627 confirmed cases of celiac disease and 1254 referents was analyzed to investigate a possible predisposition caused by early infections to celiac disease.

    Results: Current literature suggests that infections may induce, trigger the development of CD (Gl infectious episodes to the major extent) or may activate already latent CD by different mechanisms. However, our study concludes statistically significant risk associated with early infectious episodes of all types to the development of celiac disease. Besides, findings suggest higher risk associated with the combined effect of consumption of larger amounts of gluten and frequent infectious episodes.

    Conclusion: This study presents the first epidemiological findings concluding increased risk to development of celiac disease associated with occurrence of infectious episodes during early infancy (before the age of 6 months), and suggests possible involvement of molecular mimicry or other mechanism. The findings also suggest focusing on early infancy and to the events that precede immunopathogenetic processes. Thus, it provides implication for the further exploration of complete immunolopathogenetic mechanisms involved in pathogenesis of celiac disease and it may prove rewarding in designing innovative preventive, immunomodulatory and antigen-centered therapeutic strategies.

    Fulltekst (pdf)
    fulltext
  • 243.
    Kahn, Kathleen
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dying to make a fresh start: mortality and health transition in a new South Africa2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Rationale: Vital registration is lacking in developing settings where health and development problems are most pressing. Policy-makers confront an “information paradox”: the critical need for information on which to base priorities and monitor progress, and the profound shortage of such information.

    Aims: To better understand the dynamics of mortality transition in rural South Africa over a decade of profound socio-political change coupled with emerging HIV/AIDS. Thereby to inform health and development programming, policy formulation, and the research agenda; and contribute to debate on the nature of the ‘health transition’.

    Methods: The Agincourt health and demographic surveillance system is based on continuous monitoring of the Agincourt sub-district population in rural north-east South Africa. This involves annual recording of all vital events, specifically deaths, births and migrations in 11,700 households comprising some 70,000 persons. A “verbal autopsy” is conducted on every death, and special modules provide additional data.

    Key findings: A major health transition has occurred over the past decade, with marked changes in population structure and rapidly escalating mortality particularly among children and younger adults. A quadruple burden of disease is evident with persisting infectious disease and malnutrition in children, emerging non-communicable disease in the middle-aged and older, high levels of violence in an apparently peaceful community, and rapidly escalating HIV/AIDS and tuberculosis. There is evidence of sex differences and socio-economic differentials in mortality; vulnerable sub-groups include the children of Mozambican immigrants and recently returned labour migrants.

    Implications: With respect to health transition, empirical data demonstrate a marked “counter transition” with mortality increasing in children and young adults; “epidemiologic polarization” is evident with the most vulnerable experiencing a higher mortality burden; and a “protracted transition” is reflected in the co-existence of persisting infectious disease and malnutrition, emerging HIV/AIDS, and increasing chronic non-communicable disease. With respect to health policy and practice there is urgent need to: strengthen HIV/AIDS prevention, treatment and care; offer effective long-term care to control the rising burden of chronic illness and related risk; maintain and improve maternal and child health services; and address differential access to care. This poses a substantial challenge to a severely stretched health system.

    Fulltekst (pdf)
    FULLTEXT01
  • 244.
    Kahn, Kathleen
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Garenne, Michel
    Collinson, Mark A
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Tollman, Stephen M
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Mortality trends in a new South Africa: hard to make a fresh start2007Inngår i: Scandinavian journal of public health. Supplement, ISSN 1403-4956, Vol. 35, nr 69 Suppl., s. 26-34Artikkel i tidsskrift (Fagfellevurdert)
  • 245.
    Kahn, Kathleen
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Tollman, Stephen M
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stroke in rural South Africa: contributing to the little known about a big problem1999Inngår i: South African Medical Journal, ISSN 0038-2469, Vol. 89, nr 1, s. 63-65Artikkel i tidsskrift (Fagfellevurdert)
  • 246.
    Kahn, Kathleen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Tollman, Stephen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Collinson, Mark A.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Clark, Samuel J.
    Twine, Rhian
    Clark, Benjamin D.
    Shabangu, Mildred
    Gómez-Olivé, Francesc Xavier
    Mokoena, Obed
    Garenne, Michel L.
    Research into health, population, and social transitions in rural South Africa: data and methods of the Agincourt health and demographic surveillance system2007Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, nr Suppl. 69, s. 8-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Rationale for study: Vital registration is generally lacking in infrastructurally weak areas where health and development problems are most pressing. Health and demographic surveillance is a response to the lack of a valid information base that can provide high-quality longitudinal data on population dynamics, health, and social change to inform policy and practice. Design and measurement procedures: Continuous demographic monitoring of an entire geographically defined population involves a multi-round, prospective community study, with annual recording of all vital events (births, deaths, migrations). Status observations and special modules add value to particular research areas. A verbal autopsy is conducted on every death to determine its probable cause. A geographic surveillance system supports spatial analyses, and strengthens field management.

    Population and sample size considerations: Health and demographic surveillance covers the Agincourt sub-district population, sited in rural north-eastern South Africa, of some 70,000 people (nearly a third are Mozambican immigrants) in 21 villages and 11,700 households. Data enumerated are consistent or more detailed when compared with national sources; strategies to improve incomplete data, such as counts of perinatal deaths, have been introduced with positive effect.

    Basic characteristics: A major health and demographic transition was documented over a 12-year period with marked changes in population structure, escalating mortality, declining fertility, and high levels of temporary migration increasing particularly amongst women. A dual burden of infectious and non-communicable disease exists against a background of dramatically progressing HIV/AIDS.

    Potential and research questions: Health and demographic surveillance sites - fundamental to the INDEPTH Network - generate research questions and hypotheses from empirical data, highlight health, social and population priorities, provide cost-effective support for diverse study designs, and track population change and the impact of interventions over time.

  • 247.
    Kahn, Kathleen
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Tollman, Stephen M
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Garenne, Michel
    Gear, John S S
    Validation and application of verbal autopsies in a rural area of South Africa2000Inngår i: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 5, nr 11, s. 824-831Artikkel i tidsskrift (Fagfellevurdert)
  • 248.
    Kahn, Kathleen
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Tollman, Stephen M
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Garenne, Michel
    Gear, John S S
    Who dies from what?: determining cause of death in South Africa's rural north-east1999Inngår i: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 4, nr 6, s. 433-441Artikkel i tidsskrift (Fagfellevurdert)
  • 249.
    Karling, Mats
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Behavioural changes after anaesthesia: validity and liability of the Post Hospitalization Behavior Questionnaire in a Swedish paediatric population.2006Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, nr 3, s. 340-346Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To study the validity and liability of a Swedish translation of the Post Hospitalization Behavior Questionnaire (PHBQ) in children in Sweden. METHODS: The PHBQ was translated using a back-translation method. The subjects were 340 children, ages 2-13 y, admitted for elective surgery or diagnostic procedure with anaesthesia. The results were analysed using exploratory factor analysis with principal component analysis with Oblimin rotation. The fit to data was examined using confirmative factor analysis with a good measure of fit for the model (p>0.09 for all factors). RESULTS: Five factors emerged as being most consistent: general anxiety-withdrawal, eating disturbances, separation anxiety, regression-aggression and sleep anxiety. A panel of child psychologists confirmed the face validity of factors. Internal consistency (Chronbach's alpha) was adequate (0.75-0.87) for subscales and excellent for total score (0.93). Children less than 5 y old had higher scores than older children (mean 0.046+/-0.018 vs -0.0089+/-0.014, p<0.001). There were no gender differences. CONCLUSION: The results support a conclusion that a five-factor model better fits data from Swedish children than the original six-factor model.

    Fulltekst (pdf)
    FULLTEXT01
  • 250.
    Kasenga, Fyson
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Making it happen: prevention of mother to child transmission of HIV in rural Malawi2009Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The devastating consequences of HIV/AIDS have caused untold harm and human suffering globally. Over 33 million people worldwide are estimated to be living with HIV and AIDS and a majority of these are in sub-Saharan Africa. Women and children are more infected particularly in sub-Saharan countries. Globally, an estimated number of 370 000 children were newly infected in 2007, mainly through mother to child transmission (MTCT). Implementation of prevention of mother to child transmission (PMTCT) programmes has been introduced in many sub-Saharan countries during the last years.

    Operational research was conducted to study the demand and adherence of key components within a PMTCT Programme among women in rural Malawi. This study was carried out at Malamulo SDA Hospital in rural Malawi and employed a mixture of both quantitative and qualitative approaches. Data sources included antenatal care (ANC), PMTCT and delivery registers, structured questionnaires, in-depth interviews with HIV positive women in the programme and focus group discussions with community members, health care workers and traditional birth attendants.

    Over the three year period of the study (January 2005 to December 2007), three interventions were introduced in the antenatal care (ANC) at the hospital at different times. These were HIV testing integrated in the ANC clinic in March 2005, opt-out testing in January 2006 and free maternal services in October 2006. A steady increase of the service uptake as interventions were being introduced was observed over time. HIV testing was generally accepted by the community and women within the programme. However, positive HIV tests among pregnant women were also experienced to cause conflicts and fear within the family. Although hospital deliveries were recognised to be safe and clean, home deliveries were common. Lack of transport, spouse support and negative attitudes among staff were some of the underlying factors.

    Further study on the quality of care offered in the presence of increased service uptake is required. Community sensitisation on free maternal care and male involvement should be strengthened to enable full utilisation of services. Additionally, service providers at facility and community levels, policy makers at all levels and the communities should see themselves as co-workers in development to reduce preventable maternal and infant mortality including MTCT of HIV.

    Fulltekst (pdf)
    FULLTEXT02
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