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  • 1.
    Abraha, Atakelti
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Kahsay, Asmelash
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case-control study.2019In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Services that aim to prevent mother-to-child HIV transmission (PMTCT) can simultaneously reduce the overall impact of HIV infection in a population while also improving maternal and child health outcomes. By taking a health equity perspective, this retrospective case control study aimed to compare the health status of under-5 children born to HIV-positive and HIV-negative mothers in Tigray Region, Ethiopia. Two hundred and thirteen HIV-positive women (cases), and 214 HIV-negative women (controls) participated through interviews regarding their oldest children. Of the children born to HIV-positive mothers, 24% had not been tested, and 17% of those who had been tested were HIV-positive themselves. Only 29% of the HIV-positive children were linked to an ART programme. Unexpectedly, exposed HIV-negative children had fewer reports of perceived poor health as compared to unexposed children. Over 90% of all the children, regardless of maternal HIV status, were breastfed and up-to-date with the recommended immunizations. The high rate of HIV infection among the babies of HIV-positive women along with their low rates of antiretroviral treatment raises serious concerns about the quality of outreach to pregnant women in Tigray Region, and of the follow-up for children who have been exposed to HIV via their mothers.

  • 2.
    Al-Alawi, Kamila
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Team-based approach in the management of diabetes at primary health care level in Muscat, Oman: challenges and opportunities2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

  • 3.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Al Mandhari, Ahmed
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study2019In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 19, article id 18Article in journal (Refereed)
    Abstract [en]

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

  • 4.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Perceptions of type-two diabetes patients towards diabetes management visits at public primary health care centres with diverse opinions towards nurse-led clinics in Muscat, Oman: a pilot qualitative studyManuscript (preprint) (Other academic)
  • 5.
    Al-Alawi, Kamila
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The question is not what we want; the question is, are we ready?: a qualitative study exploring primary health care providers`perceptions towards different human resources for health management mechanisms at diabetes management clinics in primary health care centres in Muscat, OmanManuscript (preprint) (Other academic)
  • 6. Alberto Diaz-Sanchez, Adrian
    et al.
    Corona-Gonzalez, Belkis
    Meli, Marina L.
    Obregon Alvarez, Dasiel
    Vega Canizares, Ernesto
    Fonseca Rodriguez, Osvaldo
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Centro Nacional de Sanidad Agropecuaria (CENSA), San José de las Lajas, Mayabeque, Cuba.
    Lobo Rivero, Evelyn
    Hofmann-Lehmann, Regina
    First molecular evidence of bovine hemoplasma species (Mycoplasma spp.) in water buffalo and dairy cattle herds in Cuba2019In: Parasites & Vectors, ISSN 1756-3305, E-ISSN 1756-3305, Vol. 12, article id 78Article in journal (Refereed)
    Abstract [en]

    Background: Hemotropic mycoplasmas (aka hemoplasmas) are small bacteria which cause infectious anemia in several mammalian species including humans. Information on hemoplasma infections in Cuban bovines remains scarce and no studies applying molecular methods have been performed so far. The aim of the present study was to utilize real-time PCR and sequence analysis to investigate dairy cattle and buffalo from Cuba for the presence of bovine hemoplasma species.

    Results: A total of 80 blood samples from 39 buffalo and 41 dairy cattle were investigated for the presence of Mycoplasma wenyonii and Candidatus Mycoplasma haemobos using two species-specific real-time TaqMan PCR assays. PCR results revealed overall 53 (66.2%; 95% CI: 55.3-75.7%) positive animals for M. wenyonii and 33 (41.2%; 95% CI: 31.1-52.2%) for Ca. M. haemobos; the latter were all co-infections with M. wenyonii. The sample prevalences were similar in cattle and buffalo. Based on the sequence analysis of the nearly full-length 16S rRNA gene from two cattle and two buffalo, the presence of M. wenyonii and Ca. M. haemobos was confirmed. Statistical analysis revealed that buffalo and cattle one year of age or older were more frequently infected with M. wenyonii or Ca. M. haemobos than younger animals. PCR-positivity was not associated with anemia; however, the infection stage was unknown (acute infection versus chronic carriers).

    Conclusions: The high occurrence of bovine hemoplasma infections in buffalo and dairy cattle may have a significant impact on Cuban livestock production. To the best of our knowledge, this is the first molecular evidence of bovine hemoplasma species infection in dairy cattle and buffalo from Cuba and the Caribbean.

  • 7.
    Baroudi, Mazen
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Namatovu, Fredinah
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Annelie, Carlsson
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Preteen children’s health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 139Article in journal (Refereed)
    Abstract [en]

    Background: Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background.

    Methods: During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child’s country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups.

    Results: Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1–1.3) and more mood problems (OR: 1.35, 95% CI: 1.2–1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents’ occupation, however, children of parents with low or medium education levels reported less “mood problems” than those of parents with high education levels (OR: 0.65, 95% CI: 0.46–0.92) and (OR: 0.84, 95% CI: 0.73–0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14–2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08–6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations.

    Conclusion: More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.

  • 8. Baschieri, Angela
    et al.
    Gordeev, Vladimir S
    Akuze, Joseph
    Kwesiga, Doris
    Blencowe, Hannah
    Cousens, Simon
    Waiswa, Peter
    Fisker, Ane B
    Thysen, Sanne M
    Rodrigues, Amabelia
    Biks, Gashaw A
    Abebe, Solomon M
    Gelaye, Kassahun A
    Mengistu, Mezgebu Y
    Geremew, Bisrat M
    Delele, Tadesse G
    Tesega, Adane K
    Yitayew, Temesgen A
    Kasasa, Simon
    Galiwango, Edward
    Natukwatsa, Davis
    Kajungu, Dan
    Enuameh, Yeetey Ak
    Nettey, Obed E
    Dzabeng, Francis
    Amenga-Etego, Seeba
    Newton, Sam K
    Manu, Alexander A
    Tawiah, Charlotte
    Asante, Kwaku P
    Owusu-Agyei, Seth
    Alam, Nurul
    Haider, M M
    Alam, Sayed S
    Arnold, Fred
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Croft, Trevor N
    Herbst, Kobus
    Kishor, Sunita
    Serbanescu, Florina
    Lawn, Joy E
    "Every Newborn-INDEPTH" (EN-INDEPTH) study protocol for a randomised comparison of household survey modules for measuring stillbirths and neonatal deaths in five Health and Demographic Surveillance sites2019In: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 9, no 1, p. 1-15, article id 010901Article in journal (Refereed)
    Abstract [en]

    Background: Under-five and maternal mortality were halved in the Millennium Development Goals (MDG) era, with slower reductions for 2.6 million neonatal deaths and 2.6 million stillbirths. The Every Newborn Action Plan aims to accelerate progress towards national targets, and includes an ambitious Measurement Improvement Roadmap. Population-based household surveys, notably Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys, are major sources of population-level data on child mortality in countries with weaker civil registration and vital statistics systems, where over two-thirds of global child deaths occur. To estimate neonatal/child mortality and pregnancy outcomes (stillbirths, miscarriages, birthweight, gestational age) the most common direct methods are: (1) the standard DHS-7 with Full Birth History with additional questions on pregnancy losses in the past 5 years (FBH+) or (2) a Full Pregnancy History (FPH). No direct comparison of these two methods has been undertaken, although descriptive analyses suggest that the FBH+ may underestimate mortality rates particularly for stillbirths.

    Methods: This is the protocol paper for the Every Newborn-INDEPTH study (INDEPTH Network, International Network for the Demographic Evaluation of Populations and their Health Every Newborn, Every Newborn Action Plan), aiming to undertake a randomised comparison of FBH+ and FPH to measure pregnancy outcomes in a household survey in five selected INDEPTH Network sites in Africa and South Asia (Bandim in urban and rural Guinea-Bissau; Dabat in Ethiopia; IgangaMayuge in Uganda; Kintampo in Ghana; Matlab in Bangladesh). The survey will reach >68 000 pregnancies to assess if there is ≥15% difference in stillbirth rates. Additional questions will capture birthweight, gestational age, birth/death certification, termination of pregnancy and fertility intentions. The World Bank's Survey Solutions platform will be tailored for data collection, including recording paradata to evaluate timing. A mixed methods assessment of barriers and enablers to reporting of pregnancy and adverse pregnancy outcomes will be undertaken.

    Conclusions: This large-scale study is the first randomised comparison of these two methods to capture pregnancy outcomes. Results are expected to inform the evidence base for survey methodology, especially in DHS, regarding capture of stillbirths and other outcomes, notably neonatal deaths, abortions (spontaneous and induced), birthweight and gestational age. In addition, this study will inform strategies to improve health and demographic surveillance capture of neonatal/child mortality and pregnancy outcomes.

  • 9.
    Björnebäck, Michaela
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Health care access for rural youths: a qualitative study in Northern Sweden2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 10.
    Blomfeldt, Marcus
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Medical students’ views on and attitude towards prevention and health promotion in health care2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 11.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nurturing Global Health Action through its first decade.2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1569847Article in journal (Refereed)
  • 12. Draper, Catherine E.
    et al.
    Tomaz, Simone A.
    Jones, Rachel A.
    Hinkley, Trina
    Twine, Rhian
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Norris, Shane A.
    Cross-sectional associations of physical activity and gross motor proficiency with adiposity in South African children of pre-school age2019In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 22, no 4, p. 614-623Article in journal (Refereed)
    Abstract [en]

    Objective: The study aimed to investigate the relationship between physical activity, gross motor skills and adiposity in South African children of pm-school age.

    Design: Cross-sectional study.

    Setting: High-income urban, and low-income urban and rural settings in South Africa.

    Participants: Children (3-6 years old, n 268) were recruited from urban high-income (n 46), urban low-income (n 91) and rural low-income (n 122) settings. Height and weight were measured to calculate the main outcome variables: BMI and BMI-for-age Z-score (BAZ). Height-for-age and weight-for-age Z-scores were also calculated. Actigraph GT3X+ accelerometers were used to objectively measure physical activity; the Test of Gross Motor Development (Version 2) was used to assess gross motor skills.

    Results: More children were overweight/obese and had a higher BAZ from urban low-income settings compared with urban high-income settings and rural low-income settings. Being less physically active was associated with thinness, but not overweight/obesity. Time spent in physical activity at moderate and vigorous intensities was positively associated with BMI and BAZ. Gross motor proficiency was not associated with adiposity in this sample.

    Conclusions: The findings of this research highlight the need for obesity prevention particularly in urban low-income settings, as well as the need to take into consideration the complexity of the relationship between adiposity, physical activity and gross motor skills in South African pre-school children.

  • 13. Dubouis, Ghislain
    et al.
    Sovacool, Benjamin
    Aall, Carlo
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Barbier, Carine
    Herrmann, Alina
    Bruyère, Sébastien
    Andersson, Camilla
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Sköld, Bore
    Nadaud, Franck
    Dorner, Florian
    Moberg, Karen Richardsen
    Ceron, Jean Paul
    Fischer, Helen
    Amelung, Dorothee
    Baltruszewicz, Marta
    Fischer, Jeremy
    Benevise, Françoise
    Valerie, Valérie R
    Sauerborn, Rainer
    It starts at home? Climate policies targeting household consumption and behavioral decisions are key to low-carbon futures2019In: Energy Research & Social Science, ISSN 2214-6296, E-ISSN 2214-6326, Vol. 52, p. 144-158Article in journal (Other academic)
    Abstract [en]

    Through their consumption behavior, households are responsible for 72% of global greenhouse gas emissions. Thus, they are key actors in reaching the 1.5°C goal under the Paris Agreement. However, the possible contribution and position of households in climate policies is neither well understood, nor do households receive sufficiently high priority in current climate policy strategies. This paper investigates how behavioral change can achieve a substantial reduction in greenhouse gas emissions in European high-income countries. It uses theoretical thinking and some core results from the HOPE research project, which investigated household preferences for reducing emissions in four European cities in France, Germany, Norway and Sweden. The paper makes five major points: First, car and plane mobility, meat and dairy consumption, as well as heating are the most dominant components of household footprints. Second, household living situations (demographics, size of home) greatly influence the household potential to reduce their footprint, even more than country or city location. Third, household decisions can be sequential and temporally dynamic, shifting through different phases such as childhood, adulthood, and illness. Fourth, short term voluntary efforts will not be sufficient by themselves to achieve the drastic reductions needed to achieve the 1.5°C goal; instead, households need a regulatory framework supporting their behavioral changes. Fifth, there is a mismatch between the roles and responsibilities conveyed by current climate policies and household perceptions of responsibility. We then conclude with further recommendations for research and policy.

  • 14.
    Eid, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Biomedical Sciences Research, Faculty of Medicine, San Simon University, Cochabamba, Bolivia.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Pulkki-Brännström, Anni-Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    "Cheaper and better": an economic analysis of changing first line treatment for cutaneous leishmaniasis in BoliviaManuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: Cutaneous leishmaniasis (CL) is endemic in Bolivia, mostly affecting poor people in rainforest areas. The current first-line treatment consists of systemic pentavalent antimonials (SPA) for 20 days and is paid for by the Ministry of Health (MoH). Long periods of drug shortages, a lack of conditions to deliver treatment safely, treatment interruption are challenges to implementation. Intralesional pentavalent antimonials (ILPA) are an alternative to SPA. This study aims to compare the cost of ILPA and SPA, and to estimate the health and economic impacts of changing the first-line treatment for CL in an endemic area of Bolivia.

    Methods: The cost per patient treated was estimated for SPA and ILPA from the perspectives of the MoH and society. The quantity and unit costs of medications, staff time, transportation and loss of production were obtained through a health facility survey (N=12), official documents and key informants. A one-way sensitivity analysis was conducted on key parameters to evaluate the robustness of the results. The annual number of patients treated and the budget impact of switching to ILPA as the first-line treatment were estimated under different scenarios of increasing treatment utilization using previous estimates of the extent of underreporting. Costs were reported in 2016 international dollars (1 INT$ = 3.10 BOB).

    Results: Treating CL using ILPA was associated with a cost saving of $248 per patient treated from the MoH perspective, and $688 per patient treated from the societal perspective. ILPA was cost-saving even under a hypothetical increase of 80% in the number of cases treated. Switching first-line treatment would allow two-and-a-half times the current number of patients to be treated, while maintaining the current budget.

    Conclusions: The results of this study support a shift to ILPA as the first-line treatment for CL in Bolivia and possibly in other South American countries.

  • 15.
    Eid Rodríguez, Daniel V.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The rough journey to access health care: the case of leishmaniasis in the Bolivian rainforest2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Leishmaniasis is a parasitic infectious disease transmitted by vectors that cause three main clinical syndromes: cutaneous (CL), mucosal (ML), and visceral (VL). Since VL is not relevant to this thesis, only CL and ML will be further discussed. Leishmaniasis is present in 98 countries, with more than 350 million people at risk of infection. Leishmaniasis disproportionately affects poor countries and, in particular, remote areas where health services are weaker. Bolivia, a lower-middle-income country, is the fifth country with more cases in Latin America, and case detection and management is the main control strategy of the National Leishmaniasis Control Programme (NLCP). The NLCP provides free treatment to patients, which consists of systemic pentavalent antimonials (SPA) for 20 days. This treatment is highly toxic for patients and costly for the government, resulting in long periods of shortage of the drug. A good alternative to SPA is the use of intralesional pentavalent antimonials (ILPA), which are safer and have similar efficacy to SPA in treating CL. Case detection and management depend on a well-structured health-care system, and the primary level of care is responsible for this task in Bolivian endemic areas. It is well known that health-care access for leishmaniasis patients is limited but the extent and the determinant factors of this problem are unknown. The aim of this thesis is to assess health-care access among patients with leishmaniasis in a Bolivian rainforest rural area, addressing four specific questions: Who is most vulnerable to CL?; What is the extent of their lack of access to health care?; How do the dimensions of access and the quality of care influence health-care utilization in a context of vulnerability?; and how can a change in NLCP policy related to the treatment of CL improve the level of access to health care?

    Methods: This thesis is based on four studies that use quantitative and qualitative methods. Data collection was conducted through surveys, in-depth interviews and revision of official documents. Sub-study 1 was based on a cross-sectional study conducted in two communities of Cochabamba and assessed risk factors for CL using multivariate analysis. Sub-study 2 used the method of capture−recapture to assess the level of under-reporting of the national register for the period of 2013−2014,  using Chapman’s formula. Sub-study 3 was conducted through in-depth interviews applied to 14 participants, using thematic analysis. Sub-study 4 was an economic evaluation that used data from surveys with physicians, official documents and key informants and compared the costs of systemic pentavalent antimonials (SPA) and intralesional pentavalent antimonials (ILPA) from the perspective of the Ministry of Health (MoH) and society. Additionally, a budget impact analysis of the implementation of ILPA in hypothetical scenarios of increasing level of demand was carried out.

    Main findings: Sub-study 1 showed that gender/sex was the only statistically significant factor associated with CL, with men being the most affected group. Other classical factors, such as animal ownership, house materials and protective measures were, however, not related to CL. Sub-study 2 revealed a high level of under-reporting (73%) of CL in the study area, and this under-reporting was higher among men compared to women. Sub-study 3 showed that the lack of availability, accessibility, affordability and quality of care were the main factors that limited the access to care of CL and ML patients. In sub-study 4, the economic analysis pointed out that the use of ILPA was cost-saving for the MoH and society, and the budget analysis confirmed that the implementation of ILPA as first-line treatment was not only cost-saving for the MoH, but it would also increase the number of patients accessing the treatment.

    Conclusions: The predominance of a sylvatic pattern of transmission, with men as the most affected group, demands new approaches to prevention related to occupational activities. The NLCP policy related to case management has been essential to reducing economic barriers for patients with leishmaniasis; however, there are still a considerable amount of cases who do not have access to the treatment. Lacko f health services, equipment and drugs, as well as difficulties in reaching health services, the high costs of seeking health care and the low quality of care are important factors that must be addressed to fulfil the right to health care for these patients. Finally, new therapeutic alternatives, such as ILPA, must be considered to reduce problems of affordability, adherence, as well as side effects to the treatment. This information can be used to develop targeted interventions aimed at increasing the access to health care of people with leishmaniasis in the rainforest of Bolivia.

  • 16. Estalella, Itziar
    et al.
    San Millán, Jaione
    Trincado, María José
    Maquibar, Amaia
    Martínez-Indart, Lorea
    San Sebastián, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay.2018In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, article id S1871-5192(18)30356-1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Late-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm.

    OBJECTIVE: The aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain.

    METHODS: The intervention was designed to promote parents' education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n=212) and an intervention group (n=161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups.

    RESULTS: Infants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p=0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p=0.009).

    CONCLUSION: The intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.

  • 17.
    Fors, Ronny
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology, Ortodontics.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Persson, Maurits
    Umeå University, Faculty of Medicine, Department of Odontology, Ortodontics.
    Nickel allergy in relation to piercing and orthodontic appliances: a population study2012In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 67, no 6, p. 342-350Article in journal (Refereed)
    Abstract [en]

    Background. Studies have shown conflicting results on the association between nickel exposure from orthodontic appliances and nickel sensitization.

    Objectives & Method. In a cross-sectional study, we investigated the association between nickel sensitization and exposure to orthodontic appliances and piercings. 4376 adolescents were patch tested following a questionnaire asking for earlier piercing and orthodontic treatment. Exposure to orthodontic appliances was verified in dental records.

    Results. Questionnaire data demonstrated a reduced risk of nickel sensitization when orthodontic treatment preceded piercing (OR 0.46; CI 0.27–0.78). Data from dental records demonstrated similar results (OR 0.61, CI 0.36–1.02), but statistical significance was lost when adjusting for background factors. Exposure to full, fixed appliances with NiTi-containing alloys (OR 0.31, CI 0.10–0.98) as well as a pooled ‘high nickel-releasing’ appliance group (OR 0.56, CI 0.32–0.97) prior to piercing was associated with a significantly reduced risk of nickel sensitization.

    Conclusion. High nickel-containing orthodontic appliances preceding piercing reduces the risk of nickel sensitization by a factor 1.5–2. The risk reduction is associated with estimated nickel release of the appliance and length of treatment. Sex, age at piercing and number of piercings are also important risk indicators. Research on the role of dental materials in the development of immunological tolerance is needed.

  • 18. Fritzell, S.
    et al.
    Trygg, Nadja
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Public Health Agency of Sweden, Solna, Sweden.
    Busch, H.
    Bremberg, S.
    Inequalities in determinants and mental health in Sweden: results from a governmental initiative2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 124-124Article in journal (Other academic)
    Abstract [en]

    Mental health is an increasing concern in all European countries. Social inequalities may appear both in the distribution of mental health and the social and economic consequences. In 2016, the government commissioned The Public Health Agency of Sweden (PHAS) to increase knowledge on socioeconomic determinants of mental health problems. The present study addresses the social distribution of mental health problems and what mediates this.

    Drawing on patient registry data of the population from 2014 and a national survey representative of the population aged 16-84, years 2013-2016 (n = 155339) we analyze how mental health is distributed in social groups and what determinants mediate poor mental health. Outcomes include psychiatric in- and outpatient care (numbers and cases/1000), and for self-reported measures (ie. GHQ, stress, anxiety) odds ratios (OR) from multivariate logistic regression, adjusting for social and economic determinants.

    Preliminary results show that most outcomes in self-reported poor mental health and psychiatric diagnoses were more common among women. Social patterns differed between diagnoses.

    Among working ages in- and outpatient care, low educated showed fourfold increased risk of psychotic disorders, while neurotic stress related disorders showed a doubled risk among low educated. Care for any mental disorder (excluding dementia) was more common among lower educated men and women aged 65+ but had a reverse social gradient. In analyses modelling the risk of poor mental health (GHQ12), controlling for background-, social and economic factors in particular financial strain (OR 2.42, CI 2.11-2.77) mediated poor mental health among women 25-64.

    An educational gradient was found in most mental health outcomes with more pronounced gradient in more severe outcomes. Patterns differ by age groups, social group, and outcome. Results will be used to inform practitioners and policy makers at national and regional level to decrease inequalities in mental health.

    Key messages:

    • Social inequalities in mental health and its’ determinants are found in most age groups, and most outcomes studied.

    • Focusing on living conditions, particularly economic strain is essential for achieving equity in mental health.

  • 19. Fritzell, S.
    et al.
    Trygg, Nadja
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Public Health Agency of Sweden, Solna, Sweden.
    Busch, H.
    Bremberg, S.
    Scoping the evidence on mental health inequalities and underlying determinants in Sweden2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 316-316Article in journal (Other academic)
    Abstract [en]

    Mental health is an increasing concern in all European countries. Social inequalities may appear in both the distribution of mental health and the social and economic consequences. In 2016, the government commissioned The Public Health Agency of Sweden (PHAS) to increase the knowledge on mental health inequalities and their underlying determinants. In all, 18 research projects were initiated within different universities in Sweden and PHAS.

    Research questions addressed dimensions of inequality such as age, gender, SES, sexual orientation and disability. PHAS involved researchers from the fields of social medicine, epidemiology and economics to explore all levels of social determinants, different mechanisms, interacting forces of inequalities and consequences of disease. Evidence from scoping literature reviews were coupled with analyses of Swedish data on a range of outcomes; from positive mental health to in-patient care.

    Preliminary results have been discussed in joint workshops and show social inequalities in mental health in all age groups in Sweden, including small children, with a more pronounced gradient in severe outcomes. Generally, the results points towards policy actions focusing girls and women, low income earners, those experiencing financial strain, hbtq persons and persons with disability. Also, the interaction of different dimensions of inequality need consideration.

    The project is a collaboration between PHAS and a range of research disciplines all joining to discuss mental health and inequalities. Though challenging as interpretations may differ due to field of research, overall it has allowed for a broad approach and joint learning as experts have collaborated. This is a step towards understanding country specific determinants of mental health inequalities. Combined, the results make up a knowledge base that will guide policy makers and practitioners to develop efficient policies and practices in order to decrease inequalities in mental health.

    Key messages:

    • Combining evidence from international literature with context specific secondary data analyses improves its local relevance.

    • Collaboration between research fields enables a more comprehensive basis for decision making.

  • 20. Herrmann, A.
    et al.
    Amelung, D.
    Fischer, H.
    Wilkinson, P.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Barbier, C.
    Dubois, G.
    Aall, C.
    Sauerborn, R.
    Promoting health under the Paris Climate Agreement: results from a European mixed-methods study2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 170-170Article in journal (Other academic)
  • 21. Hitimana, Regis
    et al.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Krantz, Gunilla
    Nzayirambaho, Manasse
    Semasaka Sengoma, Jean Paul
    Pulkki-Brännström, Anni-Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Incremental cost and health gains of the 2016 WHO antenatal care recommendations for Rwanda: results from expert elicitation2019In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 17, no 1, article id 36Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: High-quality evidence of effectiveness and cost-effectiveness is rarely available and relevant for health policy decisions in low-resource settings. In such situations, innovative approaches are needed to generate locally relevant evidence. This study aims to inform decision-making on antenatal care (ANC) recommendations in Rwanda by estimating the incremental cost-effectiveness of the recent (2016) WHO antenatal care recommendations compared to current practice in Rwanda.

    METHODS: Two health outcome scenarios (optimistic, pessimistic) in terms of expected maternal and perinatal mortality reduction were constructed using expert elicitation with gynaecologists/obstetricians currently practicing in Rwanda. Three costing scenarios were constructed from the societal perspective over a 1-year period. The two main inputs to the cost analyses were a Monte Carlo simulation of the distribution of ANC attendance for a hypothetical cohort of 373,679 women and unit cost estimation of the new recommendations using data from a recent primary costing study of current ANC practice in Rwanda. Results were reported in 2015 USD and compared with the 2015 Rwandan per-capita gross domestic product (US$ 697).

    RESULTS: Incremental health gains were estimated as 162,509 life-years saved (LYS) in the optimistic scenario and 65,366 LYS in the pessimistic scenario. Incremental cost ranged between $5.8 and $11 million (an increase of 42% and 79%, respectively, compared to current practice) across the costing scenarios. In the optimistic outcome scenario, incremental cost per LYS ranged between $36 (for low ANC attendance) and $67 (high ANC attendance), while in the pessimistic outcome scenario, it ranged between $90 (low ANC attendance) and $168 (high ANC attendance) per LYS. Incremental cost effectiveness was below the GDP-based thresholds in all six scenarios.

    DISCUSSION: Implementing the new WHO ANC recommendations in Rwanda would likely be very cost-effective; however, the additional resource requirements are substantial. This study demonstrates how expert elicitation combined with other data can provide an affordable source of locally relevant evidence for health policy decisions in low-resource settings.

  • 22. Hussain-Alkhateeb, Laith
    et al.
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Institute for Global Health, University College London, London, UK.
    Petzold, Max
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. INDEPTH Network, Accra, Ghana; Medical Research Council, Johannesburg, South Africa; Medical Research Council, Johannesburg, South Africa; Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council, Johannesburg, South Africa; Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-9, article id 28302Article in journal (Refereed)
    Abstract [en]

    Background: Understanding how lay people perceive the causes of mortality and their associated risk factors is important for public health. In resource-limited settings, where verbal autopsy (VA) is used as the most expedient method of determining cause of death, it is important to understand how pre-existing concepts of cause of death among VA-informants may influence their VA-responses and the consequential impact on cause of death assessment. This study describes the agreement between VA-derived causes of death and informant-perceived causes and associated influential factors, which also reflects lay health literacy in this setting. Method: Using 20 years of VA data (n = 11,228) from the Agincourt Health and Demographic Surveillance System (HDSS) site in rural South Africa, we explored the agreement between the causes of death perceived by the VA-informants and those assigned by the automated Inter-VA tool. Kappa statistics and concordance correlation coefficients were applied to measure agreement at individual and population levels, respectively. Multivariable regression models were used to explore factors associated with recognised lay perceptions of causes of mortality. Results: Agreement between informant-perceived and VA-derived causes of death at the individual level was limited, but varied substantially by cause of death. However, agreement at the population level, comparing cause-specific mortality fractions was higher, with the notable exception of bewitchment as a cause. More recent deaths, those in adults aged 15-49 years, deaths outside the home, and those associated with external causes showed higher concordance with InterVA. Conclusion: Overall, informant perception of causes of death was limited, but depended on informant characteristics and causes of death, and to some extent involved non-biomedical constructs. Understanding discordance between perceived and recognised causes of death is important for public health planning; low community understanding of causes of death may be detrimental to public health. These findings also illustrate the importance of using rigorous and standardised VA methods rather than relying on informants' reported causes of death.

  • 23.
    Jerdén, Lars
    et al.
    Högskolan Dalarna, Jakobsgårdarnas akademiska vårdcentral, Borlänge.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Läkaren har en nyckelroll i vårdarbetet med levnadsvanor2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, article id FF4SArticle in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Updated Swedish National Guidelines on prevention and lifestyle habits: physicians' role

    The recently updated Swedish National Guidelines on prevention and lifestyle habits (tobacco use, hazardous use of alcohol, insufficient physical activity and unhealthy eating habits) emphasize the importance of supporting lifestyle changes among risk individuals, such as already affected by disease, carriers of risk factors that increase the risk of disease, and people with social vulnerability. More measures targeting youth are included, as well as measures to avoid smoking and alcohol use prior to surgery. Physicians have a key role in implementation of the new guidelines, as a great majority of patients who attend healthcare and discuss lifestyle habits do so with a physician.

  • 24.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, M.
    Complex inequalities of gender and social class in daily smoking among Swedish men and women2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 325-325Article in journal (Other academic)
    Abstract [en]

    Background: Cigarette smoking is a major public health threat. In high income countries, smoking is most prevalent in disadvantaged groups. Little is known about complex inequalitites in smoking based on multiple axes of social positions which would be necessary in designing interventions aiming at reducing smoking rates. The study aimed to describe the prevalence of daily smoking in the adult Swedish population across combinations of the social positions gender and occupational class, and to examine smoking differences attributed to the intersection of gender/occupational class

    Methods: The study sample (N = 61 316, age 26 – 84) was pooled from seven years of the annual cross sectional Swedish national public health surveys (2010 to 2016). The outcome was current daily smoking. Binary variables of gender (man/woman) and occupational class (blue collar/white collar) were used to construct the four category intersection meausure of gender/class. Complex inequalities in daily smoking were estimated by joint-, referent- and excess disparities. Survey year and age were used as covariates.

    Results: The overall daily smoking prevalence was 10.21%. The smoking rates in the categories of gender and occupational class were as follows: white collar men: 6.70%; white collar women: 7.79%; blue collar men: 13.75% and blue collar women: 16.63%. The absolute joint disparity was 9.96 percentage points (CI: 9.14 – 10.79) and that the main contributor to this inequality was occupational class (70.66%). The results of excess disparity further showed that blue collar women were particularly exposed regarding smoking.

    Conclusions: Acknowledging the complexity of disadvantage and privilege regarding daily smoking contributes to an understanding of the situation for multiply marginalised groups, for example blue collar women. The findings may inform future public health interventions to reduce smoking habits.

    Key messages:

    • Acknowledging the complexity of disadvantage and privilege contributes to an understanding of daily smoking across multiply marginalised groups.

    • Blue collar women is a particularly important group to consider in public health efforts to reduce smoking.

  • 25.
    Lennartsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    General practitioners’ experiences of suicide risk assessment and management An interview study in rural areas in northern Sweden2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 26. Lillepold, Kate
    et al.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Liu-Helmersson, Jing
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sewe, Maquins
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Semenza, Jan C.
    More arboviral disease outbreaks in continental Europe due to the warming climate?2019In: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, article id taz017Article in journal (Refereed)
  • 27. Mgaya, Andrew H.
    et al.
    Kidanto, Hussein L.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Essen, Birgitta
    Use of a criteria-based audit to optimize uptake of cesarean delivery in a low-resource setting2019In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 144, no 2, p. 199-209Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the impact of a criteria‐based audit (CBA) of obstructed labor and fetal distress on cesarean delivery and perinatal outcomes.

    Methods: A cross‐sectional study was performed at a tertiary referral hospital in Tanzania. Data were collected before and after CBA (January 2013–November 2013 and July 2015–June 2016). Outcomes of fetal distress (baseline CBA, n=248; re‐audit, n=251) and obstructed labor (baseline CBA, n=260; re‐audit n=250) were assessed using a checklist. Additionally, 27 960 parturients were assessed using the Robson classification.

    Results: Perinatal morbidity and mortality decreased from 42 of 260 (16.2%) to 22 of 250 (8.8%) among patients with obstructed labor after CBA (P=0.012). Cesarean delivery rate decreased for referred term multiparas with induced labor or prelabor cesarean delivery (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.09–0.82). Cesarean delivery rate for preterm pregnancies increased among both referred (OR 1.28, 95% CI 1.02–1.63) and non‐referred (OR 2.78, 95% CI 1.98–3.90) groups. Neonatal distress rate decreased for referred term multiparas (OR 0.72, 95% CI 0.56–0.92), referred preterm pregnancies (OR 0.32, 95% CI 0.25–0.39), and non‐referred preterm pregnancies (OR 0.26, 95% CI 0.18–0.36).

    Conclusion: Use of CBA reduced poor perinatal outcomes of obstructed labor and increased uptake of cesarean delivery.

  • 28. Nyirenda, Moffat J.
    et al.
    Ramsay, Michèle
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. STIAS Wallenberg Research Centre, Stellenbosch University, Stellenbosch, South Africa.
    Patterns of adult body mass in sub-Saharan Africa2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, p. 1-3Article in journal (Refereed)
  • 29. Nyirenda, Moffat J
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Pregnancy, programming, and predisposition2019In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 7, no 4, p. e404-e405Article in journal (Other (popular science, discussion, etc.))
  • 30. Price, Jessica
    et al.
    Pettifor, Audrey
    Selin, Amanda
    Wagner, Ryan G.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    MacPhail, Catherine
    Agyei, Yaw
    Gomez-Olive, F. Xavier
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    The association between perceived household educational support and HIV risk in young women in a rural South African community (HPTN 068): A cross sectional study2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 1, article id e0210632Article in journal (Refereed)
    Abstract [en]

    Objective: To characterise perceived household support for female education and the associations between educational support and HIV prevalence, HSV-2 prevalence and sexual risk behaviours.

    Methods: This cross-sectional study used baseline survey data from the Swa Koteka HPTN 068 trial undertaken in Mpumalanga, South Africa. The study included 2533 young women aged 13-20, in grades 8-11 at baseline. HIV and HSV-2 status were determined at baseline. Information about patterns of sexual behaviour and household support for education was collected during the baseline survey. Linear regression and binary logistic regression were used to determine associations between household support for education and both biological and behavioural outcomes.

    Results: High levels of educational support were reported across all measures. HIV prevalence was 3.2% and HSV-2 prevalence was 4.7%, both increasing significantly with age. Over a quarter (26.6%) of young women reported vaginal sex, with 60% reporting condom use at last sex. The median age of sexual debut was 16 years. Household educational support was not significantly associated with HIV or HSV-2; however, the odds of having had vaginal sex were significantly lower in those who reported greater homework supervision (OR 0.82, 95% CI: 0.72-0.94), those who engaged in regular discussion of school marks with a caregiver (OR 0.82, 95% CI: 0.71-0.95) and when caregivers had greater educational goals for the young woman (OR 0.82, 95% CI: 0.71-0.96). In contrast, greater caregiver disappointment at dropout was significantly associated with reported vaginal sex (OR 1.29, 95% CI: 1.14-1.46).

    Conclusion: Young women in rural South Africa report experiencing high levels of household educational support. This study suggests that greater household educational support is associated with lower odds of having vaginal sex and engaging in risky sexual behaviour, though not with HIV or HSV-2 prevalence.

  • 31.
    Ragnarsson, Susanne
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sjöberg, Gunnar
    Umeå University, Faculty of Science and Technology, Department of Science and Mathematics Education.
    Rosvall, Per-Åke
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Recurrent Pain and Academic Achievement in School-Aged Children: A Systematic Review2019In: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364Article, review/survey (Refereed)
    Abstract [en]

    Recurrent pain and school failures are common problems in children visiting the school nurses office. The overall aim of the current study was to investigate the relationship between recurrent pain and academic achievement in school-aged children. Literature was searched in seven electronic databases and in relevant bibliographies. Study selection, data extraction, and study and evidence quality assessments were performed systematically with standardized tools. Twenty-one studies met the inclusion criteria and 13 verified an association between recurrent pain (headache, stomachache, and musculoskeletal pain) and negative academic achievement. Two longitudinal studies indicated a likely causal effect of pain on academic achievement. All studies had substantial methodological drawbacks and the overall quality of the evidence for the identified associations was low. Thus, children’s lack of success in school may be partly attributed to recurrent pain problems. However, more highquality studies are needed, including on the direction of the association and its moderators and mediators.

  • 32. Ramji, Rathi
    et al.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Arnetz, Bengt
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wiklund, Ywonne
    Arnetz, Judy
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Taking a Stand: An Untapped Strategy to Reduce Waterpipe Smoking in Adolescents2019In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 54, no 3, p. 514-524Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Waterpipe use amongst adolescents is on the rise globally. Thus, there is a need to understand adolescents 'attitudes towards and perceptions of waterpipe use in order to develop specific interventions against this form of tobacco use.

    METHODS: Focus group interviews were conducted among 37 Swedish adolescents (14 boys and 23 girls) from grades 10 to 12. Waterpipe users and nonusers were interviewed separately, with two groups each for users and nonusers. Interviews were audiotaped, transcribed, and thematically analyzed using content analysis.

    RESULTS: Six themes emerged including taking a stand, weighing the risks, Lack of knowledge, Social context, Waterpipe new and unknown, and Family influence. Taking a stand was about being able to stand up for one's owns views rather than giving in to peer pressure to smoke waterpipe. Participants feared harming others via secondhand smoke and expressed criticism of the tobacco industry. Participants considered the health consequences and feared addiction. Lack of knowledge concerning health effects of waterpipe smoking due to the unavailability of credible information was also reported. Waterpipe smoking was considered a social event carried out in the company of friends. Perceived as novel and fun, waterpipe was smoked out of curiosity. Parents' and siblings' smoking behaviors influenced adolescent waterpipe use.

    CONCLUSION: Adolescents reported lacking information about the possible health effects of waterpipe smoking and that gaining such knowledge would make it easier for them to take a stand and refuse smoking waterpipe. Prevention strategies should focus on providing adolescents with factual information about the dangers of waterpipe use.

  • 33.
    Samuelsson, Jenny
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Digital dengue surveillance, information, and decision tool for optimised dengue prevention - A qualitative study with voluntary health workers in Yogyakarta, Indonesia2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 34.
    San Sebastian, Miguel
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Mosquera, Paola A.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Do cardiovascular disease prevention programs in northern Sweden impact on population health?: An interrupted time series analysis2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 202Article in journal (Refereed)
    Abstract [en]

    Background: Cardiovascular disease (CVD) is the main cause of morbidity and mortality in Sweden. This study aims to assess the impact of a CVD intervention implemented in 1993 in northern Sweden on the reduction of premature ischemic heart disease (IHD) morbidity and mortality in women and men during the period 1987-2013.

    Methods: An ecological controlled interrupted time series design, with pre-intervention period defined as 1987-1993 and post-intervention period 1994-2013 was carried out. For each year, IHD events, stratified by sex, were retrieved from national registers.

    Results: Impressive reductions on IHD premature morbidity and mortality were observed to a similar degree in both the intervention county and the other comparison counties across the last 27years. Significant differences in the pre-post intervention trends indicating the intervention group had smaller reductions than expected from its pre-intervention trend and the trend of control counties were found among men for both IHD morbidity and mortality. A similar pattern was observed among women but without significant differences.

    Conclusions: Taken together, the data do not support that the intervention has contributed to an additional reduction on IHD morbidity and mortality, above and beyond that which is already seen in neighbouring counties without similar programs.

  • 35.
    Santosa, Ailiana
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Öhman, Ann
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Hakimi, Mohammad
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
    Cross-sectional survey of sexual dysfunction and quality of life among older people in Indonesia2011In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 8, no 6, p. 1594-1602Article in journal (Refereed)
    Abstract [en]

    Introduction.  The burden of sexual dysfunction among older people in many low- and middle-income countries is not well known. Understanding sexual dysfunction among older people and its impact on quality of life is essential in the design of appropriate health promotion programs.

    Aims.  To assess levels of sexual function and their association with quality of life while controlling for different sociodemographic determinants and chronic diseases among men and women over 50 years of age in rural Indonesia.

    Methods.  A cross-sectional study was conducted in the Purworejo District, Central Java, Indonesia in 2007. The study involved 14,958 men and women over 50 years old. The association between sexual dysfunction and quality of life after controlling for potential confounders (e.g., sociodemographic determinants and self-reported chronic diseases) was analyzed by multivariable logistic regression.

    Main Outcome Measures.  Self-reported quality of life.

    Results.  Older men more commonly reported sexual activity, and sexual problems were more common among older women. The majority of older men and women reported their quality of life as good. Lack of sexual activity, dissatisfaction in sexual life, and presence of sexual problems were associated with poor self-reported quality of life in older men after adjustment for age, marital status, education, and history of chronic diseases. A presence of sexual problems was the only factor associated with poor self-reported quality of life in women. Being in a marital relationship might buffer the effect of sexual problems on quality of life in men and women.

    Conclusion.  Sexual dysfunction is associated with poor quality of life among older people in a rural Javanese setting. Therefore, promotion of sexual health should be an integral part of physical and mental health campaigns in older populations.

  • 36.
    Sauma Stenberg, Pascale
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Medical students’ attitudes to working as general practitioners and rural physicians – a 5-years follow-up2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 37.
    Scribani, Melissa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindvall, Kristina
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sorensen, Julie
    Jenkins, Paul
    Sex-specific associations between body mass index and death before life expectancy: a comparative study from the USA and Sweden.2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1580973Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Understanding the impact of obesity on premature mortality is critical, as obesity has become a global health issue.

    OBJECTIVE: To contrast the relationship between body mass index (BMI) and premature death (all-cause; circulatory causes) in New York State (USA) and Northern Sweden.

    METHODS: Baseline data were obtained between 1989 and 1999 via questionnaires (USA) and health exams (Sweden), with mortality data from health departments, public sources (USA) and the Swedish Death Register. Premature death was death before life expectancy based on sex and year of birth. Within country and sex, time to premature death was compared across BMI groups (18.5-24.9 kg/m2 (reference), 25-29.9 kg/m2, 30.0-34.9 kg/m2, ≥35.0 kg/m2) using Proportional Hazards regression. Absolute risk (deaths/100,000 person-years) was compared for the same stratifications among nonsmokers.

    RESULTS: 60,600 Swedish (47.8% male) and 31,198 US subjects (47.7% male) were included. Swedish males with BMI≥30 had increased hazards (HR) of all-cause premature death relative to BMI 18.5-24.9 (BMI 30-34.9, HR = 1.71 (95% CI: 1.44, 2.02); BMI≥35, HR = 2.89 (2.16, 3.88)). BMI≥25 had increased hazards of premature circulatory death (BMI 25-29.9, HR = 1.66 (1.32, 2.08); BMI 30-34.9, HR = 3.02 (2.26, 4.03); BMI≥35, HR = 4.91 (3.05, 7.90)). Among US males, only BMI≥35 had increased hazards of all-cause death (HR = 1.63 (1.25, 2.14)), while BMI 30-34.9 (HR = 1.83 (1.20, 2.79)) and BMI≥35 (HR = 3.18 (1.96, 5.15)) had increased hazards for circulatory death. Swedish females showed elevated hazards with BMI≥30 for all-cause (BMI 30-34.9, HR = 1.42 (1.18, 1.71) and BMI≥35, HR = 1.61 (1.21, 2.15) and with BMI≥35 (HR = 3.11 (1.72, 5.63)) for circulatory death. For US women, increased hazards were observed among BMI≥35 (HR = 2.10 (1.60, 2.76) for all-cause and circulatory HR = 3.04 (1.75, 5.30)). Swedish males with BMI≥35 had the highest absolute risk of premature death (762/100,000 person-years).

    CONCLUSIONS: This study demonstrates a markedly increased risk of premature death associated with increasing BMI among Swedish males, a pattern not duplicated among females.

  • 38.
    Sulistyawati, Sulistyawati
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia.
    Dwi Astuti, Fardhiasih
    Rahmah Umniyati, Sitti
    Tunggul Satoto, Tri Baskoro
    Lazuardi, Lutfan
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Andersson, Camilla
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Holmner, Åsa
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Dengue Vector Control through Community Empowerment: Lessons Learned from a Community-Based Study in Yogyakarta, Indonesia2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 6, article id E1013Article in journal (Refereed)
    Abstract [en]

    Effort to control dengue transmission requires community participation to ensure its sustainability. We carried out a knowledge attitude and practice (KAP) survey of dengue prevention to inform the design of a vector control intervention. A cross-sectional survey was conducted in June⁻August 2014 among 521 households in two villages of Yogyakarta, Indonesia. Demographic characteristics and KAP questions were asked using a self-managed questionnaire. Knowledge, attitudes and practice scores were summarized for the population according to sex, age, occupation and education. The average knowledge score was rather poor-3.7 out of 8-although both attitude and practice scores were good: 25.5 out of 32 and 9.2 out of 11 respectively. The best knowledge within the different groups were found among women, the age group 30⁻44 years, people with a university degree and government employees. Best practice scores were found among retired people and housewives. There were several significant gaps in knowledge with respect to basic dengue symptoms, preventive practices and biting and breeding habits of the Aedes mosquito. In contrast, people's practices were considered good, although many respondents failed to recognize outdoor containers as mosquito breeding sites. Accordingly, we developed a vector control card to support people's container cleaning practices. The card was assessed for eight consecutive weeks in 2015, with pre-post larvae positive houses and containers as primary outcome measures. The use of control cards reached a low engagement of the community. Despite ongoing campaigns aiming to engage the community in dengue prevention, knowledge levels were meagre and adherence to taught routines poor in many societal groups. To increase motivation levels, bottom-up strategies are needed to involve all community members in dengue control, not only those that already comply with best practices.

  • 39. Szilcz, Máté
    et al.
    Mosquera, Paola A
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastián, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Income inequalities in leisure time physical inactivity in northern Sweden: A decomposition analysis.2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494818812647Article in journal (Refereed)
    Abstract [en]

    AIMS: Increasing income inequalities in leisure time physical inactivity have been reported in the relatively socially equal setting of northern Sweden. The present report seeks to contribute to the literature by exploring the contribution of different factors to the income inequalities in leisure time physical inactivity in northern Sweden.

    METHODS: This study was based on the 2014 Health on Equal Terms survey, distributed in the four northernmost counties of Sweden. The analytical sample consisted of 21,000 respondents aged 16-84. Six thematic groups of explanatory variables were used: demographic variables, socioeconomic factors, material resources, family-, psychosocial conditions and functional limitations. Income inequalities in leisure time physical inactivity were decomposed by Wagstaff-type decomposition analysis.

    RESULTS: Income inequalities in leisure time physical inactivity were found to be explained to a considerable degree by health-related limitations and unfavourable socioeconomic conditions. Material and psychosocial conditions seemed to be of moderate importance, whereas family and demographic characteristics were of minor importance.

    CONCLUSIONS: This study suggests that in order to achieve an economically equal leisure time physical inactivity, policy may need to target the two main barriers of functional limitations and socioeconomic disadvantages.

  • 40.
    Trygg, Nadja
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Månsdotter, A.
    Public Health Agency of Sweden, Stockholm, Sweden.
    Does it add up?: intersectional inequalities in mental health in the Swedish adult population2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 95-95Article in journal (Other academic)
    Abstract [en]

    Background: Social inequalities in mental health is a growing public health concern, but has so far been approached in a disentangled manner. To better capture the complexity of reality with multiple interlocking axes of inequalities, intersectionality theory instead highlights how health is expressed in the interactions between these axes. This may expose important knowledge about particular risk groups and protective factors. In this study, we explore how mental health is distributed across intersections of gender, income, education, class, country of birth and sexual orientation as well as their interaction effects.

    Methods: The study population (N = 52,743) consists of a yearly random sample of the Swedish population 26-84 years between 2010 and 2015, from The Health on Equal Terms survey coordinated by the Public Health Agency of Sweden. Mental health was measured through self-administered General Health Questionnaire (GHQ)-12, and gender, income, education, class, country of birth and sexual orientation through survey and linked register data. Intersectional inequalities in mental health were estimated for all pairwise combination of inequalities by joint disparity, excess intersectional disparity and referent disparities.

    Results: The prevalence of symptoms of poor mental health were highest among non-heterosexuals with low income (40%) followed by non-heterosexual women (38%). However, intersectional inequalities showed unpredictable patterns; among non-heterosexuals, those with long education reported more symptoms (36%) than those with short education (31%). The excess intersectional disparity showed synergistic effects for income in combination with education; country of birth and class, but antagonistic effects for the intersections of gender and income as well as education and class.

    Conclusions: Multiple inequalities in mental health may add up in various and unexpected manners, which needs to be considered in efforts for equity in mental health.

    Key messages:

    • Mental health is distributed in various and unexpected manners across intersections of inequality dimensions.

    • Intersectionality theory may be useful when addressing mental health inequalities.

  • 41.
    Waenerlund, Anna-Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Mosquera, Paola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gustafsson, Per E
    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.
    Trends in educational and income inequalities in cardiovascular morbidity in middle age in Northern Sweden 1993–20102018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494818790406Article in journal (Refereed)
    Abstract [en]

    AIMS: Research is scarce regarding studies on income and educational inequality trends in cardiovascular disease in Sweden. The aim of this study was to assess trends in educational and income inequalities in first hospitalizations due to cardiovascular disease (CVD) from 1993 to 2010 among middle-aged women and men in Northern Sweden.

    METHODS: The study comprised repeated cross-sectional register data from year 1993-2010 of all individuals aged 38-62 years enrolled in the Västerbotten Intervention Programme (VIP). Data included highest educational level, total earned income and first-time hospitalization for CVD from national registers. The relative and slope indices of inequality (RII and SII, respectively) were used to estimate educational and income inequalities in CVD for six subsamples for women and men, and interaction analyses were used to estimate trends across time periods.

    RESULTS: Educational RII and SII were stable in women, while they decreased in men. Income inequalities in CVD developed differently compared with educational inequalities, with RII and SII for both men and women increasing during the study period, the most marked for RII in women rising from 1.52 in the 1990s to 2.62 in the late 2000s.

    CONCLUSIONS: The trend of widening income inequalities over 18 years in the middle-aged in Northern Sweden, in the face of stable or even decreasing educational inequalities, is worrisome from a public health perspective, especially as Swedish authorities monitor socioeconomical inequalities exclusively by education. The results show that certain social inequalities in CVD rise and persist even within a traditionally egalitarian welfare regime.

  • 42. Zaki, Rafdzah
    et al.
    Roffeei, Siti Norsyuhada
    Hii, Yien Ling
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Yahya, Abqariyah
    Appannan, Mahesh
    Said, Mas Ayu
    Wan, Ng Chiu
    Aghamohammadi, Nasrin
    Hairi, Noran Naqiah
    Bulgiba, Awang
    Quam, Mikkel Brandon
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Public perception and attitude towards dengue prevention activity and response to dengue early warning in Malaysia2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 2, article id e0212497Article in journal (Refereed)
    Abstract [en]

    An early warning system for dengue is meant to predict outbreaks and prevent dengue cases by aiding timely decision making and deployment of interventions. However, only a system which is accepted and utilised by the public would be sustainable in the long run. This study aimed to explore the perception and attitude of the Malaysian public towards a dengue early warning system. The sample consisted of 847 individuals who were 18 years and above and living/working in the Petaling District, an area adjacent to Kuala Lumpur, Malaysia. A questionnaire consisting of personal information and three sub-measures of; i) perception, ii) attitude towards dengue early warning and iii) response towards early warning; was distributed to participants. We found that most of the respondents know about dengue fever (97.1%) and its association with climate factors (90.6%). Most of them wanted to help reduce the number of dengue cases in their area (91.5%). A small percentage of the respondents admitted that they were not willing to be involved in public activities, and 64% of them admitted that they did not check dengue situations or hotspots around their area regularly. Despite the high awareness on the relationship between climate and dengue, about 45% of respondents do not know or are not sure how this can be used to predict dengue. Respondents would like to know more about how climate data can be used to predict a dengue outbreak (92.7%). Providing more information on how climate can influence dengue cases would increase public acceptability and improve response towards climate-based warning system. The most preferred way of communicating early warning was through the television (66.4%). This study shows that the public in Petaling District considers it necessary to have a dengue warning system to be necessary, but more education is required.

  • 43. Zetterström Dahlqvist, H.
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Gillander Gådin, K.
    A Latent Class Analysis of Violence Multi-Victimization in Youth2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 483-484Article in journal (Other academic)
    Abstract [en]

    Background: Violence among youth is common and has been linked to poor mental health outcomes. There is some evidence that there are groups of youth who are victims of more than one form of violence but more knowledge is needed in terms of patterning of subgroups of multiple violence victimization.

    Aim: To explore if there are distinct subgroups of youth with particular patterns of violence victimization.

    Methods: Survey data from a Swedish sample (n = 1,569) of youth 14-16 years old were used (females 48.4%). Using a broad definition of violence, respondents indicated if they had experienced physical violence, threat of physical violence, bullying, sexual harassment, cyber bullying, online sexual victimizayion, and other adverse sexual experience in the past six months as well as lifetime physical violence victimization. Distinct subgroups of youth within the data set with particular patterns of violence victimization were identified using Latent Class Analysis (LCA). Model fit was assessed using the Akaike information criterion (AIC) and the Bayesian information criterion (BIC), with smaller values indicating better model fit.

    Results: Preliminary results show three distinct subgroups: 1. Sexualized violence off- and online (girls 66.6%), 2. Bullying only (girls 47.5%) and 3. Multi-victimization including threat of physical violence, violence in the past six months and lifetime, sexual harassment on- and offline, bullying on- and offline as well as other adverse sexual experience (girls 47.6%).

    Conclusions: Three distinct subgroups of violence victimization in a sample of 14-16 year old youth was evident in the data. There was a greater representation of girls in the sexualized violence sub-group. Further research as well as preventive programs should acknowledge that many young people are victims of several types of violence. Future research should also investigate the implications of multi-victimization on mental health outcomes.

    Key messages:

    • Three distinct subgroups of violence victimization was present in the data: 1. Sexualized violence off- and online 2. Bullying only and 3. Multi-victimization.

    • While the gendered pattern of the Bullying only and Multi-victimization subgroups were fairly balanced, a substantially greater proportion of girls were represented in the Sexualized violence group.

1 - 43 of 43
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