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  • 1.
    Afari-Asiedu, Samuel
    et al.
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Oppong, Felix Boakye
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Tostmann, Alma
    Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands.
    Ali Abdulai, Martha
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Boamah-Kaali, Ellen
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Gyaase, Stephaney
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Agyei, Oscar
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hulscher, Marlies
    Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands.
    Wertheim, Heiman F. L.
    Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands.
    Asante, Kwaku Poku
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Determinants of Inappropriate Antibiotics Use in Rural Central Ghana Using a Mixed Methods Approach2020Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, artikel-id 90Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The consequences of antibiotic resistance are projected to be most severe in low and middle income countries with high infectious disease burden. This study examined determinants of inappropriate antibiotic use at the community level in rural Ghana. Methods: An observational study involving qualitative and quantitative methods was conducted between July, 2016 and September, 2018 in Ghana. Two household surveys were conducted at two time points (2017 and 2018) among 1,100 randomly selected households over 1 year. The surveys focused on antibiotic use episodes in the past month. Four in-depth interviews and two focus group discussions were performed to further explain the survey results. Determinants of inappropriate antibiotic use were assessed using a mixed effect logistic regression analysis (multilevel analysis) to account for the clustered nature of data. We defined inappropriate antibiotic use as either use without prescription, not completing treatment course or non-adherence to instruction for use. Qualitative data were thematically analyzed. Results: A total of 1,100 households was enrolled in which antibiotics were used in 585 (53.2%) households in the month prior to the surveys. A total of 676 (21.2%) participants out of 3,193 members from the 585 reportedly used antibiotics for 761 episodes of illness. Out of the 761 antibiotic use episodes, 659 (86.6%) were used inappropriately. Paying for healthcare without health insurance (Odds Ratio (OR): 2.10, 95% CI: 1.1-7.4, p-value: 0.026), not seeking healthcare from health centers (OR: 2.4, 95% CI: 1.2-5.0, p-value: 0.018), or pharmacies (OR: 4.6, 95% CI: 1.7-13.0, p-value: 0.003) were significantly associated with inappropriate antibiotic use. Socio-demographic characteristics were not significantly associated with inappropriate antibiotic use. However, the qualitative study described the influence of cost of medicines on inappropriate antibiotic use. It also revealed that antibiotic users with low socioeconomic status purchased antibiotics in installments which, could facilitate inappropriate use. Conclusion: Inappropriate antibiotic use was high and influenced by out-of-pocket payment for healthcare, seeking healthcare outside health centers, pharmacies, and buying antibiotics in installments due to cost. To improve appropriate antibiotic use, there is the need for ministry of health and healthcare agencies in Ghana to enhance healthcare access and healthcare insurance, and to provide affordable antibiotics.

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  • 2.
    Ahmad, Irma
    et al.
    Department of Radiation Oncology, Stanford University, Stanford, CA, United States.
    Edin, Alicia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Granvik, Christoffer
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Kumm Persson, Lowa
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap.
    Tevell, Staffan
    Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden; Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Månsson, Emeli
    Centre for Clinical Research, Region Västmanland—Uppsala University, Västmanland Hospital Västerås, Västerås, Sweden.
    Magnuson, Anders
    Center for Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Marklund, Ingela
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Persson, Ida-Lisa
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Kauppi, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Ahlm, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Forsell, Mattias N. E.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Sundh, Josefin
    Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lange, Anna
    Department of Radiation Oncology, Stanford University, Stanford, CA, United States.
    Cajander, Sara
    Department of Radiation Oncology, Stanford University, Stanford, CA, United States.
    Normark, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    High prevalence of persistent symptoms and reduced health-related quality of life 6 months after COVID-192023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 1104267Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The long-term sequelae after COVID-19 constitute a challenge to public health and increased knowledge is needed. We investigated the prevalence of self-reported persistent symptoms and reduced health-related quality of life (HRQoL) in relation to functional exercise capacity, 6 months after infection, and explored risk factors for COVID-19 sequalae. Methods: This was a prospective, multicenter, cohort study including 434 patients. At 6 months, physical exercise capacity was assessed by a 1-minute sit-to-stand test (1MSTST) and persistent symptoms were reported and HRQoL was evaluated through the EuroQol 5-level 5-dimension (EQ-5D-5L) questionnaire. Patients with both persistent symptoms and reduced HRQoL were classified into a new definition of post-acute COVID syndrome, PACS+. Risk factors for developing persistent symptoms, reduced HRQoL and PACS+ were identified by multivariable Poisson regression. Results: Persistent symptoms were experienced by 79% of hospitalized, and 59% of non-hospitalized patients at 6 months. Hospitalized patients had a higher prevalence of self-assessed reduced overall health (28 vs. 12%) and PACS+ (31 vs. 11%). PACS+ was associated with reduced exercise capacity but not with abnormal pulse/desaturation during 1MSTST. Hospitalization was the most important independent risk factor for developing persistent symptoms, reduced overall health and PACS+. Conclusion: Persistent symptoms and reduced HRQoL are common among COVID-19 survivors, but abnormal pulse and peripheral saturation during exercise could not distinguish patients with PACS+. Patients with severe infection requiring hospitalization were more likely to develop PACS+, hence these patients should be prioritized for clinical follow-up after COVID-19.

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  • 3.
    Al-Tammemi, Ala'a B.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The Battle Against COVID-19 in Jordan: An Early Overview of the Jordanian Experience2020Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, artikel-id 188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Since the initial spark of the COVID-19 outbreak in December 2019, which was later declared by the World Health Organization (WHO) to be a global pandemic, all affected countries are implementing various preventive and control measures to mitigate the spread of the disease. The newly emerging virus brings with it uncertainty-not only regarding its behavior and transmission dynamics but also regarding the current lack of approved antiviral therapy or vaccines-and this represents a major challenge for decision makers at various levels and sectors. This article aims to provide an early overview of the COVID-19 battle within the Jordanian context, including general reflections and conclusions on the value of collaborative efforts in crises management.

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  • 4.
    Andersson, Dan
    et al.
    The Research Unit for Movement, Health and Environment, Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
    Wahlgren, Lina
    The Research Unit for Movement, Health and Environment, Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
    Schantz, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. The Research Unit for Movement, Health and Environment, Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
    Pedestrians' perceptions of route environments in relation to deterring or facilitating walking2022Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, artikel-id 1012222Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Every walk takes place in a route environment, and it can play an important role in deterring or facilitating walking, and will always affect the environmental unwell-well-being of pedestrians. The aim of this study is to illuminate which the important route environmental variables are in this respect. The focus is, therefore, on pedestrians' perceptions of route environmental variables and how they relate to overall appraisals of route environments as hindering–stimulating for walking and unsafe–safe for reasons of traffic.

    Methods: Commuting pedestrians in the inner urban area of Stockholm, Sweden (n = 294, 49.5 ± 10.4 years, 77% women), were recruited via advertisements. They evaluated their commuting route environments using a self-report tool, the Active Commuting Route Environment Scale (ACRES). Correlation, multiple regression, and mediation analyses were used to study the relationships between the variables and the outcome variables.

    Results: Aesthetics and greenery appear to strongly stimulate walking, whereas noise, a proxy for motorized traffic, hinders it. Furthermore, aesthetics is positively related to traffic safety, whereas conflicts have the opposite role. Conflicts is an intermediate outcome, representing several basic environmental variables, some of which were directly and negatively related to unsafe–safe traffic.

    Conclusion: Route environmental variables appear to be potent factors in deterring or facilitating walking. This knowledge is of importance for policymakers and urban planners when designing route environments with the aim of attracting new pedestrians, and simultaneously stimulating those who already walk to keep on.

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  • 5.
    Armando, Chaibo Jose
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Heidelberg Institute of Global Health and Interdisciplinary Centre for Scientific Computing, Heidelberg University, Heidelberg, Germany.
    Sidat, Mohsin
    Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
    Tozan, Yesim
    School of Global Public Health, New York University, NY, New York, United States.
    Mavume, Alberto Francisco
    Faculty of Science, Eduardo Mondlane University, Maputo, Mozambique.
    Bunker, Aditi
    Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, MA, Boston, United States; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
    Sewe, Maquins Odhiambo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
    Climate variability, socio-economic conditions and vulnerability to malaria infections in Mozambique 2016–2018: a spatial temporal analysis2023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 1162535Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Temperature, precipitation, relative humidity (RH), and Normalized Different Vegetation Index (NDVI), influence malaria transmission dynamics. However, an understanding of interactions between socioeconomic indicators, environmental factors and malaria incidence can help design interventions to alleviate the high burden of malaria infections on vulnerable populations. Our study thus aimed to investigate the socioeconomic and climatological factors influencing spatial and temporal variability of malaria infections in Mozambique.

    Methods: We used monthly malaria cases from 2016 to 2018 at the district level. We developed an hierarchical spatial–temporal model in a Bayesian framework. Monthly malaria cases were assumed to follow a negative binomial distribution. We used integrated nested Laplace approximation (INLA) in R for Bayesian inference and distributed lag nonlinear modeling (DLNM) framework to explore exposure-response relationships between climate variables and risk of malaria infection in Mozambique, while adjusting for socioeconomic factors.

    Results: A total of 19,948,295 malaria cases were reported between 2016 and 2018 in Mozambique. Malaria risk increased with higher monthly mean temperatures between 20 and 29°C, at mean temperature of 25°C, the risk of malaria was 3.45 times higher (RR 3.45 [95%CI: 2.37–5.03]). Malaria risk was greatest for NDVI above 0.22. The risk of malaria was 1.34 times higher (1.34 [1.01–1.79]) at monthly RH of 55%. Malaria risk reduced by 26.1%, for total monthly precipitation of 480 mm (0.739 [95%CI: 0.61–0.90]) at lag 2 months, while for lower total monthly precipitation of 10 mm, the risk of malaria was 1.87 times higher (1.87 [1.30–2.69]). After adjusting for climate variables, having lower level of education significantly increased malaria risk (1.034 [1.014–1.054]) and having electricity (0.979 [0.967–0.992]) and sharing toilet facilities (0.957 [0.924–0.991]) significantly reduced malaria risk.

    Conclusion: Our current study identified lag patterns and association between climate variables and malaria incidence in Mozambique. Extremes in climate variables were associated with an increased risk of malaria transmission, peaks in transmission were varied. Our findings provide insights for designing early warning, prevention, and control strategies to minimize seasonal malaria surges and associated infections in Mozambique a region where Malaria causes substantial burden from illness and deaths.

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  • 6.
    Azfar, Hossain Syed
    et al.
    Department of Family Medicine, International School of Medicine, Bishkek, Kyrgyzstan.
    Dzhusupov, Kenesh O.
    Department of Public Health, International School of Medicine, Bishkek, Kyrgyzstan.
    Orru, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Nordin, Steven
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Orru, Kati
    Institute of Social Studies, University of Tartu, Tartu, Estonia.
    Cardiovascular Disease and Mental Distress Among Ethnic Groups in Kyrgyzstan2021Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, artikel-id 489092Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to characterize different ethnic groups in Kyrgyzstan regarding cardiovascular disease (CVD) and mental distress, and to investigate the association between CVD and mental distress. The mental distress was measured in terms of sleep disturbance, burnout, and stress.

    Materials and Methods: A cross-sectional study was carried out among six ethnic groups in Kyrgyzstan, aged 18 years and above. The sample was stratified for age, education, family status, and income. We used the Karolinska Sleep Questionnaire to assess sleep disturbance, the physical and emotional subscale of the Shirom Melamed Burnout Questionnaire to assess burnout, and the 10-item Perceived Stress Scale to assess perceived stress.

    Results: The distribution of CVD differed significantly between the six ethnic groups, with higher prevalence among East Europeans, and Western Asians and lower among Other minorities and Central Asians. In all ethnic groups in Kyrgyzstan, individuals with CVD had increased odds of sleep disturbance and burnout. There was a significant difference in burnout and stress between persons with and without CVD in Kyrgyz and East European ethnic groups.

    Conclusion: There was a significant difference in burnout and stress between persons with and without CVD in Kyrgyz and East European ethnic groups. In addition to CVD prevention, mitigating sleep disturbance and preventing burnout in the general population should be aimed at in public health measures.

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  • 7.
    Bajraktari, Saranda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Zingmark, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden.
    Pettersson, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Reaching older people with a digital fall prevention intervention in a Swedish municipality context: an observational study2022Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, artikel-id 857652Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is robust evidence that falls in old age can be prevented by exercise programs that include balance training, functional exercises, and strength training. For the interventions to have a population health impact, outreach to the population of focus with suitable interventions is needed. While digital interventions are promising there is limited knowledge on the characteristics of who is reached. The aim of this study was to describe the recruitment process, estimate reach rate at the population level and to describe participants characteristics and representativeness in a digital fall prevention intervention study.

    Methods: In a municipality-based observational study, reach of a digital fall prevention intervention was evaluated. The intervention included a digital exercise programme (Safe Step) and optional supportive strategies, complemented with a range of recruitment strategies to optimize reach. Recruitment during a period of 6 months was open to people 70 years or older who had experienced a fall or a decline in balance the past year. Reach was based on data from the baseline questionnaire including health and demographic characteristics of participants. Representativeness was estimated by comparing participants to a sample of older people from the Swedish National Public Health Survey.

    Results: The recruitment rate was 4.7% (n = 173) in relation to the estimated population of focus (n = 3,706). Most participants signed up within the first month of the intervention (n = 131). The intervention attracted primarily women, older people with high education, individuals who used the internet or digital applications almost every day and those perceiving their balance as fair or poor. Safe step participants lived more commonly alone and had higher education and better walking ability in comparison to the Swedish National Public Health Survey.

    Conclusions: With a range of recruitment strategies most participants were recruited to a digital fall intervention during the first month. The intervention attracted primarily highly educated women who frequently used the internet or smart technologies. In addition to digital fall prevention interventions, a higher diversity of intervention types (digital and non-digital) is more likely to reach a larger group of older people with different needs.

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  • 8.
    Björkman, Anders
    et al.
    Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Gisslén, Magnus
    Department of Infectious Diseases, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden; Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gullberg, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för molekylärbiologi (Medicinska fakulteten).
    Ludvigsson, Johnny
    Division of Pediatrics, Department of Biomedical and Clinical Sciences, Crown Princess Victoria Children's Hospital, Linköping University, Linköping, Sweden.
    The Swedish COVID-19 approach: a scientific dialogue on mitigation policies2023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 1206732Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    During the COVID-19 pandemic, Sweden was among the few countries that did not enforce strict lockdown measures but instead relied more on voluntary and sustainable mitigation recommendations. While supported by the majority of Swedes, this approach faced rapid and continuous criticism. Unfortunately, the respectful debate centered around scientific evidence often gave way to mudslinging. However, the available data on excess all-cause mortality rates indicate that Sweden experienced fewer deaths per population unit during the pandemic (2020–2022) than most high-income countries and was comparable to neighboring Nordic countries through the pandemic. An open, objective scientific dialogue is essential for learning and preparing for future outbreaks.

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  • 9.
    Brännström, Åke
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för matematik och matematisk statistik. Advancing Systems Analysis Program, International Institute for Applied Systems Analysis, Laxenburg, Austria.
    Sjödin, Henrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    A Method for Estimating the Number of Infections From the Reported Number of Deaths2022Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, artikel-id 648545Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    At the outset of an epidemic, available case data typically underestimate the total number of infections due to insufficient testing, potentially hampering public responses. Here, we present a method for statistically estimating the true number of cases with confidence intervals from the reported number of deaths and estimates of the infection fatality ratio; assuming that the time from infection to death follows a known distribution. While the method is applicable to any epidemic with a significant mortality rate, we exemplify the method by applying it to COVID-19. Our findings indicate that the number of unreported COVID-19 infections in March 2020 was likely to be at least one order of magnitude higher than the reported cases, with the degree of underestimation among the countries considered being particularly high in the United Kingdom.

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  • 10.
    Cheng, Sheng-Li
    et al.
    School of Philosophy and Social Development, Shandong University, Jinan, China.
    Johansson, Stina
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Liu, Shushan
    School of Philosophy and Social Development, Shandong University, Jinan, China.
    Li, Yun
    School of Philosophy and Social Development, Shandong University, Jinan, China.
    Western life courses challenged in life stories collected in contemporary China2023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 1282704Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The life course describes the progression of life as a social role, from birth to death. Traditional Western life-history studies of the life course usually describe a continuous lifeline with occasional interruptions in between. The extraordinary temporal events of the Anti-Japanese War (AJW), Civil War (CW), Great Famine (GF), Cultural Revolution (CR), and the Reform and Opening-up of China in just few decades mean that the life history of contemporary Chinese older adults may be quite different from those of their western peers.

    Methods: The study used qualitative research methods to conduct in-depth interviews with 16 older adults and collect their life stories through a standardized list of questions. Grounded theory was employed to condense, compare, conceptualize, and synthesize patterns within the collected data, approaching the investigation with a “naturalistic” perspective.

    Results: Based on a generalized analysis of the Interview transcripts, we can find that Chinese old adults’ life stories were shaped by recurring exceptional and rapidly changing environmental conditions. The themes and sub-themes of Chinese old adults’ life stories were focus on (1) violence, loss of family member, escape and unstable life in their early life which are related to AJW and CW; (2) poverty and starvation in daily life when they were adolescents and young adults which are related to GF; (3) discontinuity, timed opportunities, categorizations in order to split the social relationships and networks in CR. The data also suggest that education is an important part of the life story and that its value changes over time.

    Discussion: The discontinuity and instability of the life stories of the Chinese old adults are unexpected according to the dominant Western-influenced life course theories, which enriches life course theory and provides a new perspective for studying the individual life course in a society of constant and rapid change.

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  • 11.
    Eurenius, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Mohamed, Amal Farah
    Eating Disorder Unit, Helsinki University Hospital, Helsinki, Finland.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Öhlund, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Vaezghasemi, Masoud
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social-Emotional Problems Among 3-Year-Olds Are Associated With an Unhealthy Lifestyle: A Population-Based Study2021Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, artikel-id 694832Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Little attention has been paid to the association between preschool children’s social-emotional problems and lifestyle at the population level.

    Objective: This study aimed to overcome this knowledge gap by investigating to what extent children’s social-emotional problems are associated with their lifestyle and if there are any gender differences.

    Methods: This cross-sectional, population-based study used data from the regional Salut Register in northern Sweden, including 7,179 3-year-olds during 2014–2017. Parents responded to a questionnaire including the 36-month interval of the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) and questions regarding family and lifestyle characteristics. Single and multiple logistic regression were used to assess the association between children’s social-emotional problems and multiple family lifestyle characteristics.

    Results: More reports of social-emotional problems were found among children who did not have parents living together or had markers of an unhealthy lifestyle. Children who ate vegetables less frequently, whose parent/-s brushed their teeth less often and did not read to them regularly were more likely to have social-emotional problems. Playing outdoors <3 h during weekdays and >1 h of sedentary screen time during weekends increased the risk of social-emotional problems among boys only, while >1 h of sedentary screen time during weekdays increased the risk among girls. When it comes to lifestyle and gender differences, a high proportion of the 3-year-olds had an unhealthy lifestyle, more so for boys than for girls. The dietary quality and tooth brushing were somewhat more adequate for the girls than for the boys, but boys spent more time playing outdoors compared to the girls.

    Conclusions: This study provides us with an important overview picture of the family life situation of three-year-olds, including those with social-emotional problems. Such problems were significantly associated with markers of unhealthy lifestyle, with significant gender differences. Therefore, this study suggests that in order to maintain children’ssocial-emotional ability and support children at risk of problems, public health interventionprograms should have a broader perspective on improving children’s lifestyle rather thanmerely focusing on their social and emotional problems, and the gender differences foundmay be taken in account.

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  • 12.
    Forouzan, Setareh
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Social Determinants of Health Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
    Padyab, Mojgan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Rafiey, Hassan
    Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Iran.
    Ghazinour, Mehdi
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Dejman, Masoumeh
    Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Measuring the mental health care system responsiveness: results of an outpatient survey in Tehran2016Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 3, artikel-id 285Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    As explained by the World Health Organization (WHO) in 2000, the concept of health system responsiveness is one of the core goals of health systems. Since 2000, further efforts have been made to measure health system responsiveness and the factors affecting responsiveness, yet few studies have applied responsiveness concepts to the evaluation of mental health systems. The present study aims to measure responsiveness and its related domains in the mental health-care system of Tehran. Utilizing the same method used by the WHO for its responsiveness survey, responsiveness for outpatient mental health care was evaluated using a validated Farsi questionnaire. A sample of 500 public mental health service users in Tehran participated and subsequently completed the questionnaire. On average, 47% of participants reported experiencing poor responsiveness. Among responsiveness domains, confidentiality and dignity were the best performing factors while autonomy, access to care, and quality of basic amenities were the worst performing. Respondents who reported their social status as low were more likely to experience poor responsiveness overall. Attention and access to care were responsiveness dimensions that performed poorly but were considered to be highly important by study participants. In summary, the study suggests that measuring responsiveness could provide guidance for further development of mental health-care systems to become more patient orientated and provide patients with more respect.

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  • 13.
    Frankel, Jennifer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Wilén, Jonna
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Hansson Mild, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Assessing exposures to Magnetic resonance imaging's complex Mixture of Magnetic Fields for In Vivo, In Vitro, and epidemiologic studies of Health effects for staff and Patients2018Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 6, artikel-id 66Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A complex mixture of electromagnetic fields is used in magnetic resonance imaging (MRI): static, low-frequency, and radio frequency magnetic fields. Commonly, the static magnetic field ranges from one to three Tesla. The low-frequency field can reach several millitesla and with a time derivative of the order of some Tesla per second. The radiofrequency (RF) field has a magnitude in the microtesla range giving rise to specific absorption rate values of a few Watts per kilogram. Very little attention has been paid to the case where there is a combined exposure to several different fields at the same time. Some studies have shown genotoxic effects in cells after exposure to an MRI scan while others have not demonstrated any effects. A typical MRI exam includes muliple imaging sequences of varying length and intensity, to produce different types of images. Each sequence is designed with a particular purpose in mind, so one sequence can, for example, be optimized for clearly showing fat water contrast, while another is optimized for high-resolution detail. It is of the utmost importance that future experimental studies give a thorough description of the exposure they are using, and not just a statement such as "An ordinary MRI sequence was used." Even if the sequence is specified, it can differ substantially between manufacturers on, e.g., RF pulse height, width, and duty cycle. In the latest SCENIHR opinion, it is stated that there is very little information regarding the health effects of occupational exposure to MRI fields, and long-term prospective or retrospective cohort studies on workers are recommended as a high priority. They also state that MRI is increasingly used in pediatric diagnostic imaging, and a cohort study into the effects of MRI exposure on children is recommended as a high priority. For the exposure assessment in epidemiological studies, there is a clear difference between patients and staff and further work is needed on this. Studies that explore the possible differences between MRI scan sequences and compare them in terms of exposure level are warranted.

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  • 14. Gildner, Theresa E.
    et al.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Wu, Fan
    Guo, Yanfei
    Snodgrass, J. Josh
    Kowal, Paul
    Ideal Cardiovascular Health and Cognitive Test Performance: Testing a Modified Index of Life's Simple 7 Among Older Chinese Adults2018Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 6, artikel-id 352Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Evidence suggests that cognitive decline in older adults is influenced by cardiovascular health (CVH), with metabolic and vascular mechanisms hypothesized to underlie the etiology of cognitive impairment. Research in high-income nations suggests that improved CVH is linked with decreased cognitive impairment risk, but it is unclear if this pattern is evident in low-income countries. Nationally-representative data collected in China were drawn from the World Health Organization's Study on global AGing and adult health Wave 1 (2007-2010; n = 11,295). Seven CVH factors were classified as "ideal" or "not ideal": smoking and drinking frequency, body mass index, physical activity level, blood pressure, diet, and self-reported anxiety. Additionally, scores from five cognitive performance tests (immediate and delayed verbal recall, forward and backward digit span, verbal fluency) were used to create a composite cognitive function variable. Linear regression analyses tested whether ideal CVH measures were associated with higher composite cognitive performance, controlling for sociodemographic factors. As hypothesized, ideal CVH was generally associated with higher cognitive performance. Low anxiety levels and reliable access to sufficient food (including produce) were particularly associated with higher cognitive function. These results suggest early detection and controlling modifiable CVH risks may protect aging individuals in China from cognitive decline.

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  • 15.
    Janols, Rebecka
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för arbetsterapi.
    Sandlund, Marlene
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Lindgren, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Pettersson, Beatrice
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Older adults as designers of behavior change strategies to increase physical activity: report of a participatory design process2022Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, artikel-id 988470Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Despite the significant value of physical activity for the health of older adults, this population often fails to achieve recommended activity levels. Digital interventions show promise in providing support for self-managed physical activity. However, more information is needed about older adults' preferences for digital support to change physical activity behaviors as well as the process of designing them. The aim of this paper was to describe the participatory design process in which older adults were involved in the co-creation of digitally supported behavioral change strategies to support self-managed physical activity, and how the results were integrated in a prototype.

    Methods: The participatory design process involved with nine older adults and two researchers. The participants were divided in two groups, and each group participated in three workshops and completed home tasks in between workshops. Following an iterative design process influenced by theories of behavior change, the workshops and home tasks were continuously analyzed, and the content and process were developed between groups and the next set of workshops. Prototypes of a mobile health (mHealth) solution for fall preventive exercise for older adults were developed in which the conceptualized strategies were integrated. To support coherence in reporting and evaluation, the developed techniques were mapped to the Behavior Change Technique Taxonomy v1 and the basic human psychosocial needs according to the Self-determination Theory.

    Results: The results highlight different preferences of older adults for feedback on physical activity performance, as well as the importance of transparency regarding the identification of the sender of feedback. Preferences for content and wording of feedback varied greatly. Subsequently, the design process resulted in a virtual health coach with three different motivational profiles and tools for goal setting and self-monitoring. These behavior change strategies were integrated in the exercise application Safe Step v1. The conformity of the design concepts with the needs of Self-determination Theory and Behavior Change Technique Taxonomy v1 are presented.

    Conclusion: The participatory design process exemplifies how older adults successfully contributed to the design of theory-based digital behavior change support, from idea to finished solution. Tailoring feedback with a transparent sender is important to support and not undermine motivation.

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  • 16.
    Jeschke, Peter
    et al.
    Federal Institute for Occupational Safety and Health, Dortmund, Germany.
    Alteköster, Carsten
    Institute for Occupational Safety and Health of the German Social Accident Insurance, Sankt Augustin, Germany.
    Hansson Mild, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Israel, Michel
    National Centre of Public Health and Analyses, Sofia, Bulgaria.
    Ivanova, Mihaela
    National Centre of Public Health and Analyses, Sofia, Bulgaria.
    Schiessl, Klaus
    Austrian Workers' Compensation Board, Vienna, Austria.
    Shalamanova, Tsvetelina
    National Centre of Public Health and Analyses, Sofia, Bulgaria.
    Soyka, Florian
    Institute for Occupational Safety and Health of the German Social Accident Insurance, Sankt Augustin, Germany.
    Stam, Rianne
    National Institute for Public Health and the Environment, Bilthoven, Netherlands.
    Wilén, Jonna
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Protection of workers exposed to radiofrequency electromagnetic fields: a perspective on open questions in the context of the new ICNIRP 2020 guidelines2022Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, artikel-id 875946Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Workers in occupational settings are usually exposed to numerous sources of electromagnetic fields (EMF) and to different physical agents. Risk assessment for industrial workplaces concerning EMF is not only relevant to operators of devices or machinery emitting EMF, but also to support-workers, bystanders, service and maintenance personnel, and even visitors. Radiofrequency EMF guidelines published in 2020 by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) may also be indirectly applied to assess risks emerging from EMF sources at workplaces by technical standards or legislation. To review the applicability and adequacy to assess exposure to EMF in occupational settings in the European Union, the most current ICNIRP guidelines on radiofrequency EMF are reviewed. Relevant ICNIRP fundamentals and principles are introduced, followed by practical aspects of exposure assessment. To conclude, open questions are formulated pointing out gaps between the guidelines' principles and occupational practice, such as the impact of hot and humid environments and physical activity or controversies around ICNIRPS's reduction factors in view of assessment uncertainty in general. Thus, the article aims to provide scientific policy advisors, labor inspectors, or experts developing standards with a profound understanding about ICNIRP guidelines' applicability to assess hazards related to radiofrequency EMF in occupational settings.

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  • 17.
    Krauskopf, Julian
    et al.
    Maastricht University, Maastricht, Netherlands.
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Johansson, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Palli, Domenico
    Prevention and Clinical Network - ISPRO, Florence, Italy.
    Lundh, Thomas
    Division of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden.
    Kyrtopoulos, Soterios A.
    National Hellenic Research Foundation, Athens, Greece.
    de Kok, Theo M.
    Maastricht University, Maastricht, Netherlands.
    Kleinjans, Jos C.
    Maastricht University, Maastricht, Netherlands.
    Blood Transcriptome Response to Environmental Metal Exposure Reveals Potential Biological Processes Related to Alzheimer's Disease2020Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, artikel-id 557587Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Alzheimer's disease (AD) is a neurodegenerative disease which is manifested by a progressive and irreversible decline of cognition, memory loss, a shortened attention span, and changes in personality. Aging and genetic pre-dispositions, particularly the presence of a specific form of apolipoprotein E (APOE), are main risk factors of sporadic AD; however, a large body of evidence has shown that multiple environmental factors, including exposure to toxic metals, increase the risk for late onset AD. Lead (Pb) and cadmium (Cd) are ubiquitous toxic metals with a wide range of applications resulting in global distribution in the environment and exposure of all living organisms on earth. In addition to being classified as carcinogenic (Cd) and possibly carcinogenic (Pb) to humans by the International Agency for Research on Cancer, both compounds disrupt metal homeostasis and can cause toxic responses at the cellular and organismal levels. Pb toxicity targets the central nervous system and evidence for that has emerged also for Cd. Recent epidemiological studies show that both metals possibly are etiological factors of multiple neurodegenerative diseases, including Alzheimer's disease (AD). To further explore the association between metal exposure and AD risk we applied whole transcriptome gene expression analysis in peripheral blood leukocytes (PBLs) from 632 subjects of the general population, taken from the EnviroGenomarkers project. We used linear mixed effect models to associate metal exposure to gene expression after adjustment for gender, age, BMI, smoking, and alcohol consumption. For Pb exposure only few associations were identified, including a downregulation of the human eukaryotic translation initiation factor 5 (eIF5). In contrast, Cd exposure, particularly in males, revealed a much stronger transcriptomic response, featuring multiple pathways related to pathomolecular mechanisms of AD, such as endocytosis, neutrophil degranulation, and Interleukin-7 signaling. A gender stratified analysis revealed that the Cd responses were male-specific and included a downregulation of the APOE gene in men. This exploratory study revealed novel hypothetical findings which might contribute to the understanding of the neurotoxic effects of chronic Pb and Cd exposure and possibly improve our knowledge on the molecular mechanisms linking metal exposure to AD risk.

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  • 18.
    Liu-Helmersson, Jing
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Brännström, Åke
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för matematik och matematisk statistik. Evolution and Ecology Program, International Institute for Applied Systems Analysis, Laxenburg, Austria.
    Sewe, Maquins
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Estimating past, present and future trends in the global distribution and abundance of the arbovirus vector Aedes aegypti2019Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 7, artikel-id 148Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Aedes aegypti is the principal vector for several important arbovirus diseases, including dengue, chikungunya, yellow fever, and Zika. While recent empirical research has attempted to identify the current global distribution of the vector, the seasonal, and longer-term dynamics of the mosquito in response to trends in climate, population, and economic development over the twentieth and the twenty-first century remains to be elucidated.

    Methods: In this study, we use a process-based mathematical model to estimate global vector distribution and abundance. The model is based on the lifecycle of the vector and its dependence on climate, and the model sensitivity to socio-economic development is tested. Model parameters were generally empirically based, and the model was calibrated to global databases and time series of occurrence and abundance records. Climate data on temperature and rainfall were taken from CRU TS3.25 (1901–2015) and five global circulation models (CMIP5; 2006–2099) forced by a high-end (RCP8.5) and a low-end (RCP2.6) emission scenario. Socio-economic data on global GDP and human population density were from ISIMIP (1950–2099).

    Findings: The change in the potential of global abundance in A. aegypti over the last century up to today is estimated to be an increase of 9.5% globally and a further increase of 20 or 30% by the end of this century under a low compared to a high carbon emission future, respectively. The largest increase has occurred in the last two decades, indicating a tipping point in climate-driven global abundance which will be stabilized at the earliest in the mid-twenty-first century. The realized abundance is estimated to be sensitive to socioeconomic development.

    Interpretation: Our data indicate that climate change mitigation, i.e., following the Paris Agreement, could considerably help in suppressing risks of increased abundance and emergence of A. aegypti globally in the second half of the twenty-first century.

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  • 19.
    Mosquera, Paola A.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Burström, Bo
    Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Performing Through Privatization: An Ecological Natural Experiment of the Impact of the Swedish Free Choice Reform on Ambulatory Care Sensitive Conditions2021Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, artikel-id 504998Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In 2010, Sweden opened up for establishment of privately owned primary health care providers, as part of a national Free Choice in Primary Health Care reform. The reform has been highly debated, and evidence on its effects is scarce. The present study therefore sought to evaluate whether the reform have impacted on primary health care service performance.

    Methods: This ecological register-based study used a natural experimental approach through an interrupted time series design. Data comprised the total adult population of the 21 counties of Sweden 2001–2009 (pre-intervention period) and 2010–2016 (post-intervention period). Hospitalizations and emergency department visits for ambulatory care sensitive conditions (ACSC) were used as indicators of primary health care performance. Segmented regression analysis was used to assess the effects of the reform, in Sweden as a whole, as well as compared between counties grouped by (i) change in private provision pre- to post reform; (ii) the timing of the implementation; and (iii) sustained presence of private providers both pre- and post-reform.

    Results: The results suggest that, following the introduction of the reform in Sweden as a whole, the trends in total hospitalizations rates were slowed down by 1.0% albeit acute emergency visits increased 1.1% more rapidly after the introduction of the reform. However, we found no evidence of more beneficial effects in counties where the reform had been implemented more ambitiously, specifically those with a larger increase in private primary care providers, or where the reform was introduced early and thus had longer time effects to emerge. Lastly, counties with a sustained high presence of private primary care providers displayed the least favorable development when it comes to ACSC.

    Conclusion: Taken together, the present study does not support that the Swedish Free Choice reform has improved performance of the primary care delivery system in Sweden, and suggests that high degree of private provision may involve worse performance and higher care burden for specialized health care. Further evaluations of the consequences of the reform are dire needed to provide a comprehensive picture of its intended and unintended impact on health care provision, delivery and results.

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  • 20.
    Mutola, Sianga
    et al.
    School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Gómez-Olivé, F. Xavier
    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.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The path between socioeconomic inequality and cognitive function: A mediation analysis based on the HAALSI cohort in rural South Africa2023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 1011439Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Socioeconomic position (SEP) strongly predicts late-life cognitive health, yet the pathways between SEP and cognitive function remain unclear. This study assessed whether and to what extent the association between SEP and cognitive function in the adult population in rural South Africa is mediated by some health conditions, behavioral factors, and social capital factors.

    Methods: In this cross-sectional study, we used data from the 2014–15 “Health and Aging Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI) cohort, including 5,059 adults aged 40+ years from the Agincourt sub-district in Mpumalanga Province, South Africa. SEP, the independent variable, was measured based on ownership of household goods. Cognitive function, the dependent variable, was assessed using questions related to time orientation and immediate and delayed word recall. We used the multiple-mediation analysis on 4125 individuals with complete values on all variables to assess the mediating roles of health conditions (hypertension, diabetes, obesity, and disability), behavioral factors (leisure physical activity, alcohol consumption, and tobacco smoking), and social capital factors (community's willingness to help, trust, sense of safety, and social network contact) in the association between SEP and cognitive function.

    Results: Compared to adults in the poorest wealth quintile, those in the richest wealth quintile had better cognition (β = 0.903, p < 0.001). The mediation analysis revealed that health conditions mediated 20.7% of the total effect of SEP on cognitive function. In comparison, 3.3% was mediated by behavioral factors and only 0.7% by social capital factors. In the multiple-mediator model, 17.9% of the effect of SEP on cognitive function was jointly mediated by health conditions, behavioral factors, and social capital factors.

    Conclusion: Low socioeconomic position is a significant factor associated with poor cognitive function among adults aged 40 years and above in South Africa. Health conditions mainly mediate the effects between SEP and cognitive function. Therefore, actions to prevent and control chronic health conditions can serve as the entry point for intervention to prevent poor cognitive function among people with low socioeconomic status.

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  • 21.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Malin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Guerrero, Esteban
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Gustafsson, Carina
    Public Health Unit, Region Västerbotten, Umeå, Sweden.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindberg, Jens
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lindgren, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap.
    Lindvall, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lundgren, Anna Sofia
    Umeå universitet, Humanistiska fakulteten, Institutionen för kultur- och medievetenskaper.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Santosa, Ailiana
    School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Richter Sundberg, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Public Health Unit, Region Västerbotten, Umeå, Sweden.
    Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme2021Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, artikel-id 593453Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The Västerbotten Intervention Programme (VIP) in the Region Västerbotten Sweden is one of the very few cardiovascular disease (CVD) prevention programmes globally that is integrated into routine primary health care. The VIP has been shown as a cost-effective intervention to significantly reduce CVD mortality. However, little is known about the effectiveness of a digital solution to tailor risk communication strategies for supporting behavioral change. STAR-C aims to develop and evaluate a technical platform for personalized digital coaching that will support behavioral change aimed at preventing CVD.

    Methods: STAR-C employs a mixed-methods design in seven multidisciplinary projects, which runs in two phases during 2019–2024: (i) a formative intervention design and development phase, and (ii) an intervention implementation and evaluation phase. In the 1st phase, STAR-C will model the trajectories of health behaviors and their impact on CVDs (Project 1), evaluate the role of the social environment and social networks on behavioral change (Project 2) and assess whether and how social media facilitates the spread of health information beyond targeted individuals and stimulates public engagement in health promotion (Project 3). The findings will be utilized in carrying out the iterative, user-centered design, and development of a person-tailored digital coaching platform (Project 4). In the 2nd phase, STAR-C will evaluate the implementation of the coaching programme and its effectiveness for promoting behavioral change and the spreading of health information across social networks and via social media (Project 5). The cost-effectiveness (Project 6) and ethical issues (Project 7) related to the coaching programme intervention will be evaluated.

    Discussion: The STAR-C research programme will address the knowledge and practice research gaps in the use of information technologies in health promotion and non-communicable disease (NCD) prevention programmes in order to narrow the health inequality gaps.

    Ethics: STAR-C has received approval from the Swedish Ethical Review Authority (Dnr. 2019-02924;2020-02985).

    Dissemination: The collaboration between Umeå University and Region Västerbotten will ensure the feasibility of STAR-C in the service delivery context. Results will be communicated with decision-makers at different levels of society, stakeholders from other regions and healthcare professional organizations, and through NGOs, local and social media platforms.

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  • 22.
    Nyström, Monica E.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
    Tolf, Sara
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
    Sparring, Vibeke
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden; Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden.
    Strehlenert, Helena
    Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden; Stockholm Gerontology Research Centre Foundation, Stockholm, Sweden.
    Systems thinking in practice when implementing a national policy program for the improvement of women's healthcare2023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 957653Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Interest in applying systems thinking (ST) in public health and healthcare improvement has increased in the past decade, but its practical use is still unclear. ST has been found useful in addressing the complexity and dynamics of organizations and welfare systems during periods of change. Exploring how ST is used in practice in national policy programs addressing complex and ill-structured problems can increase the knowledge of the use and eventually the usefulness of ST during complex changes. In ST, a multi-level approach is suggested to coordinate interventions over individual, organizational, and community levels, but most attempts to operationalize ST focus on the individual level. This study aimed to investigate how ST is expressed in policy programs addressing wicked problems and describe the specific action strategies used in practice in a national program in Sweden, using a new conceptual framework comprising ST principles on the organizational level as an analytical tool. The program addresses several challenges and aims to achieve systems change within women's healthcare.

    Methods: The case study used a rich set of qualitative, longitudinal data on individual, group, and organizational levels, collected during the implementation of the program. Deductive content analysis provided narrative descriptions of how the ST principles were expressed in actions, based on interviews, observations, and archival data.

    Results: The results showed that the program management team used various strategies and activities corresponding to organizational level ST. The team convened numerous types of actors and used collaborative approaches and many different information sources in striving to create a joint and holistic understanding of the program and its context. Visualization tools and adaptive approaches were used to support regional contact persons and staff in their development work. Efforts were made to identify high-leverage solutions to problems influencing the quality and coordination of care before, during, and after childbirth, solutions adaptable to regional conditions.

    Discussion/conclusions: The organizational level ST framework was useful for identifying ST in practice in the policy program, but to increase further understanding of how ST is applied within policy programs, we suggest a multi-dimensional model to identify ST on several levels.

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  • 23.
    Orru, Hans
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
    Viitak, Anu
    Herodes, Koit
    Veber, Triin
    Lukk, Marten
    Human Biomonitoring in the Oil Shale Industry Area in Estonia: Overview of Earlier Programmes and Future Perspectives2020Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, artikel-id 582114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ida-Viru County, in Eastern Estonia, features industrially contaminated sites–where oil shale has been mined and used for electricity generation, and shale oil extraction. Higher prevalence of respiratory and cardiovascular disease has been found in the region due to high quantities of air pollution. Within the framework of “Studies of the health impact of the oil shale sector—SOHOS,” this analysis aimed to map earlier human biomonitoring (HBM) studies and identify the suitable biomarkers for upcoming HBM in Estonia. Altogether, three studies have been conducted among residents: first, among adults in the 1980's; second, among children in the 1990's; and third, among employees, with a focus on workers and miners in the oil shale chemistry industry in the late 1990's and 2000's. In some of those studies, increased levels of biomarkers in blood and urine (heavy metals, 1-OHP) have appeared; nevertheless, in last 20 years, there has been no population-wide HBM in Estonia. According to air pollution monitoring and emission analysis, the pollutants of concern are benzene, PM10, PM2.5, and PAHs. In general, there is a decreasing trend in air pollutant levels, with the exception of a slight increase in 2018. One of the aims of HBM is to be analyzed if this trend can be identified in HBM, using similar biomarkers as applied earlier. The future perspective HBM could be divided into two Tiers. Tier 1 should focus on exposure biomarkers as heavy metals, PAH, and BTEX metabolites and Tier 2, in later stage, on effect biomarkers as Ox LDL, TBARS, etc.

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  • 24.
    Petrie, Samuel
    et al.
    Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
    Carson, Dean B.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Peters, Paul
    Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    LeBlanc, Michele
    Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
    Simpson, Holly
    Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
    Barnabe, Jaymie
    Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
    Young, Mikayla
    Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
    Ostafichuk, Mara
    Spatial Determinants of Health Laboratory, Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
    Hodge, Heidi
    School of Business and Law, Central Queensland University, Rockhampton, QLD, Australia.
    Gladman, Justin
    College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
    Smale, Matilda
    College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
    Gonzalez Garcia, Manueal
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    What a Pandemic Has Taught Us About the Potential for Innovation in Rural Health: Commencing an Ethnography in Canada, the United States, Sweden, and Australia2021Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 9, artikel-id 768624Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The COVID-19 pandemic coincided with a multi-national federally funded research project examining the potential for health and care services in small rural areas to identify and implement innovations in service delivery. The project has a strong focus on electronic health (eHealth) but covers other areas of innovation as well. The project has been designed as an ethnography to prelude a realist evaluation, asking the question under what conditions can local health and care services take responsibility for designing and implementing new service models that meet local needs? The project had already engaged with several health care practitioners and research students based in Canada, Sweden, Australia, and the United States. Our attention is particularly on rural communities with fewer than 5,000 residents and which are relatively isolated from larger service centres. Between March and September 2020, the project team undertook ethnographic and auto-ethnographic research in their own communities to investigate what the service model responses to the pandemic were, and the extent to which local service managers were able to customize their responses to suit the needs of their communities. An initial program theory drawn from the extant literature suggested that “successful” response to the pandemic would depend on a level of local autonomy, “absorptive capacity,*” strong service-community connections, an “anti-fragile†” approach to implementing change, and a realistic recognition of the historical barriers to implementing eHealth and other innovations in these types of rural communities. The field research in 2020 has refined the theory by focusing even more attention on absorptive capacity and community connections, and by suggesting that some level of ignorance of the barriers to innovation may be beneficial. The research also emphasized the role and power of external actors to the community which had not been well-explored in the literature. This paper will summarize both what the field research revealed about the capacity to respond well to the COVID-19 challenge and highlight the gaps in innovative strategies at a managerial level required for rapid response to system stress.

    *Absorptive Capacity is defined as the ability of an organization (community, clinic, hospital) to adapt to change. Organizations with flexible capacity can incorporate change in a productive fashion, while those with rigid capacity take longer to adapt, and may do so inappropriately.

    †Antifragility is defined as an entities' ability to gain stability through stress. Biological examples include building muscle through consistent use, and bones becoming stronger through subtle stress. Antifragility has been used as a guiding principle in programme implementation in the past.

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  • 25.
    Rostami, Arian
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för polisutbildning vid Umeå universitet. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Ghazinour, Mehdi
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för polisutbildning vid Umeå universitet.
    Burman, Monica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för polisutbildning vid Umeå universitet.
    Hansson, Jonas
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för polisutbildning vid Umeå universitet.
    Job satisfaction among Swedish police officers: The role of work-related stress, gender-based and sexual harassment2022Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, artikel-id 889671Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this cross-sectional study is to increase our understanding of job satisfaction in Swedish police officers by taking into account work-related stress, and sexual and gender-based harassment. Data were collected from 152 police officers working in vulnerable areas in Stockholm using sociodemographic questions, the Police Stress Identification Questionnaire (PSIQ), Sexual and gender-based harassment questions, and Job Descriptive Index (JDI). The obtained results indicated that male and female police officers reported the highest satisfaction in “people on your present job.” The lowest score of job satisfaction in both male and female police officers was related to “opportunity for promotion” and then “pay.” There were no significant differences in the subscales of job satisfaction between male and female police officers. The older and more experienced officers, the less satisfaction was reported in “job in general” and more satisfaction reported in “pay.” Comparing job satisfaction between patrol officers and those officers who worked in internal services showed police patrol officers had higher job satisfaction in “job in general,” “work in the present job,” “opportunity for promotion” and “supervision” compared to their counterparts in internal services. There were not any significant differences between the subscales of job satisfaction between male and female police officers. There was not any significant association between job satisfaction subscales and having experience of sexual or gender-based harassment. Among various subscales of police stressors, organizational stress was in negative relation with three domains of job satisfaction; “job in general,” “pay” and “supervision.” Also, hierarchical multiple regression analyses showed organizational stress was most often of predictive impact related to various job satisfaction domains in police officers.

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  • 26.
    Rådholm, Karin
    et al.
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; The George Institute for Global Health, University of New South Wales, NSW, Sydney, Australia.
    af Geijerstam, Peder
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Woodward, Mark
    The George Institute for Global Health, University of New South Wales, NSW, Sydney, Australia; School of Public Health, Imperial College London, London, United Kingdom.
    Chalmers, John
    The George Institute for Global Health, University of New South Wales, NSW, Sydney, Australia.
    Hellgren, Margareta
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; The Skaraborg Institute, Skövde, Sweden.
    Jansson, Stefan
    School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Rolandsson, Olov
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Dog ownership, glycaemic control and all-cause death in patients with newly diagnosed type 2 diabetes: a national cohort study2023Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, artikel-id 1265645Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: To evaluate whether dog ownership from the time of type 2 diabetes diagnosis improved glycaemic control, increased achievement of major guideline treatment goals or reduced the risk of all-cause death.

    Methods: Patients diagnosed with type 2 diabetes were followed by linkage of four Swedish national registers covering diabetes, dog ownership, socioeconomics, and mortality. Linear regression was used to estimate the mean yearly change in glycated haemoglobin (HbA1c). Cox survival analysis and logistic regression were used to analyse associations between dog ownership and all-cause death and achievement of treatment goals, respectively.

    Results: Of 218,345 individuals included, 8,352 (3.8%) were dog-owners. Median follow-up was 5.2 years. Dog-owners had worse yearly change in HbA1c, and were less likely to reach HbA1c, low-density lipoprotein (LDL), and systolic blood pressure (SBP) treatment goals than non-dog-owners (adjusted odds ratios [95% CI] of 0.93 [0.88–0.97], 0.91 [0.86–0.95], and 0.95 [0.90–1.00], respectively). There was no difference in the risk of all-cause death (adjusted hazard ratio [95% CI] 0.92 [0.81–1.04], dog owners versus not).

    Conclusion: Owning a dog when diagnosed with diabetes did not lead to better achievement of treatment goals or reduced mortality, but was in fact associated with a smaller reduction in HbA1c and reduced likelihood of achieving treatment goals.

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  • 27. Santosa, Ailiana
    et al.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zetterberg, Liv
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Eriksson, Malin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Study Protocol: Social capital as a resource for the planning and design of socially sustainable and health promoting neighbourhoods: A mixed method study2020Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, artikel-id 581078Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Promoting inclusive, safe, resilient, and sustainable communities is one of the 17 Sustainable Development Goals ratified in 2015 by 193 UN member states, not least in Sweden. Social sustainability involves preserving particular societal values (e.g., local identity) as well as developing values (e.g., social cohesion) that are perceived as needed. Socially sustainable development also implies promoting integration and preventing segregation. Social capital is one important indicator to measure how socially sustainable an area is. This project aims to explore how social capital can be used as a conceptual tool in developing housing policy for social sustainability in Umeå Municipality.

    Methods: The three sub-studies in this project combine quantitative and qualitative methods. We will conduct a review of the municipality’s documents to understand how the ideas of social sustainability have influenced political declarations and implemented social and housing policies and interventions during the period 2006–2020. The quantitative study includes a longitudinal follow-up to the 2006 survey’s respondents to assess the longitudinal impacts of neighborhood social capital on health and well-being; as well as a new repeated cross-sectional survey to investigate how social capital has changed in local neighborhoods from 2006 to 2020. The qualitative study includes case studies in neighborhoods with different social capital dynamics to understand how different resident sub-groups perceive their neighborhoods and how implemented social and housing policies have influenced the social capital dynamics and responded to the needs of different sub-groups. The project is run in close collaboration with the Commission for a Socially Sustainable Umeå.

    Discussions: This project will create new and unique perspectives on long-term structural changes of relevance for a socially sustainable housing policy; knowledge that is highly valuable for continuous municipal planning; and will outline recommendations to guide local housing policies for social sustainable neighborhoods in Umeå Municipality.

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  • 28.
    Schantz, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. The Research Unit for Movement, Health and Environment, Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
    Olsson, Karin Sofia Elisabeth
    The Research Unit for Movement, Health and Environment, Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
    Salier Eriksson, Jane
    The Research Unit for Movement, Health and Environment, Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
    Rosdahl, Hans
    The Research Unit for Movement, Health and Environment, Department of Physiology, Nutrition and Biomechanics, The Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden.
    Perspectives on exercise intensity, volume, step characteristics and health outcomes in walking for transport2022Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 10, artikel-id 911863Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Quantification of movement intensity and energy utilization, together with frequency of trips, duration, distance, step counts and cadence, is essential for interpreting the character of habitual walking for transport, and its potential support of health. The purpose of the study is to illuminate this with valid methods and novel perspectives, and to thereby provide a new basis for characterizing and interpreting walking in relation to health outcomes.

    Methods: Habitual middle-aged commuting pedestrians (males = 10, females = 10) were investigated in the laboratory at rest and with maximal treadmill and cycle ergometer tests. Thereafter, levels of oxygen uptake, energy expenditure, ventilation, heart rate, blood lactate, rated perceived exertion, cadence, number of steps, duration, distance, and speed were recorded during the normal walking commute of each participant in Greater Stockholm, Sweden. The number of commutes per week over the year was self-reported.

    Results: Walking in the field demanded about 30% more energy per km compared to level treadmill walking. For both sexes, the walking intensity in field was about 46% of maximal oxygen uptake, and energy expenditure amounted to 0.96 kcal · kg−1 · km−1. The MET values (males: 6.2; females: 6.5) mirrored similar levels of walking speed (males: 5.7; females: 5.9 km · h−1) and levels of oxygen uptake (males: 18.6; females: 19.5 mL · kg−1 · min−1). The average number of MET-hours per week in a typical month was 22 for males and 20 for females. This resulted in a total weekly energy expenditure of ~1,570 and 1,040 kcal for males and females, respectively. Over the year, the number of walking commutes and their accumulated distance was ~385 trips and 800 km for both sexes.

    Conclusion: Walking in naturalistic field settings demands its own studies. When males and females walk to work, their relative aerobic intensities and absolute energy demands for a given distance are similar. It is equivalent to the lower part of the moderate relative intensity domain. The combination of oxygen uptake, trip duration and frequency leads to high and sustained levels of MET-hours as well as energy expenditure per week over the year, with a clear health enhancing potential. Based on this study we recommend 6000 transport steps per day, or equivalent, during five weekdays, over the year, in order to reach optimal health gains.

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  • 29.
    Schlesinger, Mikaela
    et al.
    Global Health Research Group, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Prieto Alvarado, Franklyn Edwin
    Directorate of Surveillance and Risk Analysis in Public Health, Instituto Nacional de Salud (INS) de Colombia, Bogota, Colombia.
    Borbón Ramos, Milena Edith
    Directorate of Surveillance and Risk Analysis in Public Health, Instituto Nacional de Salud (INS) de Colombia, Bogota, Colombia.
    Sewe, Maquins Odhiambo
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Merle, Corinne Simone
    Special Program for Research and Training in Tropical Diseases (TDR-WHO), World Health Organization, Geneva, Switzerland.
    Kroeger, Axel
    Freiburg University, Center for Medicine, and Society (ZMG), Institute of Infection Prevention, Freiburg, Germany.
    Hussain-Alkhateeb, Laith
    Global Health Research Group, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Population Health Research Section, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
    Enabling countries to manage outbreaks: statistical, operational, and contextual analysis of the early warning and response system (EWARS-csd) for dengue outbreaks2024Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 12, artikel-id 1323618Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Dengue is currently the fastest-spreading mosquito-borne viral illness in the world, with over half of the world's population living in areas at risk of dengue. As dengue continues to spread and become more of a health burden, it is essential to have tools that can predict when and where outbreaks might occur to better prepare vector control operations and communities' responses. One such predictive tool, the Early Warning and Response System for climate-sensitive diseases (EWARS-csd), primarily uses climatic data to alert health systems of outbreaks weeks before they occur. EWARS-csd uses the robust Distribution Lag Non-linear Model in combination with the INLA Bayesian regression framework to predict outbreaks, utilizing historical data. This study seeks to validate the tool's performance in two states of Colombia, evaluating how well the tool performed in 11 municipalities of varying dengue endemicity levels.

    Methods: The validation study used retrospective data with alarm indicators (mean temperature and rain sum) and an outbreak indicator (weekly hospitalizations) from 11 municipalities spanning two states in Colombia from 2015 to 2020. Calibrations of different variables were performed to find the optimal sensitivity and positive predictive value for each municipality.

    Results: The study demonstrated that the tool produced overall reliable early outbreak alarms. The median of the most optimal calibration for each municipality was very high: sensitivity (97%), specificity (94%), positive predictive value (75%), and negative predictive value (99%; 95% CI).

    Discussion: The tool worked well across all population sizes and all endemicity levels but had slightly poorer results in the highly endemic municipality at predicting non-outbreak weeks. Migration and/or socioeconomic status are factors that might impact predictive performance and should be further evaluated. Overall EWARS-csd performed very well, providing evidence that it should continue to be implemented in Colombia and other countries for outbreak prediction.

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  • 30.
    Wannheden, Carolina
    et al.
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Stenfors, Terese
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Stenling, Andreas
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway.
    von Thiele Schwarz, Ulrica
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Satisfied or frustrated? A qualitative analysis of need satisfying and need frustrating experiences of engaging with digital health technology in chronic care2021Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, artikel-id 623773Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Digital health technologies such as self-monitoring devices and apps are becoming increasingly important as tools to promote healthy habits and support individuals in their self-care. There is still a scarcity of research that builds on motivational theory to better understand the functioning of digital health technologies. The self-determination theory (SDT) is a macro theory of motivation that delineates three basic psychological needs that are linked to different types of motivation and lead to well-being when satisfied and illbeing when frustrated.

    Objective: To explore how the use of a digital tool for self-monitoring and communication with healthcare satisfies or frustrates basic psychological needs across four spheres of user experience: interface, task, behavior, and life.

    Methods: The study was conducted in a Swedish primary care setting with individuals who participated in a pilot study of a digital health intervention for self-monitoring in chronic care management. Data from a follow-up survey with participants 7 months after recruitment were analyzed using a thematic approach mixing inductive and deductive analysis. The unit of analysis is based on a total of 642 individual answers to seven open-ended questions, from 121 respondents.

    Results: The analysis identified positive and negative influences of self-monitoring and digital communication with healthcare on all three psychological needs. Three main findings are that: (1) data covered all four spheres of user experiences, but most user experiences concerned the behavior and task spheres; (2) satisfaction and frustration of competence needs was more prominent than influences on other needs; (3) the same experience may be perceived as both need frustrating and need satisfying, which suggests a tension that reflects individual differences.

    Conclusion: Designers of digital health technologies need to take into account basic psychological needs within all spheres of user experience, from interface to life in general. Because some features may be simultaneously experienced as satisfying and frustrating by different users, these types of tools need to be flexible to accommodate for variation of user experiences. Careful design considerations that take motivational theory into account would contribute to the transformation of care for individuals with chronic conditions.

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