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  • 1.
    Ahlm, Kristin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs: a retrospective study, 1992-20092013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, s. 216-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs.

    Methods: During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine.

    Results: During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (<= 18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688/4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons.

    Conclusion: Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.

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  • 2.
    Alrawashdeh, Hamzeh Mohammad
    et al.
    Sharif Eye Centers, Irbid, Jordan.
    Al-Tammemi, Ala'a B
    Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
    Alzawahreh, Mohammad Kh.
    Department of Special Surgery, Division of Urology, Al Bashir Hospital, Ministry of Health, Amman, Jordan.
    Al-Tamimi, Ashraf
    Department of Radiology, King Hussein Hospital, Jordanian Royal Medical Services, Amman, Jordan.
    Elkholy, Mohamed
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Al Sarireh, Fawaz
    Department of Ophthalmology, College of Medicine, Mutah University, Karak, Jordan.
    Abusamak, Mohammad
    Department of General and Special Surgery, Division of Ophthalmology, Faculty of Medicine, Al Balqa Applied University, Salt, Jordan.
    Elehamer, Nafisa M. K.
    Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary; Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Faculty of Public and Environmental Health, University of Khartoum, Khartoum, Sudan.
    Malkawi, Ahmad
    School of Nutrition and Translational Research in Metabolism (NUTRIM), Department of Health Promotion, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands.
    Al-Dolat, Wedad
    Department of Ophthalmology, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
    Abu-Ismail, Luai
    Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
    Al-Far, Ali
    Department of Orthopedic and Trauma Surgery, Jordan Hospital, Amman, Jordan.
    Ghoul, Imene
    Department of Pediatrics, Ibn Al Haytham Hospital, Amman, Jordan.
    Occupational burnout and job satisfaction among physicians in times of COVID-19 crisis: a convergent parallel mixed-method study2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 811Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Healthcare professionals including physicians were subjected to an increased workload during the COVID-19 crisis, leaving them exposed to significant physical and psychological distress. Therefore, our present study aimed to (i) assess the prevalence of burnout and levels of job satisfaction among physicians in Jordan, and (ii) explore physicians' opinions, experiences, and perceptions during the pandemic crisis.

    METHODS: This was a mixed-method study that utilized a structured web-based questionnaire and semi-structured individual interviews. The 10-Item Burnout Measure-Short version (BMS), and the 5-Item Short Index of Job Satisfaction (SIJS) were adopted to assess occupational burnout and job satisfaction, respectively. Semi-structured interviews were conducted, based on a conceptual framework that was developed from Herzberg's Two-Factor Theory of Motivation and Job Demands-Resources Model. Descriptive statistics and regression models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data, respectively.

    RESULTS: A total of 973 survey responses and 11 interviews were included in our analysis. The prevalence of burnout among physicians was (57.7%). Several significant factors were positively associated with burnout, including female gender, working at highly loaded hospitals, working for long hours, doing night shifts, lack of sufficient access to personal protective equipment, and being positively tested for SARS-CoV-2. Regarding job satisfaction, regression analysis revealed that age was positively associated with higher levels of job satisfaction. On contrary, being a general practitioner or specialist, working at highly loaded hospitals, low salaries, and suffering from burnout have predicted lower levels of job satisfaction. Besides, four themes have emerged from the thematic analysis: (i) Work-induced psychological distress during the pandemic, (ii) Decision-driven satisfactory and dissatisfactory experiences, (iii) Impact of the pandemic on doctor-patient communication and professional skills, and (iv) Economic impacts of the pandemic crisis and lockdown.

    CONCLUSION: A significant physical and psychological burden was associated with the COVID-19 pandemic. Reliable efforts should be implemented aiming at protecting physicians' physical and mental wellbeing, enhancing their working conditions, and raising awareness about burnout. Evidence-based decisions and proper utilization of financial and human resources at institutional and national levels are believed to be crucial for the sustainability of the health workforce, especially in crises.

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  • 3.
    Amani, Paul Joseph
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Kiwara, Angwara Denis
    Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 459Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Healthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers' experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania.

    METHODS: An exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data.

    RESULTS: Three categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement.

    CONCLUSION: While health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.

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  • 4.
    Anticona, Cynthia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Coe, Anna-Britt
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Bergdahl, Ingvar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Easier said than done: applying the Ecohealth principles to a study of heavy metals exposure among indigenous communities of the Peruvian Amazon2013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, artikel-id 437Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The renewed interest in community participation in health research is linked to its potential for bridging gaps between research and practice. Its main attributes are the generation of knowledge that can lead to socially robust, long-lasting solutions and the creation of a colearner relationship between researchers and research users. Following this philosophy, Ecohealth has evolved into a specialized framework for participatory research on the impact of pollution on ecosystems and human health. However, its principles pose considerable challenges. Its outcomes are strongly influenced by contextual factors that are impossible to control for ahead of time.

    This paper describes how the Ecohealth principles were applied to an epidemiological study of heavy metals exposure among indigenous communities of the Peruvian Amazon. It illustrates how knowledge generated from participatory research does not necessarily imply solving a public health problem. This study aimed to contribute to the understanding of the benefits and barriers of following the basic principles of the Ecohealth approach, and assist researchers working in similar contexts.

    Research process Based upon their personal experience as participant observers, the authors describe the research process; then, they discuss the most important challenges faced, their implications, and the attempted strategies for resolution.

    Challenges Challenges were grouped into four themes: (1) building trust; (2) one partnership, many stakeholders, multiple agendas; (3) being a researcher; and (4) communicating complex and unexpected findings.

    Conclusions Integrating the principles of transdisciplinarity and participation posed a series of challenges to the research process that were difficult, and sometimes impossible to overcome. However, positive outcomes from this experience were the lessons learned by the different actors. Despite the lack of immediate action, it is expected that useful interventions to prevent and control lead exposure in the Corrientes population will be implemented in the medium term.

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  • 5.
    Arnadottir, Solveig A
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. School of Health Sciences, University of Akureyri, Iceland .
    Gunnarsdottir, Elin D
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Determinants of self-rated health in old age: a population-based, cross-sectional study using the international classification of functioning2011Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 11, s. 670-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Self-rated health (SRH) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older populations concerning future health, functional decline, disability, and mortality. The aim of this study was to use the theoretical framework of the International Classification of Functioning, Disability and Health (ICF) to create a better understanding of factors associated with SRH among community-dwelling older people in urban and rural areas.

    Methods: The study design was population-based and cross-sectional. Participants were 185 Icelanders, randomly selected from a national registry, community-dwelling, 65-88 years old, 63% urban residents, and 52% men. Participants were asked: "In general, would you say your health is excellent, very good, good, fair, or poor?" Associations with SRH were analyzed with ordinal logistic regression. Explanatory variables represented aspects of body functions, activities, participation, environmental factors and personal factors components of the ICF.

    Results: Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables. Multivariate analysis, however, demonstrated that SRH had an independent association with five variables representing ICF body functions, activities, and personal factors components: The likelihood of a better SRH increased with advanced lower extremity capacity (adjusted odds ratio [adjOR] = 1.05, < 0.001), upper extremity capacity (adjOR = 1.13, = 0.040), household physical activity (adjOR = 1.01, = 0.016), and older age (adjOR = 1.09, = 0.006); but decreased with more depressive symptoms (adjOR = 0.79, < 0.001).

    Conclusions: The results highlight a collection of ICF body functions, activities and personal factors associated with higher SRH among community-dwelling older people. Some of these, such as physical capacity, depressive symptoms, and habitual physical activity are of particular interest due to their potential for change through public health interventions. The use of ICF conceptual framework and widely accepted standardized assessments should make these results comparable and relevant in an international context.

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    Determinants of self-rated health in old age: a population-based, cross-sectional study using the international classification of functioning
  • 6. Aronsson, Gunnar
    et al.
    Theorell, Tores
    Grape, Tom
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hogstedt, Christer
    Marteinsdottir, Ina
    Skoog, Ingmar
    Traskman-Bendz, Lil
    Hall, Charlotte
    A systematic review including meta-analysis of work environment and burnout symptoms2017Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 17, artikel-id 264Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies – original as well as reviews - restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms.

    Methods: A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990–2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1–5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used.

    Results: Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout.

    Conclusion: While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.

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  • 7.
    Arumugam, Ashokan
    et al.
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Neuromusculoskeletal Rehabilitation Research Group, RIMHS - Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Sustainable Engineering Asset Management Research Group, RISE - Research Institute of Sciences and Engineering, University of Sharjah, Sharjah, United Arab Emirates; Adjunct Faculty, Department of Physiotherapy, Manipal College of Health professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
    Mohammad Zadeh, Shima A.
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Zabin, Zina Anwar
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Hawarneh, Tamara Mohammad Emad
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Ahmed, Hejab Iftikhar
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Jauhari, Fatema Shabbir
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Alkalih, Hanan Youssef
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
    Shousha, Tamer Mohamed
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Neuromusculoskeletal Rehabilitation Research Group, RIMHS - Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Adjunct Faculty, Department of Physiotherapy, Manipal College of Health professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
    Moustafa, Ibrahim M.
    Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Neuromusculoskeletal Rehabilitation Research Group, RIMHS - Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
    Häger, Charlotte
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Sedentary and physical activity time differs between self-reported ATLS-2 physical activity questionnaire and accelerometer measurements in adolescents and young adults in the United Arab Emirates2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 1045Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Most young adults and adolescents in the United Arab Emirates (UAE) do not meet the established internationally recommended physical activity levels per day. The Arab Teen Lifestyle Study (ATLS) physical activity questionnaire has been recommended for measuring self-reported physical activity of Arab adolescents and young adults (aged 14 years to mid-twenties). The first version of the ATLS has been validated with accelerometers and pedometers (r ≤ 0.30). The revised version of the questionnaire (ATLS-2, 2021) needs further validation. The aim of this study was to validate the self-reported subjective sedentary and physical activity time of the ATLS-2 (revised version) physical activity questionnaire with that of Fibion accelerometer-measured data.

    METHODS: In this cross-sectional study, 131 healthy adolescents and young adults (aged 20.47 ± 2.16 [mean ± SD] years (range 14-25 years), body mass index 23.09 ± 4.45 (kg/m2) completed the ATLS-2 and wore the Fibion accelerometer for a maximum of 7 days. Participants (n = 131; 81% non-UAE Arabs (n = 106), 13% Asians (n = 17) and 6% Emiratis (n = 8)) with valid ATLS-2 data without missing scores and Fibion data of minimum 10 h/day for at least 3 weekdays and 1 weekend day were analyzed. Concurrent validity between the two methods was assessed by the Spearman rho correlation and Bland-Altman plots.

    RESULTS: The questionnaire underestimated sedentary and physical activity time compared to the accelerometer data. Only negligible to weak correlations (r ≤ 0.12; p > 0.05) were found for sitting, walking, cycling, moderate intensity activity, high intensity activity and total activity time. In addition, a proportional/systematic bias was evident in the plots for all but two (walking and moderate intensity activity time) of the outcome measures of interest.

    CONCLUSIONS: Overall, self-reported ATLS-2 sedentary and physical activity time had low correlation and agreement with objective Fibion accelerometer measurements in adolescents and young adults in the UAE. Therefore, sedentary and physical activity assessment for these groups should not be limited to self-reported measures.

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  • 8.
    Arvidsson, Inger
    et al.
    Occupational and Environmental Medicine, Lund University, Sweden.
    Leo, Ulf
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för skolledarutveckling.
    Larsson, Anna
    Occupational and Environmental Medicine, Lund University, Sweden.
    Håkansson, Carita
    Occupational and Environmental Medicine, Lund University, Sweden.
    Persson, Roger
    Occupational and Environmental Medicine; and Department of Psychology, Lund University, Sweden; Centre for Medicine and Technology for Working Life and Society (Metalund), Lund, Sweden.
    Björk, Jonas
    Occupational and Environmental Medicine, Lund University, Sweden.
    Burnout among school teachers: quantitative and qualitative results from a follow-up study in southern Sweden2019Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, artikel-id 655Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Teachers are at high risk of stress-related disorders. This longitudinal study aimed to (a) identify which occupational, sociodemographic and life-style factors and self-efficacy at baseline that were of importance for burnout, (b) explore associations between changes in the studied factors versus changes in burnout, and (c) by interviews increase the understanding of perceived job demands among teachers.

    Methods: A cohort of 310 Swedish teachers in school-years 4–9 responded to a questionnaire of occupational, sociodemographic and life-style factors, self-efficacy and burnout, at baseline and at follow-up (mean 30 months later). A combined measure with four levels of burnout was crafted, based on exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey). Quantitative data were analysed with multiple ordinal regression, and qualitative data were analysed with content analysis of interview responses from a subgroup of the teachers (n = 81).

    Results: The occurrence of high burnout (level 2 and 3 combined) were similar at baseline and follow-up (14% vs. 15%). However, many teachers fluctuated between the levels of burnout (28% increased and 24% decreased). Burnout at baseline was of importance for change of work or being off duty at follow up. In the multi-exposure model, low self-efficacy [OR 0.42; CI 0.26–0.68] and high job demands [OR 1.97; CI 1.02–3.8] were the strongest explanatory variables. Low self-efficacy remained as the strongest explanatory factor after adjustment for burnout at baseline. Increased job demands during follow-up was associated with an increased level of burnout [OR 3.41; CI 1.73–6.69], whereas increased decision latitude was associated with a decreased level of burnout [OR 0.51; CI 0.30–0.87]. Two major categories of demands emerged in the qualitative analysis; i.e. too high workload and a sense of inadequacy.

    Conclusions: A substantial proportion of teachers showed signs of burnout at both occasions. Low self-efficacy and high job demands was of importance for burnout, and changes in burnout was further associated with changes in decision latitude. The results points to the need of actions on individual, organizational and a societal levels.

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  • 9.
    Audulv, Åsa
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    The over time development of chronic illness self-management patterns: a longitudinal qualitative study2013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, artikel-id 452Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There currently exists a vast amount of literature concerning chronic illness self-management, however the developmental patterns and sustainability of self-management over time remain largely unknown. This paper aims to describe the patterns by which different chronic illness self-management behaviors develop and are maintained over time.

    Method: Twenty-one individuals newly diagnosed with chronic illnesses (e.g., diabetes, rheumatism, ischemic heart disease, multiple sclerosis, chronic renal disease, inflammatory bowel disease) were repeatedly interviewed over two-and-a-half years. The interviews were conducted in Sweden from 2006 to 2008. A total of 81 narrative interviews were analyzed with an interpretive description approach.

    Results: The participants’ self-management behaviors could be described in four different developmental patterns: consistent, episodic, on demand, and transitional. The developmental patterns were related to specific self-management behaviors. Most participants took long-term medications in a consistent pattern, whereas exercise was often performed according to an episodic pattern. Participants managed health crises (e.g., angina, pain episodes) according to an on demand pattern and everyday changes due to illness (e.g., adaptation of work and household activities) according to a transitional pattern. All of the participants used more than one self-management pattern.

    Conclusion: The findings show that self-management does not develop as one uniform pattern. Instead different self-management behaviors are enacted in different patterns. Therefore, it is likely that self-management activities require support strategies tailored to each behavior’s developmental pattern.

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  • 10.
    Ballin, Marcel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Antonsson, Oskar
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Rosenqvist, Viktor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. School of Sport Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
    Association of dog ownership with accelerometer-measured physical activity and daily steps in 70-year-old individuals: a population-based cross-sectional study2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 2313Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Dog ownership (DO) has been associated with higher levels of self-reported walking and physical activity. However, compared to device-based measures, self-reported measures of physical activity may suffer from bias due to recall and social desirability. They are also incapable of quantifying light-intensity physical activity (LPA) and step volume, both of which may have important health benefits, especially for older adults. In this study, we investigated the association of DO with accelerometer-measured physical activity of different intensities and daily steps in 70-year-old individuals.

    Methods: This was a population-based cross-sectional study including 1406 participants aged 70 years [54.1% female] who participated in a health survey in Umeå, Sweden between February 2017–November 2019. All participants self-reported DO [yes/no]. Daily averages of LPA, moderate-to-vigorous-intensity physical activity (MVPA), and steps per day [steps/d] were measured for 1 week using hip-mounted Actigraph GT3X+ accelerometers. Associations were investigated using linear- and logistic regression models, adjusted for sociodemographic and health-related factors, date of examination, and accelerometer wear time.

    Results: The prevalence of DO was 14.1% [N = 199]. After adjustment for all covariates, DO was associated with 19.2 more minutes/d of LPA [95% CI, 8.8–29.6], 11.4 more minutes/d of MVPA [95% CI, 8.0–14.9] and 1738 more steps/d [95% CI, 1326–2149]. DO was also associated with twice the odds of meeting the physical activity recommendations [OR, 2.07, 95% CI, 1.48–2.90]. Exploratory interaction analyses showed that the association between DO and steps/d was stronger [Pinteraction = 0.030] in female [β = 2165, 95% CI, 1585–2744] than in male [β =1255, 95% CI, 664–1845], with a similar trend for MVPA [Pinteraction = 0.082].

    Conclusions: In this study of community-dwelling 70-year-old individuals, DO was associated with higher levels of daily LPA, MVPA, and steps. With the limitation of the observational design of the study, these findings add knowledge regarding the beneficial role that DO may play for promoting physical activity in the older population. In turn, these findings could support the development and evaluation of targeted interventions seeking to promote dog-friendly environments and facilitate dog walking in the community.

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  • 11.
    Ballin, Marcel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Niklasson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Alamäki, Antti
    Condell, Joan
    Tedesco, Salvatore
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. School of Sport Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
    Daily step count and incident diabetes in community-dwelling 70-year-olds: a prospective cohort study2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikel-id 1830Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Older adults with diabetes take fewer steps per day than those without diabetes. The purpose of the present study was to investigate the association of daily step count with incident diabetes in community-dwelling 70-year-olds.

    Methods: This prospective cohort study included N = 3055 community-dwelling 70-year-olds (52% women) who participated in a health examination in Umeå, Sweden during 2012–2017, and who were free from diabetes at baseline. Daily step count was measured for 1 week using Actigraph GT3X+ accelerometers. Cases of diabetes were collected from the Swedish National Patient Register. The dose-response association was evaluated graphically using a flexible parametric model, and hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regressions.

    Results: During a mean follow-up of 2.6 years, diabetes was diagnosed in 81 participants. There was an inverse nonlinear dose-response association between daily step count and incident diabetes, with a steep decline in risk of diabetes from a higher daily step count until around 6000 steps/day. From there, the risk decreased at a slower rate until it leveled off at around 8000 steps/day. A threshold of 4500 steps/day was found to best distinguish participants with the lowest risk of diabetes, where those taking ≥ 4500 steps/day, had 59% lower risk of diabetes, compared to those taking fewer steps (HR, 0.41, 95% CI, 0.25–0.66). Adjusting for visceral adipose tissue (VAT) attenuated the association (HR, 0.64, 95% CI, 0.38–1.06), which was marginally altered after further adjusting for sedentary time, education and other cardiometabolic risk factors and diseases (HR, 0.58, 95% CI, 0.32–1.05).

    Conclusions: A higher daily step count is associated with lower risk of incident diabetes in community-dwelling 70-year-olds. The greatest benefits occur at the lower end of the activity range, and much earlier than 10,000 steps/day. With the limitation of being an observational study, these findings suggest that promoting even a modest increase in daily step count may help to reduce the risk of diabetes in older adults. Because VAT appears to partly mediate the association, lifestyle interventions targeting diabetes should apart from promoting physical activity also aim to prevent and reduce central obesity.

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  • 12.
    Baroudi, Mazen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Social factors associated with trust in the health system in northern Sweden: a cross-sectional study2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, nr 1, artikel-id 881Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Despite the importance of having trust in the health system, there is a paucity of research in this feldin Sweden. The aim of this study was to estimate the level of trust in the health system and to assess the factors asso‑ciated with it in northern Sweden.

    Methods: A cross-sectional survey was conducted in 2014 in the four northern regions of Sweden. A total of 24 795 participants (48% response rate) aged 18 to 84 years were involved in the study. A log-binomial regression was usedto measure the association between sociodemographic factors and trust in the health system.

    Results: Two thirds of the participants (68.5%) reported high trust in the health system i.e. had very much or quitea lot confdence in the health system. Women had lower prevalence of trust compared to men (PR=0.96; 95%CI=0.94–0.98) while older participants had a higher trust compared to youth (PR=1.11; 95% CI=1.06–1.16). Participants with lower level of education, those who experienced economic stress, those who were born outside Swedenand those living in small municipalities also had lower prevalence of trust in the health system. Conversely, lowerincome was associated with higher trust (PR=1.08; 95% CI=1.04–1.12). Finally, a strong relationship between highersocial capital (having emotional and instrumental support, horizontal trust, and higher social participation) and trustin the health system was also found.

    Conclusions: Trust in the health system was moderately high in northern Sweden and strongly associated withsociodemographic and social capital factors. Trust is a complex phenomenon and a deeper exploration of the relationbetween trust in the health system and sociodemographic factors is needed.

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  • 13.
    Baroudi, Mazen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Goicolea, Isabel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Jonzon, Robert
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. The Public Health Agency of Sweden, Solna, Sweden.
    Nkulu Kalengayi, Faustine
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Young migrants' sexual rights in Sweden: a cross-sectional study2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 1618Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In national public health surveys including those assessing sexual and reproductive health, migrants generally tend to be underrepresented due to cultural, linguistic, structural and legal barriers, minimising the possibility to measure sexual rights' fulfilment in this group. This study aims to describe to what extent sexual rights of young migrants in Sweden are being fulfilled. A self-administered questionnaire was used to collect data from 1773 young (16 - 29 years) migrants by post, online, and at language schools and other venues. Sexual rights were operationalised and categorised into five domains adapted from the Guttmacher-Lancet Commission's definition. These domains included the right to: 1) access sexual and reproductive healthcare, 2) access information and education about sexuality and sexual and reproductive health and rights, 3) have bodily integrity, 4) make free informed decisions about sexuality and sexual relations and 5) have a satisfying and safe sexual life. Descriptive analysis was used to assess the extent of fulfilment for each right. There were wide variations in the fulfilment of sexual rights between subgroups and among the five domains. Most respondents rated their sexual health as good/fair, however, 6.3% rated their sexual health as bad/very bad. While most of those who visited related services were satisfied, 17.4% of respondents refrained from visiting the services despite their needs. Around four in ten respondents did not know where to get information about sexuality and sexual health. One-fourth of respondents reported sexual violence. Another 12.7% were limited by family members or fellow countrymen regarding with whom they can have an intimate relationship. Most respondents were satisfied with their sexual life, except for 11.9%. Men, non-binary respondents, lesbians, gays, bisexuals, asexuals, those who were awaiting a decision regarding residence permit and those born in South Asia reported poor sexual health to a greater extent and fulfilment of their sexual rights to a lesser extent than other groups. Timely and culturally adapted information about sexual rights, gender equalities, laws and available services in Sweden should be provided in appropriate languages and formats in order to raise awareness about sexual rights and improve access to available services. Tailored attention should be paid to specific vulnerable subgroups.

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  • 14.
    Baroudi, Mazen
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Petersen, Solveig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Namatovu, Fredinah
    Umeå universitet, Humanistiska fakulteten, Institutionen för idé- och samhällsstudier.
    Annelie, Carlsson
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Preteen children’s health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups2019Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, artikel-id 139Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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  • 15. Belyhun, Yeshambel
    et al.
    Medhin, Girmay
    Amberbir, Alemayehu
    Erko, Berhanu
    Hanlon, Charlotte
    Alem, Atalay
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Venn, Andrea
    Britton, John
    Davey, Gail
    Prevalence and risk factors for soil-transmitted helminth infection in mothers and their infants in Butajira, Ethiopia: a population based study2010Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 10, s. 21-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this rural Ethiopian community with a relatively high prevalence of STH infection, we found a reduced risk of infection in relation to maternal hygiene and urban living. Daily use of soap and a safe supply of water are likely to reduce the risk of STH infection.

  • 16.
    Berglund, Staffan K.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik. Centre of Excellence for Paediatric Research EURISTIKOS, Department of Paediatrics, School of Medicine, University of Granada, Avda. De Madrid 11, 18012 Granada, Spain.
    García-Valdes, Luz
    Torres-Espinola, Francisco J.
    Segura, Maria Teresa
    Martínez-Zaldivar, Cristina
    Aguilar, Maria J.
    Agil, Ahmad
    Lorente, Jose A.
    Florido, Jesús
    Padilla, Carmen
    Altmäe, Signe
    Marcos, Acensión
    Carmen López-Sabater, M.
    Campoy, Cristina
    Maternal, fetal and perinatal alterations associated with obesity, overweight and gestational diabetes: an observational cohort study (PREOBE)2016Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 16, artikel-id 207Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Maternal overweight, obesity, and gestational diabetes (GD) have been negatively associated with offspring development. Further knowledge regarding metabolic and nutritional alterations in these mother and their offspring are warranted.

    Methods: In an observational cohort study we included 331 pregnant women from Granada, Spain. The mothers were categorized into four groups according to BMI and their GD status; overweight (n:56), obese (n:64), GD (n:79), and healthy normal weight controls (n:132). We assessed maternal growth and nutritional biomarkers at 24 weeks (n = 269), 34 weeks (n = 310) and at delivery (n = 310) and the perinatal characteristics including cord blood biomarkers.

    Results: Obese and GD mothers had significantly lower weight gain during pregnancy and infant birth weight, waist circumference, and placental weight were higher in the obese group, including a significantly increased prevalence of macrosomia. Except for differences in markers of glucose metabolism (glucose, HbA1c, insulin and uric acid) we found at some measures that overweight and/or obese mothers had lower levels of transferrin saturation, hemoglobin, Vitamin B12 and folate and higher levels of C-reactive protein, erythrocyte sedimentation rate, ferritin, and cortisol. GD mothers had similar differences in hemoglobin and C-reactive protein but higher levels of folate. The latter was seen also in cord blood.

    Conclusions: We identified several metabolic alterations in overweight, obese and GD mothers compared to controls. Together with the observed differences in infant anthropometrics, these may be important biomarkers in future research regarding the programming of health and disease in children.

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  • 17.
    Bergman, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Boraxbekk, Carl-Johan
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Increasing physical activity in officeworkers – the Inphact Treadmill study: a study protocol for a 13-month randomized controlled trial of treadmill workstations2015Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 15, artikel-id 632Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Sedentary behaviour is an independent risk factor for mortality and morbidity, especially for type 2 diabetes. Since office work is related to long periods that are largely sedentary, it is of major importance to find ways for office workers to engage in light intensity physical activity (LPA). The Inphact Treadmill study aims to investigate the effects of installing treadmill workstations in offices compared to conventional workstations.

    Methods/Design: A two-arm, 13-month, randomized controlled trial (RCT) will be conducted. Healthy overweight and obese office workers (n = 80) with mainly sedentary tasks will be recruited from office workplaces in Umeå, Sweden. The intervention group will receive a health consultation and a treadmill desk, which they will use for at least one hour per day for 13 months. The control group will receive the same health consultation, but continue to work at their regular workstations. Physical activity and sedentary time during workdays and non-workdays as well as during working and non-working hours on workdays will be measured objectively using accelerometers (Actigraph and activPAL) at baseline and after 2, 6, 10, and 13 months of follow-up. Food intake will be recorded and metabolic and anthropometric variables, body composition, stress, pain, depression, anxiety, cognitive function, and functional magnetic resonance imaging will be measured at 3–5 time points during the study period. Interviews with participants from the intervention group will be performed at the end of the study.

    Discussion: This will be the first long-term RCT on the effects of treadmill workstations on objectively measured physical activity and sedentary time as well as other body functions and structures/morphology during working and non-working hours among office workers. This will provide further insight on the effects of active workstations on our health and could fill in some of the knowledge gaps regarding how we can reduce sedentary time in office environments.

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  • 18. Bjelkmar, Par
    et al.
    Hansen, Anette
    Schonning, Caroline
    Bergstrom, Jakob
    Lofdahl, Margareta
    Lebbad, Marianne
    Wallensten, Anders
    Allestam, Gorel
    Stenmark, Stephan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Lindh, Johan
    Early outbreak detection by linking health advice line calls to water distribution areas retrospectively demonstrated in a large waterborne outbreak of cryptosporidiosis in Sweden2017Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 17, artikel-id 328Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In the winter and spring of 2011 a large outbreak of cryptosporidiosis occurred in Skelleftea municipality, Sweden. This study summarizes the outbreak investigation in terms of outbreak size, duration, clinical characteristics, possible source(s) and the potential for earlier detection using calls to a health advice line. Methods: The investigation included two epidemiological questionnaires and microbial analysis of samples from patients, water and other environmental sources. In addition, a retrospective study based on phone calls to a health advice line was performed by comparing patterns of phone calls between different water distribution areas. Results: Our analyses showed that approximately 18,500 individuals were affected by a waterborne outbreak of cryptosporidiosis in Skelleftea in 2011. This makes it the second largest outbreak of cryptosporidiosis in Europe to date. Cryptosporidium hominis oocysts of subtype IbA10G2 were found in patient and sewage samples, but not in raw water or in drinking water, and the initial contamination source could not be determined. The outbreak went unnoticed to authorities for several months. The analysis of the calls to the health advice line provides strong indications early in the outbreak that it was linked to a particular water treatment plant. Conclusions: We conclude that an earlier detection of the outbreak by linking calls to a health advice line to water distribution areas could have limited the outbreak substantially.

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  • 19.
    Blom, Helena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Department of Obstetrics and Gynaecology, Sundsvall Hospital, Sundsvall, Sweden.
    Högberg, Ulf
    Uppsala, Sweden.
    Olofsson, Niclas
    Sundsvall; Linköping, Sweden.
    Danielsson, Ingela
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Department of Research and Development, Västernorrland County Council, Sundsvall, Sweden.
    Strong association between earlier abuse and revictimization in youth2014Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 14, nr 14, artikel-id 715Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:  Violence victimization among youth is recognized as a public health problem. The objective was to analyze the risk pattern of emotional, physical, and sexual abuse during the past 12 months by gender, sociodemographic factors, health risk behaviors, and exposure to abuse before the age of 15, among young men and women attending youth health centers in Sweden.

    Methods: A cross-sectional survey was conducted using a nationally representative sample of youth health centers. A total of 2,250 young women and 920 young men aged 15-23 completed a self-administered questionnaire. Odds ratios (OR) and adjusted odds ratios (AOR) with 95% CI were calculated.

    Results: A consistent and strong association was noted between exposure to all types of violence during the past year and victimization before the age of 15 for all types of violence for both women and men. The only exceptions were childhood sexual victimization and sexual violence during the past year for men. Younger age was associated with all violence exposure for the women and with emotional violence for the men. For the women, drug use was associated with all types of violence, while the association with hazardous alcohol use and not living with parents was restricted to physical and sexual violence exposure, present smoking was restricted to emotional and physical violence exposure, and partnership and living in urban areas were restricted to sexual violence. For men, not being partnered, hazardous alcohol consumption, and drug use meant increased risk for physical violence, while smoking and living in urban areas were associated with sexual violence. After adjustment, immigration had no association with violence exposure.

    Conclusions: Violence victimization in young men and women is often not a single experience. Findings underline the importance of early interventions among previously abused youth.

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  • 20.
    Blomstedt, Yulia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Karolinska Institute, Center for Family and Community Medicine, Huddinge, Sweden.
    Johansson, Sven-Erik
    Karolinska Institute, Center for Family and Community Medicine, Huddinge, Sweden.
    Sundquist, Jan
    Karolinska Institute, Center for Family and Community Medicine, Huddinge, Sweden.
    Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross-sectional study2007Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 7, s. Article nr 27-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Enlargement of the European Union has caused worries about the possibility of increased migration from its new members, the former Soviet countries, and consequently increased demands on the health care systems of the host countries. This study investigated whether or not earlier immigrants from the former Soviet Bloc have poorer self-reported mental health, measured as self-reported psychiatric illness and psychosomatic complaints, than the host population in Sweden. It also examined the particular factors which might determine the self-reported mental health of these immigrants. METHODS: The cross-sectional national sample included 25-84-year-old Swedish-born persons (n = 35,459) and immigrants from Poland (n = 161), other East European countries (n = 164), and the former Soviet Union (n = 60) who arrived in Sweden after 1944 and were interviewed during 1994-2001. Unconditional multivariate logistic regression was used in the analyses. RESULTS: The findings indicated that the country of birth had a profound influence on self-reported mental health. Polish and other East European immigrants in general had a twofold higher odds ratio of reporting psychiatric illness and psychosomatic complaints, which fact could not be explained by adjustments for the demographic and socioeconomic variables. However, immigrants from the former Soviet Union had odds similar to those of the Swedish-born reference group. Adjustments for migration-related variables (language spoken at home and years in Sweden) changed the association between the country of birth and the outcomes only to a limited extent. CONCLUSION: Since poor mental health may hinder acculturation, the mental health of immigrants from Poland and other East European countries should be acknowledged, particularly with the expansion of the European Union and inclusion of nine former Soviet Bloc countries by 2007.

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    Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross-sectional study
  • 21.
    Blomstedt, Yulia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Research Unit Medicine-Geriatric Clinic, Skellefteå County Hospital, SE-931 86 Skellefteå, Sweden..
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al2019Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, nr 1, artikel-id 1095Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An evaluation of Vasterbotten Intervention Programme (VIP) was recently conducted by San Sebastian et al. (BMC Public Health 19:202, 2019). Evaluation of health care interventions of this kind require 1) an understanding of both the design and the nature of the intervention, 2) correct definition of the target population, and 3) careful choice of the appropriate evaluation method. In this correspondence, we review the approach used by San Sebastian et al. as relates to these three criteria. Within this framework, we suggest important explanations for why the conclusions drawn by these authors contradict a large body of research on the effectiveness of the VIP.

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  • 22. Bojsen-Møller, Emil
    et al.
    Wang, Rui
    Nilsson, Jonna
    Heiland, Emerald G.
    Boraxbekk, Carl-Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi. Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diag‑ nostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark; Institute of Sports Medicine Copenhagen (ISMC) and Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark.
    Kallings, Lena V.
    Ekblom, Maria
    The effect of two multi-component behavior change interventions on cognitive functions2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, nr 1, artikel-id 1082Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We previously reported the effects of two cluster-randomized 6-month multi-component workplace interventions, targeting reducing sedentary behavior or increasing physical activity among office workers, on movement behaviors and cardiorespiratory fitness. The primary aim of this study was to investigate the effects of these interventions on cognitive functions compared to a wait-list control group. The secondary aims were to examine if changes in cognition were related to change in cardiorespiratory fitness or movement behaviors and if age, sex, or cardiorespiratory fitness moderated these associations.

    Methods: Both interventions encompassed multi-components acting on the individual, environmental, and organizational levels and aimed to change physical activity patterns to improve mental health and cognitive function. Out of 263 included participants, 139 (mean age 43 years, 76% females) completed a neuropsychological test battery and wore accelerometers at baseline and 6-month follow-up. The intervention effect (aim 1) on cognitive composite scores (i.e., Executive Functions, Episodic Memory, Processing Speed, and Global Cognition) was investigated. Additionally, associations between changes in movement behaviors and cardiorespiratory fitness, and changes in cognition were examined (aim 2). Moreover, age, sex, and cardiorespiratory fitness level were investigated as possible moderators of change associations (aim 3).

    Results: Overall, cognitive performance improved from baseline to follow-up, but the change did not differ between the intervention groups and the control group. Changes in cardiorespiratory fitness or any movement behavior category did not predict changes in cognitive functions. The association between changes in time in bed and changes in both Executive Function and Global Cognition were moderated by age, such that a more positive relation was seen with increasing age. A less positive association was seen between changes in sedentary behavior and Processing Speed for men vs. women, whereas higher cardiorespiratory fitness was related to a more positive association between changes in moderate-intensity physical activity and Global Cognition.

    Conclusion: The lack of an intervention effect on cognitive functions was expected since the intervention did not change movement behavior or fitness. Age, sex, and cardiorespiratory fitness level might moderate the relationships between movement behaviors and cognitive functions changes.

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  • 23. Bortes, Cristian
    et al.
    Geidne, Susanna
    Eriksson, Charli
    Evaluating the effectiveness of the SMART contract-signing strategy in reducing the growth of Swedish Adolescents’ substance use and problem behaviors2016Ingår i: BMC Public Health, E-ISSN 1471-2458Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In 2013, around 40 % of the schools in Sweden had structured programs to prevent tobacco and alcohol debut in compulsory school. There has unfortunately been a lack of scientific evidence to support most of the prevention methods focusing on primary prevention in schools in Sweden. The aim and purpose of the present study is to evaluate the effectiveness of the Non-Governmental Organization SMART contract-signing strategy in reducing the growth of youth substance use and other problem behaviors amongst Swedish adolescents. Methods: Students from five schools in a medium-sized Swedish municipality were surveyed in three waves from 7th to 9th grade of compulsory school. We used General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures smoking, use of snus and alcohol, drunkenness, delinquency, and bullying significantly changed different amounts over time in groups that had participated in the SMART program for long time, a short time, sporadically- or not at all. Groups were compared on demographic background variables, and outcome measures were assessed on all measurement occasions by a one-way ANOVA. The magnitude of group differences at the end of the study was estimated according to Cohen’s d. Results: Number of years with a contract has an effect on the levels of self-reported youth problems in 9th grade. We found small to medium-sized differences in measured outcomes between students who participated in the program for the longest period of time, 5 years, and who participated for the shortest time, 0–2 years. Conclusion: Findings suggests that the SMART program has preventive effects on adolescent substance use.

  • 24.
    Brydsten, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    The impact of economic recession on the association between youth unemployment and functional somatic symptoms in adulthood: a difference-in-difference analysis from Sweden2016Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 16, artikel-id 230Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The impact of macroeconomic conditions on health has been extensively explored, as well as the relationship between individual unemployment and health. There are, however, few studies taking both aspects into account and even fewer studies looking at the relationship in a life course perspective. In this study the aim was to assess the role of macroeconomic conditions, such as national unemployment level, for the long-term relationship between individual unemployment and functional somatic symptoms (FSS), by analysing data from two longitudinal cohorts representing different periods of unemployment level in Sweden.

    Methods: A difference-in-difference (DiD) analysis was applied, looking at the difference over time between recession and pre-recession periods for unemployed youths (age 21 to 25) on FSS in adulthood. FSS was constructed as an index of ten self-reported items of somatic ill-health. Covariates for socioeconomics, previous health status and social environment were included.

    Results: An association was found in the difference of adult FSS between unemployed and employed youths in the pre-recession and recession periods, remaining in the adjusted model for the pre-recession period. The DiD analysis between unemployed youths showed that men had significantly lower adult FSS during the recession compared to men in the pre-recession time.

    Conclusions: Adulthood FSS showed to be significantly lower among unemployed youths, in particular among men, during recession compared to pre-recession times. Since this is a fairly unexplored research field, more research is needed to explore the role of macroeconomic conditions for various health outcomes, long-term implications and gender differences.

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  • 25. Cambaco, Olga
    et al.
    Menendez, Yara Alonso
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sigauque, Betuel
    Wertheim, Heiman
    Do, Nga
    Gyapong, Margaret
    John-Langba, Johannes
    Sevene, Esperanca
    Munguambe, Khatia
    Community knowledge and practices regarding antibiotic use in rural Mozambique: where is the starting point for prevention of antibiotic resistance?2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikel-id 1183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundAntibiotic misuse and other types of unnecessary use of antibiotics can contribute to accelerate the process of antibiotic resistance, which is considered a global concern, mostly affecting low-and middle-income countries (LMICs). In Mozambique there is limited evidence on community knowledge and practices regarding antibiotics and antibiotic resistance. As part of the ABACUS project, this paper describes knowledge and practices of antibiotic use among the general population in the semi-rural district of Manhica to inform evidence-based communication intervention strategies for safer antibiotic use.MethodsThe study was conducted in Manhica, a semi-rural district of Southern Mozambique. Sixteen in-depth interviews and four focus group discussions (FGDs) were conducted with community members to explore lay knowledge and practices regarding antibiotics and awareness of antibiotic resistance. The qualitative data was analysed using a combination of content and thematic analysis. The SRQR guidelines for reporting qualitative studies was performed.ResultsAlthough participants did not hold any consistent knowledge of antibiotics, their visual recognition of amoxicillin (distinct red yellow capsule) was acceptable, but less so for different types and brands of antibiotics. The majority of participants were aware of the term 'antibiotic', yet the definition they gave was rarely backed by biomedical knowledge. Participants associated antibiotics with certain colours, shapes and health conditions. Participants reported common habits that may contribute to resistance: not buying the full course, self-medication, sharing medicines and interruption of treatment. Most had never heard of the term 'antibiotic resistance' but were familiar with the phenomenon. They often understood the term 'resistance' as treatment failure and likened 'resistance' to non-compliance, ineffective medication, disease resistance or to an inability of the physical body to respond to it.ConclusionThere is a broad understanding of the importance of medication compliance but not specifically of antibiotic resistance. In addition, there is a recognized gap between knowledge of responsible drug compliance and actual behaviour. Future qualitative research is required to further explore what determines this behaviour. The existing ability to visually identify amoxicillin by its distinct red and yellow appearance is informative for future awareness and behavioural change campaigns that may incorporate visual aids of antibiotics.

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  • 26. Canivet, Catarina
    et al.
    Bodin, Theo
    Emmelin, Maria
    Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University.
    Toivanen, Susanna
    Moghaddassi, Mahnaz
    Östergren, Per-Olof
    Precarious employment is a risk factor for poor mental health in young individuals in Sweden: a cohort study with multiple follow-ups2016Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 16, artikel-id 687Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The globalisation of the economy and the labour markets has resulted in a growing proportion of individuals who find themselves in a precarious labour market situation, especially among the young. This pertains also to the Nordic countries, despite their characterisation as well developed welfare states with active labour market policies. This should be viewed against the background of a number of studies, which have shown that several aspects of precarious employment are detrimental to mental health. However, longitudinal studies from the Nordic region that examine the impact of precarious labour market conditions on mental health in young individuals are currently lacking. The present study aims to examine this impact in a general cohort of Swedish young people.

    METHODS: Postal questionnaires were sent out in 1999/2000 to a stratified random sample of the Scania population, Sweden; the response rate was 58 %. All of those who responded at baseline were invited to follow-ups after 5 and 10 years. Employment precariousness was determined based on detailed questions about present employment, previous unemployment, and self-rated risk of future unemployment. Mental health was assessed by GHQ-12. For this study individuals in the age range of 18-34 years at baseline, who were active in the labour market (employed or seeking job) and had submitted complete data from 1999/2000, 2005, and 2010 on employment precariousness and mental health status, were selected (N = 1135).

    RESULTS: Forty-two percent of the participants had a precarious employment situation at baseline. Labour market trajectories that included precarious employment in 1999/2000 or 2005 predicted poor mental health in 2010: the incidence ratio ratio was 1.4 (95 % CI: 1.1-2.0) when excluding all individuals with mental health problems at baseline and adjusting for age, gender, social support, social capital, and economic difficulties in childhood. The population attributable fraction regarding poor mental health in the studied age group was 18 %.

    CONCLUSIONS: This study supported the hypothesis that precarious employment should be regarded as an important social determinant for subsequent development of mental health problems in previously mentally healthy young people.

  • 27.
    chilambe, Kunda
    et al.
    Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Mulubwa, Chama
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Zulu, Joseph Mumba
    Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Malizgani, Chavula Paul
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Policy and Education, School of Public Health, University of Zambia, Lusaka, Zambia.
    Experiences of teachers and community-based health workers in addressing adolescents’ sexual reproductive health and rights problems in rural health systems: a case of the RISE project in Zambia2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 335Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Adolescents in low-and-middle-income countries like Zambia face a high burden of sexual, reproductive, health and rights problems including coerced sex, teenage pregnancies, and early marriages. The Zambia government through Ministry of Education has integrated comprehensive sexuality education (CSE) in the education and school system to contribute towards addressing Adolescents sexual, reproductive, health and rights (ASRHR) problems. This paper sought to explore teachers and community based health workers (CBHWs)’ experiences in addressing ASRHR problems in in rural health systems in Zambia.

    Methodology: The study was conducted under Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aims to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted qualitative 21 in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services.

    Results: The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing and sensitizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referral to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution.

    Conclusion: This study provides significant insight on the important roles that teachers CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescents SRHR problems.

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  • 28.
    Clancy, India L.
    et al.
    Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK.
    Jones, Robert T.
    Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
    Power, Grace M.
    Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
    Logan, James G.
    Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
    Iriart, Jorge Alberto Bernstein
    Institute of Collective Health, Universidade Federal da Bahia, Salvador, Brazil.
    Massad, Eduardo
    School of Applied Mathematics, Fundacao Getulio Vargas, Rua Praia de Botafogo 190, Rio de Janeiro, RJ, CEP 22250-900, Brazil.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Public health messages on arboviruses transmitted by Aedes aegypti in Brazil2021Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 21, nr 1, artikel-id 1362Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The outbreak of Zika virus in Brazil in 2015 followed the arrival of chikungunya in 2014 and a long history of dengue circulation. Vital to the response to these outbreaks of mosquito-borne pathogens has been the dissemination of public health messages, including those promoted through risk communication posters. This study explores the content of a sample of posters circulated in Brazil towards the end of the Zika epidemic in 2017 and analyses their potential effectiveness in inducing behaviour change.

    Methods: A content analysis was performed on 37 posters produced in Brazil to address outbreaks of mosquito-borne pathogens. The six variables of the Health Belief Model were used to assess the potential effectiveness of the posters to induce behaviour change.

    Results: Three overarching key messages emerged from the posters. These included (i) the arboviruses and their outcomes, (ii) a battle against the mosquito, and (iii) a responsibility to protect and prevent. Among the six variables utilised through the Health Belief Model, cues to action were most commonly featured, whilst the perceived benefits of engaging in behaviours to prevent arbovirus transmission were the least commonly featured.

    Conclusions: The posters largely focused on mosquito-borne transmission and the need to eliminate breeding sites, and neglected the risk of the sexual and congenital transmission of Zika and the importance of alternative preventive actions. This, we argue, may have limited the potential effectiveness of these posters to induce behaviour change.

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  • 29. Clark, Samuel J
    et al.
    Gómez-Olivé, F. Xavier
    Houle, Brian
    Thorogood, Margaret
    Klipstein-Grobusch, Kerstin
    Angotti, Nicole
    Kabudula, Chodziwadziwa
    Williams, Jill
    Menken, Jane
    Tollman, Stephen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
    Cardiometabolic disease risk and HIV status in rural South Africa: establishing a baseline2015Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 15, artikel-id 135Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To inform health care and training, resource and research priorities, it is essential to establish how non-communicable disease risk factors vary by HIV-status in high HIV burden areas; and whether long-term anti-retroviral therapy (ART) plays a modifying role. Methods: As part of a cohort initiation, we conducted a baseline HIV/cardiometabolic risk factor survey in 2010-2011 using an age-sex stratified random sample of ages 15+ in rural South Africa. We modelled cardiometabolic risk factors and their associations by HIV-status and self-reported ART status for ages 18+ using sex-stratified logistic regression models. Results: Age-standardised HIV prevalence in women was 26% (95% CI 24-28%) and 19% (95% CI 17-21) in men. People with untreated HIV were less likely to have a high waist circumference in both women (OR 0.67; 95% CI 0.52-0.86) and men (OR 0.42; 95% CI 0.22-0.82). Untreated women were more likely to have low HDL and LDL, and treated women high triglycerides. Cardiometabolic risk factors increased with age except low HDL. The prevalence of hypertension was high (40% in women; 30% in men). Conclusions: Sub-Saharan Africa is facing intersecting epidemics of HIV and hypertension. In this setting, around half the adult population require long-term care for at least one of HIV, hypertension or diabetes. Together with the adverse effects that HIV and its treatment have on lipids, this may have serious implications for the South African health care system. Monitoring of the interaction of HIV, ART use, and cardiometabolic disease is needed at both individual and population levels.

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  • 30.
    Cordoba-Dona, Juan Antonio
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. 1Delegación Territorial de Igualdad, Salud y Políticas Sociales de Andalucía.
    Escolar-Pujolar, Antonio
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Gustafsson, Per E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    How are the employed and unemployed affected by the economic crisis in Spain?: Educational inequalities, life conditions and mental health in a context of high unemployment2016Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 16, artikel-id 267Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Despite an increasing number of studies on the factors mediating the impact of the economic recession on mental health, research beyond the individual employment status is scarce. Our objectives were to investigate in which ways the mental health of employed and unemployed populations is differently affected by the current economic recession along the educational scale and to examine whether financial strain and social support explain these effects of the crisis. Methods: A repeated cross-sectional study, using two waves of the Andalusian Health Survey in 2007 (pre-crisis) and 2011-2012 (crisis). A population aged between 19 and 64 years was selected. The dependent variable was the Mental Component Summary of the SF-12 questionnaire. We performed Poisson regression models stratified by working status, with period, educational level, financial strain and social support as independent variables. We examined interactions between period and educational level. Age, sex, main earner, cohabitation and partner's working status were considered as covariates. Results: The study included 3210 individuals (1185 women) in 2007 and 3633 individuals (1486 women) in 2011-2012. In working individuals the prevalence of poor mental health increased for secondary and complete primary studies groups during crisis compared to the pre-crisis period, while it decreased significantly in the university study group (PR = 0.76, 95 % CI: 0.58-0.99). However, in unemployed individuals prevalence ratios for poor mental health increased significantly only in the secondary studies group (PR = 1.73, 95 % CI: 1.06-2.83). Financial strain and social support yielded consistent associations with mental health in all subgroups. Only financial strain could partly explain the crisis effect on mental health among the unemployed. Conclusions: Our study supports the finding that current economic recession is associated with poorer mental health differentially according to labour market status and educational level. Those with secondary studies may be at risk in times of economic recession. In connection with this, emerging educational inequalities in mental health among the employed population were observed. Our research also suggests a partial mediating role of financial strain for the effects of crisis on poor mental health among the unemployed. Good social support appears to buffer poor mental health in all subgroups but not specifically during crisis period.

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  • 31.
    Daca, Chanvo S. L.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Directorate of Planning and Cooperation, Ministry of Health, Maputo, Mozambique; Centre for African Studies, Universidade Eduardo Mondlane, Maputo, Mozambique.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Arnaldo, Carlos
    Centre for African Studies, Universidade Eduardo Mondlane, Maputo, Mozambique.
    Schumann, Barbara
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Socioeconomic and geographical inequalities in health care coverage in Mozambique: a repeated cross-sectional study of the 2015 and 2018 national surveys2023Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 23, nr 1, artikel-id 1007Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Over the past years, Mozambique has implemented several initiatives to ensure equitable coverage to health care services. While there have been some achievements in health care coverage at the population level, the effects of these initiatives on social inequalities have not been analysed.

    Objective: The present study aimed to assess changes in socioeconomic and geographical inequalities (education, wealth, region, place of residence) in health care coverage between 2015 and 2018 in Mozambique.

    Methods: The study was based on repeated cross-sectional surveys from nationally representative samples: the Survey of Indicators on Immunisation, Malaria and HIV/AIDS in Mozambique (IMASIDA) 2015 and the 2018 Malaria Indicator survey. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage of three indicators: insecticide-treated net use, fever treatment of children, and use of Fansidar malaria prophylaxis for pregnant women. Absolute risk differences and the slope index of inequality (SII) were calculated for the 2015 survey period and the 2018 survey period, respectively. An interaction term between the socioeconomic and geographical variables and the period was included to assess inequality changes between 2015 and 2018.

    Results: The non-use of insecticide-treated nets dropped, whereas the proportion of women with children who were not treated for fever and the prevalence of women who did not take the full Fansidar dose during pregnancy decreased between 2015 and 2018. Significant reductions in the inequality related to insecticide-treated net use were observed for all socioeconomic variables. Concerning fever treatment, some reductions in socioeconomic inequalities were observed, though not statistically significant. For malaria prophylaxis, the SII was significant for education, wealth, and residence in both periods, but no significant inequality reductions were observed in any of these variables over time.

    Conclusions: We observed significant reductions of socioeconomic inequalities in insecticide-treated net use, but not in fever treatment of children and Fansidar prophylaxis for pregnant women. Decision-makers should target underserved populations, specifically the non-educated, poor, and rural women, to address inequalities in health care coverage.

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  • 32.
    D'Ambruoso, Lucia
    et al.
    Immpact, University of Aberdeen, UK.
    Abbey, Mercy
    Hussein, Julia
    Please understand when I cry out in pain: women's accounts of maternity services during labour and delivery in Ghana2005Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 5, nr 140, s. 1-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This study was undertaken to investigate women's accounts of interactions with health care providers during labour and delivery and to assess the implications for acceptability and utilisation of maternity services in Ghana.

    METHODS: Twenty-one individual in-depth interviews and two focus group discussions were conducted with women of reproductive age who had delivered in the past five years in the Greater Accra Region. The study investigated women's perceptions and experiences of care in terms of factors that influenced place of delivery, satisfaction with services, expectations of care and whether they would recommend services.

    RESULTS: One component of care which appeared to be of great importance to women was staff attitudes. This factor had considerable influence on acceptability and utilisation of services. Otherwise, a successful labour outcome and non-medical factors such as cost, perceived quality of care and proximity of services were important. Our findings indicate that women expect humane, professional and courteous treatment from health professionals and a reasonable standard of physical environment. Women will consciously change their place of delivery and recommendations to others if they experience degrading and unacceptable behaviour.

    CONCLUSION: The findings suggest that inter-personal aspects of care are key to women's expectations, which in turn govern satisfaction. Service improvements which address this aspect of care are likely to have an impact on health seeking behaviour and utilisation. Our findings suggest that user-views are important and warrant further investigation. The views of providers should also be investigated to identify channels by which service improvements, taking into account women's views, could be operationalised. We also recommend that interventions to improve delivery care should not only be directed to the health professional, but also to general health system improvements.

  • 33.
    Dewi, Fatwa Sari Tetra
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Public Health Division, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Marlinawati, V. Utari
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    A community intervention for behaviour modification: an experience to control cardiovascular diseases in Yogyakarta, Indonesia2013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, artikel-id 1043Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Non-communicable Disease (NCD) is increasingly burdening developing countries including Indonesia. However only a few intervention studies on NCD control in developing countries are reported. This study aims to report experiences from the development of a community-based pilot intervention to prevent cardiovascular disease (CVD), as initial part of a future extended PRORIVA program (Program to Reduce Cardiovascular Disease Risk Factors in Yogyakarta, Indonesia) in an urban area within Jogjakarta, Indonesia.

    Methods: The study is quasi-experimental and based on a mixed design involving both quantitative and qualitative methods. Four communities were selected as intervention areas and one community was selected as a referent area. A community-empowerment approach was utilized to motivate community to develop health promotion activities. Data on knowledge and attitudes with regard to CVD risk factors, smoking, physical inactivity, and fruit and vegetable were collected using the WHO STEPwise questionnaire. 980 people in the intervention areas and 151 people in the referent area participated in the pre-test. In the post-test 883 respondents were re-measured from the intervention areas and 144 respondents from the referent area. The qualitative data were collected using written meeting records (80), facilitator reports (5), free-listing (112) and in-depth interviews (4). Those data were analysed to contribute a deeper understanding of how the population perceived the intervention.

    Results: Frequency and participation rates of activities were higher in the low socioeconomic status (SES) communities than in the high SES communities (40 and 13 activities respectively). The proportion of having high knowledge increased significantly from 56% to 70% among men in the intervention communities. The qualitative study shows that respondents thought PRORIVA improved their awareness of CVD and encouraged them to experiment healthier behaviours. PRORIVA was perceived as a useful program and was expected for the continuation. Citizens of low SES communities thought PRORIVA was a “cheerful” program.

    Conclusion: A community-empowerment approach can encourage community participation which in turn may improve the citizen’s knowledge of the danger impact of CVD. Thus, a bottom-up approach may improve citizens’ acceptance of a program, and be a feasible way to prevent and control CVD in urban communities within a low income country.

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  • 34. Doring, Nora
    et al.
    Hansson, Lena M.
    Andersson, Elina Scheers
    Bohman, Benjamin
    Westin, Maria
    Magnusson, Margaretha
    Larsson, Christel
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Univ Gothenburg, Dept Food & Nutr & Sport Sci, Gothenburg, Sweden.
    Sundblom, Elinor
    Willmer, Mikaela
    Blennow, Margareta
    Heitmann, Berit L.
    Forsberg, Lars
    Wallin, Sanna
    Tynelius, Per
    Ghaderi, Ata
    Rasmussen, Finn
    Primary prevention of childhood obesity through counselling sessions at Swedish child health centres: design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised trial2014Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 14, nr 335Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. Methods/Design: The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children's body mass index and waist circumference at four years. Secondary outcomes are children's and mothers' eating habits (assessed by a food frequency questionnaire), and children's and mothers' physical activity (measured by accelerometer and a validated questionnaire), and mothers' body mass index and waist circumference. Discussion: The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control group, before they reached 10 months of age). The food frequency questionnaire showed acceptable relative validity when compared with an 8-day food diary. We are not aware of any previous RCT, concerned with the primary prevention of childhood obesity through sessions at CHC that addresses healthy eating habits and physical activity in the context of a routine child health services programme.

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  • 35.
    Edvardsson, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Garvare, Rickard
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Small, Rhonda
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Giving offspring a healthy start: parents' experiences of health promotion and lifestyle change during pregnancy and early parenthood2011Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 11, s. 936-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There are good opportunities in Sweden for health promotion targeting expectant parents and parents of young children, as almost all are reached by antenatal and child health care. In 2005, a multisectoral child health promotion programme (the Salut Programme) was launched to further strengthen such efforts.

    METHODS: Between June and December 2010 twenty-four in-depth interviews were conducted separately with first-time mothers and fathers when their child had reached 18 months of age. The aim was to explore their experiences of health promotion and lifestyle change during pregnancy and early parenthood. Qualitative manifest and latent content analysis was applied.

    RESULTS: Parents reported undertaking lifestyle changes to secure the health of the fetus during pregnancy, and in early parenthood to create a health-promoting environment for the child. Both women and men portrayed themselves as highly receptive to health messages regarding the effect of their lifestyle on fetal health, and they frequently mentioned risks related to tobacco and alcohol, as well as toxins and infectious agents in specific foods. However, health promotion strategies in pregnancy and early parenthood did not seem to influence parents to make lifestyle change primarily to promote their own health; a healthy lifestyle was simply perceived as 'common knowledge'. Although trust in health care was generally high, both women and men described some resistance to what they saw as preaching, or very directive counselling about healthy living and the lack of a holistic approach from health care providers. They also reported insufficient engagement with fathers in antenatal care and child health care.

    CONCLUSION: Perceptions about risks to the offspring's health appear to be the primary driving force for lifestyle change during pregnancy and early parenthood. However, as parents' motivation to prioritise their own health per se seems to be low during this period, future health promoting programmes need to take this into account. A more gender equal provision of health promotion to parents might increase men's involvement in lifestyle change. Furthermore, parents' ranking of major lifestyle risks to the fetus may not sufficiently reflect those that constitute greatest public health concern, an area for further study.

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  • 36.
    Edvardsson, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Garvare, Rickard
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Small, Rhonda
    Nyström, Monica E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Improving child health promotion practices in multiple sectors: outcomes of the Swedish Salut Programme2012Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 12, nr 1, s. 920-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals' self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation.

    Methods: A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points.

    Results: Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men's violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate 'fathers visits' in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff.

    Conclusion: This multisectoral programme for health promotion, based on sector-specific intervention packages developed and tested by end users, and introduced via interactive multisectoral seminars, shows potential for improving health promotion practices and collaboration across sectors. Consideration of the key facilitators and barriers for programme implementation as highlighted in this study can inform future improvement efforts.

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    Improving child health promotion practices in multiple sectors: outcomes of the Swedish Salut Programme
  • 37.
    Edvardsson, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindkvist, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eurenius, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Small, Rhonda
    La Trobe University, Melbourne, Australia .
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    A population-based study of overweight and obesity in expectant parents: socio-demographic patterns and within-couple associations2013Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, artikel-id 923Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Overweight and obesity in pregnancy increase the risk of several adverse pregnancy outcomes. However, both mothers’ and fathers’ health play an important role for long-term health outcomes in offspring. While aspects of health and lifestyle of pregnant women have been reported, the health of expectant fathers and correlations of health variables within couples have received less attention. This study aimed to explore the prevalence and socio-demographic patterns of overweight and obesity in Swedish expectant parents, and to assess within-couple associations.

    Methods: This population-based, cross-sectional study investigated self-reported data from 4352 pregnant women and 3949 expectant fathers, comprising 3356 identified couples. Data were collected in antenatal care clinics between January 2008 and December 2011. Descriptive, correlation and logistic regression analyses were performed.

    Results: The self-reported prevalence of overweight (BMI 25.0-29.99) and obesity (BMI ≥30.0) was 29% among women (pre-pregnancy) and 53% among expectant fathers. In a majority of couples (62%), at least one partner was overweight or obese. The odds of being overweight or obese increased relative to partner’s overweight or obesity, and women’s odds of being obese were more than six times higher if their partners were also obese in comparison with women whose partners were of normal weight (OR 6.2, CI 4.2-9.3). A socio-demographic gradient was found in both genders in relation to education, occupation and area of residence, with higher odds of being obese further down the social ladder. The cumulative influence of these factors showed a substantial increase in the odds of obesity for the least compared to the most privileged (OR 6.5, CI 3.6-11.8).

    Conclusions: The prevalence of overweight and obesity in expectant parents was high, with a clear social gradient, and a minority of couples reported both partners with a healthy weight at the onset of pregnancy. Partner influence on health and health behaviours, and the role both mothers and fathers play in health outcomes of their offspring, underpin the need for a more holistic and gender inclusive approach to the delivery of pregnancy care and postnatal and child health services, with active measures employed to involve fathers.

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  • 38. Ekblom, Örjan
    et al.
    Ekblom-Bak, Elin
    Bolam, Kate A.
    Ekblom, Björn
    Schmidt, Caroline
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bergström, Göran
    Börjesson, Mats
    Concurrent and predictive validity of physical activity measurement items commonly used in clinical settings– data from SCAPIS pilot study2015Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 15, artikel-id 978Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: As the understanding of how different aspects of the physical activity (PA) pattern relate to health and disease, proper assessment is increasingly important. In clinical care, self-reports are the most commonly used assessment technique. However, systematic comparisons between questions regarding concurrent or criterion validity are rare, as are measures of predictive validity. The aim of the study was to examine the concurrent (using accelerometry as reference) and predictive validity (for metabolic syndrome) of five PA questions.

    Methods: A sample of 948 middle-aged Swedish men and women reported their PA patterns via five different questions and wore an accelerometer (Actigraph GT3X) for a minimum of 4 days. Concurrent validity was assessed as correlations and ROC-analyses. Predictive validity was assessed using logistic regression, controlling for potential confounders.

    Results: Concurrent validity was low-to-moderate (r <0.35 and ROC AUC <0.7) with large misclassifications regarding time spent sitting/sedentary and in moderate-to vigorous PA. The predictive validity of the questions was good, and one question (PHAS) showed an 80 % decreased odds-ratio of having metabolic syndrome, after taking potential confounders into consideration.

    Discussion: In this mixed sample of adults, both concurrent and predictive validity vaired between items and between measures of the physical activity pattern. The PHAS and WALK items are proposed for assessment of adherence to PA recommendations.

    Conclusion: Assessing PA patterns using self-report measures results in methodological problems when trying to predict individual risk for the metabolic syndrome, as the concurrent validity generally was low. However, several of the investigated questions may be useful for assessing risk at a group level, showing better predictive validity.

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  • 39.
    Elwér, Sofia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Klara
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Workplace gender composition and psychological distress: the importance of the psychosocial work environment2014Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 14, s. 241-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Health consequences of the gender segregated labour market have previously been demonstrated in the light of gender composition of occupations and workplaces, with somewhat mixed results. Associations between the gender composition and health status have been suggested to be shaped by the psychosocial work environment. The present study aims to analyse how workplace gender composition is related to psychological distress and to explore the importance of the psychosocial work environment for psychological distress at workplaces with different gender compositions.

    Methods: The study population consisted of participants from the Northern Swedish Cohort with a registered workplace in 2007 when the participants were 42 years old (N = 795). Questionnaire data were supplemented with register data on the gender composition of the participants' workplaces divided into three groups: workplaces with more women, mixed workplaces, and workplaces with more men. Associations between psychological distress and gender composition were analysed with multivariate logistic regression analysis adjusting for socioeconomic position, previous psychological distress, psychosocial work environment factors and gender. Logistic regression analyses (including interaction terms for gender composition and each work environment factor) were also used to assess differential associations between psychosocial work factor and psychological distress according to gender composition.

    Results: Working at workplaces with a mixed gender composition was related to a higher likelihood of psychological distress compared to workplaces with more men, after adjustments for socioeconomic position, psychological distress at age 21, psychosocial work environment factors and gender. Psychosocial work environment factors did not explain the association between gender composition and psychological distress.

    Conclusions: The association between gender composition and psychological distress cannot be explained by differences in the perception of the psychosocial work environment and thus the work environment hypothesis is not supported. Workplaces with a mixed gender composition needs further research attention to explain the negative development of psychological distress during working life for both women and men at these workplaces.

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  • 40.
    Emmelin, Maria
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    To be seen, confirmed and involved - a ten year follow-up of perceived health and cardiovascular risk factors in a Swedish community intervention programme2007Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 7, s. 190-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Public health interventions are directed towards social systems and it is difficult to foresee all consequences. While targeted outcomes may be positively influenced, interventions may at worst be counterproductive. To include self-reported health in an evaluation is one way of addressing possible side-effects. This study is based on a 10 year follow-up of a cardiovascular community intervention programme in northern Sweden. METHODS: Both quantitative and qualitative approaches were used to address the interaction between changes in self-rated health and risk factor load. Qualitative interviews contributed to an analysis of how the outcome was influenced by health related norms and attitudes. RESULTS: Most people maintained a low risk factor load and a positive perception of health. However, more people improved than deteriorated their situation regarding both perceived health and risk factor load. "Ideal types" of attitude sets towards the programme, generated from the interviews, helped to interpret an observed polarisation for men and the lower educated. CONCLUSION: Our observation of a socially and gender differentiated intervention effect suggests a need to test new intervention strategies. Future community interventions may benefit from targeting more directly those who in combination with high risk factor load perceive their health as bad and to make all participants feel seen, confirmed and involved.

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    To be seen, confirmed and involved - a ten year follow-up of perceived health and cardiovascular risk factors in a Swedish community intervention programme
  • 41.
    Engberg, Isak
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Segerstedt, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Waller, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Eliasson, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Fatigue in the general population-associations to age, sex, socioeconomic status, physical activity, sitting time and self-rated health: the northern Sweden MONICA study 20142017Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 17, artikel-id 654Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Fatigue is widespread in the population and a common complaint in primary care. Little is known about prevalence of fatigue in the population and its predictors. We aimed to describe the pattern of fatigue in the general population and to explore the associations with age, sex, socioeconomic status, self-reported physical activity, sitting time and self-rated health.

    Methods: One thousand, five hundred and fifty-seven out of 2500 invited subjects in the Northern Sweden MONICA Study 2014, aged 25-74 years, filled out the Multidimensional Fatigue Inventory (MFI-20), consisting of four subscales: General fatigue (GF), Physical fatigue (PF), Reduced activity (RA) and Mental fatigue (MF). Questions regarding age, sex, socioeconomic status, physical activity, sitting time and self-rated health were also included.

    Results: Higher age correlated significantly with lower fatigue scores for the GF and MF subscales. Women had higher fatigue scores than men on all subscales (p < 0.05). Among men, higher socioeconomic status was related to lower fatigue for the GF, PF and RA subscales (age adjusted p < 0.05). Among women, higher socioeconomic status was related to lower fatigue for the PF and MF subscales (age adjusted p < 0.05). Higher physical activity was connected to lower levels of fatigue for all subscales (age and sex adjusted p < 0.001) except for MF. Longer time spent sitting was also related to more fatigue on all subscales (age and sex adjusted p < 0.005) except for MF. Better self-rated health was strongly associated with lower fatigue for all subscales (age and sex adjusted p < 0.001).

    Conclusion: Older, highly educated, physically active men, with little sedentary behavior are generally the least fatigued. Self-rated health is strongly related to fatigue. Interventions increasing physical exercise and reducing sedentary behavior may be important to help patients with fatigue and should be investigated in prospective studies.

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  • 42. Eriksson, Charli
    et al.
    Kimber, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Skoog, Therése
    Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol2018Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 18, nr 1, s. 1-11, artikel-id 1250Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This research program aims to investigate the implementation and effects of a theoretically promising prevention method. It is being developed in a European research collaboration within a Comenius project (2012-2015) between 6 European universities (in Malta, Italy, Greece, Croatia, Portugal and Sweden) with the purpose of enhancing European children's resilience.

    METHODS/DESIGN: RESCUR in Sweden consists in a RCT study of the Resilience Curriculum (RESCUR) that is taking place in Sweden 2017-2019. The study is being performed by Junis, IOGT-NTO's Junior Association, part of IOGT International, in conjunction with researchers at Göteborg, Umeå and Stockholm universities, and is being funded by the Public Health Agency of Sweden. Around 1000 children of the ages 7-12 will, through their schools and associations, or via groups in social services, be acquainted with the material. Children will learn and practice mindfulness, storytelling, group discussions and much more, all designed to strengthen protective factors and increase their resilience. The program also involves parents, who are taking part in the work to reinforce children's protective factors. Based on the work with groups of children, an effectiveness study including children aged 7-12 in school classes, with randomized and controlled pre- and post-measurements, self-rating questionnaires and group observations is being performed. The program will also be implemented in a non-governmental organization and in groups in social services. The study also investigates forms of implementation.

    DISCUSSION: The design of the study will enable the researchers to answer five research questions by using a mixed-methods approach. Implementation will be studied, which is a necessary prerequisite for an effect study. Moreover, the research procedure has been tailored to the target group, with age-appropriate measures as well as multiple informants, which will produce high-quality data for analysis. A special ethical challenge is the study of young children, and efforts to give children a voice have been included in the program. This project is regarded as having good potential to benefit children in general, and particularly children in vulnerable positions.

    TRIAL REGISTRATION: National Institute of Health, ClinicalTrials.gov identifier NCT03655418. Registered August 31, 2018.

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  • 43.
    Fagrell Trygg, Nadja
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Gustafsson, Per E
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Månsdotter, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Reducing or reproducing inequalities in health?: An intersectional policy analysis of how health inequalities are represented in a Swedish bill on alcohol, drugs, tobacco and gambling2022Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 22, artikel-id 1302Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: According to post-structural policy analyses, policies and interventions aiming at reducing social inequalities have been found to be part in producing and reifying such inequalities themselves. Given the central role of health inequalities on the public health policy agenda globally it seems important to examine the way policy on health inequalities may potentially counteract the goal of health equity. The aim of this intersectional policy analysis, was to critically analyze the representation of health inequalities in a government bill proposing a national strategy on alcohol, drugs, tobacco and gambling, to examine its performative power, and to outline alternative representations.

    Method: A post-structural approach to policy analysis was combined with an intersectional framework. The material was analyzed through an interrogating process guided by the six questions of the “What’s the problem represented to be?” (WPR) approach. Thus, the underlying assumptions of the problem representation, its potential implications and historical background were explored. In a final step of the analysis we examined our own problem representations.

    Results: The recommendations found in the gender and equity perspective of the bill represented the problem of health inequalities as a lack of knowledge, with an emphasis on quantitative knowledge about differences in health between population groups. Three underlying assumptions supporting this representation were found: quantification and objectivity, inequalities as unidimensional, and categorization and labelling. The analysis showed how the bill, by opting into these partly overlapping assumptions, is part of enacting a discourse on health inequalities that directs attention to specific subjects (e.g., vulnerable) with special needs (e.g., health care), in certain places (e.g., disadvantaged neighborhoods). It also showed how underlying processes of marginalization are largely neglected in the bill due to its focus on describing differences rather than solutions. Finally, we showed how different intersectional approaches could be used to complement and challenge this, potentially counteractive, problem representation.

    Conclusions: The problem representation of health inequalities and its underlying assumptions may have counteractive effects on health equity, and even though some of its strengths are raised, it seems to be profoundly entangled with a system resisting the kind of change that the bill itself advocates for. If carefully used, intersectionality has the potential to support a more comprehensive and inclusive equality-promoting public health policy and practice.

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  • 44. Fantahun, Mesganaw
    et al.
    Berhane, Yemane
    Högberg, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Young adult and middle age mortality in Butajira demographic surveillance site, Ethiopia: lifestyle, gender and household economy2008Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 8, s. Article nr 268-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Public health research characterising the course of life through the middle age in developing societies is scarce. The aim of this study is to explore patterns of adult (15–64 years) mortality in an Ethiopian population over time, by gender, urban or rural lifestyle, causes of death and in relation to household economic status and decision-making.

    Methods The study was conducted in Butajira Demographic Surveillance Site (DSS) in south-central Ethiopia among adults 15–64 years old. Cohort analysis of surveillance data was conducted for the years 1987–2004 complemented by a prospective case-referent (case control) study over two years.

    Rate ratios were computed to assess the relationships between mortality and background variables using a Poisson regression model. In the case-referent component, odds ratios (95% confidence intervals) were used to assess the effect of certain risk factors that were not included in the surveillance system.

    Results A total of 367 940 person years were observed in a period of 18 years, in which 2 860 deaths occurred. One hundred sixty two cases and 486 matched for age, sex and place of residence controls were included in the case referent (case control) study. Only a modest downward trend in adult mortality was seen over the 18 year period. Rural lifestyle carried a significant survival disadvantage [mortality rate ratio 1.62 (95% CI 1.44 to 1.82), adjusted for gender, period and age group], while the overall effects of gender were negligible. Communicable disease mortality was appreciably higher in rural areas [rate ratio 2.05 (95% CI 1.73 to 2.44), adjusted for gender, age group and period]. Higher mortality was associated with a lack of literacy in a household, poor economic status and lack of women's decision making.

    Conclusion A complex pattern of adult mortality prevails, still influenced by war, famine and communicable diseases. Individual factors such as a lack of education, low economic status and social disadvantage all contribute to increased risks of mortality.

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    Young adult and middle age mortality in Butajira demographic surveillance site, Ethiopia: lifestyle, gender and household economy
  • 45. Feldman, Adina L
    et al.
    Griffin, Simon J
    Ahern, Amy L
    Long, Grainne H
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Fhärm, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants2017Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 17, artikel-id 170Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Weight loss in individuals at high risk of diabetes is an effective prevention method and a major component of the currently prevailing diabetes prevention strategies. The aim of the present study was to investigate the public health potential for diabetes prevention of weight maintenance or moderate weight loss on a population level in an observational cohort with repeated measurements of weight and diabetes status.

    METHODS: Height, weight and diabetes status were objectively measured at baseline and 10 year follow-up in a population-based cohort of 33,184 participants aged 30-60 years between 1990 and 2013 in Västerbotten County, Sweden. The association between risk of incident diabetes and change in BMI or relative weight was modelled using multivariate logistic regression. Population attributable fractions (PAF) were used to assess population impact of shift in weight.

    RESULTS: Mean (SD) BMI at baseline was 25.0 (3.6) kg/m(2). Increase in relative weight between baseline and follow-up was linearly associated with incident diabetes risk, odds ratio (OR) 1.05 (95% confidence interval (CI) 1.04-1.06) per 1% change in weight. Compared to weight maintenance (±1.0 kg/m(2)), weight gain of > +1.0 kg/m(2) was associated with an increased risk of incident diabetes, OR 1.52 (95% CI 1.32, 1.74), representing a PAF of 21.9% (95% CI 15.8, 27.6%). For moderate weight loss (-1.0 to -2.0 kg/m(2)) the OR was 0.72 (95% CI 0.52, 0.99).

    CONCLUSIONS: Weight maintenance in adulthood is strongly associated with reduced incident diabetes risk and there is considerable potential for diabetes prevention in promoting this as a whole population strategy.

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  • 46. Fransson, Eleonor
    et al.
    de Faire, Ulf
    Ahlbom, Anders
    Reuterwall, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hallqvist, Johan
    Alfredsson, Lars
    The effect of leisure-time physical activity on the risk of acute myocardial infarction depending on body mass index: a population-based case-control study.2006Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 6, s. 296-Artikel i tidskrift (Refereegranskat)
  • 47. Fransson, Eleonor I.
    et al.
    Nyberg, Solja T.
    Heikkila, Katriina
    Alfredsson, Lars
    Bacquer, De Dirk
    Batty, G. David
    Bonenfant, Sebastien
    Casini, Annalisa
    Clays, Els
    Goldberg, Marcel
    Kittel, France
    Koskenvuo, Markku
    Knutsson, Anders
    Leineweber, Constanze
    Hanson, Linda L. Magnusson
    Nordin, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Singh-Manoux, Archana
    Suominen, Sakari
    Vahtera, Jussi
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Theorell, Tores
    Kivimaki, Mika
    Comparison of alternative versions of the job demand-control scales in 17 European cohort studies: the IPD-Work consortium2012Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 12, s. 62-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Job strain (i.e., high job demands combined with low job control) is a frequently used indicator of harmful work stress, but studies have often used partial versions of the complete multi-item job demands and control scales. Understanding whether the different instruments assess the same underlying concepts has crucial implications for the interpretation of findings across studies, harmonisation of multi-cohort data for pooled analyses, and design of future studies. As part of the 'IPD-Work' (Individual-participant-data meta-analysis in working populations) consortium, we compared different versions of the demands and control scales available in 17 European cohort studies. Methods: Six of the 17 studies had information on the complete scales and 11 on partial scales. Here, we analyse individual level data from 70 751 participants of the studies which had complete scales (5 demand items, 6 job control items). Results: We found high Pearson correlation coefficients between complete scales of job demands and control relative to scales with at least three items (r > 0.90) and for partial scales with two items only (r = 0.76-0.88). In comparison with scores from the complete scales, the agreement between job strain definitions was very good when only one item was missing in either the demands or the control scale (kappa > 0.80); good for job strain assessed with three demand items and all six control items (kappa > 0.68) and moderate to good when items were missing from both scales (kappa = 0.54-0.76). The sensitivity was > 0.80 when only one item was missing from either scale, decreasing when several items were missing in one or both job strain subscales. Conclusions: Partial job demand and job control scales with at least half of the items of the complete scales, and job strain indices based on one complete and one partial scale, seemed to assess the same underlying concepts as the complete survey instruments.

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  • 48. Fredriksson, Mio
    et al.
    Eriksson, Max
    Umeå universitet, Samhällsvetenskapliga fakulteten, Statsvetenskapliga institutionen.
    Tritter, Jonathan
    Who wants to be involved in health care decisions?: Comparing preferences for individual and collective involvement in England and Sweden2017Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 18, artikel-id 18Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Patient and public involvement (PPI) is framed as positive for individuals, the health system, public health, as well as for communities and society as a whole. We investigated whether preferences for PPI differed between two countries with Beveridge type health systems-Sweden and England. We measured willingness to be involved in individual treatment decisions and in decisions about the organization and provision of local health and social care services. Methods: This was a comparative cross-sectional study of the general population's preferences. Together, the two samples included 3125 respondents; 1625 in England and 1500 in Sweden. Country differences were analysed in a multinomial regression model controlling for gender, age and educational attainment. Results: Overall, 68% of respondents wanted a passive patient role and 44% wanted to be involved in local decisions about organization and provision of services. In comparison with in Sweden, they were in England less likely to want a health professional such as a GP or consultant to make decisions about their treatment and also more likely to want to make their own decisions. They were also less likely to want to be involved in local service development decisions. An increased likelihood of wanting to be involved in organizational decision-making was associated with individuals wanting to make their own treatment decisions. Women were less likely to want health professionals to make decisions and more likely to want to be involved in organizational decisions. Conclusions: An effective health system that ensures public health must integrate an effective approach to PPI both in individual treatment decisions and shaping local health and social care priorities. To be effective, involvement activities must take in to account the variation in the desire for involvement and the implications that this has for equity. More work is needed to understand the relationship between the desire to be involved and actually being involved, but both appear related to judgements of the impact of involvement on health care decisions.

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  • 49. Gatimu, Samwel Maina
    et al.
    Milimo, Benson Williesham
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Department of Nursing I, University of the Basque country.
    Prevalence and determinants of diabetes among older adults in Ghana2016Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 16, artikel-id 1174Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Diabetes is one of the leading non-communicable diseases in Africa, contributing to the increasing disease burden among the old adults. Thus, the aim of this study was to determine the prevalence and determinants of diabetes among adults aged 50 years and above in Ghana. Methods: A cross sectional study based on data collected from Study of Ageing and Adult Health (SAGE) Wave 1 from 2007 to 2008. Data was collected from 5565 respondents of whom 4135 were aged 50+ years identified using a multistage stratified clusters design. Bivariate and hierarchical multivariable logistic regression models were used to examine the association of the determinants and diabetes. Results: The weighted prevalence of diabetes among the adults aged 50 years and above in Ghana was 3.95% (95% Confidence Interval: 3.35-4.55) with the prevalence being insignificantly higher in females than males (2.16%, 95% CI: 1. 69-2.76 vs. 1.73%, 95% CI: 1.28-2.33). Low level of physical activity (Adjusted Odds Ratio [AOR] 2.11, 95% CI: 1.21-3.69) and obesity (AOR 4.81, 95% CI: 1.92-12.0) were associated with increased odds of diabetes among women while old age (AOR 2.58, 95% CI: 1.29-5.18) and university (AOR 12.8, 95% CI: 4.20-39.1), secondary (AOR 3.61, 95% CI: 1.38-9.47) and primary education (AOR 2.71, 95% CI: 1.02-7.19) were associated with increased the odds of diabetes among men. Conclusion: The prevalence of diabetes among old adults shows a similar trend with that of the general population. However, the prevalence may have been underestimated due to self-reporting and a high rate of undiagnosed diabetes. In addition, the determinants of diabetes among older adults are a clear indication of the need for diabetes prevention programme targeting the young people and that are gender specific to reduce the burden of diabetes at old age. Physical activity and nutrition should be emphasised in any prevention strategy.

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  • 50. Gaziano, Thomas A.
    et al.
    Abrahams-Gessel, Shafika
    Gomez-Olive, F. Xavier
    Wade, Alisha
    Crowther, Nigel J.
    Alam, Sartaj
    Manne-Goehler, Jennifer
    Kabudula, Chodziwadziwa W.
    Wagner, Ryan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana ; Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand.
    Rohr, Julia
    Montana, Livia
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana ; Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand.
    Baernighausen, Till W.
    Berkman, Lisa F.
    Tollman, Stephen
    Cardiometabolic risk in a population of older adults with multiple co-morbidities in rural south africa: the HAALSI (Health and Aging in Africa: longitudinal studies of INDEPTH communities) study2017Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 17, artikel-id 206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A consequence of the widespread uptake of anti-retroviral therapy (ART) is that the older South African population will experience an increase in life expectancy, increasing their risk for cardiometabolic diseases (CMD), and its risk factors. The long-term interactions between HIV infection, treatment, and CMD remain to be elucidated in the African population. The HAALSI cohort was established to investigate the impact of these interactions on CMD morbidity and mortality among middle-aged and older adults. Methods: We recruited randomly selected adults aged 40 or older residing in the rural Agincourt sub-district in Mpumalanga Province. In-person interviews were conducted to collect baseline household and socioeconomic data, self-reported health, anthropometric measures, blood pressure, high-sensitivity C-reactive protein (hsCRP), HbA1c, HIV-status, and point-of-care glucose and lipid levels. Results: Five thousand fifty nine persons (46.4% male) were enrolled with a mean age of 61.7 +/- 13.06 years. Waist-to- hip ratio was high for men and women (0.92 +/- 0.08 vs. 0.89 +/- 0.08), with 70% of women and 44% of men being overweight or obese. Blood pressure was similar for men and women with a combined hypertension prevalence of 58.4% and statistically significant increases were observed with increasing age. High total cholesterol prevalence in women was twice that observed for men (8.5 vs. 4.1%). The prevalence of self-reported CMD conditions was higher among women, except for myocardial infarction, and women had a statistically significantly higher prevalence of angina (10.82 vs. 6.97%) using Rose Criteria. The HIV- persons were significantly more likely to have hypertension, diabetes, or be overweight or obese than HIV+ persons. Approximately 56% of the cohort had at least 2 measured or self-reported clinical co-morbidities, with HIV+ persons having a consistently lower prevalence of co-morbidities compared to those without HIV. Absolute 10-year risk cardiovascular risk scores ranged from 7.7-9.7% for women and from 12.5-15.3% for men, depending on the risk score equations used. Conclusions: This cohort has high CMD risk based on both traditional risk factors and novel markers like hsCRP. Longitudinal follow-up of the cohort will allow us to determine the long-term impact of increased lifespan in a population with both high HIV infection and CMD risk.

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