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  • 1.
    Abdelaziz, Amr Abdelaziz Badrawy
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Troeller, Kenan Craig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Cost-Effectiveness Analysis of Endovascular versus Open Repair of Ruptured Abdominal Aortic Aneurysm in Sweden2018Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Approximately 600 people die from ruptured abdominal aortic aneurism annually in Sweden. Abdominal aortic aneurysm (AAA) is a widening of the abdominal aorta. If a ruptured aortic aneurysm occurs (RAAA), it is a medical emergency and it is a life-threatening condition. The two interventions used to treat RAAA patients are known as the endovascular strategy (EVAR) and the open repair method (OR). Given the life-threatening nature of RAAA, mortality rates are quite high especially considering that this medical condition affects predominantly the elderly. Determining whether a patient is more suitable for EVAR or OR depends on —among other clinical factors— whether technical expertise and resources are available to perform EVAR. The Swedish Agency for Health and Technology Assessment (SBU) explain that it is currently unclear as to which of the two intervention is the cost-effective alternative in treating RAAA in Sweden. 

    Objective: The aim of this study is to evaluate whether the non-invasive EVAR (endovascular) or traditional surgery known as OR (open repair) is more cost-effective in treating RAAA in Sweden.

    Methods: A Cost-effectiveness analysis with healthcare provider perspective using secondary data from relevant peer-reviewed literature from Sweden, other European countries, Swedvascs' and Socialstyrelsens' registries. The model of choice for this evaluation is a decision tree. The target population is males and females who suffer from RAAA in Sweden ranging from ages 50 – 90+, the majority of which were >65. Two subgroups were analyzed; RAAA patients treated with EVAR  and RAAA patients treated with OR. Total RAAA patients n=178. EVAR n= 73. OR n= 105. The time horizon in the base-case is 90 days. The outcome measures are incremental cost-effectiveness ratio (ICER), QALYs and cost/QALY. A one-way deterministic sensitivity analyses, in addition to a probabilistic sensitivity analysis were performed in order to assess the level of confidence that may be associated with the conclusion of this economic evaluation

    Results: Results from the base-case analysis shows that EVAR's cost per QALY gained is SEK 715,823.82 with an ICER of SEK 1,113,499.44 per QALY gained. Results of the base-case analysis shows that EVAR is not cost-effective when considering the commonly accepted threshold of SEK 500,000 per QALY gained. Results of the deterministic sensitivity analyses show that under all suggested scenarios EVAR was not cost-effective. However, results of the probabilistic sensitivity analysis result shows that there is a considerable uncertainty around the cost-effectiveness of EVAR.

    Conclusion: EVAR is not cost-effective with marginal clinical benefits compared to OR. Since it is a high cost intervention which lacks national guidelines from "Socialstyrelsen", individual county councils in Sweden will likely have to make the decision individually if they want to adopt EVAR as a treatment method for RAAA. While RAAA is a very severe health condition it also has a low prevalence in Sweden meaning county councils with larger population centers, budgets and availability of technical expertise/equipment can still introduce EVAR to treat RAAA even if the cost-effectiveness analysis results exceed the commonly accepted threshold value of SEK 500,000 per QALY gained. Due to uncertainties vis-à-vis a lack of more conclusive data in a Swedish context, further investigation is required before recommending EVAR for subsidization. It would however be worth pursuing this end given the promise of EVAR as a non-invasive and more benign treatment method for patients. 

  • 2.
    Abdelhay, Amro Gaber
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Antibiotic misuse in Egypt from the community pharmacists' perspective.: A study protocol.2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction/Background: Antibiotic resistance (AR) has become a danger threats to all countries and regions in the world. Decreased effectiveness of antibiotics in treating some infections due to antibiotic resistance is leading to more suffering for patients, increased treatment costs, increased days of hospitalization as well as increasing morbidity and mortality. In order to tackle AR, a much more responsible use of antibiotics is needed including avoidance of overuse, overprescribing and any other type of inappropriate use of antibiotics. Egypt is one of the countries with high rate of antibiotic misuse- In the study that this study protocol is outlining, the reasons for misuse will be explored from the community pharmacists’ perspectives in order to suggest possible solutions.

    Objective: The general objective is to study factors contributing to antibiotic misuse in Egypt from the perspective of community pharmacists.

    Method: A cross sectional study will be conducted using structured questionnaire. Answers will be collected from community pharmacists in Fayoum governorate in Egypt whereafter data analysis will be done.

    Study work plan: It is intended that the study period altogether will be six months.

  • 3.
    Abdou, Ahmed
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Experiences and Perspectives of Arabic- speaking Migrants about Healthcare in Sweden2023Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 4.
    Abdullahi, Mohamed Farah
    et al.
    Department of Research and Development, Puntland University of Science and Technology , Galkayo City, Somalia..
    Stewart Williams, Jennifer
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle , Callaghan, Australia.
    Sahlen, Klas-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Bile, Khalif
    enior National Advisor Health Systems and Policy and Board Member Somali and Swedish Researchers' Association (SSRA) , Vällingby, Sweden.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet , Stockholm, Sweden.
    Factors contributing to the uptake of childhood vaccination in Galkayo District, Puntland, Somalia2020Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 13, nr 1, artikel-id 1803543Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: As in many Sub-Saharan African countries, the health system in Somalia is not operating at the capacity needed to lift childhood vaccination coverage to ninety percent or above, as recommended by United Nations Children's Fund. Current national estimates of coverage for the six major vaccine preventable childhood diseases range from thirty to sixty percent. Infectious disease outbreaks continue to pose significant challenges for the country's health authorities.

    OBJECTIVE: This important qualitative study, conducted in Galkayo District, Somalia, investigates limiting factors associated with childhood vaccination uptake from the perspective of both communities and health care workers.

    METHODS: Qualitative information was collected through six focus group discussions with parents (n = 48) and five one-to-one interviews with health workers (n = 15) between March and May 2017, in three settings in the Galkayo District - Galkayo city, Bayra and Bacadwayn.

    RESULTS: From a health system perspective, the factors are: awareness raising, hard to reach areas, negative attitudes and perceived knowledge of health workers, inadequate supplies and infrastructure, and missed vaccination opportunities. From the perspective of individuals and communities the factors are: low trust in vaccines, misinterpretation of religious beliefs, vaccine refusals, Somalia's patriarchal system and rumours and misinformation. Parents mostly received immunization information from social mobilizers and health facilities. Fathers, who are typically family decision-makers, were poorly informed. The findings highlight the need for in-service training to enable health workers to improve communication with parents, particularly fathers, peripheral communities and local religious leaders.

    CONCLUSIONS: Enhancing knowledge and awareness of vaccination among parents is crucial. Fathers' involvement is lacking. This may be boosted by highlighting fathers' obligation to protect their children's health through vaccination. It is also important that men engage with the wider community in decision-making and advance towards the global vaccination targets.

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  • 5.
    Abraha, Atakelti
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Tigray Health Bureau, Tigray and Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia.
    Myléus, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Institutes of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, United Kingdom; 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.
    Kahsay, Asmelash
    Tigray Health Bureau, Tigray and Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institute, Stockholm, Sweden.
    Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia2019Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 14, nr 6, artikel-id e0218101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Despite the significant reductions seen in under-5 child mortality in Ethiopia over the last two decades, more than 10,000 children still die each year in Tigray Region alone, of whom 75% die from preventable diseases. Using an equity lens, this study aimed to investigate the social determinants of child health in one particularly vulnerable district as a means of informing the health policy decision-making process. An exploratory qualitative study design was adopted, combining focus group discussions and qualitative interviews. Seven Focus Group Discussions with mothers of young children, and 21 qualitative interviews with health workers were conducted in Wolkayit district in May-June 2015. Data were subjected to thematic analysis. Mothers’ knowledge regarding the major causes of child mortality appeared to be good, and they also knew about and trusted the available child health interventions. However, utilization and practice of these interventions was limited by a range of issues, including cultural factors, financial shortages, limited female autonomy on financial resources, seasonal mobility, and inaccessible or unaffordable health services. Our findings pointed to the importance of a multi-sectoral strategy to improve child health equity and reduce under-5 mortality in Wolkayit. Recommendations include further decentralizing child health services to local-level Health Posts, and increasing the number of Health Facilities based on local topography and living conditions.

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  • 6.
    Abraha, Atakelti
    et al.
    Tigray Health Bureau, Tigray, Ethiopia;Ethiopian Health Insurance Agency, Addis Ababa, Ethiopia.
    Myléus, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Kahsay, Asmelash
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
    The effects of maternal and child HIV infection on health equity in Tigray Region, Ethiopia, and the implications for the health system: a case-control study2019Ingår i: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 31, nr 10, s. 1271-1281Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 7.
    Abraha Derbew, Atakelti
    et al.
    Ministry of Health, Addis Ababa, Ethiopia; Department of health promotion and disease prevention, Tigray Health Bureau, Mekelle, Tigray, Ethiopia.
    Debeb, Hagos Godefay
    Tigray Health Bureau, Meklle, Tigray, Ethiopia.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Myléus, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. MRC-Wits Rural Public Health and Health Transitions Research, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Gauteng, Johannesburg, South Africa.
    Assessing the performance of the family folder system for collecting community-based health information in Tigray Region, North Ethiopia: a capture–recapture study2024Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 14, nr 2, artikel-id e067735Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To assess completeness and accuracy of the family folder in terms of capturing community-level health data.

    Study design: A capture–recapture method was applied in six randomly selected districts of Tigray Region, Ethiopia.

    Participants: Child health data, abstracted from randomly selected 24 073 family folders from 99 health posts, were compared with similar data recaptured through household survey and routine health information made by these health posts.

    Primary and secondary outcome measures: Completeness and accuracy of the family folder data; and coverage selected child health indicators, respectively.

    Results: Demographic data captured by the family folders and household survey were highly concordant, concordance correlation for total population, women 15–49 years age and under 5-year child were 0.97 (95% CI 0.94 to 0.99, p<0.001), 0.73 (95% CI 0.67 to 0.88) and 0.91 (95% CI 0.85 to 0.96), respectively. However, the live births, child health service indicators and child health events were more erratically reported in the three data sources. The concordance correlation among the three sources, for live births and neonatal deaths was 0.094 (95% CI −0.232 to 0.420) and 0.092 (95% CI −0.230 to 0.423) respectively, and for the other parameters were close to 0.

    Conclusion: The family folder system comprises a promising development. However, operational issues concerning the seamless capture and recording of events and merging community and facility data at the health centre level need improvement.

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  • 8.
    Abrahams-Gessel, Shafika
    et al.
    Center for Health Decision Science, Harvard T.H. Chan School of Public Health, MA, Boston, United States.
    Gómez-Olivé, F. Xavier
    Harvard Center for Population and Development Studies, Harvard University, MA, Cambridge, United States; Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Tollman, Stephen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Wade, Alisha N.
    Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Du Toit, Jacques D.
    Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa.
    Ferro, Enrico G.
    Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, MA, Boston, United States; Harvard Medical School, MA, Boston, United States.
    Kabudula, Chodziwadziwa W.
    Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Gaziano, Thomas A.
    Center for Health Decision Science, Harvard T.H. Chan School of Public Health, MA, Boston, United States; Harvard Center for Population and Development Studies, Harvard University, MA, Cambridge, United States; Cardiovascular Medicine Division, Brigham & Women's Hospital, MA, Boston, United States.
    Improvements in Hypertension Control in the Rural Longitudinal HAALSI Cohort of South African Adults Aged 40 and Older, From 2014 to 20192023Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 36, nr 6, s. 324-332Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Over half of the South African adults aged 45 years and older have hypertension but its effective management along the treatment cascade (awareness, treatment, and control) remains poorly understood.

    METHODS: We compared the prevalence of all stages of the hypertension treatment cascade in the rural HAALSI cohort of older adults at baseline and after four years of follow-up using household surveys and blood pressure data. Hypertension was a mean systolic blood pressure >140 mm Hg or diastolic pressure >90 mm Hg, or current use of anti-hypertension medication. Control was a mean blood pressure <140/90 mm Hg. The effects of sex and age on the treatment cascade at follow-up were assessed. Multivariate Poisson regression models were used to estimate prevalence ratios along the treatment cascade at follow-up.

    RESULTS: Prevalence along the treatment cascade increased from baseline (B) to follow-up (F): awareness (64.4% vs. 83.6%), treatment (49.7% vs. 73.9%), and control (22.8% vs. 41.3%). At both time points, women had higher levels of awareness (B: 70.5% vs. 56.3%; F: 88.1% vs. 76.7%), treatment (B: 55.9% vs. 41.55; F: 79.9% vs. 64.7%), and control (B: 26.5% vs. 17.9%; F: 44.8% vs. 35.7%). Prevalence along the cascade increased linearly with age for everyone. Predictors of awareness included being female, elderly, or visiting a primary health clinic three times in the previous 3 months, and the latter two also predicted hypertension control.

    CONCLUSIONS: There were significant improvements in awareness, treatment, and control of hypertension from baseline to follow-up and women fared better at all stages, at both time points.

  • 9.
    Abrahamsson, Klara
    et al.
    Folkhälsomyndigheten.
    Jonzon, Robert
    Folkhälsomyndigheten.
    Goicolea, Isabel (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Baroudi, Mazen (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hurtig, Anna-Karin (Medarbetare/bidragsgivare)
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Migration, sexuell hälsa och hiv/STI prevention: en sammanfattande rapport2020Rapport (Övrigt vetenskapligt)
  • 10.
    Adams, Victor Eseoghene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Rural and urban disparities in smoking behaviors among men in Nigeria: A decomposition analysis.2022Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Tobacco smoking have been identified as one of the major contributors to preventable death globally. In a study done in Nigeria, on Exploring regional differences and determinants of tobacco use, it was identified that there exist a difference in the use of tobacco between the rural and urban settlement. The goal of this study is to identify the factors that contribute to rural-urban differences in tobacco use among Nigerian men.

    Method: The Nigerian Demographic Health Survey data was employed in our study, which used a cross-sectional design (DHS). This research comprised of 13,311 Nigerian men. To summarize and identify the factors contributing to tobacco usage differences between rural and urban areas, descriptive statistics and Blinder-Oaxaca decomposition were utilized.

    Results: The study identified a small difference in tobacco usage between rural and urban residents, which was largely explained by household affluence and educational attainment. Men from the wealthiest and wealthiest households provided 417.3 percent and 129.8% of the disparity, respectively, while those with a primary and secondary education contributed 34.4% and 143.2%.

    Conclusion: In Nigeria, there are disparities in tobacco use between rural and urban men, according to this study, which is however very small. Materialistic perspective accounted for the majority of the disparities which is quite little. These findings point to key area where the government can focus on in order to remove this gap in tobacco use between rural and urban residents in the country.

  • 11.
    Adams, Victor Eseoghene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Tobacco use in Nigeria: Exploring regional differences and determinants2021Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Globally, tobacco use has been classified as one of the major public health challenges, as it is the largest preventable cause of premature death globally. Tobacco smoking was attributable to 11.5% of total global deaths in 2015 and 150 million disability-adjusted life years. The WHO estimated about 13 million smokers in Nigeria in 2012, while another study gave an estimate of 4.7 million adults above the age of 15 years who use tobacco. Thus, this study will aim to explore the regional trend: regional distributions of tobacco use among Nigerians and factors associated with tobacco use in Nigeria. 

    Method: We did a secondary analysis of cross-sectional data collected from the Demographic Health Survey conducted among households sampled across all the states in Nigeria in 2018. Data were analyzed using the Stata software version 13.

    Results: A total of 55,132 respondent was interviewed, 41,821 women age 15-49 and 13,311 men, age 15-59 were interviewed. The prevalence of tobacco use among men is 7.14% which is significantly higher than in women 0.47%. For the regional differences, the odds of tobacco use among males in South-east (AOR 1.76, 95% CI: 1.38-2.25), South-South (AOR 1.51, 95% CI:1.18-1.9), and South-West (AOR 1.01, 95% 0.78-1.31) is higher than the North-Central. And for females; South-East (AOR 1.82, 95% CI: 1.15-2.91), South-West (AOR 1.11, 95% CI: 0.66-1.87), have higher odds of tobacco use than females in the North-Central. The odds of males in rural settlement using tobacco in (AOR 0.89, 95% CI: 0.76-1.06) is lower compare to those in the urban settlement, while females in the rural settlement (AOR 0.58, 95% CI:0.41-0.81) have a lower odds of using tobacco than those in the urban settlement. After adjusting for demographic characteristics, factors found to be significantly associated with tobacco use in Nigeria at 95% CI include; Age, Region, type of settlement, religion, level of education, and wealth index.

    Conclusion: This study on Tobacco use in Nigeria provided an adequate picture of the regional distribution of tobacco use in Nigeria, and factors that are significantly associated with its use. We found a lack of proper education, type of settlement, older age as factors associated with increased use of tobacco in Nigeria. Thus a more organized and comprehensive measure should be targeted at these factors, and also a more aggressive public enlightenment campaign on the dangers of tobacco to the regions and settlements affected.

  • 12.
    Aden, Jamila Ahmed
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Faculty of Medicine and Health Sciences, East Africa University, Bosaso, Puntland State of Somalia, Somalia; Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Ahmed, Hinda Jama
    Östergren, Per-Olof
    Causes and contributing factors of maternal mortality in Bosaso District Somalia. A retrospective study of 30 cases using a Verbal Autopsy proach2019Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, nr 1, artikel-id 1672314Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Somali women suffer from one of the highest maternal mortality rates in the world. Somalia characterises a specific low-income country situation with a mix of newly urbanized and nomadic culture combined with a frail health care infrastructure set in a post-conflict era. Very little is known about the effects that these contextual factors can have on maternal mortality.

    Objectives: To explore and describe causes and contributing factors concerning maternal deaths in the Bosaso District, Puntland State of Somalia.

    Methods: Data was collected using an adapted Verbal Autopsy tool. In 2017 30 cases of maternal deaths occurring in 2016 in the Bosaso District were reviewed. Information was assessed by three independent reviewers who classified the cause of death and the contributing factors. The Three Delay Model was employed to identify socio-cultural and economic and health system factors that may have contributed to these maternal deaths.

    Results: Direct obstetric deaths accounted for 28 cases. Among these, haemorrhage was the leading cause, followed by eclampsia, sepsis and obstructed labour. Two cases were indirect obstetric deaths, caused by anaemia. All three types of delay were frequent among the studied cases. Delay in deciding to seek care was found in 25 cases, delay in reaching care in 22 cases and delay in receiving health care in 24 cases. Lack of knowledge, money, transportation, poor access and availability of adequate services, as well as substandard management by health care providers, were all underlying the delays.

    Conclusion: A comprehensive intervention programme is needed in order to decrease maternal mortality among Somali women. Such a programme must include health education, improved referral systems and strategic upgrading of care services.

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  • 13. Ades, A. E.
    et al.
    Brickley, Elizabeth B.
    Alexander, Neal
    Brown, David
    Jaenisch, Thomas
    Miranda-Filho, Democrito de Barros
    Pohl, Moritz
    Rosenberger, Kerstin D.
    Soriano-Arandes, Antoni
    Thorne, Claire
    Ximenes, Ricardo Arraes de Alencar
    de Araujo, Thalia Velho Barreto
    Avelino-Silva, Vivian, I
    Bethencourt Castillo, Sarah Esperanza
    Borja Aburto, Victor Hugo
    Brasil, Patricia
    Christie, Celia D. C.
    de Souza, Wayner Vieira
    Gotuzzo, H. Jose Eduardo
    Hoen, Bruno
    Koopmans, Marion
    Martelli, Celina Maria Turchi
    Martins Teixeira, Mauro
    Marques, Ernesto T. A.
    Miranda, Maria Consuelo
    Montarroyos, Ulisses Ramos
    Moreira, Maria Elisabeth
    Morris, J. Glenn
    Rockx, Barry
    Saba Villarroel, Paola Mariela
    Soria Segarra, Carmen
    Tami, Adriana
    Turchi, Marilia Dalva
    Giaquinto, Carlo
    de Lamballerie, Xavier
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Zika virus infection in pregnancy: a protocol for the joint analysis of the prospective cohort studies of the ZIKAlliance, ZikaPLAN and ZIKAction consortia2020Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 10, nr 12, artikel-id e035307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Zika virus (ZIKV) infection in pregnancy has been associated with microcephaly and severe neurological damage to the fetus. Our aim is to document the risks of adverse pregnancy and birth outcomes and the prevalence of laboratory markers of congenital infection in deliveries to women experiencing ZIKV infection during pregnancy, using data from European Commission-funded prospective cohort studies in 20 centres in 11 countries across Latin America and the Caribbean.

    Methods and analysis: We will carry out a centre-by-centre analysis of the risks of adverse pregnancy and birth outcomes, comparing women with confirmed and suspected ZIKV infection in pregnancy to those with no evidence of infection in pregnancy. We will document the proportion of deliveries in which laboratory markers of congenital infection were present. Finally, we will investigate the associations of trimester of maternal infection in pregnancy, presence or absence of maternal symptoms of acute ZIKV infection and previous flavivirus infections with adverse outcomes and with markers of congenital infection. Centre-specific estimates will be pooled using a two-stage approach.

    Ethics and dissemination: Ethical approval was obtained at each centre. Findings will be presented at international conferences and published in peer-reviewed open access journals and discussed with local public health officials and representatives of the national Ministries of Health, Pan American Health Organization and WHO involved with ZIKV prevention and control activities.

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  • 14.
    Afari-Asiedu, Samuel
    et al.
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Oppong, Felix Boakye
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Tostmann, Alma
    Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands.
    Ali Abdulai, Martha
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Boamah-Kaali, Ellen
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Gyaase, Stephaney
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Agyei, Oscar
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Kinsman, John
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Hulscher, Marlies
    Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands.
    Wertheim, Heiman F. L.
    Radboud University Medical Center, Institute for Health Sciences, Nijmegen, Netherlands.
    Asante, Kwaku Poku
    Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
    Determinants of Inappropriate Antibiotics Use in Rural Central Ghana Using a Mixed Methods Approach2020Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, artikel-id 90Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 15.
    Aguiar, Rosaline Bezerra
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Stories of taking part in longterm, timed, personalized rehabilitation: A narrative inquiry of residents with severe mental illness and their rehabilitation pathway2023Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 16.
    Ahmed, Amin
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Prevalence and socioeconomic factors associated with stress in northern Sweden2022Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Stress is worth studying because of the lack of studies in northern Sweden. The aim of studying is to estimate the prevalence of stress and to assess the socioeconomic factors associated to stress in Northern Sweden.

    Methods: Cross-sectional data from the 2018 Health on Equal Terms survey in four regions in northern Sweden was used (N = 23439). The following groups were created: region, sex, age, education, marital status, occupation, unemployment, low cash margin, and financial strain. Prevalence differences corresponding to the intersectional factor were estimated using crude and adjusted regression for outcome variables like stress.

    Results: Stress was significantly higher in females than in males (AOR=1.90, 95% CI: 1.74–2.09). Age was negatively associated with stress (30–44 and 45–64) with (AOR = 0.55, 95% CI: 0.48–0.63) and (AOR = 0.16, 95% CI: 0.14–0.19). stress was significantly higher with marital status. The unmarried, not cohabiting, and divorced were more likely to become stressed (AOR = 1.26, 95% CI: 1.12-1.41) and (AOR = 1.29, 95% CI: 1.07-1.54). stress was also significant among the unemployed (AOR = 1.43, 95% CI: 1.17–1.75) and among those with low cash and making ends meet (AOR = 2.10, 95% CI: 1.85–2.38). Occupation, both highly skilled white collars and low-skilled blue collars were significantly affected by stress (AOR = 1.49, 95% CI: 1.32–1.68) and (AOR = 1.21, 95% CI: 1.06–1.37).

    Conclusion: A series of socioeconomic risk factors were associated to stress in northern Sweden. Our findings might help policymakers develop and implement effective policies and interventions.

  • 17.
    Ahmed, Nazmul
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Are Hypertension and Diabetes associated with Socioeconomic inequalities in Northern Sweden?: A cross-sectional study2022Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background and Aims: Finding socioeconomic inequalities in health is important to creating and starting public health programs that prevent and counteract health inequality. Increasing gaps in socioeconomic inequalities are reported in Northern Sweden for some health indicators. However, less is known about inequality across the social gradient in Northern Sweden in relation to hypertension and diabetes, the two major leading causes of mortality and morbidity worldwide.To bridge this gap, this study aims to examine the association between socioeconomic determinants and two non-communicable diseases (NCD), hypertension, and diabetes in northern Sweden.

    Method: Cross-sectional data from the ‘Health on Equal Terms 2018’ survey in four regions in northern Sweden is used for this study. Birthplace, education, and household income are utilized as socioeconomic indicators. Logistic regression analyses are run to obtain the odds of association across the outcome of hypertension and diabetes separately. 23085 people, 16-84 years of age, is the available sample for hypertension, and for diabetes, the sample size is 23096.

    Result: The prevalence of hypertension is 31.26% in northern Sweden, while the prevalence of diabetes is 7.96%. The male sex, as well as chronologically higher age, lower education, and lower household income are significantly associated with a sequentially greater extent of hypertension and diabetes. Immigrants to northern Sweden who were born outside Europe/USA are also prone to these diseases. ‘Divorced’ people show 23% less vulnerability for diabetes in this study.

    Conclusion: There are two important socioeconomic barriers in front of the population of Northern Sweden; one is income equality, and another is low education. These social gradients are associated with the development of NCD, like hypertension and diabetes, which can increase the risk of mortality and morbidity in the population.

  • 18.
    Ahmed, Nazmul
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Income inequality in hypertension in Northern Sweden: An Wagstaff decomposition Analysis.2023Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 19.
    Ahmed, Tarig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Delayed diagnosis of celiac disease and increased symptoms before the diagnosis2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background Celiac disease is one of the diseases which are not easy to diagnose because it shares common symptoms with many other diseases. The unavailability of diagnostic facilities, the lack of updated guidelines and shortage in training for the medical staff are the factors that contribute to delay the diagnosis.

    Objectives The objective of this study is to investigate the association between the delayed diagnosis of the celiac disease and the increase in the frequency of the symptoms before the diagnosis.

    Methods The survey was conducted in collaboration with the Swedish society of celiac disease, 1560 participants selected randomly, 1031 responded. The participants were asked about the type, duration, and frequency of the symptoms before and after the diagnosis. The symptoms which the participants were asked about are fatigue, body pain, weight loss, abdominal pain, upset stomach, heartburn, nausea, vomiting, mouth ulcer, flatulence, hard stool, soft stool, skin rash, hair loss, joint pain, depression, headache and mood swinging. Furthermore, the participants were asked to report when they had symptoms that could be related to undiagnosed celiac disease and when they got their diagnosis. Also, there were other questions related to their quality of life.The analysis was done by stratifying the answers of the frequency of the symptoms into a binary outcome and the duration of delayed diagnosis into four categories of exposure. A logistic regression model reporting odds ratios was run to assess the association between the predictor and response variables.

    Result An association between delayed diagnosis of celiac disease and increasing the frequency of the symptoms before the diagnosis was found. The gastrointestinal symptoms (abdominal pain, upset stomach, mouth ulcer, flatulence, soft stool, hard stool) showed an association with delayed diagnosis with a significant result of logistic regression reporting odds ratios. Likewise, the frequency of the extra-gastrointestinal symptoms (fatigue, body pain, joint pain, skin rash, and headache) indicated a relationship with delayed diagnosis.

    Conclusion It was found that the delayed diagnosis of celiac disease increases the frequency of the symptoms before the diagnosis. It was suggested that updated guidelines for early detection and screening programs could be an effective solution.

  • 20.
    Akour, Amal
    et al.
    Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan; Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah Univeristy of Jordan, Amman, Jordan.
    Abuloha, Sumaya
    Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan.
    Mulakhudair, Ali R.
    Department of Food Health and Nutrition, College of Food Science, Al-Qasim Green University, Babylon, Iraq.
    Kasabri, Violet
    Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan.
    Al-Tammemi, Ala'a B.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
    Complementary and alternative medicine for urinary tract illnesses: a cross-sectional survey in Jordan2021Ingår i: Complementary Therapies in Clinical Practice, ISSN 1744-3881, E-ISSN 1873-6947, Vol. 43, artikel-id 101321Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to assess the extent of Complementary and Alternative Medicine (CAM) usage, especially herbal preparations, in treating urinary tract illnesses, and their perceived efficacy. This was a cross-sectional survey that used a convenience sample of 278 adults who reported having any form of urinary tract illness. During the last 3 months, 105 (37.8%) of participants had used CAM for various urinary tract conditions, of which, 87 (82.9%) used herbal remedies. Urinary tract infections (UTIs) were the most reported urinary condition (n = 77, 73.3%) among CAM users. The most commonly used herbs were, parsley (n = 54, 19.2%), followed by chamomile (n = 29, 10.4%), barley (n = 20, 7.4%) and ginger (n = 18, 6.7%).The study provides an overview of various CAM remedies used to treat urinary tract illnesses in the Jordanian society, which would draw attention to the necessity of conducting interventional studies to evaluate the efficacy and safety of CAMs in treating urinary tract illnesses, either as stand-alone or adjuvant treatment.

  • 21. Akour, Amal
    et al.
    Al-Tammemi, Ala'a B.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
    Barakat, Muna
    Kanj, Rama
    Fakhouri, Hussam
    Malkawi, Ahmad
    Musleh, Ghadeer
    The Impact of the COVID-19 Pandemic and Emergency Distance Teaching on the Psychological Status of University Teachers: A Cross-Sectional Study in Jordan2020Ingår i: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 103, nr 6, s. 2391-2399Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The COVID-19 pandemic has struck many countries globally. Jordan has implemented strict nationwide control measures to halt the viral spread, one of which was the closure of universities and shifting to remote teaching. The impact of this pandemic could extend beyond the risk of physical harm to substantial psychological consequences. Our study aimed at assessing 1) psychological status, 2) challenges of distance teaching, and 3) coping activities and pandemic-related concerns among university teachers in Jordan in the midst of COVID-19–related quarantine and control measures. We conducted a cross-sectional study using an anonymous online survey. The measure of psychological distress was obtained using a validated Arabic version of the Kessler Distress Scale (K10). Other information collected included sociodemographic profile, methods used to handle distress, motivation to participate in distance teaching, and challenges of distance teaching as well as the most worrisome issues during this pandemic. Three hundred eighty-two university teachers returned completed surveys. Results of K10 showed that 31.4% of respondents had severe distress and 38.2% had mild to moderate distress. Whereas gender was not associated with distress severity, age had a weak negative correlation (Rho = −0.19, P < 0.0001). Interestingly, most teachers had moderate to high motivation for distance teaching. Engagement with family was the most reported self-coping activity. More than half of the participants were most concerned and fearful about SARS-CoV-2 infection. In conclusion, university teachers have shown to exhibit various levels of psychological distress and challenges during the implementation of precautionary national measures in the battle against COVID-19 in Jordan.

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  • 22.
    Aksnes, Dag W.
    et al.
    Nordic Institute for Studies in Innovation, Research & Education (NIFU), Norway.
    Blöcker, Christopher
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för fysik.
    Colliander, Cristian
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen. Umeå universitet, Umeå universitetsbibliotek (UB).
    Nilsson, Lena Maria
    Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Kullerud, Lars (Medarbetare/bidragsgivare)
    UArctic.
    Larson, Keith (Medarbetare/bidragsgivare)
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för ekologi, miljö och geovetenskap.
    SCITE team, (Medarbetare/bidragsgivare)
    Arctic Research Trends: Bibliometrics 2016-20222023Rapport (Övrigt vetenskapligt)
    Abstract [en]

    This work was conducted by the UArctic Thematic Network on Research Analytics and Bibliometrics. It was supported by Global Affairs Canada through the Global Arctic Leadership Initiative.

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  • 23.
    Aksnes, Dag W.
    et al.
    Nordic Institute for Studies in Innovation, Research & Education (NIFU), Norway.
    Danell, Rickard
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Kullerud, Lars
    University of the Arctic (UArctic).
    Nilsson, Lena Maria
    Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Larson, Keith (Medarbetare/bidragsgivare)
    Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum).
    Diane, Hirshberg (Redaktör)
    Institute of Social and Economic Research, University of Alaska Anchorage, United States.
    Arctic research trends: external funding 2016-20222024Rapport (Övrigt vetenskapligt)
    Abstract [en]

    This report aims to provide an update to the two studies published in 2016 and 2017 (Osipov et al 2016 & 2017) with the primary task of assessing the global funding landscape around Arctic-related research. While the previous reports were focusing on the periods 2006-2015 and 2007-2016 respectively, this report covers 2016 to 2022, using the funding data from the Dimensions[1] dataset, which includes information from more than 600 funders and 7 million awarded grants with funding totalling $2.4 trillion+ (in US Dollars).

    The key findings of the updated report, based on the available data, highlight the following trends:  

    ·       The fields of Earth Sciences (10.3 percent) and Environmental Science (5.5 percent) are the two largest recipients of Arctic research funding. 

    ·       The US is the largest Arctic research nation in terms of total spending and number of projects started. It also has the most comprehensive coverage of funding sources in the dataset.  

    ·       Canada and Russia are the second and third largest nations in terms of number of projects started, followed by Norway and Sweden.

    ·       UArctic institutions are central actors in Arctic research globally. 

    ·       Researchers from Arctic Council Observer nations are financing a substantial amount of research on the Arctic. In particular, the UK and Japan finance a significant number of projects, followed by Germany and China with considerable numbers of Arctic-related research projects.

    ·       Funding from the European Union holds the position of the eighth-largest funder based on the number of projects awarded. The European Union is characterized by a few projects with large funding.

    ·       The analysis suggests that there is neither growth nor shrinkage in the relative volume of Arctic research funding over the period 2016–2022 in comparison with the growth of the general scientific community.

    ·       Private funders and foundations contribute little to Arctic research. Only one percent of the projects starting in 2016–2022 were funded privately. 

    In general, the largest sources of external public funding for Arctic research come from the United States (US), Russia, Canada, and Norway, with the US being the biggest net contributor. Other kinds of funding, such as base budgets, are not described in this report. In addition, data on the public funding and funding amounts of Arctic research in Russia, Canada, and the Kingdom of Denmark are not always provided by the funders in project profiles, and net value is sometimes not disclosed by the funders themselves. 

    This report specifically investigates projects initiated between 2016 and 2022, providing insights into the contemporary funding landscape of Arctic research. Understanding the geographical and institutional distribution of funding, as well as the specific areas of focus within this funding, holds significance for UArctic and Arctic Council officials. Such insights facilitate their ability to offer informed guidance to their respective members, aiding in the identification of strategic priorities.

    Moreover, gaining insights into the entities funding Arctic research, and those not engaged in such funding, holds importance for UArctic and Arctic Council science officers. Armed with information about Arctic-focused endeavours they can engage with funding bodies, fostering dialogue aimed at enhancing support, and collaboration for such initiatives.

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  • 24.
    Al- Rubaye, Ali Kadhim Qasim
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Health Behavioral Risk Factors Associated to Quality of Life: A Cross-Sectional Study in Northern Sweden2019Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Obesity, smoking, low level of physical activity, lack of fruit and vegetable intake, and harmful consumption of alcohol, are all established risk factors that have undesirable effects on health. These behavioural risk factors have a joint adverse effect on both morbidity and mortality. This thesis aims to explore the relationship between these risk factors and the quality of life among adults population with an age range between 16 to 84 year old livings in Northern Sweden.

    Methodology: This cross-sectional study is based on data from Sweden‘s national public health survey Hälsa på lika villkor – HLV (Health on Equal Terms) that was conducted between February and May 2014 in the four Northern counties in Sweden: Norrbotten, Västerbotten, Västernorrland, and Jämtland. With a response rate of 50%, the final sample consisted of 25.667 individuals. In this study, individuals with missing data from any of the study variables were dropped to assure complete analysis. The final study population was 17,138 (67% of those who responded to the HET 2014 survey) Multivariable linear regression was used to statistically analyze the relationship between the outcome variable, the EQ5D utility score which is a standardized instrument widely used for measuring the generic health status, and the following independent variables: BMI, physical activity, smoking status, fruit and vegetable intake, and alcohol consumption. The association was presented in terms of coefficient factor and CI 95%.

    Results: The findings showed that risk factors namely obesity, less than the recommended daily level of physical activity, low daily consumption of fruits and vegetables, daily use of tobacco and the heavy episodic drinking of alcohol had significantly associated with Low EQ5D.

    Conclusion: The results of the study suggest that HRQoL measured by EQ5D-3L might have a significant relation with lifestyle behaviours. This finding would emphasize the role of public health interventions for better overall health to the population. More research is needed to fully understand and explore the determinants of the relationship between the lifestyle behaviours and the HRQol.

  • 25.
    Al-Alawi, Kamila
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Team-based approach in the management of diabetes at primary health care level in Muscat, Oman: challenges and opportunities2019Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

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  • 26.
    Al-Alawi, Kamila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Al Mandhari, Ahmed
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Care providers' perceptions towards challenges and opportunities for service improvement at diabetes management clinics in public primary health care in Muscat, Oman: a qualitative study2019Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 19, artikel-id 18Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 27.
    Al-Alawi, Kamila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Perceptions of type-two diabetes patients towards diabetes management visits at public primary health care centres with diverse opinions towards nurse-led clinics in Muscat, Oman: a pilot qualitative studyManuskript (preprint) (Övrigt vetenskapligt)
  • 28.
    Al-Alawi, Kamila
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The question is not what we want; the question is, are we ready?: a qualitative study exploring primary health care providers`perceptions towards different human resources for health management mechanisms at diabetes management clinics in primary health care centres in Muscat, OmanManuskript (preprint) (Övrigt vetenskapligt)
  • 29.
    Al-Alawi, Kamila
    et al.
    Department of Training and Studies, Royal Hospital, Ministry of Health, Muscat, Oman.
    Johansson, Helene
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    “Yes to discuss different models of care between primary care physicians and diabetes-practice nurses, but not to complete implementation yet”: Explorative qualitative study at diabetes clinics in primary health care centres in Muscat, Oman2020Ingår i: International Journal of Healthcare, ISSN 2377-7338, Vol. 6, nr 1, s. 72-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Globally, many models of care through which the way health services are delivered have been adopted withinteam-based primary health care. Although these models have aimed to solve some of the health care challenges related tophysician’s shortages in clinics and further acceptance of non-physician-led clinics, their application is usually determined by arange of factors, such as preparedness of the health care providers, preparedness of patients and support from higher authorities.

    Objective: The study was designed to explore health care providers’ perceptions for changes in models of care in diabetes clinicsat primary health care in Muscat, Oman.

    Methods: A total of 27 semi-structured interviews were conducted with health care providers involved in diabetes clinics atfive purposively selected primary health care centres in Muscat. The interviewees included the core members of the diabetesmanagement team and other supportive members available at the centres, and were of mixed genders, nationalities and professions.Qualitative thematic analysis was applied.

    Results: The analysis resulted in one main theme, which captured positive responses towards task-sharing model, but revealedworries and requirements for complete implementation. Nurses’ competences and diabetic patients’ acceptance were among themain concerns. Health care providers revealed that for complete implementation of the model, nurses’ involvement in the teamcould be improved through updating their knowledge and through the provision of support from higher authorities, while diabeticpatients’ acceptance could be improved through understanding of their perceived knowledge towards the model which couldpromote nurse-led clinics.

    Conclusion: Task-sharing within the discussed possibilities could provide many positive outcomes and a rewarding future fordiabetes clinics at primary health care centres. Omani culture could play a role in its implementation; therefore, if successfulimplementation is desired, carefully considered steps must be applied by the government and the community

  • 30.
    Alao, Jonathan Afamefuna
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    “If Education is expensive, ignorance is more expensive.”: A Qualitative study Exploring the Knowledge, Attitudes, and Beliefs of Diabetes Mellitus by the Staff of Nigeria Baptist Seminary, Ogbomosho, Nigeria.2023Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Diabetes is rapidly increasing worldwide, and in Africa, the prevalence rate is also rapidly increasing. Nigeria has the highest prevalence of Diabetes in Africa. Although the rate of diabetes has been underrepresented because of the traditional and religious influence over the beliefs and the perspective of the people towards diabetes; as well as the inadequate knowledge of the people has affected the management, diagnosis, and prevention of diabetes.

    The study aimed to explore the knowledge, attitudes, and beliefs of diabetes mellitus by the staff of Nigerian Baptist Theological Seminary, Ogbomosho, Nigeria.

    Methods: The qualitative research method was used in the study. The Snowball technique was used to recruit participants, The responses in interview sessions from 5 staff in various offices as lecturers, administrative staff, and service workers, were interpreted using thematic analysis. The themes that were identified and the sub-themes helped in interpreting the result of the study.

    The results show that the participants had some, but limited knowledge about diabetes. There were significant misconceptions that Diabetes could be treated by eating bitter leaves, the disease was perceived as severe, and Education was seen as very important. Secondly, the participants demonstrated a negative attitude towards diabetes, indicating that it is stigmatized. Diabetes was also considered to be a disease of the rich. Thirdly, the participants expressed that diabetes should be treated with care through exercise, right eating habits, and adhering to the doctor's instructions.

    Conclusion: The study identifies that diabetes by the participants is commonly associated with increased sugar [literally sweet food] and carbohydrate in the body. The knowledge level of the staff was poor [they were not aware of any other type of diabetes or about insulin]. The attitude towards diabetes was negative [DM was seen as a problem of the rich, and the stigmatization of diabetes is in relation to beliefs and negative perceptions of diabetes]. The staff’s belief about the management of diabetes or the diabetic was that they are being poorly managed, as it was observed that people may know good practices such as going for medical checkups but don’t necessarily practice it.

  • 31.
    Albahrani, Mohammed
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Minority Stress Model Utilization to Assess Mental Health Outcomes Among Transgender Youth: A scoping review2022Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 32. Alberto Diaz-Sanchez, Adrian
    et al.
    Corona-Gonzalez, Belkis
    Meli, Marina L.
    Obregon Alvarez, Dasiel
    Vega Canizares, Ernesto
    Fonseca Rodriguez, Osvaldo
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Centro Nacional de Sanidad Agropecuaria (CENSA), San José de las Lajas, Mayabeque, Cuba.
    Lobo Rivero, Evelyn
    Hofmann-Lehmann, Regina
    First molecular evidence of bovine hemoplasma species (Mycoplasma spp.) in water buffalo and dairy cattle herds in Cuba2019Ingår i: Parasites & Vectors, E-ISSN 1756-3305, Vol. 12, artikel-id 78Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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  • 33.
    Alemayehu, Asebe Abreham
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Is a Two Component-Dimeticone Cost effective over the standard treatment: A Markov Modelling of Tungiasis Treatment in Sub-Saharan Africa2021Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Tungiasis is a neglected tropical disease caused by infestation of an ectoparasite from the genus Tunga. It is associated with severe morbidity and impaired quality of life. Recently, the Two component Dimeticone found effective in killing sandfleas more than the standard treatment with potassium permanganate and Vaseline. The aim of the study was to assess the cost-effectiveness of the Two-component Dimeticone against the standard treatment among children in the age group of 5-9 in Sub-Saharan Africa region using a decision analysis approach with a health care perspective.

    Method: A four-state Markov model with a cycle duration of one month and a cycle length of 5 years was constructed. The health care perspective was employed to estimate the costs and benefits. The study simulated 100, 000 children at the age of 5 years and followed them until the end of age 9 in the Sub-Saharan Africa region. The discount rate of 5% was used for both benefits and costs. The Incremental cost-effectiveness ratio was calculated, and a one-way sensitivity analysis was performed to assess the uncertainty of parameters.

    Results: The Two-component Dimeticone dominated the standard treatment with the discounted incremental cost-effectiveness ratio (ICER) of 280.8USD. The discounted health gain was 0.1 more QALYs per person with an associated saved discounted cost of 309,358USD. The model was insensitive to the one-way sensitive analysis.

    Conclusion: This study concludes that the Two-component Dimeticone is likely cost-effective and cost saving drug for Tungiasis infested children in the age group 5-9 in the Sub-Saharan Africa compared to the standard treatment.

  • 34.
    Alemayehu, Asebe Abreham
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Study Protocol on Exploring How Women Articulate Their Experience of Violence and Perceive Facilitators and Barriers to Disclose the Violence at One-stop Centres in Ethiopia2020Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 35.
    Alfvén, Tobias
    et al.
    Institutionen för global folkhälsa, Karolinska institutet; Sachsska barn- och ungdomssjukhuset, Stockholm.
    Ekman, Anna-Theresia
    Institutionen för global folkhälsa, Karolinska institutet; S:t Görans sjukhus, Stockholm.
    Awil, Hana
    ST-läkare i allmänmedicin, Mora.
    Holmer, Hampus
    Institutionen för global folkhälsa, Karolinska institutet, Stockholm; Duke Global Health Institute, USA.
    Mia Ekström, Anna
    Institutionen för global folkhälsa, Karolinska institutet; Tema infektion och inflammation, Karolinska universitetssjukhuset, Stockholm.
    Preet, Raman
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Agardh, Anette
    Socialmedicin och global hälsa, Lunds universitet.
    Frielingsdorf Lundqvist, Helena
    Flyktingmedicinskt centrum, Norrköping; Centrum för social och affektiv neurovetenskap, Linköpings universitet.
    Agenda 2030 och målen för en hållbar utveckling angår oss alla: [The 2030 Agenda for Sustainable Development - an important opportunity to improve global health]2020Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, artikel-id 20037Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 36.
    Ali, Mohammed Hassan
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The need for research and evidence-based practice amongst health professionals in Somalia: The case of “The Training of Trainers' program” in research methodology.2019Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 37.
    Ali, Saeeda
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    “Marry them off quickly and get the responsibility over”: A qualitative study of exploring perceptions of child marriage among Rohingya refugees in Cox’s Bazar camps, Bangladesh; Grounded theory approach2019Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

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

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

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

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

  • 38.
    Ali, Sebat Abdulkadir
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Prevalence and predictors of smoking in Northern Sweden: A population-based cross-sectional study.2022Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 39.
    Ali, Winifred
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The role of psychoeducation in reducing the burden of care for relatives of patients with schizophrenia: A scoping review.2022Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

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

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

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

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

  • 40.
    Aljaberi, Musheer A.
    et al.
    Faculty of Medicine & Health Sciences, Taiz University, Taiz, Yemen; Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
    Alsalahi, Abdulsamad
    Department of Pharmacology, Faculty of Pharmacy, Sana’a University, Sana’a, Yemen.
    Juni, Muhamad Hanafiah
    Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
    Noman, Sarah
    Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
    Al-Tammemi, Ala'a B.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary; Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
    Hamat, Rukman Awang
    Department of Medical Microbiology, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
    Efficacy of interventional programs in reducing acculturative stress and enhancing adjustment of international students to the new host educational environment: a systematic review and meta-analysis2021Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, nr 15, artikel-id 7765Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

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

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  • 41.
    Allebeck, Peter
    et al.
    Department of Global Public Health, Karolinska Institutet, Sweden..
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Fifty years of Nordic social medicine and public health: snapshots of a journal2022Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, nr 7, s. 827-830Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 42.
    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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  • 43. Al-Rubaye, Ali K. Q.
    et al.
    Johansson, Klara
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Alrubaiy, Laith
    The association of health behavioral risk factors with quality of life in northern Sweden: A cross-sectional survey2020Ingår i: Journal of general and family medicine, ISSN 2189-7948, Vol. 21, nr 5, s. 167-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It is well known that behavioral risk factors such as obesity, smoking, physical activity, diet, and excessive alcohol are linked to general health in northern Sweden. This study aimed to explore the joint relationship between these risk factors and the quality of life (QoL).

    Methods: Data were collected from Sweden's national public health survey between February and May 2014 in the four northern counties in Sweden. QoL was assessed using the EuroQol (EQ‐5D). Multivariable regression analysis was used to examine the relationship between five risk factors: BMI, physical activity, smoking status, fruit and vegetable intake, and alcohol consumption and QoL.

    Results: Data from 17 138 complete questionnaires showed that individuals who were not obese, did at least 30 minutes of physical activity daily, consumed at least 3 portions of vegetable or fruits, were not smoking daily, and who did not report being drunk at least once every week were found to have better QoL (P < .005). The mean EQ‐5D score ranged from 0.85 to 0.79. Approximately, two thirds of the studied population reported being physically active for at least 30 minutes every day and two fifths of them had a normal BMI. Only around 7% of the sample reported that they were eating the recommended daily level of fruits and vegetables.

    Conclusions: The results of the study suggest that QoL has a significant relationship with lifestyle behaviors. This finding would emphasize the role of interventions to improve population health.

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  • 44.
    Alseddig, Suha
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Covid 19 vaccine dilemma: an exploration of vaccine perceptions among health care workers in Sudan.2021Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 45.
    Alseddig, Suha
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Health and Lifestyle of preschool children with migrant background in Sweden: An outcome-wide epidemiology study2022Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: The immigrant population and Swedish population with a migrant background in Sweden has grown considerably in recent decades. A comprehensive assessment of the health profile and lifestyle characteristics of this population becomes a necessity in order to develop a policy and strategy that targets this population. The aim of this study was to investigate the relationships between children’s migrant background (parents born outside Sweden) and a variety of outcomes, such as health and lifestyle indicators.

    Methods: In this study, the outcome-wide epidemiology approach was used to examine the effects of one exposure (children whose parents were born outside Sweden) on several outcome variables, including health and lifestyle. The study population included 9099 children aged between 33 and 42 months of age. The data were secondary data collected by the SALUT program between 2014 and 2018. Outcome variables were dichotomized. The data were analyzed using descriptive statistics. Simple logistic and linear regressions were used to analyse the associations between parents' place of birth and each outcome variable, whereas multiple logistic and linear regressions were used to control for the effects of parents' income and education. The odds ratios (OR) and confidence intervals (CI) were reported. The P-value was used to support or reject the null hypothesis. The test result was considered statistically significant if the P-value was ≤ 0.05 and the 95% confidence interval was used (95%CI).

    Results: This study found that children whose parents were born outside of Sweden had lower parent-rated health and more socio-emotional problems than children whose parents were born in Sweden. There were no significant differences in BMI between children of immigrants and those of Swedish descent.

    In terms of lifestyle characteristics, children whose parents were born outside of Sweden spent more time playing outdoors during the weekdays and weekends. In contrast, they spent less time watching television during the weekdays and using screens. In spite of this, the screen time spent during the weekend did not differ significantly between children whose parents were born outside of Sweden and those whose parents were born in Sweden.

    On the other hand, migrant children exhibit poorer lifestyle characteristics, such as drinking less than one glass of milk per day, eating less vegetables, eating sweets at least once per day, and brushing their teeth only once per day. Neither fruit nor fish consumption differed significantly between migrant and native-born children.

    Conclusion: The results of this study provide a deeper understanding and a comprehensive insight into the strengths and weaknesses related to health and lifestyle of children of parents with immigrant backgrounds living in Västerbotten, Sweden. Hopefully, this study will assist policy and decision makers in identifying problematic areas in order to reduce inequalities among migrants. Moreover, this study demonstrates the heterogeneity of foreign-born and native children aged three in the country of Västerbotten. Therefore, it is recommended that more research be conducted in order to understand the heterogeneity among migrants’ children.

  • 46.
    AlShurman, Bara’ Abdallah
    et al.
    School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Waterloo, Canada.
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Waterloo, Canada; School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Nanyonjo, Agnes
    Lincoln International Institute for Rural Health, University of Lincoln, Brayford Way, Brayford, Pool, Lincoln, United Kingdom.
    Butt, Zahid Ahmad
    School of Public Health Sciences, Faculty of Health, University of Waterloo, ON, Waterloo, Canada.
    Waite, Nancy M.
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Vernon-Wilson, Elizabeth
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Wong, Ginny
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Grindrod, Kelly
    School of Pharmacy, University of Waterloo, ON, Kitchener, Canada.
    Understanding the COVID-19 vaccine policy terrain in Ontario Canada: a policy analysis of the actors, content, processes, and context2023Ingår i: Vaccines, E-ISSN 2076-393X, Vol. 11, nr 4, artikel-id 782Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    (1) Background: Canada had a unique approach to COVID-19 vaccine policy making. The objective of this study was to understand the evolution of COVID-19 vaccination policies in Ontario, Canada, using the policy triangle framework.

    (2) Methods: We searched government websites and social media to identify COVID-19 vaccination policies in Ontario, Canada, which were posted between 1 October 2020, and 1 December 2021. We used the policy triangle framework to explore the policy actors, content, processes, and context.

    (3) Results: We reviewed 117 Canadian COVID-19 vaccine policy documents. Our review found that federal actors provided guidance, provincial actors made actionable policy, and community actors adapted policy to local contexts. The policy processes aimed to approve and distribute vaccines while continuously updating policies. The policy content focused on group prioritization and vaccine scarcity issues such as the delayed second dose and the mixed vaccine schedules. Finally, the policies were made in the context of changing vaccine science, global and national vaccine scarcity, and a growing awareness of the inequitable impacts of pandemics on specific communities.

    (4) Conclusions: We found that the triad of vaccine scarcity, evolving efficacy and safety data, and social inequities all contributed to the creation of vaccine policies that were difficult to efficiently communicate to the public. A lesson learned is that the need for dynamic policies must be balanced with the complexity of effective communication and on-the-ground delivery of care.

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  • 47.
    Al-Tammemi, Ala'a B.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The Battle Against COVID-19 in Jordan: An Early Overview of the Jordanian Experience2020Ingår i: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, artikel-id 188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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  • 48.
    Al-Tammemi, Ala'a B.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary.
    Akour, Amal
    Alfalah, Laith
    Is It Just About Physical Health?: An Online Cross-Sectional Study Exploring the Psychological Distress Among University Students in Jordan in the Midst of COVID-19 Pandemic2020Ingår i: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 11, artikel-id 562213Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Since the spread of COVID-19 on a global scale, most of efforts at national and international levels were directed to mitigate the spread of the disease and its physical harm, paying less attention to the psychological impacts of COVID-19 on global mental health especially at early stages of the pandemic.

    Objectives: This study aimed to assess and explore (i) The levels of psychological distress and its correlates (ii) Motivation for distance learning (iii) Coping activities and pandemic related concerns, among university students in Jordan in the midst of COVID-19 pandemic.

    Methods: A cross-sectional study was conducted using an online self-administered questionnaire. The measure of psychological distress was obtained using the 10-item Kessler Psychological Distress Scale, while other questions have explored our study’s second and third aims.

    Results: A total of 381 completed questionnaires were included in the analysis. Female participants slightly predominated the sample (n = 199, 52.2%). The respondents aged 18–38 years (mean 22.6 years, SD: 3.16). Concerning distress severity, most of respondents were regarded as having severe psychological distress (n = 265, 69.5%). 209 students (54.9%) reported that they had no motivation for distance learning. Ordinal logistic regression revealed a significant correlation between distress severity and many predictors. Among the predictors that were found to act as protective factors against higher levels of distress included older age (aOR = 0.64, P = 0.022; 95% CI: 0.44–0.94), and having a strong motivation for distance learning (aOR = 0.10, P = 0.048; 95% CI: 0.01–0.96). In contrary, being a current smoker (aOR = 1.99, P = 0.049; 95% CI: 1.10–3.39), and having no motivation for distance learning (aOR = 2.49, P = 0.007; 95% CI: 1.29–4.80) acted as risk factors for having higher levels of psychological distress among the students. The most common coping activity reported was spending more time on social media platforms (n = 269, 70.6%), and 209 students (54.9%) reported distance learning as their most distressing concern.

    Conclusion: The COVID-19 pandemic and related control measures could impact the mental health of individuals, including students. We recommend a nationwide psychological support program to be incorporated into Jordan’s preparedness plan and response strategy in combating the COVID-19 pandemic.

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  • 49.
    Al-Tammemi, Ala'a Bahjat Mohammad Ali
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    The Era of Electronic Cigarettes: A Protocol for a Convergent Parallel Mixed-Method Study Exploring the Use of Electronic Cigarettes in Jordan2020Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 50. Amaku, Marcos
    et al.
    Covas, Dimas Tadeu
    Bezerra Coutinho, Francisco Antonio
    Azevedo Neto, Raymundo Soares
    Struchiner, Claudio
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department Public Health and Clinical, Heidelberg Institute of Global Health, University of Heidelberg, Germany; Department of Disease Control, London School of Hygiene and Tropical, Medicine, U.
    Massad, Eduardo
    Modelling the test, trace and quarantine strategy to control the COVID-19 epidemic in the state of Sao Paulo, Brazil2021Ingår i: Infectious Disease Modelling, ISSN 2468-0427, Vol. 6, s. 46-55Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Testing for detecting the infection by SARS-CoV-2 is the bridge between the lockdown and the opening of society. In this paper we modelled and simulated a test-trace-and-quarantine strategy to control the COVID-19 outbreak in the State of Sao Paulo, Brasil. The State of Sao Paulo failed to adopt an effective social distancing strategy, reaching at most 59% in late March and started to relax the measures in late June, dropping to 41% in 08 August. Therefore, Sao Paulo relies heavily on a massive testing strategy in the attempt to control the epidemic.

    Two alternative strategies combined with economic evaluations were simulated. One strategy included indiscriminately testing the entire population of the State, reaching more than 40 million people at a maximum cost of 2.25 billion USD, that would reduce the total number of cases by the end of 2020 by 90%. The second strategy investigated testing only symptomatic cases and their immediate contacts - this strategy reached a maximum cost of 150 million USD but also reduced the number of cases by 90%. The conclusion is that if the State of Sao Paulo had decided to adopt the simulated strategy on April the 1st, it would have been possible to reduce the total number of cases by 90% at a cost of 2.25 billion US dollars for the indiscriminate strategy but at a much smaller cost of 125 million US dollars for the selective testing of symptomatic cases and their contacts. 

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