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  • 201.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Landstad, Bodil
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Romild, Ulla
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Information Technology and Media.
    Werner, Suzanne
    Self-related health, physical activity and complaints in Swedish high school students2006In: Scientific World Journal, ISSN 1537-744X, E-ISSN 1537-744X, Vol. 6, 816-826 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this investigation was to study self-related health, physical activity and level of exertion, as well as body complaints in Swedish high school students. A total of 993 high school students aged 16–19 years participated in the study. A questionnaire was completed at school and included questions about self-related health, physical activity behavior, type of physical activity/sport, intensity, duration, possible injuries or complaints, and absence from physical training at school, during the last 3 months. The results showed that 26% of the high school students participated in sports on a regular basis. Males reported significantly better health than females (p < 0.0005). A significantly higher number of females participated in physical activities at a lower level of effort (p < 0.0005) and a higher number of males trained at a higher level of effort (p < 0.005). Sixty-one percent reported body pain during the last 3 months, representing a higher number of females than males (p = 0.03). A higher number of females than males reported complaints from the back (p = 0.002), the knees (p = 0.015), the neck (p = 0.001), and the hip (p = 0.015). Females with body complaints reported poorer health than those without complaints. There was a correlation between poor self-related health and a lower level of physical effort (0.219; p < 0.001). The results showed that the prevalence of musculoskeletal symptoms was high in this population and demonstrated a certain association with self-related health. Therefore, it is important to make it easy for adolescents to perform physical activity at school and during their leisure time in order to prevent chronic diseases.

  • 202.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Molin, Ibe
    Physical activity and health among adolescents with cerebral palsy in Sweden2009In: International journal of adolescent medicine and health, ISSN 0334-0139, Vol. 21, no 4, 623-633 p.Article in journal (Refereed)
    Abstract [en]

    Cerebral palsy (CP) is the most common disorder of movement and posture in children. The disorder results from a non-progressive brain lesion occurring in the fetal or infant brain. Children with CP have challenges with movement, posture, and mobility that last a life time. Few studies describe physical activity and health among adolescents with CP. Aim: The aim of this study was to describe self-related health, physical activity, and body complaints among adolescents with CP in Sweden. Methods: A questionnaire was answered by 64 adolescents with CP, with 143 adolescents without disabilities serving as controls. Results: Adolescents with CP reported their general health to be better than adolescents without disabilities (p = .001). Adolescents with CP participated less than adolescents without disabilities in sport during recreation time (p = .009). About 19% of adolescents with CP were never or seldom physically active, compared with 8% in the control group (p = .025). A total of 50% of adolescents with CP reported musculoskeletal complaints during the last three months, compared with 69.5% in the control group. There was a correlation between musculoskeletal complaints and self-related health in adolescents with CP (p = .015) but not in the controls. Conclusion: Adolescents with CP reported their general health to be good. Adolescents with CP were less physically active than adolescents without disabilities. There was a correlation between musculoskeletal complaints and self-related health among adolescents with CP. Further research is needed to determine the cause of the low physical activity among adolescents with CP and also to determine the relationship between musculoskeletal complaints and physical activity.

  • 203.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sjöström, Rita
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Ragnar
    Back to work - evaluation of multidisciplinary rehabilitation programme with emphasis on musculoskeletal disorders. A two year follow-up2007In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 30, no 1, 35-36 p.Article in journal (Refereed)
    Abstract [en]

    Purpose. The aim of this study was to evaluate the 2-year outcome of a multidisciplinary rehabilitation programme for working-age people, regarding sick leave and mental health. Method. The test persons consisted of 40 women and 20 men (mean age 46.8 +/- SD 7.9) with musculoskeletal disorders, mainly neck and back pain. The rehabilitation programme was individually adapted and consisted of physical activity in several forms, relaxation, theoretical and practical education and individual guidance. Before, during and after the programme all participants were evaluated with the Global Self-Efficacy Index, Hospital Anxiety and Depression Scale, and stress test. Results. At the 2-year follow-up full-time sick leave had decreased by 37% (p < 0.0001) in the women, and by 25% (p < 0.05) in the men. Both women and men showed an increased quality of life (QoL) and decreased anxiety, depression and self-experienced stress at the 2-year follow-up compared with the start of the rehabilitation programme. Conclusions. The most important conclusion was that the effects of the rehabilitation programme persisted for up to 2 years. At 2 years the majority of the participants were still physically active, their QoL was increased, and most participants had returned to work.

  • 204.
    Alricsson, Marie
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Werner, Suzanne
    Dansträning för längdskidåkare: får jag lov, Per Elofsson?2002In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 11, no 4, 77-79 p.Article in journal (Other academic)
  • 205.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Werner, Suzanne
    Dansträning för längdskidåkare: får jag lov, Per Elofsson?2002In: Svensk idrottsforskning, ISSN 1103-4629, Vol. 11, no 4, 77-79 p.Article in journal (Other scientific)
  • 206.
    Alricsson, Marie
    et al.
    University of Kalmar, School of Human Sciences. Mittuniversitetet, Institutionen för hälsovetenskap.
    Werner, Suzanne
    Reliability tests of joint motion and muscle flexibility of the hip.2002In: Nordisk fysioterapi, ISSN 1402-3024, Vol. 6, no 3, 119-124 p.Article in journal (Refereed)
  • 207.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Werner, Suzanne
    Reliability tests of joint motion and muscle flexibility of the hip. 2002In: Nordisk fysioterapi, ISSN 1402-3024, Vol. 6, no 3, 119-124 p.Article in journal (Refereed)
  • 208.
    Alricsson, Marie
    et al.
    Mittuniversitetet ; Karolinska Institute.
    Werner, Suzanne
    Karolinska Institute.
    Self-reported health, physical activity and prevalence of complaints in elite cross-country skiers and matched controls2005In: Journal of Sports Medicine and Physical Fitness, ISSN 0022-4707, E-ISSN 1827-1928, Vol. 45, no 4, 547-552 p.Article in journal (Refereed)
    Abstract [en]

    Aim. The purpose of this study was to compare physical health, physical activity and location for possible symptoms in high school students with cross-country skiers of the same age from ski high schools. Another aim was to study back pain with regards to influence on skiing.Methods. The subjects studied were: 92% (n=120) of all Swedish cross-country skiers at ski high schools and 68% (n=993) of regular high school students from the North part of Sweden answered a reliable questionnaire (r=1) with regards to health, physical activity and location of possible symptoms/injuries during the last 3 months. Furthermore, the skiers answered questions on possible ski related back pain.Results. All skiers were active also in other sports compared with 26% of the controls and at considerably higher levels of physical effort than the controls; 92% of the skiers and 76% of the controls described themselves as healthy, meaning "very good" or "good" (P=0.0001); 55% of the skiers and 64% of the controls reported recent symptoms (P=0.06); 47% of the skiers reported previous or present complaints of back pain, mainly low back pain, which could be relieved by changing body position from a flexed to a more extended one while skiing, and 77% reported their back pain to disappear during rest.Conclusion. These results show the need for encouraging regular high school students to participate in sport. It also shows the importance of introducing preventative strategies regarding back pain to long-distance cross-country skiers, who are exposed to a prolonged flexed position of their back.

  • 209.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Section of Sports Medicine, Department of Surgical Sciences, Karolinska Institute, Stockholm.
    Werner, Suzanne
    Section of Sports Medicine, Department of Surgical Sciences, Karolinska Institute, Stockholm; Capio Artro Clinic, S:t Görans Hospital, Stockholm.
    Self-reported health, physical activity and prevalence of complaints in elite cross-country skiers and matched controls2005In: Journal of Sports Medicine and Physical Fitness, ISSN 0022-4707, E-ISSN 1827-1928, Vol. 45, no 4, 547-552 p.Article in journal (Refereed)
    Abstract [en]

    Aim. The purpose of this study was to compare physical health, physical activity and location for possible symptoms in high school students with cross-country skiers of the same age from ski high schools. Another aim was to study back pain with regards to influence on skiing.Methods. The subjects studied were: 92% (n=120) of all Swedish cross-country skiers at ski high schools and 68% (n=993) of regular high school students from the North part of Sweden answered a reliable questionnaire (r=1) with regards to health, physical activity and location of possible symptoms/injuries during the last 3 months. Furthermore, the skiers answered questions on possible ski related back pain.Results. All skiers were active also in other sports compared with 26% of the controls and at considerably higher levels of physical effort than the controls; 92% of the skiers and 76% of the controls described themselves as healthy, meaning "very good" or "good" (P=0.0001); 55% of the skiers and 64% of the controls reported recent symptoms (P=0.06); 47% of the skiers reported previous or present complaints of back pain, mainly low back pain, which could be relieved by changing body position from a flexed to a more extended one while skiing, and 77% reported their back pain to disappear during rest.Conclusion. These results show the need for encouraging regular high school students to participate in sport. It also shows the importance of introducing preventative strategies regarding back pain to long-distance cross-country skiers, who are exposed to a prolonged flexed position of their back.

  • 210.
    Alricsson, Marie
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Werner, Suzanne
    The effect of pre-season dance training on physical indices and back pain in elite cross-country skiers: a prospective controlled intervention study2004In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 38, no 2, 148-153 p.Article in journal (Refereed)
  • 211.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Werner, Suzanne
    The effect of pre-season dance training on physical indices and back pain in elite cross-country skiers: a prospective controlled intervention study2004In: British journal of sports medicine, ISSN 0306-3674, Vol. 38, no 2, 148-153 p.Article in journal (Refereed)
  • 212.
    Alricsson, Marie
    et al.
    Mittuniversitetet.
    Werner, Suzanne
    Karolinska Institutet.
    Young elite cross-country skiers and low back pain: A 5-year study2006In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 7, no 4, 181-184 p.Article in journal (Refereed)
    Abstract [en]

    Objectives To evaluate possible changes in spinal curvature over a period of 5 years of an elite cross-country skiing squad, and to study whether there are any differences in this respect between individuals who report low back pain and those how do not. Participants Fifteen young cross-country skiers (M age=13.6±0.9) participated voluntarily throughout the entire study period. Main outcome measures Debrunner's kyphometer was used for measuring the difference between thoracic kyphosis and lumbar lordosis of the spine. All subjects also answered a questionnaire including questions about ski-related low back pain, the amount of ski training, and participation in other sports. Results The results at the end of the 5-year period comprise data from 15 skiers (M age=18.5±0.9 years). The relationship between thoracic kyphosis and lumbar lordosis increased from 3.5° to 13.1°, respectively (p=0.0001). Of the 15 elite cross-country skiers, seven reported low back pain at the 5-year examination. At the 5-year follow-up, skiers with low back pain showed significantly higher relationship between thoracic kyphosis and lumbar lordosis than did those skiers without low back pain, 18.2° and 10.5°, respectively (p=0.035). Of the eight elite cross-country skiers without low back pain, seven were also involved in other sports (p=0.005). Conclusions Based on these findings, our advice is that adolescent cross-country skiers also should participate in other physical activities besides cross-country skiing.

  • 213.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Werner, Suzanne
    Karolinska Institutet, Stockholm.
    Young elite cross-country skiers and low back pain: A 5-year study2006In: Physical Therapy in Sport, ISSN 1466-853X, E-ISSN 1873-1600, Vol. 7, no 4, 181-184 p.Article in journal (Refereed)
    Abstract [en]

    Objectives To evaluate possible changes in spinal curvature over a period of 5 years of an elite cross-country skiing squad, and to study whether there are any differences in this respect between individuals who report low back pain and those how do not. Participants Fifteen young cross-country skiers (M age=13.6±0.9) participated voluntarily throughout the entire study period. Main outcome measures Debrunner's kyphometer was used for measuring the difference between thoracic kyphosis and lumbar lordosis of the spine. All subjects also answered a questionnaire including questions about ski-related low back pain, the amount of ski training, and participation in other sports. Results The results at the end of the 5-year period comprise data from 15 skiers (M age=18.5±0.9 years). The relationship between thoracic kyphosis and lumbar lordosis increased from 3.5° to 13.1°, respectively (p=0.0001). Of the 15 elite cross-country skiers, seven reported low back pain at the 5-year examination. At the 5-year follow-up, skiers with low back pain showed significantly higher relationship between thoracic kyphosis and lumbar lordosis than did those skiers without low back pain, 18.2° and 10.5°, respectively (p=0.035). Of the eight elite cross-country skiers without low back pain, seven were also involved in other sports (p=0.005). Conclusions Based on these findings, our advice is that adolescent cross-country skiers also should participate in other physical activities besides cross-country skiing.

  • 214.
    Al-Seadi, Sara
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Leva med ADHD: En intervjustudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 215.
    Alsen, Pia
    et al.
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Thörn, Susanna
    Primary Health Care, Sollentuna, Sweden.
    Nordqvist, Linnea
    Primary Health Care, Munkedal, Sweden.
    Berndtsson, Ina
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Men’s Experience of Difficulties during First Year Following Myocardial Infarction: Not OnlyFatigue2016In: Health, ISSN 1949-4998, Vol. 8, 1654-1667 p.Article in journal (Refereed)
    Abstract [en]

    Recovery from a myocardial infarction (MI) can be a very difficult process and some patients are also stricken by fatigue. The aim of the study was to describe the difficulties experienced by men with fatigue during the first year following their MI. The study was conducted using qualitative content analysis of semi-structured interviews with nine men in working age (mean age: 55 years) with verified fatigue (≥12 of 20 on the Multidimensional Fatigue Scale with a mean of 17) one year after their MI. During the first year after the MI the men suffering from fatigue experienced various difficulties in terms of both themselves and the care received. The analysis generated three themes with difficulties described by the interviewed men. 1) Going through involuntary change: not recognizing their body and the inability to recognize themselves. 2) Lacking individualized care: To be denied satisfactory health care treatment and to be denied respectful treatment. 3) Not being seen in the light of the social context: The MI affects the whole family and caregivers do not pay attention to the family. In order to make both the patient and relatives feel secure and cared for, it is essential that caregivers be aware of the importance of providing individualized care over time with particular attention for the patient’s social context.

  • 216. Alssema, M
    et al.
    Vistisen, D
    Heymans, M W
    Nijpels, G
    Glümer, C
    Zimmet, P Z
    Shaw, J E
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stehouwer, C D A
    Tabák, A G
    Colagiuri, S
    Borch-Johnsen, K
    Dekker, J M
    Risk scores for predicting type 2 diabetes: using the optimal tool2011In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 54, no 9, 2468-2470 p.Article in journal (Refereed)
  • 217.
    Altin, Carolina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Kvist Lindholm, Sofia
    Linköping University, Department of Thematic Studies, Department of Child Studies. Linköping University, Faculty of Arts and Sciences.
    Wejdmark, Mats
    Nature School, Municipality of Nynäshamn, Stockholm, Sweden.
    Lättman-Masch, Robert
    Nature School, Municipality of Nynäshamn, Stockholm, Sweden.
    Boldemann, Cecilia
    Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden .
    Upgrading Preschool Environment in a Swedish Municipality: Evaluation of an Implementation Process2015In: Health Promotion Practice, ISSN 1524-8399, E-ISSN 1552-6372, Vol. 16, no 4, 583-591 p.Article in journal (Refereed)
    Abstract [en]

    Redesigning outdoor preschool environment may favorably affect multiple factors relevant to health and reach many children. Cross-sectional studies in various landscapes at different latitudes have explored the characteristics of preschool outdoor environment considering the play potential triggering combined physical activity and sun-protective behavior due to space, vegetation, and topography. Criteria were pinpointed to upgrade preschool outdoor environment for multiple health outcomes to be applied in local government in charge of public preschools. Purposeful land use policies and administrative management of outdoor land use may serve to monitor the quality of preschool outdoor environments (upgrading and planning). This study evaluates the process of implementing routines for upgrading outdoor preschool environments in a medium-sized municipality, Sweden, 2008-2011, using qualitative and quantitative analysis. Recorded written material (logs and protocols) related to the project was processed using thematic analysis. Quantitative data (m2 flat/multileveled, overgrown/naked surface, and fraction of free visible sky) were analyzed to assess the impact of implementation (surface, topography, greenery integrated in play). The preschool outdoor environments were upgraded accordingly. The quality of implementation was assessed using the theory of policy streams approach. Though long-term impact remains to be confirmed the process seems to have changed work routines in the interior management for purposeful upgrading of preschool outdoor environments. The aptitude and applicability of inexpensive methods for assessing, selecting, and upgrading preschool land at various latitudes, climates, and outdoor play policies (including gender aspects and staff policies) should be further discussed, as well as the compilation of data for monitoring and evaluation.

  • 218. Alvarez, J. L.
    et al.
    Kunst, A. E.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Bopp, M.
    Strand, B. H.
    Menvielle, G.
    Lundberg, O.
    Martikainen, P.
    Deboosere, P.
    Kalediene, R.
    Artnik, B.
    Mackenbach, J. P.
    Richardus, J. H.
    Educational inequalities in tuberculosis mortality in sixteen European populations2011In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 15, no 11, 1461-1467 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the magnitude of socioeconomic inequalities in tuberculosis (TB) mortality by level of education in male, female, urban and rural populations in several European countries. DESIGN: Data were obtained from the Eurothine Project, covering 16 populations between 1990 and 2003. Age- and sex-standardised mortality rates, the relative index of inequality and the slope index of inequality were used to assess educational inequalities. RESULTS: The number of TB deaths reported was 8530, with a death rate of 3 per 100000 per year, of which 73% were males. Educational inequalities in TB mortality were present in all European populations. Inequalities in TB mortality were greater than in total mortality. Relative and absolute inequalities were large in Eastern European and Baltic countries but relatively small in Southern European countries and in Norway, Finland and Sweden. Inequalities in mortality were observed among both men and women, and in both rural and urban populations. CONCLUSIONS: Socio-economic inequalities in TB mortality exist in all European countries. Firm political commitment is required to reduce inequalities in the social determinants of TB incidence. Targeted public health measures are called for to improve access to treatment of vulnerable groups and thereby reduce TB mortality.

  • 219.
    Alwin, Jenny
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Eckard, Nathalie
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Fixartjänster i Sveriges kommuner: Kartläggning och samhällsekonomisk analys. Regeringsuppdrag2013Report (Other academic)
    Abstract [en]

    This report deals with so called minor home help services. These services are primarily meant for older persons with the aim to prevent injuries caused by falling in domestic environments (ones home). The minor home help services are mostly provided by the municipalities in Sweden, although it is not mandatory to provide these services. The extent of the provision and use of minor home help services has previously not been studied on a national level. The aim of this study was to delineate the minor home help services run by the municipalities in Sweden and further to examine and estimate the societal costs and consequences of providing these services.

    Out of the 290 municipalities in Sweden, 191 (66 %) offer minor home help services to their citizens. The tasks carried out are primarily aimed at preventing falls from furniture such as step stools or ladders, removing items that may cause falls (cords, carpets etc.) and providing an overhaul of injury risks in the home. A few municipalities also offer outdoor services such as removing snow in wintertime. In the majority of the municipalities (58 %) the services are offered free of charge but the user has to pay for the materials, in 32 % the services are completely free of charge and in 9 % of the municipalities an amount is charged for the services. The minor home help services are organized in various ways in the municipalities: the services can be completely run by the municipality where the services are carried out by one or several employed persons, by persons with disabilities (involved in daily activity programmes in the municipality) or by persons involved in work programmes; or the minor home help services can be carried out by the community rescue service or companies paid by the municipality to offer these services to the citizens. There are also organizations with volunteers that carry out minor home help services, these are however not included in the main results since the focus in this report is on municipal minor home help services. Ninety nine municipalities do not offer minor home help services to their citizens. Reasons for this are e.g. economic restraints and low demand.

    Experienced gains with minor home help services from the perspectives of the municipalities are prevention of falls, facilitation of the possibility to remain living in one’s own home, contribution to social wellbeing and being able to offer meaningful work tasks for persons in work programmes or persons with disabilities. Problems that have been brought forward are low demand of the services, problems with providing the target group with information and difficulties to measure the effect on fall injuries.

    A socioeconomic model was constructed for the analysis of costs and consequences of fall injuries. The model includes the large cost items as well as outcomes such as mortality and loss of quality of life when affected by a fall injury. The total direct costs in Sweden for fall injuries has previously been calculated to approximately 5 billion SEK, which includes only the direct costs during the first year of the injury. A calculation exercise was performed and applied to a hypothetical municipality with 50 000 inhabitants. This calculation exercise shows that if only a small amount of falls that lead to serious injuries (fractures) can be prevented by minor home help services, then the costs saved are approximately equivalent to the mean budget of minor home help services with one employed person. Calculations using real data including both costs and effects need to be performed.

  • 220. Amaku, M
    et al.
    Azevedo, F
    Burattini, M N
    Coelho, G E
    Coutinho, F A B
    Greenhalgh, D
    Lopez, L F
    Motitsuki, R S
    Wilder-Smith, Annelies
    Massad, E
    Magnitude and frequency variations of vector-borne infection outbreaks using the Ross-Macdonald model: explaining and predicting outbreaks of dengue fever2016In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 144, no 16, 3435-3450 p.Article in journal (Refereed)
    Abstract [en]

    The classical Ross-Macdonald model is often utilized to model vector-borne infections; however, this model fails on several fronts. First, using measured (or estimated) parameters, which values are accepted from the literature, the model predicts a much greater number of cases than what is usually observed. Second, the model predicts a single large outbreak that is followed by decades of much smaller outbreaks, which is not consistent with what is observed. Usually towns or cities report a number of recurrences for many years, even when environmental changes cannot explain the disappearance of the infection between the peaks. In this paper, we continue to examine the pitfalls in modelling this class of infections, and explain that, if properly used, the Ross-Macdonald model works and can be used to understand the patterns of epidemics and even, to some extent, be used to make predictions. We model several outbreaks of dengue fever and show that the variable pattern of yearly recurrence (or its absence) can be understood and explained by a simple Ross-Macdonald model modified to take into account human movement across a range of neighbourhoods within a city. In addition, we analyse the effect of seasonal variations in the parameters that determine the number, longevity and biting behaviour of mosquitoes. Based on the size of the first outbreak, we show that it is possible to estimate the proportion of the remaining susceptible individuals and to predict the likelihood and magnitude of the eventual subsequent outbreaks. This approach is described based on actual dengue outbreaks with different recurrence patterns from some Brazilian regions.

  • 221. Ameh, Soter
    et al.
    Gomez-Olive, Francesc Xavier
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), Accra, Ghana.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH), Accra, Ghana.
    Klipstein-Grobusch, Kerstin
    Relationships between structure, process and outcome to assess quality of integrated chronic disease management in a rural South African setting: applying a structural equation model2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, 229Article in journal (Refereed)
    Abstract [en]

    Background: South Africa faces a complex dual burden of chronic communicable and non-communicable diseases (NCDs). In response, the Integrated Chronic Disease Management (ICDM) model was initiated in primary health care (PHC) facilities in 2011 to leverage the HIV/ART programme to scale-up services for NCDs, achieve optimal patient health outcomes and improve the quality of medical care. However, little is known about the quality of care in the ICDM model. The objectives of this study were to: i) assess patients’ and operational managers’ satisfaction with the dimensions of ICDM services; and ii) evaluate the quality of care in the ICDM model using Avedis Donabedian’s theory of relationships between structure (resources), process (clinical activities) and outcome (desired result of healthcare) constructs as a measure of quality of care.

    Methods: A cross-sectional study was conducted in 2013 in seven PHC facilities in the Bushbuckridge municipality of Mpumalanga Province, north-east South Africa - an area underpinned by a robust Health and Demographic Surveillance System (HDSS). The patient satisfaction questionnaire (PSQ-18), with measures reflecting structure/process/outcome (SPO) constructs, was adapted and administered to 435 chronic disease patients and the operational managers of all seven PHC facilities. The adapted questionnaire contained 17 dimensions of care, including eight dimensions identified as priority areas in the ICDM model - critical drugs, equipment, referral, defaulter tracing, prepacking of medicines, clinic appointments, waiting time, and coherence. A structural equation model was fit to operationalise Donabedian’s theory, using unidirectional, mediation, and reciprocal pathways.

    Results: The mediation pathway showed that the relationships between structure, process and outcome represented quality systems in the ICDM model. Structure correlated with process (0.40) and outcome (0.75). Given structure, process correlated with outcome (0.88). Of the 17 dimensions of care in the ICDM model, three structure (equipment, critical drugs, accessibility), three process (professionalism, friendliness and attendance to patients) and three outcome (competence, confidence and coherence) dimensions reflected their intended constructs.

    Conclusion: Of the priority dimensions, referrals, defaulter tracing, prepacking of medicines, appointments, and patient waiting time did not reflect their intended constructs. Donabedian’s theoretical framework can be used to provide evidence of quality systems in the ICDM model.

  • 222. Ameh, Soter
    et al.
    Klipstein-Grobusch, Kerstin
    D'ambruoso, Lucia
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; The International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries (INDEPTH) Accra, Ghana.
    Gomez-Olive, Francesc Xavier
    Quality of integrated chronic disease care in rural South Africa: user and provider perspectives2017In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 32, no 2, 257-266 p.Article in journal (Refereed)
    Abstract [en]

    The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model. In 2013, we conducted a case study of the seven PHC facilities in the rural Agincourt sub-district in northeast South Africa. Focus group discussions (n = 8) were used to obtain data from 56 purposively selected patients >= 18 years. In-depth interviews were conducted with operational managers of each facility and the sub-district health manager. Donabedian's structure, process and outcome theory for service quality evaluation underpinned the conceptual framework in this study. Qualitative data were analysed, with MAXQDA 2 software, to identify 17 a priori dimensions of care and unanticipated themes that emerged during the analysis. The manager and patient narratives showed the inadequacies in structure (malfunctioning blood pressure machines and staff shortage); process (irregular prepacking of drugs); and outcome (long waiting times). There was discordance between managers and patients regarding reasons for long patient waiting time which managers attributed to staff shortage and missed appointments, while patients ascribed it to late arrival of managers to the clinics. Patients reported anti-hypertension drug stock-outs (structure); sub-optimal defaulter-tracing (process); rigid clinic appointment system (process). Emerging themes showed that patients reported HIV stigmatisation in the community due to defaulter-tracing activities of home-based carers, while managers reported treatment of chronic diseases by traditional healers and reduced facility-related HIV stigma because HIV and NCD patients attended the same clinic. Leveraging elements of HIV programmes for NCDs, specifically hypertension management, is yet to be achieved in the study setting in part because of malfunctioning blood pressure machines and anti-hypertension drug stock-outs. This has implications for the nationwide scale up of the ICDM model in South Africa and planning of an integrated chronic disease care in other low-and middle-income countries.

  • 223. Ameh, Soter
    et al.
    Klipstein-Grobusch, Kerstin
    Musenge, Eustasius
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Witwatersrand, Sch Publ Hlth, Fac Hlth Sci, Med Res Council,Wits Univ Rural Publ Hlth, Johannesburg, South Africa ; Int Network Demog Evaluat Populat & Their Hlth De, Accra, Ghana ; Univ Witwatersrand, Sch Publ Hlth, Fac Hlth Sci, Hlth Transit Res Unit Agincourt, Johannesburg, South Africa.
    Tollman, Stephen
    Gomez-Olive, Francesc Xavier
    Effectiveness of an Integrated Approach to HIV and Hypertension Care in Rural South Africa: Controlled Interrupted Time-Series Analysis2017In: Journal of Acquired Immune Deficiency Syndromes, ISSN 1525-4135, E-ISSN 1944-7884, Vol. 75, no 4, 472-479 p.Article in journal (Refereed)
    Abstract [en]

    Background: South Africa faces a dual burden of HIV/AIDS and noncommunicable diseases. In 2011, a pilot integrated chronic disease management (ICDM) model was introduced by the National Health Department into selected primary health care (PHC) facilities. The objective of this study was to assess the effectiveness of the ICDM model in controlling patients' CD4 counts (>350 cells/mm(3)) and blood pressure [BP (<140/90 mm Hg)] in PHC facilities in the Bushbuckridge municipality, South Africa. Methods: A controlled interrupted time-series study was conducted using the data from patients' clinical records collected multiple times before and after the ICDM model was initiated in PHC facilities in Bushbuckridge. Patients >18 years were recruited by proportionate sampling from the pilot (n = 435) and comparing (n = 443) PHC facilities from 2011 to 2013. Health outcomes for patients were retrieved from facility records for 30 months. We performed controlled segmented regression to model the monthly averages of individuals' propensity scores using autoregressive moving average model at 5% significance level. Results: The pilot facilities had 6% greater likelihood of controlling patients' CD4 counts than the comparison facilities (coefficient = 0.057; 95% confidence interval: 0.056 to 0.058; P < 0.001). Compared with the comparison facilities, the pilot facilities had 1.0% greater likelihood of controlling patients' BP (coefficient = 0.010; 95% confidence interval: 0.003 to 0.016; P = 0.002). Conclusions: Application of the model had a small effect in controlling patients' CD4 counts and BP, but showed no overall clinical benefit for the patients; hence, the need to more extensively leverage the HIV program for hypertension treatment.

  • 224.
    Amroussia, Nada
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    "Is the doctor God to punish me?!!": Childbirth experiences and self-perceptions of single mothers in Tunisia2016Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Worldwide, single mothers are considered a vulnerable group in the society. This vulnerability draws on multiple factors and it is reflected in different aspects of women's social, economic and health status depending on the context. In Tunisia, single mothers suffer from social stigmatization and socio-economic marginalization. There are few studies that have explored the social aspects of single motherhood in Tunisia, but, to the authors’ knowledge, the experiences of single mothers with the maternal health services facilities have not been explored yet. The general aim of this study is to explore the childbirth experiences of single mothers at the public health facilities in Tunisia.

    Methods: The thesis follows a qualitative design. In collaboration with non-governmental organizations in Tunisia, 11 single mothers were interviewed in regard to their experiences with maternal health care services and their perceptions of the attitudes of the health workers towards them. The interviews also addressed the barriers faced by these women in accessing adequate maternal health care services, and their self-perceptions as single mothers. The data was analyzed using an inductive thematic approach to generate codes. The development of themes was guided by a theoretical framework that connects the gender relational theory and the intersectional approach.

    Results: Three themes emerged during the data analysis. The first theme "Health systems disciplines single mothers" describes the relation between the single mothers and the maternal health care providers. The majority of the participants were subjected to discriminatory practices, neglect and even violence inflicted by the maternal health care providers. Few of the participants described positive childbirth experiences that are considered as signs of resistance. The second theme "If a woman makes a mistakes once. She has to pay for the rest of her life" reflects the self-perceptions of the participants as single mothers. The participants' self-perceptions are multifaceted: they are overwhelmed mothers living with a persistent feeling of guilt, and they are also challenging and determined mothers. The last theme "The trilogy of vulnerability" includes: the social stigmatization and the socio-economic marginalization experienced by the participants as single mothers, and the situation of the health system described as crumbling by the participants.

    Conclusion: The study highlights that childbirth experiences of single mothers are shaped by intersectional factors that go beyond the health system. Gender plays a major role in constructing these experiences while intersecting with other social structures. The participants had experienced disrespectful and discriminatory practices and even violence when they sought maternal health care services at the public health facilities in Tunisia. Those experiences reflect how the health system translate in its practices the discrimination and stigma culturally associated with single motherhood in this setting. Social discrimination and stigma did not only affect how single mother were treated during the childbirth, but also how they perceived themselves. Thus, ensuring women's right to dignified, respectful health care during childbirth requires tackling the underlying causes of women's marginalization and discrimination in many settings where women face the contingency of multiple social inequities.

  • 225.
    Amroussia, Nada
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Reproductive health policy in Tunisia (1994-2014): Impact on women's right to reproductive health and gender empowerment2015Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Tunisia was regarded as a pioneer in adopting a successful population policy in North Africa and the Middle East region. The Tunisian official family planning program started in 1966 with an objective of controlling population growth. After the International Conference on Population and Development (ICPD) in Cairo in 1994, there was a shift in the Tunisian population policy as the concept of reproductive health was introduced for the first time in national health programs and strategies.

    Methods: The thesis is a policy analysis of the reproductive health policy in Tunisia from a human rights based approach using the Health Rights of Women Assessment Instrument (HeRWAI). The analysis focuses on the impact of this policy on women’s right to reproductive health and gender empowerment.

    Results: The results revealed that Tunisia has started adopting laws promoting for reproductive rights since 1960s, in the form of the right to contraceptive use and the right to abortion. However, slow progress has been made since the ICPD conference in 1994. Furthermore,   significant limitations were found in the implementation of reproductive health policy in relation to women’s right to reproductive health: regional inequities in women’s access to reproductive health care services, discriminatory practices affecting single women and HIV patients, low quality of maternal care services and delay in the integration of the gender-based violence component into the reproductive health care services. The thesis also found that there was a lack of meaningful engagement in action to achieve gender equality in Tunisia. 

  • 226.
    Amroussia, Nada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hernandez, Alison
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Reproductive health policy in Tunisia: women's right to reproductive health and gender empowerment2016In: Health and Human Rights: An International Journal, ISSN 1079-0969, E-ISSN 2150-4113, Vol. 18, no 2, 183-194 p.Article in journal (Refereed)
    Abstract [en]

    Although Tunisia is regarded as a pioneer in the Middle East and North Africa in terms of women's status and rights, including sexual and reproductive health and rights, evidence points to a number of persisting challenges. This article uses the Health Rights of Women Assessment Instrument (HeRWAI) to analyze Tunisia's reproductive health policy between 1994 and 2014. It explores the extent to which reproductive rights have been incorporated into the country's reproductive health policy, the gaps in the implementation of this policy, and the influence of this policy on gender empowerment. Our results reveal that progress has been slow in terms of incorporating reproductive rights into the national reproductive health policy. Furthermore, the implementation of this policy has fallen short, as demonstrated by regional inequities in the accessibility and availability of reproductive health services, the low quality of maternal health care services, and discriminatory practices. Finally, the government's lack of meaningful engagement in advancing gender empowerment stands in the way as the main challenge to gender equality in Tunisia.

  • 227.
    Amroussia, Nada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mosquera, Paola A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Explaining mental health inequalities in Northern Sweden: a decomposition analysis2017In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, 1305814Article in journal (Refereed)
    Abstract [en]

    Background: There has been a substantial increase of income inequalities in Sweden over the last 20 years, which also could be reflected in health inequalities, including mental health inequalities. Despite the growing body of literature focusing on health inequalities in Sweden, income-related inequalities in mental health have received little attention. Particularly scarce are research from Northern Sweden and examinations of the social determinants of health inequalities.

    Objectives: The present study seeks to provide evidence regarding inequalities in mental health in Northern Sweden. The specific aims were to (1) quantify the income-related inequality in mental health in Northern Sweden, and (2) determine the contribution of social determinants to the inequality.

    Methods: The study population comprised 25,646 participants of the 2014 Health on Equal Terms survey in the four northernmost counties of Sweden, aged 16 to 84 years old. Income-related inequalities in mental health were quantified by the concentration index and further decomposed by applying Wagstaff-type decomposition analysis.

    Results: The overall concentration index of mental health in Northern Sweden was −0.15 (95% CI: −0.17 to −0.13), indicating income inequalities in mental health disfavoring the less affluent population. The decomposition analysis results revealed that socio-economic conditions, including employment status (31%), income (22.6%), and cash margin (14%), made the largest contribution to the pro-rich inequalities in mental health. The second-largest contribution came from demographic factors, mainly age (11.3%) and gender (6%). Psychosocial factors were of smaller importance, with perceived discrimination (8%) and emotional support (3.4%) making moderate contributions to the health inequalities. 

    Conclusions: The present study demonstrates substantial income-related mental health inequalities in Northern Sweden, and provides insights into their underpinnings. These findings suggest that addressing the root causes is essential for promoting mental health equity in this region.

  • 228.
    Amroussia, Nada
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hernandez, Alison
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Vives-Cases, Carmen
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    "Is the doctor God to punish me?!": An intersectional examination of disrespectful and abusive care during childbirth against single mothers in Tunisia2017In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 14, 32Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Disrespectful and abusive treatment during childbirth is a violation of women's right to dignified, respectful healthcare throughout pregnancy and childbirth. Although reports point out that marginalized groups in society such as single mothers are particularly vulnerable to abusive and disrespectful care, there is a lack of in-depth research exploring single mothers' encounters at the maternal healthcare facilities, especially in Tunisia. In Tunisia, single mothers are particularly vulnerable due to their social stigmatization and socio-economic marginalization. This study examines the self-perceptions and childbirth experiences of single mothers at the public healthcare facilities in Tunisia.

    METHODS: This study follows a qualitative design. Eleven single mothers were interviewed in regard to their experiences with maternal healthcare services and their perceptions of the attitudes of the health workers towards them. The interviews also addressed the barriers faced by the participants in accessing adequate maternal healthcare services, and their self-perceptions as single mothers. The data were analyzed using an inductive thematic approach guided by the feminist intersectional approach. Emergent codes were grouped into three final themes.

    RESULTS: Three themes emerged during the data analysis: 1) Experiencing disrespect and abuse, 2) Perceptions of regret and shame attributed to being a single mother, and 3) The triad of vulnerability: stigma, social challenges, and health system challenges. The study highlights that the childbirth experiences of single mothers are shaped by intersectional factors that go beyond the health system. Gender plays a major role in constructing these experiences while intersecting with other social structures. The participants had experienced disrespectful and discriminatory practices and even violence when they sought maternal healthcare services at the public healthcare facilities in Tunisia. Those experiences reflect not only the poor quality of maternal health services but also how health system practices translate the stigma culturally associated with single motherhood in this setting. Social stigma did not only affect how single mothers were treated during the childbirth, but also how they perceived themselves and how they perceived their care.

    CONCLUSION: Ensuring women's right to dignified, respectful healthcare during childbirth requires tackling the underlying causes of social inequalities leading to women's marginalization and discrimination.

  • 229.
    Anandavadivelan, Poorna
    et al.
    Karolinska Inst, Stockholm, Sweden..
    Wikman, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Johar, Asif
    Karolinska Inst, Stockholm, Sweden..
    Lagergren, Pernilla
    Karolinska Inst, Stockholm, Sweden..
    Influence of weight loss and eating difficulties on postoperative health-related quality of life across a 10 year trajectory in oesophageal cancer survivors2016In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 25, 25-26 p.Article in journal (Refereed)
  • 230. Ancelle-Park, R.
    et al.
    Armaroli, P.
    Ascunce, N.
    Bisanti, L.
    Bellisario, C.
    Broeders, M.
    Cogo, C.
    de Koning, H.
    Duffy, S. W.
    Frigerio, A.
    Giordano, L.
    Hofvind, S.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Lynge, E.
    Massat, N.
    Miccinesi, G.
    Moss, S.
    Naldoni, C.
    Njor, S.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Paap, E.
    Paci, E.
    Patnick, J.
    Ponti, A.
    Puliti, D.
    Segnan, N.
    Von Karsa, L.
    Tornberg, S.
    Zappa, M.
    Zorzi, M.
    Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet2012In: Journal of Medical Screening, ISSN 0969-1413, Vol. 19, 5-13 p.Article in journal (Refereed)
    Abstract [en]

    Objectives To construct a European 'balance sheet' of key outcomes of population-based mammographic breast cancer screening, to inform policy-makers, stakeholders and invited women. Methods From the studies reviewed, the primary benefit of screening, breast cancer mortality reduction, was compared with the main harms, over-diagnosis and false-positive screening results (FPRs). Results Pooled estimates of breast cancer mortality reduction among invited women were 25% in incidence-based mortality studies and 31% in case-control studies (38% and 48% among women actually screened). Estimates of over-diagnosis ranged from 1% to 10% of the expected incidence in the absence of screening. The combined estimate of over-diagnosis for screened women, from European studies correctly adjusted for lead time and underlying trend, was 6.5%. For women undergoing 10 biennial screening tests, the estimated cumulative risk of a FPR followed by non-invasive assessment was 17%, and 3% having an invasive assessment. For every 1000 women screened biennially from age 50-51 until age 68-69 and followed up to age 79, an estimated seven to nine lives are saved, four cases are over-diagnosed, 170 women have at least one recall followed by non-invasive assessment with a negative result and 30 women have at least one recall followed by invasive procedures yielding a negative result. Conclusions The chance of saving a woman's life by population-based mammographic screening of appropriate quality is greater than that of over-diagnosis. Service screening in Europe achieves a mortality benefit at least as great as the randomized controlled trials. These outcomes should be communicated to women offered service screening in Europe.

  • 231.
    Anchalia, Manju M
    et al.
    Civil Hospital, Asarwa, Ahmedabad, Gujarat, India .
    D'Ambruoso, Lucia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Immpact, University of Aberdeen, UK.
    Seeking solutions: scaling-up audit as a quality improvement tool for infection control in Gujarat, India2011In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 23, no 4, 464-470 p.Article in journal (Refereed)
    Abstract [en]

    QUALITY PROBLEM OR ISSUE: Surgical-site infections (SSIs) give rise to significant demands on the health systems as well as economic and social sequelae for patients. This article describes an audit for infection control developed in a surgical unit of a tertiary care setting in Gujarat state, India that was scaled-up to all state-owned hospitals in the district.

    IMPLEMENTATION: Surveillance and hospital epidemiology were established and practice reforms implemented. Monthly and annual meetings to review implementation were held.

    EVALUATION: After 12 months, an 88% decrease in the infection rate in the surgical unit was demonstrated. Thereafter, the process was replicated across the surgical department and for all cases undergoing surgery. After 12 months, a 67% reduction in the infection rate was detected. The process has since been applied across the state.

    LESSONS LEARNED: A locally owned and team-led process embedded within routine working conditions can challenge widely held perceptions, inform low-cost and no-cost remedial actions, and improve cultures of practice, quality of care and health outcomes. As urban populations grow, methods that are capable of continuously identifying, and responding to, problems and sustaining quality of care in facilities are necessary. SSIs may be largely preventable. With careful implementation, audit has the potential to be a major contributor to their reduction.

  • 232. Anchang-Kimbi, Judith K.
    et al.
    Achidi, Eric Akum
    Nkegoum, Blaise
    Mendimi, Joseph-Marie N.
    Sverremark-Ekström, Eva
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Troye-Blomberg, Marita
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    IgG isotypic antibodies to crude Plasmodium falciparum blood-stage antigen associated with placental malaria infection in parturient Cameroonian women2016In: African Health Sciences, ISSN 1680-6905, E-ISSN 1729-0503, Vol. 16, no 4, 1007-1017 p.Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have reported an association between placental malaria (PM) infection and levels of isotypic antibodies against non-pregnancy associated antigens. Objective: To determine and evaluate IgG isotypic antibody levels to crude P. falciparum blood stage in women with and without PM infection. Methods: Levels of IgG (IgG1-IgG4) and IgM to crude P. falciparum blood stage antigen were measured by ELISA in 271 parturient women. Placental malaria infection was determined by placental blood microscopy and placental histology. Age, parity and intermittent preventive treatment during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) usage were considered during analysis. Results: P. falciparum-specific IgG1 (96.5%) and IgG3 (96.7%) antibodies were predominant compared with IgG2 (64.6%) and IgG4 (49.1%). Active PM infection was associated with significant increased levels of IgG1, IgG4 and IgM while lower levels of these antibodies were associated with uptake of two or more IPTp-SP doses. PM infection was the only independent factor associated with IgG4 levels. Mean IgG1 + IgG3/IgG2 + IgG4 and IgG1 + IgG2 + IgG3/IgG4 ratios were higher among the PM-uninfected group while IgG4/IgG2 ratio prevailed in the infected group. Conclusion: PM infection and IPTp-SP dosage influenced P. falciparum-specific isotypic antibody responses to blood stage antigens. An increase in IgG4 levels in response to PM infection is of particular interest.

  • 233. Andel, Ross
    et al.
    Crowe, Michael
    Hahn, Elizabeth A.
    Mortimer, James
    Pedersen, Nancy L.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Johansson, Boo
    Gatz, Margaret
    Work-Related Stress May Increase the Risk of Vascular Dementia2012In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 60, no 1, 60-67 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To examine job control, job demands, social support at work, and job strain (ratio of demands to control) in relation to risk of any dementia, Alzheimer's disease (AD), and vascular dementia (VaD). DESIGN: Cohort study. SETTING: The population-based Study of Dementia in Swedish Twins. PARTICIPANTS: Two hundred fifty-seven people with dementia (167 AD, 46 VaD) and 9,849 without. MEASUREMENTS: Dementia diagnoses were based on telephone screening for cognitive impairment followed by in-person clinical examination. An established job exposure matrix was matched to main occupation categories to measure work characteristics. RESULTS: In generalized estimating equations (adjusted for the inclusion of complete twin pairs), lower job control was associated with greater risk of any dementia (odds ratio (OR) = 1.17, 95% confidence interval (CI) = 1.04-1.31) and VaD specifically (OR = 1.39, 95% CI = 1.07-1.81). Lower social support at work was associated with greater risk of dementia (OR = 1.15, 95% CI = 1.03-1.28), AD (OR = 1.14, 95% CI = 1.00-1.31), and VaD (OR = 1.28, 95% CI = 1.02-1.60). Greater job strain was associated with greater risk of VaD only (OR = 1.28, 95% CI = 1.02-1.60), especially in combination with low social support (OR = 1.35, 95% CI = 1.11-1.64). Age, sex, and education were controlled for. Work complexity, manual work, and vascular disease did not explain the results. No differences in work-related stress scores were observed in the 54 twin pairs discordant for dementia, although only two pairs included a twin with VaD. CONCLUSION: Work-related stress, including low job control and low social support at work, may increase the risk of dementia, particularly VaD. Modification to work environment, including attention to social context and provision of meaningful roles for employees, may contribute to efforts to promote cognitive health.

  • 234. Andel, Ross
    et al.
    Silverstein, Merril
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Occupational and Leisure Time Engagement at Midlife and Cognitive Functioning in Advanced Old Age2012In: The 21st Nordic Congress of Gerontology, Dilemmas in Ageing Societies, Abstracts and Program, Copenhagen, Denmark, June 10th - 13th, 2012, 2012Conference paper (Refereed)
  • 235.
    Anderberg, Natasha
    Örebro University, School of Health and Medical Sciences.
    Ungdomars erfarenheter av vattenpipsrökning: En kvalitativ intervjustudie2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 236.
    Anderbro, Therese
    et al.
    Stockholm Univ, Dept Psychol, S-10691 Stockholm, Sweden.
    Gonder-Frederick, Linda
    Univ Virginia, Dept Psychiat & Neurobehav Sci, Charlottesville, VA USA.
    Bolinder, Jan
    Karolinska Inst, Karolinska Univ Hosp, Dept Med, Huddinge, Sweden.
    Lins, Per-Eric
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Div Med, Stockholm, Sweden.
    Wredling, Regina
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Div Med, Stockholm, Sweden.
    Moberg, Erik
    Karolinska Inst, Karolinska Univ Hosp, Dept Med, Huddinge, Sweden.
    Lisspers, Jan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Sophiahemmet Univ Coll, Stockholm, Sweden.
    Johansson, Unn-Britt
    Sophiahemmet Univ Coll, Stockholm, Sweden.
    Fear of hypoglycemia: relationship to hypoglycemic risk and psychological factors2015In: Acta Diabetologica, ISSN 0940-5429, E-ISSN 1432-5233, Vol. 52, no 3, 581-589 p.Article in journal (Refereed)
    Abstract [en]

    The major aims of this study were to examine (1) the association between fear of hypoglycemia (FOH) in adults with type 1 diabetes with demographic, psychological (anxiety and depression), and disease-specific clinical factors (hypoglycemia history and unawareness, A(1c)), including severe hypoglycemia (SH), and (2) differences in patient subgroups categorized by level of FOH and risk of SH. Questionnaires were mailed to 764 patients with type 1 diabetes including the Swedish translation of the Hypoglycemia Fear Survey (HFS) and other psychological measures including the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, Social Phobia Scale, and Fear of Complications Scale. A questionnaire to assess hypoglycemia history was also included and A(1c) measures were obtained from medical records. Statistical analyses included univariate approaches, multiple stepwise linear regressions, Chi-square t tests, and ANOVAs. Regressions showed that several clinical factors (SH history, frequency of nocturnal hypoglycemia, self-monitoring) were significantly associated with FOH but R (2) increased from 16.25 to 39.2 % when anxiety measures were added to the model. When patients were categorized by level of FOH (low, high) and SH risk (low, high), subgroups showed significant differences in non-diabetes-related anxiety, hypoglycemia history, self-monitoring, and glycemic control. There is a strong link between FOH and non-diabetes-related anxiety, as well as hypoglycemia history. Comparison of patient subgroups categorized according to level of FOH and SH risk demonstrated the complexity of FOH and identified important differences in psychological and clinical variables, which have implications for clinical interventions.

  • 237.
    Andersen, C. D.
    et al.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Bennet, L.
    Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindblad, U.
    Department of Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lindholm, E.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Groop, L.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Worse glycaemic control in LADA patients than in those with type 2 diabetes, despite a longer time on insulin therapy2013In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 56, no 2, 252-258 p.Article in journal (Refereed)
    Abstract [en]

    Our aim was to study whether glycaemic control differs between individuals with latent autoimmune diabetes in adults (LADA) and patients with type 2 diabetes, and whether it is influenced by time on insulin therapy. We performed a retrospective study of 372 patients with LADA (205 men and 167 women; median age 54 years, range 35-80 years) from Swedish cohorts from SkAyenne (n = 272) and Vasterbotten (n = 100). Age- and sex-matched patients with type 2 diabetes were included as controls. Data on the use of oral hypoglycaemic agents (OHAs), insulin and insulin-OHA combination therapy was retrieved from the medical records. Poor glycaemic control was defined as HbA(1c) a parts per thousand yen7.0% (a parts per thousand yen53 mmol/mol) at follow-up. The individuals with LADA and with type 2 diabetes were followed for an average of 107 months. LADA patients were leaner than type 2 diabetes patients at diagnosis (BMI 27.7 vs 31.0 kg/m(2); p < 0.001) and follow-up (BMI 27.9 vs 30.2 kg/m(2); p < 0.001). Patients with LADA had been treated with insulin for longer than those with type 2 diabetes (53.3 vs 28.8 months; p < 0.001). There was no significant difference between the patient groups with regard to poor glycaemic control at diagnosis, but more patients with LADA (67.8%) than type 2 diabetes patients (53.0%; p < 0.001) had poor glycaemic control at follow-up. Patients with LADA had worse glycaemic control at follow-up compared with participants with type 2 diabetes (OR = 1.8, 95% CI 1.2, 2.7), adjusted for age at diagnosis, HbA(1c), BMI at diagnosis, follow-up time and duration of insulin treatment. Individuals with LADA have worse glycaemic control than patients with type 2 diabetes despite a longer time on insulin therapy.

  • 238. Andersen, Pia
    et al.
    Olander, Ewy
    Blekinge Institute of Technology, School of Health Science.
    Utvärdering av implementeringen av hälsotorgen i Blekinge -med fokus på hälsotorgens utvecklingsmöjligheter2008Other (Other academic)
    Abstract [en]

    I den svenska folkhälsopolitiken betonas hälso- och sjukvårdens roll i folkhälsoarbetet genom ett eget målområde, ”En hälsofrämjande hälso- och sjukvård” År 2000 påbörjade Landstinget i Blekinge ett samarbete med Apoteket AB för utveckling av Hälsotorg som en ny typ av offentlig arena för hälsofrämjande och förebyggande arbete. Den är tänkt som en mötesplats för hälsoinformation, egenvårdsrådgivning och hälsosamtal med professionell personal från landsting och apotek. Syftet med denna utvärdering är att beskriva implementeringen av hälsotorgen i Blekinge och hälsotorgens utvecklingsmöjligheter. Enskilda intervjuer har genomförts med nyckelinformanter för att ta del av deras erfarenheter och upplevelser av hälsotorgsarbetet. Verksamhetschefer och hälsotorgspersonal intervjuades, sammanlagt tolv personer. Idag finns hälsotorg som har byggts upp i samverkan mellan Apoteket AB och Landstinget Blekinge i fyra av länets fem kommuner. Hälsotorgen har startat vid olika tidpunkter mellan år 2000 och 2006. De är något olika utformande, bemannade och lokaliserade. Resultatet visar en övervägande positiv bild av hälsotorgens verksamhet och det finns en framtidstro på fortsatt utveckling av hälsotorgen. Såväl ”uppifrån” stöd i form av direktiv och ekonomiska medel som ”underifrån” stöd genom lokalt engagemang och delaktighet har varit betydelsefulla faktorer i implementeringsprocessen. Det finns en ganska samstämmig uppfattning om hur de övergripande målen för hälsotorgen uppfyllts men målen är inte väl förankrade i verksamheten. Varje hälsotorg har utformat sin egen verksamhet utifrån befintligt avtal mellan Apoteket AB och Landstinget Blekinge samt utifrån hälsotorgspersonalens engagemang. Den mest framträdande svagheten är en otillräcklig marknadsföring, vilket har medfört att hälsotorgens verksamhet inte har blivit förankrad i önskvärd omfattning bland befolkningen och övrig personal på vårdcentralerna. Det råder en osäkerhet om hur det fortsatta samarbetet med Apoteket AB kan utvecklas med anledning av omregleringen av apoteksmarknaden 2009. Utvärderingen ger en positiv bild av hälsotorg både som fenomen och verksamhet. Informanterna anser att hälsotorgen har potential till att kunna vara en hälsofrämjande arena. För fortsatt utveckling till en sådan arena är det betydelsefullt med utbildningsinsatser som kan stärka hälsotorgspersonalens kompetens för hälsofrämjande arbete. Det är också betydelsefullt med informationsinsatser bland befolkning och hälso- och sjukvårdspersonal för att öka medvetenheten om hälsotorgens verksamhet och därmed skapa grund för samarbete och ett ökat utnyttjande av hälsotorgens service.

  • 239. Andersen, Ronald
    et al.
    Smedby, Björn
    Vågerö, Denny
    Cost containment, solidarity and cautious experimentation: Swedish dilemmas2001In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 52, 1195-1204 p.Article in journal (Refereed)
    Abstract [en]

    This paper uses secondary data analysis and a literature review to explore a “Swedish Dilemma”: Can Sweden continue to provide a high level of comprehensive health services for all regardless of ability to pay — a policy emphasizing “solidarity” — or must it decide to impose increasing constraints on health services spending and service delivery — a policy emphasizing “cost containment?” It examines recent policies and longer term trends including: changes in health personnel and facilities; integration of health and social services for older persons; introduction of competition among providers; cost sharing for patients; dismantling of dental insurance; decentralization of government responsibility; priority settings for treatment; and encouragement of the private sector. It is apparent that the Swedes have had considerable success in attaining cost containment — not primarily through “market mechanisms” but through government budget controls and service reduction. Further, it appears that equal access to care, or solidarity, may be adversely affected by some of the system changes.

  • 240. Anderson, Ian
    et al.
    Robson, Bridget
    Connolly, Michele
    Al-Yaman, Fadwa
    Bjertness, Espen
    King, Alexandra
    Tynan, Michael
    Madden, Richard
    Bang, Abhay
    Coimbra, Carlos E. A., Jr.
    Pesantes, Maria Amalia
    Amigo, Hugo
    Andronov, Sergei
    Armien, Blas
    Obando, Daniel Ayala
    Axelsson, Per
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Bhatti, Zaid Shakoor
    Bhutta, Zulfi Qar Ahmed
    Bjerregaard, Peter
    Bjertness, Marius B.
    Briceno-Leon, Roberto
    Broderstad, Ann Ragnhild
    Bustos, Patricia
    Chongsuvivatwong, Virasakdi
    Chu, Jiayou
    Deji, .
    Gouda, Jitendra
    Harikumar, Rachakulla
    Htay, Thein Thein
    Htet, Aung Soe
    Izugbara, Chimaraoke
    Kamaka, Martina
    King, Malcolm
    Kodavanti, Mallikharjuna Rao
    Lara, Macarena
    Laxmaiah, Avula
    Lema, Claudia
    Taborda, Ana Maria Leon
    Liabsuetrakul, Tippawan
    Lobanov, Andrey
    Melhus, Marita
    Meshram, Indrapal
    Miranda, J. Jaime
    Mu, Thet Thet
    Nagalla, Balkrishna
    Nimmathota, Arlappa
    Popov, Andrey Ivanovich
    Poveda, Ana Maria Penuela
    Ram, Faujdar
    Reich, Hannah
    Santos, Ricardo V.
    Sein, Aye Aye
    Shekhar, Chander
    Sherpa, Lhamo Y.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University.
    Tano, Sofia
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Business Administration.
    Tanywe, Asahngwa
    Ugwu, Chidi
    Ugwu, Fabian
    Vapattanawong, Patama
    Wan, Xia
    Welch, James R.
    Yang, Gonghuan
    Yang, Zhaoqing
    Yap, Leslie
    Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10040, 131-157 p.Article in journal (Refereed)
    Abstract [en]

    Background: International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries.

    Methods: Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated.

    Findings: Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations.

    Interpretation: We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems.

  • 241.
    Anderson, Peter
    et al.
    Newcastle University, England; Maastricht University, Netherlands.
    Kaner, Eileen
    Newcastle University, England.
    Keurhorst, Myrna
    Radboud University of Nijmegen, Netherlands; Saxion University of Appl Science, Netherlands.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    van Steenkiste, Ben
    Maastricht University, Netherlands.
    Reynolds, Jillian
    IDIBAPS, Spain.
    Segura, Lidia
    Govt Catalonia, Spain.
    Wojnar, Marcin
    Medical University of Warsaw, Poland.
    Kloda, Karolina
    Pomeranian Medical University, Poland.
    Parkinson, Kathryn
    Newcastle University, England.
    Drummond, Colin
    Kings Coll London, England; Maudsley NHS Fdn Trust, England.
    Okulicz-Kozaryn, Katarzyna
    State Agency Prevent Alcohol Related Problems, Poland.
    Mierzecki, Artur
    Pomeranian Medical University, Poland.
    Laurant, Miranda
    Radboud University of Nijmegen, Netherlands; HAN University of Appl Science, Netherlands.
    Newbury-Birch, Dorothy
    University of Teesside, England.
    Gual, Antoni
    IDIBAPS, Spain.
    Attitudes and Learning through Practice Are Key to Delivering Brief Interventions for Heavy Drinking in Primary Health Care: Analyses from the ODHIN Five Country Cluster Randomized Factorial Trial2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 2, 121Article in journal (Refereed)
    Abstract [en]

    In this paper, we test path models that study the interrelations between primary health care provider attitudes towards working with drinkers, their screening and brief advice activity, and their receipt of training and support and financial reimbursement. Study participants were 756 primary health care providers from 120 primary health care units (PHCUs) in different locations throughout Catalonia, England, The Netherlands, Poland, and Sweden. Our interventions were training and support and financial reimbursement to providers. Our design was a randomized factorial trial with baseline measurement period, 12-week implementation period, and 9-month follow-up measurement period. Our outcome measures were: attitudes of individual providers in working with drinkers as measured by the Short Alcohol and Alcohol Problems Perception Questionnaire; and the proportion of consulting adult patients (age 18+ years) who screened positive and were given advice to reduce their alcohol consumption (intervention activity). We found that more positive attitudes were associated with higher intervention activity, and higher intervention activity was then associated with more positive attitudes. Training and support was associated with both positive changes in attitudes and higher intervention activity. Financial reimbursement was associated with more positive attitudes through its impact on higher intervention activity. We conclude that improving primary health care providers screening and brief advice activity for heavy drinking requires a combination of training and support and on-the-job experience of actually delivering screening and brief advice activity.

  • 242.
    Andersson, Anders-Petter
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap II. Kristianstad University, Research Platform for Collaboration for Health.
    Cappelen, Birgitta
    The Oslo School of Architecture and Design.
    Musical interaction for health improvement2014In: Oxford handbook of interactive audio / [ed] Karen Collins, Bill Kapralos, Holly Tessler, Oxford: Oxford University Press , 2014, 247-262 p.Chapter in book (Refereed)
    Abstract [en]

    During the past decade, tangible sensor technologies have matured and become less expensive and easier to use, leading to an explosion of innovative musical designs within video games, smartphone applications, and interactive art installations. Interactive audio has become an important design quality in commercially successful games like Guitar Hero , and a range of mobile phone applications motivating people to interact, play, dance, and collaborate with music. Parallel to the game, phone, and art scenes, an area of music and health research has grown, showing the positive results of using music to promote health and wellbeing in everyday situations and for a broad range of people, from children and elderly to people with psychological and physiological disabilities. Both quantitative medical and ecological humanistic research show that interaction with music can improve health, through music’s ability to evoke feelings, motivate people to interact, master, and cope with difficult situations, create social relations and experience shared meaning. Only recently, however, the music and health field has started to take interest in interactive audio, based on computer-mediated technologies’ potential for health improvement. Here, we show the potential of using interactive audio in what we call interactive musicking in the computer-based interactive environment Wave. Interactive musicking is based on musicologist Christopher Small’s concept “musicking”, meaning any form of relation-building that occurs between people, and people and things, related to activities that include music. For instance, musicking includes dancing, listening, and playing with music (in professional contexts and in amateur, everyday contexts). We have adapted the concept of "musicking" on the design of computer-based musical devices. The context for this chapter is the research project RHYME. RHYME is a multidisciplinary collaboration between the Centre for Music and Health at the Norwegian Academy of Music, the Oslo School of Architecture and Design (AHO), and Informatics at the University of Oslo. Our target group is families with children with severe disabilities. Our goal is to improve health and wellbeing in the families through everyday musicking activities in interactive environments. Our research approach is to use knowledge from music and health research, musical composition and improvisation, musical action research, musicology, music sociology, and soundscape studies, when designing the tangible interactive environments. Our focus here is interaction design and composition strategies, following research-by-design methodology, creating interactive musicking environments. We describe the research and design of the interactive musicking environment Wave, based on video documentation, during a sequence of actions. Our findings suggest some interactive audio design strategies to improve health. We base the design strategies on musical actions performed while playing an instrument, such as impulsive or iterative hitting, or sustainable stroking of an instrument. Musical actions like these can also be used for musicking in everyday contexts, creating direct sound responses to evoke feelings that create expectations and confirm interactions. In opposition to a more control-oriented, instrument and interface perspective, we argue that musical variation and narrative models can be used to design interactive audio, where the audio is seen as an actor taking many different roles, as instrument, co-musician, toy, etc. In this way, the audio and the interactive musicking environments will change over time, answering with direct response, as well as nose-thumbing and changing response, motivating creation, play, and social interaction. Musical variation can also be used to design musical backgrounds and soundscapes that can be used for creating layers of ambience. These models create a safe environment and contribute to shared meaning.

  • 243.
    Andersson, Anders-Petter
    et al.
    Institute of Design, The Oslo School of Architecture and Design.
    Cappelen, Birgitta
    Institute of Design, The Oslo School of Architecture and Design.
    Vocal and tangible interaction crossing borders2013In: Include Asia 2013 Proceedings: global challenges and local solutions in inclusive design, Conference on inclusive design / [ed] Jeremy Myerson, London: Helen Hamlyn Centre of Design, The Royal College of Art in London, The Hong Kong Design Centre , 2013Conference paper (Refereed)
    Abstract [en]

    Our voice and body are important parts of our self-expression and self-experience for all of us. They are also essential for our way to communicate and build relations cross borders such as abilities, ages, locations and backgrounds. Voice, body and tangibility gradually become more important for ICT, due to increased development of tangible interaction and mobile communication. The voice and tangible interaction therefore also become more important for the Universal Design field. In this paper we present and discuss our work with voice and tangible interaction in our ongoing research project RHYME. The goal is to improve health for families, adults and children with disabilities through use of collaborative, musical, tangible and sensorial media. We build on use of voice in Music Therapy, knowledge from multi-sensory stimulation and on a humanistic health approach. Our challenge is to design vocal and tangible interactive media that are sensorially stimulating. Interactive media that through use reduce isolation and passivity and increase empowerment for all the users. We use sound recognition, generative sound synthesis, vibrations and cross-media techniques, to create rhythms, melodies and harmonic chords to stimulate voice-body connections, positive emotions and structures for actions.

  • 244.
    Andersson, Björn
    Karlstad University, Faculty of Social and Life Sciences.
    Risklinjen: - Empowerment, men med olika perspektiv2009Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Injuries caused by accidents are one of the major health problems in Sweden. Risklinjen is a model to increase people’s awareness and possibilities to report risk for injuries. In spite of this several municipalities choose to leave Risklinjen. This thesis tries to find out how municipalities argue about Risklinjen and membership in this function.

  • 245.
    Andersson, Björn
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Avdelningen för hälsa och miljö.
    Dahl, Gunnar
    Karlstads kommun.
    Mårtensson, Ulf
    Karlstads kommun.
    Andersson, Ragnar
    Karlstad University, Faculty of Social and Life Sciences, Avdelningen för hälsa och miljö.
    Skolbränder och skolbrandsprevention: Underlag för planerade insatser enligt ”Karlstadsmodellen”2009Report (Other academic)
    Abstract [sv]

    Kan man förebygga anlagda bränder och annan skadegörelse i skolor med miljöinriktade åtgärder? Den bedömningen gör man i Karlstads kommun med stöd i kriminologisk teori och erfarenheter från andra sektorer. Den traditionella ansatsen är annars är att kombinera brandtekniska åtgärder med ett mer individorienterat perspektiv riktat mot gärningspersoner. Syftet med föreliggande rapport är att ge en djupare belysning av den teoretiska grundvalen för en bredare miljöinriktad strategi, samt att peka på möjligheter att följa och utvärdera effekter av en lokal tillämpning. I bilaga redovisas även en forskningsöversikt kring den vetenskapliga evidens som idag föreligger beträffande miljöinriktad brottsprevention.

  • 246.
    Andersson, Carolina
    et al.
    University West, Department of Nursing, Health and Culture, Divison for Health, Culture and Educational Sciences.
    Johansson, Jennifer
    University West, Department of Nursing, Health and Culture, Divison for Health, Culture and Educational Sciences.
    Visionen om ledarskapet: Hur förverkligas ledarskapsvisionen i den vardagliga verksamheten?2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose with our qualitative study is to investigate the vision of leadership but how does one perfect visionary leadership in an everyday activity? To help us find out the purpose of this we have conducted semi structured interviews involving leadership in occupations. These interviews have provided phenomenal inspiration since our main focus is the experiences of leadership. In our analysis we have used the method of phenomenal analysis and as well as the process of the data. Our empiricist consists of ten interviews, eight of which are conducted with co-workers and two of which are conducted with team leaders.

    Our result shows that the activity doesn't have an outspoken vision between co-workers and leaders. However both the leaders have a vision about their leadership which doesn't appear literally. Our study shows that if a leaders visions appears in practice, it therefore doesn't have to be official since it is already clearly expressed. We find that through our case study that occupation can evolve their leadership as well as their employeeship with the help of our results

  • 247.
    Andersson, Christina
    et al.
    University of Skövde, School of Health and Education.
    Lindberg, Cecilia
    University of Skövde, School of Health and Education.
    Hälsorisker hos flickor vilka använde sociala medier: en litteraturöversikt2016Independent thesis Basic level (university diploma), 5 credits / 7,5 HE creditsStudent thesis
    Abstract [en]

    Introduction: Social media has created a new arena for integration. Social media seems to affect young girls mental health. The purpose of the literature review is to examine some health risks among girls aged 11 to 17 years born after 1993 witch has been exposed to through social media. Method: Ten original articles published in the past five years have been sought out through PubMed. Relevant articles were reviewed and thematized based on health risks which are found in the overview. Results: The literature review examined previous research on health risks in young girls born after 1993 in the use of social media. Girls tend to be more affected by the comments and are affected over time which can lead to depression and anxiety. Self-harm and suicidal tendencies are directly linked to depression. Self-confidence is affected by comments on social media. Girls tend increasingly to suffer from psychosomatic disorders due to use of social media. Social media can increase the feeling of fear and insecurity. The girls' body image is influenced by social media, which ultimately can lead to eating disorders. Discussion: The use of social media can be seen as a health risk in young girls. Nevertheless, the impact of social media is seen as on of the triggers for other underlying causes. Social media can also provide health benefits.

  • 248.
    Andersson, David
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Co-morbidity and health care utilisation five years prior to diagnosis for depression: A register-based study in a Swedish population2011In: BMC Public Health, ISSN 1471-2458, Vol. 11, 552- p.Article in journal (Refereed)
    Abstract [en]

    Background

    Depressive disorders have been associated with a number of co-morbidities, and we   hypothesized that patients with a depression diagnosis would be heavy users of health   care services, not only when first evaluated for depression, but also for preceding   years. The aim of this study was to investigate whether increased health care utilisation   and co-morbidity could be seen during five years prior to an initial diagnosis of   depression.

    Methods

    We used a longitudinal register-based study design. The setting comprised the general   population in the county of Östergötland, south-east Sweden. All 2470 patients who   were 20 years or older in 2006 and who received a new diagnosis of depression (F32   according to ICD-10) in 2006, were selected and followed back to the year 2001, five   years before their depression diagnosis. A control group was randomly selected among   those who were aged 20 years or over in 2006 and who had received no depression diagnosis   during the period 2001-2006.

    Results

    Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status.

    Patients who received a diagnosis of depression used twice the amount of health care   (e.g. physician visits and hospital days) during the five year period prior to diagnosis   compared to the control group. A particularly strong increase in health care utilisation   was seen the last year before diagnosis. These findings were supported with a high   level of co-morbidity as for example musculoskeletal disorders during the whole five-year   period for patients with a depression diagnosis.

    Conclusions

    Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status. To find early signs   of depression in the clinical setting and to use a preventive strategy to handle these   patients is important.

  • 249.
    Andersson, Elin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ström, Josefin
    Örebro University, School of Health and Medical Sciences.
    Psykosocial arbetsmiljö samt självupplevd hälsa hos anställda inom idéella fotbolls- och gymnastikföreningar: En kvantitativ tvärsnittsstudie2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 250.
    Andersson, Elina
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013).
    Fredriksson, Jessica
    Karlstad University, Faculty of Health, Science and Technology (starting 2013).
    Kunskap och inställning till munvård och oral hälsa hos en grupp omsorgspersonal på äldreboende2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
2345678 201 - 250 of 8091
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