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  • 201.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Domalewski, D
    Physical activity, health and prevalence of overweight and musculoskeletal complaints in young women2008In: Exercise and Women's Health Research, New York: Nova Science Publishers, Inc., 2008, 143-155 p.Chapter in book (Other academic)
  • 202.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Domalewski, D
    Romild, Ulla
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Asplund, Ragnar
    Physical activity, health, body mass index, sleeping habits and bodycomplaints in Australian senior high school students2008In: International Journal of Adolescent Medicine and Health, ISSN 0334-0139, E-ISSN 2191-0278, Vol. 20, no 4, 501-512 p.Article in journal (Refereed)
    Abstract [en]

    Adolescents in the industrial world are becoming less physically active and are increasingly adopting a sedentary life-style in front of computers and television screens. OBJECTIVE: to determine self-related health, physical activity, sleeping habits, prevalence of overweight, and body complaints in Australian senior high school students. METHODS: Participants were 466 high school students aged 15-17 years enrolled in academic and vocational programs. A questionnaire was completed at two senior high schools with questions about weight and height, health, physical activity, type of physical activity/sport, intensity, sleeping habits, and possible injuries or complaints during the last three months. RESULTS: Seventy seven percent of the high school students participated in sports on a regular basis. Compared with vocational programs, more males and females in academic programs participated in sports (71% and 80% respectively) (p = .036). Males reported significantly better health than females (p < .0001). 65% of the study group reported body complaints during the last 3 months. A higher number of females than males reported complaints about the back (p = .007) and the hip (p = .05). Good sleep was reported in 82.1% of males and in 76.6% of females. In males, 44.3% were often sleepy in the daytime (females 56.6%, p < .01). CONCLUSIONS: Underweight, physical activity and good sleep are factors with significant positive effect on good health, whereas overweight is a negative factor. Proper sleep habits and higher physical activity levels should be promoted among high school students, and TV viewing time and video game use restricted. Additionally, schools should provide opportunities for young people to participate in a wider range of physical activities that address their individual needs while promoting the health benefits of engaging in regular exercise.

  • 203.
    Alricsson, Marie
    et al.
    Mid Sweden University.
    Domalewski, Debra
    Griffith University, Australia.
    Physical activity, health and prevalence of overweight and musculoskeletal complaints in young women2008In: Exercise and Women's Health Research / [ed] Laura A. Charlington, New York: Nova Science Publishers, Inc., 2008, 143-155 p.Chapter in book (Refereed)
  • 204.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Domalewski, Debra
    Romild, Ulla
    Asplund, Ragnar
    Health, sleeping Habits and Physical activity2009In: Obesity and Adolescence: A Public Health Concern / [ed] Omar H A, Greydanus D E, Patel D R, Merrick J., New york: Nova Science Publishers, Inc., 2009, 97-105 p.Chapter in book (Other academic)
  • 205.
    Alricsson, Marie
    et al.
    Mid Sweden University ; Griffith University, Australia.
    Domalewski, Debra
    Griffith University, Australia.
    Romild, Ulla
    Mid Sweden University.
    Asplund, Ragnar
    Karolinska Institutet ; Jämtland County Council.
    Health, sleeping Habits and Physical activity2009In: Obesity and Adolescence: A Public Health Concern / [ed] Hatim A. Omar, Donald E. Greydanus, Dilip R. Patel, Joav Merrick, New york: Nova Science Publishers, Inc., 2009, 95-105 p.Chapter in book (Refereed)
    Abstract [en]

    Adolescents are becoming less physically active and are increasingly adopting a sedentary life-style in front of computers and television screens. In this chapter we look at self-related health, physical activity, sleeping habits, the prevalence of overweight and body complaints in two senior high schools with questions about weight and height, health, physical activity, type of physical activity/sport, intensity, sleeping habits and possible injuries or complaints during the last three months. Seventy seven percent % of the high school students participated in sports on a regular basis. In academic programs compared to vocational programs, more males and females in academic programs participated in sports (71% and 80% respectively). Males reported significantly better health than females, but 65% reported body complaints during the last three months. A higher number of females than males reported back and hip complaints. Good sleep was reported in 82.1% of the males (76.6% of the females). In males 44.3% were often sleepy in the daytime (females 56.6%). Underweight, physical activity and good sleep were found to be factors with significant positive effect on good health, whereas overweight was a negative factor. Proper sleep habits and higher physical activity levels should be promoted among high school students and TV viewing time and video game use restricted. Additionally, schools should provide opportunities for young people to participate in a wider range of physical activities that address their individual needs, while promoting the health benefits of engaging in regular exercise.

  • 206.
    Alricsson, Marie
    et al.
    Mittuniversitetet ; Griffith University Logan Campus, Australia.
    Domalewski, Debra
    Romild, Ulla
    Mittuniversitetet.
    Asplund, Ragnar
    Physical activity, health, body mass index, sleeping habits and bodycomplaints in Australian senior high school students2008In: International Journal of Adolescent Medicine and Health, ISSN 0334-0139, E-ISSN 2191-0278, Vol. 20, no 4, 501-512 p.Article in journal (Refereed)
    Abstract [en]

    Adolescents in the industrial world are becoming less physically active and are increasingly adopting a sedentary life-style in front of computers and television screens. OBJECTIVE: to determine self-related health, physical activity, sleeping habits, prevalence of overweight, and body complaints in Australian senior high school students. METHODS: Participants were 466 high school students aged 15-17 years enrolled in academic and vocational programs. A questionnaire was completed at two senior high schools with questions about weight and height, health, physical activity, type of physical activity/sport, intensity, sleeping habits, and possible injuries or complaints during the last three months. RESULTS: Seventy seven percent of the high school students participated in sports on a regular basis. Compared with vocational programs, more males and females in academic programs participated in sports (71% and 80% respectively) (p = .036). Males reported significantly better health than females (p < .0001). 65% of the study group reported body complaints during the last 3 months. A higher number of females than males reported complaints about the back (p = .007) and the hip (p = .05). Good sleep was reported in 82.1% of males and in 76.6% of females. In males, 44.3% were often sleepy in the daytime (females 56.6%, p < .01). CONCLUSIONS: Underweight, physical activity and good sleep are factors with significant positive effect on good health, whereas overweight is a negative factor. Proper sleep habits and higher physical activity levels should be promoted among high school students, and TV viewing time and video game use restricted. Additionally, schools should provide opportunities for young people to participate in a wider range of physical activities that address their individual needs while promoting the health benefits of engaging in regular exercise.

  • 207.
    Alricsson, Marie
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Harms-Ringdahl, Karin
    Larsson, Börje
    Linder, Jan
    Werner, Suzanne
    Neck muscle strength and endurance in fighter pilots: effects of a supervised training program2004In: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 75, no 1, 23-28 p.Article in journal (Refereed)
  • 208.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Harms-Ringdahl, Karin
    Larsson, Börje
    Linder, Jan
    Werner, Suzanne
    Neck muscle strength and endurance in fighter pilots: effects of a supervised training program2004In: Aviation, Space, and Environmental Medicine, ISSN 0095-6562, Vol. 75, no 1, 23-28 p.Article in journal (Refereed)
  • 209.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Harms-Ringdahl, Karin
    Schüldt, Kristina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    linder, Jürgen
    Mobility, muscular strength and endurance in the cervical spine in Swedish air force pilots2001In: Aviation, Space, and Environmental Medicine, ISSN 0095-6562, Vol. 72, no 4, 336-342 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Muscle strength, endurance and range of movement of the cervical spine in a group of Swedish Air Force jet pilots (AF) and in a reference group of conscripts doing their military service (RG) were compared. METHODS: We tested 30 (AF) 24-42 yr and 33 (RG) 19-22 yr. A questionnaire was used to document complaints. Maximum voluntary isometric muscle strength of the flexor and extensor muscles of the cervical spine and sub-maximum isometric endurance in the flexor and extensor muscles were measured. RESULTS: Eleven AF (37%) and four RG (12%) had experienced discomfort in the neck within the previous year. The pilots' flexor and extensor muscle strength (47 Nm and 65 Nm) was superior to that of the conscripts (36 Nm and 59 Nm) (p = 0.0001, p = < 0.05, respectively). However, the RG group had greater isometric endurance in the flexor muscles than AF (p = < 0.05) and greater neck rotation (p = <0.005). There was no difference between the two groups in the other variables. CONCLUSION: Differences between the groups with regard to muscle strength and endurance might depend on variations in work-related physical muscle strain, and/or differences in fiber composition in the muscles, which might be reflected by pilot selection procedures.

  • 210.
    Alricsson, Marie
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Harms-Ringdahl, Karin
    Schüldt, Kristina
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Ekholm, Jan
    linder, Jürgen
    Mobility, muscular strength and endurance in the cervical spine in Swedish air force pilots2001In: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 72, no 4, 336-342 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Muscle strength, endurance and range of movement of the cervical spine in a group of Swedish Air Force jet pilots (AF) and in a reference group of conscripts doing their military service (RG) were compared. METHODS: We tested 30 (AF) 24-42 yr and 33 (RG) 19-22 yr. A questionnaire was used to document complaints. Maximum voluntary isometric muscle strength of the flexor and extensor muscles of the cervical spine and sub-maximum isometric endurance in the flexor and extensor muscles were measured. RESULTS: Eleven AF (37%) and four RG (12%) had experienced discomfort in the neck within the previous year. The pilots' flexor and extensor muscle strength (47 Nm and 65 Nm) was superior to that of the conscripts (36 Nm and 59 Nm) (p = 0.0001, p = < 0.05, respectively). However, the RG group had greater isometric endurance in the flexor muscles than AF (p = < 0.05) and greater neck rotation (p = <0.005). There was no difference between the two groups in the other variables. CONCLUSION: Differences between the groups with regard to muscle strength and endurance might depend on variations in work-related physical muscle strain, and/or differences in fiber composition in the muscles, which might be reflected by pilot selection procedures.

  • 211.
    Alricsson, Marie
    et al.
    Mittuniversitetet, Institutionen för hälsovetenskap.
    Harms-Ringdahl, Karin
    Werner, Suzanne
    Reliability of sports related functional tests with emphasis on speed and agility in young athletes.2001In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 11, no 4, 229-232 p.Article in journal (Refereed)
    Abstract [en]

    The aim of the present investigation was to test the reliability of two sports related functional tests, a speed test (slalom-test) and an agility test (hurdle-test). Eleven athletes aged 11 years (8 boys, 3 girls) participated voluntarily in the study. All subjects completed four different test sessions for both the slalom-test and the hurdle-test using six standard track hurdles placed at 2-m intervals along a 12-m length of track. There were no significant differences between testing sessions for either the slalom-test (P=0.99) or the hurdle-test (P=0.96), showing no systematic variation between test times. The intraclass correlation coefficients were 0.96 and 0.90 respectively, indicating a good reliability. We conclude that the slalom-test and the hurdle-test are reliable sports related functional tests for measuring speed and agility in groups of young athletic individuals.

  • 212.
    Alricsson, Marie
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Harms-Ringdahl, Karin
    Werner, Suzanne
    Reliability of sports related functional tests with emphasis on speed and agility in young athletes.2001In: Scandinavian Journal of Medicine & Science in Sports, ISSN 0905-7188, Vol. 11, no 4, 229-232 p.Article in journal (Refereed)
    Abstract [en]

    The aim of the present investigation was to test the reliability of two sports related functional tests, a speed test (slalom-test) and an agility test (hurdle-test). Eleven athletes aged 11 years (8 boys, 3 girls) participated voluntarily in the study. All subjects completed four different test sessions for both the slalom-test and the hurdle-test using six standard track hurdles placed at 2-m intervals along a 12-m length of track. There were no significant differences between testing sessions for either the slalom-test (P=0.99) or the hurdle-test (P=0.96), showing no systematic variation between test times. The intraclass correlation coefficients were 0.96 and 0.90 respectively, indicating a good reliability. We conclude that the slalom-test and the hurdle-test are reliable sports related functional tests for measuring speed and agility in groups of young athletic individuals.

  • 213.
    Alricsson, Marie
    et al.
    Mid Sweden University.
    Kahlin, Yvonne
    Karolinska Institutet.
    Physical activity and Health in Adolescents2016In: Sedentary Lifestyle: Predictive Factors, Health Risks and Physiological Implications / [ed] Ahmad Alkhatib, New York: Nova Science Publishers, Inc., 2016, 115-130 p.Chapter in book (Refereed)
  • 214.
    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.
    Physical activity, self-related health and complaints in adolescents2007In: Adolescent behaviour research: International perspectives, New York: Nova Science Publishers, Inc., 2007, , 179 p.119-128 p.Chapter in book (Other academic)
  • 215.
    Alricsson, Marie
    et al.
    Mid Sweden University.
    Landstad, Bodil
    Mid Sweden University ; Griffith University, Australia ; Nord-Trøndelag University College, Norway.
    Physical activity, self-related health and complaints in adolescents2007In: Adolescent behaviour research: International perspectives / [ed] Joav Merrick, Hatim A. Omar, New York: Nova Science Publishers, Inc., 2007, 119-128 p.Chapter in book (Refereed)
  • 216.
    Alricsson, Marie
    et al.
    Mittuniversitetet.
    Landstad, Bodil
    Mittuniversitetet.
    Romild, Ulla
    Mittuniversitetet.
    Werner, Suzanne
    Karolinska Institutet.
    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.

  • 217.
    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.

  • 218.
    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.

  • 219.
    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.

  • 220.
    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)
  • 221.
    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)
  • 222.
    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)
  • 223.
    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)
  • 224.
    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.

  • 225.
    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.

  • 226.
    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)
  • 227.
    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)
  • 228.
    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.

  • 229.
    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.

  • 230.
    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
  • 231.
    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.

  • 232. 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)
  • 233.
    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.

  • 234. 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.

  • 235.
    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.

  • 236. 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.

  • 237. 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.

  • 238. 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.

  • 239. 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.

  • 240.
    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.

  • 241.
    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. 

  • 242.
    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.

  • 243.
    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.

  • 244.
    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.

  • 245.
    Amréus, Carina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Omorganisation och Hälsa: Hur påverkas anställdas hälsa av upprepad omorganisation/omstrukturering?2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
  • 246.
    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)
  • 247. 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, E-ISSN 1475-5793, 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.

  • 248.
    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.

  • 249. 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.

  • 250. 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.

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