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  • 8051.
    Tabernero, Patricia
    et al.
    Mahosot Hosp, Lao Oxford Mahosot Hosp Wellcome Trust Res Unit, Viangchan, Laos.;WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Oxford, Ctr Trop Med & Global Hlth, Oxford, England..
    Parker, Michael
    Univ Oxford, Ethox Ctr, Oxford, England..
    Ravinetto, Raffaella
    Inst Trop Med, Dept Clin Sci, B-2000 Antwerp, Belgium.;Katholieke Univ Leuven, Dept Pharmaceut & Pharmacol Sci, Leuven, Belgium..
    Phanouvong, Souly
    US Pharmacopeial Convent Inc, Promoting Qual Med Program, US Pharmacopeia, Rockville, MD USA..
    Yeung, Shunmay
    London Sch Hyg & Trop Med, Fac Publ Hlth & Policy, Dept Global Hlth & Dev, London WC1, England..
    Kitutu, Freddy E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Makerere Univ, Coll Hlth Sci, Dept Pharm, Kampala, Uganda.;Makerere Univ, Coll Hlth Sci, Sch Publ Hlth, Kampala, Uganda..
    Cheah, Phaik Yeong
    Univ Oxford, Ctr Trop Med & Global Hlth, Oxford, England.;Univ Oxford, Ethox Ctr, Oxford, England.;Mahidol Univ, Mahidol Oxford Trop Med Res Unit, Bangkok 10700, Thailand..
    Mayxay, Mayfong
    Mahosot Hosp, Lao Oxford Mahosot Hosp Wellcome Trust Res Unit, Viangchan, Laos.;Univ Oxford, Ctr Trop Med & Global Hlth, Oxford, England.;Univ Hlth Sci, Fac Postgrad Studies, Viangchan, Laos..
    Guerin, Philippe J.
    WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Oxford, Ctr Trop Med & Global Hlth, Oxford, England..
    Newton, Paul N.
    Mahosot Hosp, Lao Oxford Mahosot Hosp Wellcome Trust Res Unit, Viangchan, Laos.;WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Oxford, Ctr Trop Med & Global Hlth, Oxford, England.;London Sch Hyg & Trop Med, Fac Infect & Trop Dis, London WC1, England..
    Ethical challenges in designing and conducting medicine quality surveys2016In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 21, no 6, p. 799-806Article in journal (Refereed)
    Abstract [en]

    ObjectivesIn this paper we discuss the main ethical challenges related to the conduct of medicine quality surveys and make suggestions on how to address them. MethodMost evidence-based information regarding medicine quality derives from surveys. However, existing research ethical guidelines do not provide specific guidance for medicine quality surveys. Hence, those conducting surveys are often left wondering how to judge what counts as best practice. A list of the main ethical challenges in the design and conduct of surveys is presented. Results and conclusionsIt is vital that the design and conduct of medicine quality surveys uphold moral and ethical obligations and analyse the ethical implications and consequences of such work. These aspects include the impact on the local availability of and access to medicines; the confidentiality and privacy of the surveyors and the surveyed; questions as to whether outlet staff personnel should be told they are part of a survey; the need of ethical and regulatory approvals; and how the findings should be disseminated. Medicine quality surveys should ideally be conducted in partnership with the relevant national Medicine Regulatory Authorities. An international, but contextually sensitive, model of good ethical practice for such surveys is needed. ObjectifsIdentifier et discuter les principaux enjeux ethiques lies a la conduite des surveillances et formuler des suggestions sur la facon de les aborder. MethodeLa plupart des informations fondees sur des preuves en ce qui concerne la qualite des medicaments decoule des enquetes. Cependant, les directives ethiques de recherche existantes ne fournissent pas d'indications precises pour les enquetes sur la qualite de la medecine. Par consequent, ceux menant des enquetes sont souvent laisses a se demander comment juger ce qui compte comme la meilleure pratique. Une liste des principaux defis ethiques dans la conception et la conduite des enquetes est presentee. Resultats et conclusionsIl est essentiel que la conception et la conduite des enquetes sur la qualite de la medecine respectent les obligations morales et ethiques et analysent les implications ethiques et les consequences d'un tel travail. Celles-ci sont: l'impact sur la disponibilite locale et l'acces aux medicaments, la confidentialite et la protection de la vie privee des enqueteurs et des enquetes, des questions quant a savoir si les membres du personnel de sortie doivent etre informes quils font partie d'une enquete, la necessite d'approbations reglementaires et d'ethique et la facon dont les resultats devraient etre diffuses. Les enquetes sur la qualite de la medecine devraient idealement etre menees en partenariat avec les autorites relevantes de reglementation des medicaments nationaux. Un modele international, mais contextuellement sensible, de bonne pratique ethique pour ces enquetes est necessaire. ObjetivosIdentificar y discutir los principales retos eticos relacionados con la realizacion de encuestas y hacer sugerencias sobre la forma de abordarlas. MetodoLa mayor parte de la informacion basada en la evidencia en lo que respecta a la calidad de los medicamentos se obtiene a traves de encuestas. Sin embargo, las guias eticas de investigacion existentes no proveen una guia especifica para las encuestas de calidad de medicamentos. Por lo tanto, aquellos que llevan a cabo las encuestas a menudo no saben como definir lo que se considera como la mejor practica. Aqui se presenta una lista de los principales retos eticos en el diseno y en la realizacion de encuestas. Resultados y conclusionesEs vital que el diseno y el pase de encuestas de calidad de medicamentos apoyen obligaciones eticas y morales, asi como el analisis de las implicaciones y las consecuencias eticas de dicho trabajo. Estas son: el impacto sobre la disponibilidad local de y el acceso a las medicinas; la confidencialidad y la privacidad de los encuestados y encuestadores; preguntas sobre si los trabajadores del punto de entrega deberian ser avisados de que estan formando parte de un estudio; la necesidad de aprobaciones eticas y regulatorias; y como diseminar los hallazgos obtenidos. Las encuestas sobre la calidad de los medicamentos deberian idealmente realizarse junto con las autoridades nacionales relevantes en regulacion de medicamentos. Se requiere un modelo internacional, pero contextualmente sensible, de buenas practicas eticas.

  • 8052. Tadesse, Elazar
    et al.
    Berhane, Yemane
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Olsson, Pia
    Ekström, Eva-Charlotta
    Perceptions of usage and unintended consequences of provision of ready-to-use therapeutic food for management of severe acute child malnutrition. A qualitative study in Southern Ethiopia2015In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 30, no 10, p. 1334-1341Article in journal (Refereed)
    Abstract [en]

    Background: Severe acute child malnutrition (SAM) is associated with high risk of mortality. To increase programme effectiveness in management of SAM, community-based management of acute malnutrition (CMAM) programme that treats SAM using ready-to-use-therapeutic foods (RUTF) has been scaled-up and integrated into existing government health systems. The study aimed to examine caregivers’ and health workers perceptions of usages of RUTF in a chronically food insecure area in South Ethiopia.

    Methods: This qualitative study recorded, transcribed and translated focus group discussions and individual interviews with caregivers of SAM children and community health workers (CHWs). Data were complemented with field notes before qualitative content analysis was applied.

    Results: RUTF was perceived and used as an effective treatment of SAM; however, caregivers also see it as food to be shared and when necessary a commodity to be sold for collective benefits for the household. Caregivers expected prolonged provision of RUTF to contribute to household resources, while the programme guidelines prescribed RUTF as a short-term treatment to an acute condition in a child. To get prolonged access to RUTF caregivers altered the identities of SAM children and sought multiple admissions to CMAM programme at different health posts that lead to various control measures by the CHWs.

    Conclusion: Even though health workers provide RUTF as a treatment for SAM children, their caregivers use it also for meeting broader food and economic needs of the household endangering the effectiveness of CMAM programme. In chronically food insecure contexts, interventions that also address economic and food needs of entire household are essential to ensure successful treatment of SAM children. This may need a shift to view SAM as a symptom of broader problems affecting a family rather than a disease in an individual child.

  • 8053.
    Tafazoli, Farideh
    et al.
    Division of Medical Microbiology, Department of Health and Environment, Linköping University, Linköping, Sweden.
    Holmström, Anna
    Swedish Defence Research Agency, Division of CBRN Defence and Security, SE-901 82 Umeå, Sweden.
    Forsberg, Åke
    Department of Microbiology, National Defence Research Establishment, Umeå, Sweden.
    Magnusson, Karl-Eric
    Division of Medical Microbiology, Department of Health and Environment, Linköping University, Linköping, Sweden.
    Apically exposed, tight junction-associated beta1-integrins allow binding and YopE-mediated perturbation of epithelial barriers by wild-type Yersinia bacteria2000In: Infection and Immunity, ISSN 0019-9567, E-ISSN 1098-5522, Vol. 68, no 9, p. 5335-5343Article in journal (Refereed)
    Abstract [en]

    Using polarized epithelial cells, primarily MDCK-1, we assessed the mode of binding and effects on epithelial cell structure and permeability of Yersinia pseudotuberculosis yadA-deficient mutants. Initially, all bacteria except the invasin-deficient (inv) mutant adhered apically to the tight junction areas. These contact points of adjacent cells displayed beta1-integrins together with tight junction-associated ZO-1 and occludin proteins. Indeed, beta1-integrin expression was maximal in the tight junction area and then gradually decreased along the basolateral membranes. Wild-type bacteria also opened gradually the tight junction to paracellular permeation of different-sized markers, viz., 20-, 40-, and 70-kDa dextrans and 45-kDa ovalbumin, as well as to their own translocation between adjacent cells in intimate contact with beta1-integrins. The effects on the epithelial cells and their barrier properties could primarily be attributed to expression of the Yersinia outer membrane protein YopE, as the yopE mutant bound but caused no cytotoxicity. Moreover, the apical structure of filamentous actin (F-actin) was disturbed and tight junction-associated proteins (ZO-1 and occludin) were dispersed along the basolateral membranes. It is concluded that the Yersinia bacteria attach to beta1-integrins at tight junctions. Via this localized injection of YopE, they perturb the F-actin structure and distribution of proteins forming and regulating tight junctions. Thereby they promote paracellular translocation of bacteria and soluble compounds.

  • 8054. Taha, Hana
    et al.
    Al-Qutob, Raeda
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wahlstorm, Rolf
    Berggren, Vanja
    "Would a man smell a rose then throw it away?" Jordanian men's perspectives on women's breast cancer and breast health2013In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 13, p. Article number 41-Article in journal (Refereed)
    Abstract [en]

    Background: Breast cancer is the most common malignancy afflicting women, and the most common cancer overall in Jordan. A woman's decision to go for screening is influenced by her social support network. This study aims to explore Jordanian men's individual and contextual perspectives on women's breast cancer and their own role in the breast health of the females within their families. Methods: An explorative qualitative design was used to purposively recruit 24 married men aged 27 to 65 years (median 43 years) from four governorates in Jordan. Data in the form of interviews transcriptions was subjected to qualitative content analysis. Results: Three themes were identified: a) Supporting one's wife; b) Marital needs and obligations; c) Constrained by a culture of destiny and shame. The first theme was built on men's feelings of responsibility for the family's health and well-being, their experiences of encouraging their wives to seek health care and their providing counselling and instrumental support. The second theme emerged from men's views about other men's rejection of a wife inflicted by breast cancer, their own perceptions of diminished femininity due to mastectomy and their own concerns about protecting the family from the hereditary risk of breast cancer. The third theme was seen in men's perception of breast cancer as an inevitable act of God that is far away from one's own family, in associating breast cancer with improper behaviour and in their readiness to face the culture of Eib (shame). Conclusions: Jordanian men perceive themselves as having a vital role in supporting, guiding and encouraging their wives to follow breast cancer early detection recommendations. Breast health awareness campaigns could involve husbands to capitalize on family support.

  • 8055. Taha, Hana
    et al.
    Al-Qutob, Raeda
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wahlström, Rolf
    Berggren, Vanja
    "Voices of fear and safety". Women's ambivalence towards breast cancer and breast health: a qualitative study from Jordan2012In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 12, p. 21-Article in journal (Refereed)
    Abstract [en]

    Background: Breast cancer is the leading cause of cancer mortality among Jordanian women. Breast malignancies are detected at late stages as a result of deferred breast health-seeking behaviour. The aim of this study was to explore Jordanian women's views and perceptions about breast cancer and breast health. Methods: We performed an explorative qualitative study with purposive sampling. Ten focus groups were conducted consisting of 64 women (aged 20 to 65 years) with no previous history and no symptoms of breast cancer from four governorates in Jordan. The transcribed data was analysed using latent content analysis. Results: Three themes were constructed from the group discussions: a) Ambivalence in prioritizing own health; b) Feeling fear of breast cancer; and c) Feeling safe from breast cancer. The first theme was seen in women's prioritizing children and family needs and in their experiencing family and social support towards seeking breast health care. The second theme was building on women's perception of breast cancer as an incurable disease associated with suffering and death, their fear of the risk of diminished femininity, husband's rejection and social stigmatization, adding to their apprehensions about breast health examinations. The third theme emerged from the women's perceiving themselves as not being in the risk zone for breast cancer and in their accepting breast cancer as a test from God. In contrast, women also experienced comfort in acquiring breast health knowledge that soothed their fears and motivated them to seek early detection examinations. Conclusions: Women's ambivalence in prioritizing their own health and feelings of fear and safety could be better addressed by designing breast health interventions that emphasize the good prognosis for breast cancer when detected early, involve breast cancer survivors in breast health awareness campaigns and catalyse family support to encourage women to seek breast health care.

  • 8056. Taha, Hana
    et al.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Al-Qutob, Raeda
    Berggren, Vanja
    Esmaily, Hamideh
    Wahlström, Rolf
    Home visits to improve breast health knowledge and screening practices in a less privileged area in Jordan2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 428-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breast cancer is the most common cancer afflicting women in Jordan. This study aimed to assess the effects of an educational intervention through home visits, including offering free mammography screening vouchers, on changing women's breast health knowledge and screening practices for early detection of breast cancer in a less privileged area in Jordan.

    METHODS: Two thousand four hundred breast health awareness home visits were conducted and 2363 women aged 20-79 years (median: 41) answered a pre-test interview-administrated questionnaire to assess their breast health knowledge and practices at the baseline. After a home-based educational session, 625 women aged 40 years or older were referred to free mammography screening. Five hundred and ninety six homes were revisited six months later and out of these 593 women participated in a post-test. The women's retained breast health knowledge, the changes in their reported breast health practices and their usage of the free mammography voucher, were assessed.

    RESULTS: The mean knowledge score increased significantly (p < 0.001) from 11.4 in the pre-test to 15.7 in the post-test (maximum score: 16). At the six month follow-up the post-test showed significant (p < 0.001) improvement in women's perceived breast self-examination (BSE) knowledge, reported BSE practice and mammography screening. Out of 625 women that received a voucher for free mammography screening 73% attended the mammography unit, while only two women without a voucher went for mammography screening at the assigned unit. Women who received a follow-up visit were more likely to use the free mammography voucher compared to those who were not followed-up (83% vs. 67%; p < 0.001).

    CONCLUSIONS: Home visits by local community outreach workers that incorporated education about breast cancer and breast health in addition to offering free mammography screening vouchers were effective in improving women's breast health knowledge and practices in a less privileged area in Jordan.

  • 8057.
    Tahir, Navid
    et al.
    Punjab Emergency Service, Lahore, Pakistan .
    Naseer, Rizwan
    Punjab Emergency Service, Lahore, Pakistan.
    Khan, Samina Mohsin
    Division of Global Health, Karolinska Institute, Stockholm, Sweden .
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden .
    Hashimi, Waseem
    Punjab Emergency Service, Lahore, Pakistan .
    Durrani, Moshin
    Punjab Emergency Service, Lahore, Pakistan .
    Road traffic crashes managed by Rescue 1122 in Lahore, Pakistan2012In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 19, no 4, p. 347-350Article in journal (Refereed)
    Abstract [en]

    The objective of this retrospective study was to describe demographic characteristics, injury patterns and causes of road traffic crashes (RTCs) managed by Rescue 1122 in Lahore, Pakistan during the period 2005–2010. In total 123,268 RTCs were reported and responded by Rescue 1122 ambulance service during the study period. Of the 132,504 victims of RTCs, there were 67% male and 33% female subjects, and the maximum share (65%) was reported among people aged 16–35 years. Motorcyclists were involved in 45% of crashes, with over-speeding (40%) found to be the major reason of these collisions. Similarly, minor injuries (65%) and fractures (25%) were the most reported outcome of these crashes. It is concluded that data from ambulance services, if appropriately collected, can provide valuable epidemiological information to monitor RTCs in developing countries. However, in Pakistan, the collection of data as well as the registration process needs further improvement.

  • 8058.
    Takaoka, Motoko
    et al.
    Kobe College, School of Human Science, Department of Biosphere Sciences.
    Suzuki, Kyoko
    Kobe College, School of Human Science, Department of Biosphere Sciences.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine. Uppsala University Hospital.
    Current asthma, respiratory symptoms and airway infections among students in relation to the school and home environment in Japan2017In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 54, no 6, p. 652-661Article in journal (Refereed)
    Abstract [en]

    Objective: To study associations between the school and home environment and current asthma, respiratory symptoms and airway infections among Japanese students. Methods: Japanese students (12-15 y) (N = 1048) in four schools responded to a questionnaire on respiratory health, allergy and the home environment. Temperature, relative air humidity (RH) and student density (students/m(2) floor area) was measured in the classrooms: dust was collected from floors and in classroom air and analysed for cat (Fel d 1) and dog (Can f 1) allergens. Health associations were analysed by multi-level logistic regression. Results: Doctor's diagnosed asthma was common (13.4%), 8.8% reported cat allergy and 6.1% dog allergy. The median level in floor dust was 41ng/g (IQR 23-92) for Fel d 1 and 101ng/g (IQR 54-101) for Can f 1. The median level in air was 18.6ng/ m(2)/ day (IQR5.9-25.1) for Fel d 1 and 18.6ng/ m(2)/ day (IQR 6.0-13.3) for Can f 1. High RH, high student density and airborne cat allergen was associated with airway infections. In the home environment, recent indoor painting, new floor materials, odour, having cats as pets, window pane condensation in winter, and dampness in floor construction were associated with respiratory illness. Conclusion: High relative air humidity, high student density and airborne cat allergens at school may increase the risk of airway infections. Having cats as pets, chemical emissions from paint and new floor materials, odour and dampness can constitute domestic risk factors for respiratory symptoms while having dogs as pets could be protective.

  • 8059. Takaro, Tim K
    et al.
    Davis, Devra
    Van Rensburg, Sue Janse
    Arroyo Aguilar, Ruth Sara
    Algranti, Eduardo
    Bailar, John C, III
    Belpoggi, Fiorella
    Berlin, Mathis
    Bhattacharya, Shelley
    Viger, Y V Bonnier
    Brophy, James
    Bustinza, Ray
    Cameron, Robert B
    Dement, John M
    Egilman, David
    Castleman, Barry
    Chaturvedi, Sanjay
    Cherniack, Martin
    Choudhury, Harlal
    Demers, Paul A
    Digangi, Joseph
    Ana Digon, Medica
    Edwards, John G
    Englund, Anders
    Erikson, Björn
    Correa Filho, Heleno Rodrigues
    Franco, Giuliano
    Frank, Arthur L
    Freund, Alice
    Gee, David
    Giordano, Antonio
    Gochfeld, Michael
    Gilberg, Marcel
    Goldsmith, David F
    Goldstein, Bernard D
    Grandjean, Philippe
    Greenberg, Morris
    Gut, Ivan
    Harari, Raul
    Hindry, Marc
    Hogstedt, Christer
    Huff, James
    Infante, Peter F
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Kern, David G
    Keifer, Matthew
    Khatter, Kapil
    Kjuus, Helge
    Keith, Margaret
    Koo, Linda C
    Kumar, Arun
    LaDou, Joseph
    Landrigan, Philip J
    Lemen, Richard A
    Last, John M
    Lee, Christopher W
    Leigh, James
    Levin, Stephen M
    Lippman, Abby
    Aguilar Madrid, Guadalupe
    McCulloch, Jock
    McDiarmid, Melissa A
    Merchant, James A
    Monforton, Celeste
    Morse, Tim
    Muir, David C F
    Mukerjee, Debdas
    Mulloy, Karen B
    Myers, J
    Nuwayhid, Iman
    Orris, Peter
    Ozonoff, David
    Paek, Domyung
    Patra, Manomita
    Pelclova, Daniela
    Pepper, Lew
    Poje, Gerald V
    Rahman, Qamar
    Reyes, Bernardo
    Robinson, Bruce W S
    Rodriguez, Eduardo
    Rose, Cecile
    Rosenman, Kenneth D
    Rosenstock, Linda
    Ruchirawat, Mathuros
    Rydzynski, Konrad
    Schneider, Joachim
    Silverstein, Barbara
    Siqueira, C Eduardo
    Slatin, Craig
    Soffritti, Morando
    Soskoline, Colin
    Sparer, Judy
    Stayner, Leslie Thomas
    Tarkowski, Stanislaw
    Teitelbaum, Daniel Thau
    Tompa, Anna
    Trosic, Ivancica
    Turcotte, Fernand
    Vilela, Rodolfo A G
    Waterman, Yvonne R K
    Watterson, Andrew
    Wegman, David H
    Welch, Laura S
    Woitowitz, Hans-Joachim
    Yanri, Zulmiar
    Zavariz, Cecilia
    Scientists Appeal to Quebec Premier Charest to Stop Exporting Asbestos to the Developing World2010In: International journal of occupational and environmental health, ISSN 1077-3525, E-ISSN 2049-3967, Vol. 16, no 2, p. 241-248Article in journal (Refereed)
  • 8060.
    Takaro, Tim K.
    et al.
    Simon Fraser Univ, Vancouver, BC, Canada..
    Scott, James A.
    Univ Toronto, Toronto, ON, Canada..
    Allen, Ryan W.
    Simon Fraser Univ, Vancouver, BC, Canada..
    Anand, Sonia S.
    McMaster Univ, Hamilton, ON, Canada..
    Becker, Allan B.
    Univ Manitoba, Winnipeg, MB, Canada..
    Befus, A. Dean
    Univ Alberta, Edmonton, AB, Canada..
    Brauer, Michael
    Univ British Columbia, Vancouver, BC V5Z 1M9, Canada..
    Duncan, Joanne
    McMaster Univ, Hamilton, ON, Canada..
    Lefebyre, Diana L.
    McMaster Univ, Hamilton, ON, Canada..
    Lou, Wendy
    Univ Toronto, Toronto, ON, Canada..
    Mandhane, Plush J.
    Univ Alberta, Edmonton, AB, Canada..
    McLean, Kathleen E.
    Simon Fraser Univ, Vancouver, BC, Canada..
    Miller, Gregory
    Northwestern Univ, Evanston, IL USA..
    Sbihi, Hind
    Univ British Columbia, Vancouver, BC V5Z 1M9, Canada..
    Shu, Huan
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Simon Fraser Univ, Vancouver, BC, Canada.;Karlstad Univ, Karlstad, Varmland, Sweden..
    Subbarao, Padmaja
    Univ Toronto, Toronto, ON, Canada.;Hosp Sick Children, Toronto, ON M5G 1X8, Canada..
    Turvey, Stuart E.
    Univ British Columbia, Vancouver, BC V5Z 1M9, Canada..
    Wheeler, Amanda J.
    Edith Cowan Univ, Joondalup, WA, Australia.;Hlth Canada, Ottawa, ON K1A 0L2, Canada..
    Zeng, Leilei
    Univ Waterloo, Waterloo, ON N2L 3G1, Canada..
    Sears, Malcolm R.
    McMaster Univ, Hamilton, ON, Canada..
    Brook, Jeffrey R.
    Univ Toronto, Toronto, ON, Canada.;Environm Canada, Toronto, ON, Canada..
    The Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study: assessment of environmental exposures2015In: Journal of Exposure Science and Environmental Epidemiology, ISSN 1559-0631, E-ISSN 1559-064X, Vol. 25, no 6, p. 580-592Article in journal (Refereed)
    Abstract [en]

    The Canadian Healthy Infant Longitudinal Development birth cohort was designed to elucidate interactions between environment and genetics underlying development of asthma and allergy. Over 3600 pregnant mothers were recruited from the general population in four provinces with diverse environments. The child is followed to age 5 years, with prospective characterization of diverse exposures during this critical period. Key exposure domains include indoor and outdoor air pollutants, inhalation, ingestion and dermal uptake of chemicals, mold, dampness, biological allergens, pets and pests, housing structure, and living behavior, together with infections, nutrition, psychosocial environment, and medications. Assessments of early life exposures are focused on those linked to inflammatory responses driven by the acquired and innate immune systems. Mothers complete extensive environmental questionnaires including time-activity behavior at recruitment and when the child is 3, 6, 12, 24, 30, 36, 48, and 60 months old. House dust collected during a thorough home assessment at 3-4 months, and biological specimens obtained for multiple exposure-related measurements, are archived for analyses. Geo-locations of homes and daycares and land-use regression for estimating traffic-related air pollution complement time-activity-behavior data to provide comprehensive individual exposure profiles. Several analytical frameworks are proposed to address the many interacting exposure variables and potential issues of co-linearity in this complex data set.

  • 8061.
    Talebi Jaghargh, Maliheh
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Realistic evaluation on Public health intervention. Literature review2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 8062.
    Taloyan, Marina
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Aronsson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Alexanderson, Kristina
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Sickness presenteeism predicts suboptimal self-rated health and sickness absence: a nationally representative study of the Swedish working population2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 9, article id e44721Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Earlier studies have suggested that sickness presenteeism (SP) may be a risk factor for future health problems. The purpose of the present study was to test this in a nationally representative prospective study of Swedish workers.

    METHODS: Prospective cohort with a representative sample of the Swedish working population surveyed in 2008 and 2010. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using logistic regression.

    RESULTS: Those who reported more than 7 days of SP had higher risk of suboptimal SRH compared to those who reported no SP (OR = 5.95; 95% CI 4.98-7.12), also after adjustment for confounders (OR = 1.64; 95% CI 1.30-2.06). Those who reported 1-7 days of SP also had an increased risk before and after adjustments. Inclusion of self-rated physical and psychological work capacity did not attenuate the associations, whereas of emotional exhaustion attenuated the ORs to non-significance for both outcomes, indicating that the health consequences associated with SP are largely related to mental health.

    CONCLUSION: The results strengthen earlier findings suggesting that SP can be a risk factor for future suboptimal general health and sickness absence, particularly through mental health problems. This indicates that asking about SP could yield important information for employers, occupational health practitioners and GPs, possibly leading to more timely intervention that could decrease the risk of future sickness absence and more serious health problems, especially in the mental domain. Further studies of the possible causal pathways between SP and future health development are also warranted, especially since going to work is often seen as desirable also for those with poor health.

  • 8063.
    Taloyan, Marina
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hyde, Martin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Self-rated health amongst male and female employees in Sweden: a nationally representative study2015In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 88, no 7, p. 849-859Article in journal (Refereed)
    Abstract [en]

    Purpose Self-rated health (SRH) is a well-established measure within social epidemiology. However, most studies on SRH tend to be amongst the general population, where SRH has been found to be lower in women than in men. Few studies have specifically investigated patterns of SRH just within an employed population. The purpose of this study was to (1) investigate whether there are gender differences in reporting suboptimal SRH in an employed Swedish population and (2) study whether these differences could be explained by socio-economic, work-, health- and/or lifestyle-related factors. Methods This study is cross-sectional analysis of data from the 2008 wave of Swedish Longitudinal Occupational Survey of Health, a nationally representative cohort of the Swedish working population. This study includes the responses of 9,756 employed individuals. Logistic regression analyses were performed. Results After adjusting for age, income and working hours (full vs. part time), men had significantly higher odds of suboptimal SRH than women OR 1.38 (95 % CI 1.22-1.55). With stepwise inclusion of health factors such as long-standing disease, sleep quality and fatigue, the OR for men increased to 1.65 (95 % CI 1.44-1.89). Gender differences in reporting suboptimal SRH were attenuated to 1.29 (95 % CI 1.11-1.51) with the inclusion of lifestyle factors. However, they remained significant after inclusion of all explanatory variables. Conclusions In contrast to findings in general population studies, our results show that men in employment have higher odds of suboptimal SRH than their female counterparts. As SRH is an important indicator of health with a strong association with mortality, an excess risk of suboptimal SRH amongst employed men shows that more attention should be paid to men's health in the workplace.

  • 8064.
    Taloyan, Marina
    et al.
    Karolinska Inst, Ctr Family & Community Med, Dept Neurobiol Caring Sci & Soc, Stockholm, Sweden; Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.
    Löfvander, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Depression and gender differences among younger immigrant patients on sick leave due to chronic back pain: a primary care study2014In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 15, no 1, p. 5-14Article in journal (Refereed)
    Abstract [en]

    Background Mental ill-health and pain are major causes for disability compensation in female adults in Sweden.

    Aims The aims of this study were to (1) analyse gender differences in the prevalence of depression among immigrant patients with chronic back pain and (2) explore whether factors such as age, marital status, educational level, religious faith, number of children and number of diagnosed pain sites could explain these differences.

    Methods The study sample consisted of 245 sick-listed primary care patients in consecutive order aged 18 through 45 years with a median duration of sick leave of 10 months for back pain and participating in a rehabilitation programme. Explanatory variables included physicians’ diagnosed pain sites, age, marital status, education, number of children and religious affiliation. Predictive factors for depression were analysed using logistic regression.

    Findings The women differed significantly from the men in three aspects: they were less educated, had more children and had more multiple pain sites, that is, 68% versus 45%. In the age-adjusted model, women were twice as likely to have depression (odds ratio (OR) 2.1). Regardless the gender, those with intermediate education of 9–11 years had the lowest odds of outcome compared with those with <0–8 years and ⩾12 years education. Finally, after adjusting for all explanatory variables, the ORs of depression for women decreased to a non-significant level (OR 1.8; 95% confidence interval (CI) 0.94–3.43). Furthermore, regardless of the gender, those with multiple pain sites had twice higher odds (OR 2.04; 95% CI 1.11–3.74) of depression than those with fewer pain sites.

    Conclusion Gender differences in odds of depression in our study could be explained by a higher prevalence of diagnosed multiple pain sites in women. This calls for tailor-made treatments that focus on the pain relief needs of immigrant women with low education and chronic back pain.

  • 8065.
    Taloyan, Marina
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Center for Primary Health Care Research, Region Skåne/Lund University, Sweden.
    Wajngot, Alexandre
    Johansson, Sven-Erik
    Tovi, Jonas
    Sundquist, Kristina
    Sexual dysfunction in Assyrian/Syrian immigrants and Swedish-born persons with type 2 diabetes2012In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 5, article id 522Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Few studies have investigated sexual dysfunction in immigrant patients with type 2 diabetes in Sweden. The aim of this study was to examine the association between ethnicity and sexual dysfunction and to analyze if this association remains after adjusting for explanatory variables including age, marital status, HbA1c, triglycerides, and hypertension. This cross-sectional study was conducted at four primary health care centers in the Swedish town of Sodertalje. A total of 354 persons with type 2 diabetes (173 Assyrians/Syrians and 181 Swedish-born patients) participated in the survey. The main outcome measure was the self-reported presence of sexual dysfunction based on two questions, one regarding loss of ability to have sexual intercourse and the other loss of sexual desire. Response rates were 78% and 86%, respectively. FINDINGS: The total prevalence of loss of ability to have intercourse was 29.5%. In the multivariate models, the odds of loss of ability to have intercourse was significantly higher in the oldest age group (OR = 5.80; 95% CI, 2.33--14.40), in men (OR = 3.33; 95% CI, 1.33--8.30), and in unmarried individuals (OR = 2.40; 95% CI, 1.02--5.70). The odds of reporting loss of sexual desire was higher in Assyrians/Syrians than in Swedish-born patients and increased from 2.00 in the age- and gender-adjusted model to 2.70 in the fully adjusted model when all confounders were taken into account. CONCLUSIONS: Sexual dysfunction appears to be more common in Assyrians/Syrians than in Swedish-born patients. Health care workers should actively ask about sexual function in their patients with type 2 diabetes.

  • 8066.
    Talundzic, Dzevida
    et al.
    University West, Department of Nursing, Health and Culture, Divison for Health, Culture and Educational Sciences.
    Sillgren, Lazzat
    University West, Department of Nursing, Health and Culture, Divison for Health, Culture and Educational Sciences.
    Salutogent arbetssätt - ett modeord?: en studie om undersköterskors uppfattningar av salutogent arbetssätt i hemtjänsten2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 8067.
    Talungchit, Pattarawalai
    et al.
    Mahidol Univ, Maternal & Fetal Med Unit, Dept Obstet & Gynecol, Siriraj Hosp, Bangkok 10700, Thailand.
    Liabsuetrakul, Tippawan
    Prince Songkla Univ, Obstet & Gynecol Epidemiol Unit, Hat Yai, Thailand.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). INFORM Hlth, Norwood, MA USA.
    Development and Assessment of Indicators for Quality of Care in Severe Preeclampsia/Eclampsia and Postpartum Hemorrhage2013In: Journal for healthcare quality, ISSN 1945-1474, Vol. 35, no 3, p. 22-34Article in journal (Refereed)
    Abstract [en]

    Severe preeclampsia/eclampsia and postpartum hemorrhage (PPH) are serious obstetric problems worldwide. Quality improvement of care measured by evidence-based indicators is recommended as a recent important strategy; however, the indicators for quality of care of these two conditions have not been established. This study aimed to develop such indicators and assess their validity, reliability, and feasibility at different contextual levels. Of 32 initially valid indicators for care of severe preeclampsia/eclampsia, after two rounds of Delphi technique, 21 and 30 indicators were agreed to be suitable to monitor care at district and referral hospitals. Of 13 initial indicators for PPH, 8 and 13 indicators were selected, respectively. The interrater reliability of indicators varied from 0.28 to 0.63. At least three-fourths of all indicators rated by local doctors and nurses were assessed as feasible in terms of relevance, measurability, and improvability. The process identified reliable and feasible performance indicators to monitor quality of care in severe preeclampsia/eclampsia and PPH for either basic or comprehensive emergency obstetric care (EmOC). The informative applicability of these indicators in clinical practice needs further evaluation.

  • 8068. Tambyah, Paul A
    et al.
    Wilder-Smith, Annelies
    Institute of Public Health, University of Heidelberg, Germany.
    Pavlova, Borislava G
    Barrett, P Noel
    Oh, Helen M L
    Hui, David S
    Yuen, Kwok-yung
    Fritsch, Sandor
    Aichinger, Gerald
    Loew-Baselli, Alexandra
    van der Velden, Maikel
    Maritsch, Friedrich
    Kistner, Otfried
    Ehrlich, Hartmut J
    Safety and immunogenicity of two different doses of a Vero cell-derived, whole virus clade 2 H5N1 (A/Indonesia/05/2005) influenza vaccine.2012In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 30, no 2, p. 329-35Article in journal (Refereed)
    Abstract [en]

    A successful vaccine development strategy for areas with clustered H5N1 events requires conduct of vaccine trials in potentially non-naïve subjects and evaluation of post-vaccination responsiveness. An open-label, randomized, phase I/II study therefore assessed the immunogenicity and safety of two different dose levels of an inactivated, non-adjuvanted, whole virus clade 2.1 (A/Indonesia/05/2005) H5N1 Vero cell-derived influenza vaccine in healthy adults (21-45 years) from a region where the virus has been circulating (Hong Kong) as well as Singapore. Subjects (N=110) were randomized 1:1 to receive two vaccinations with either 3.75 μg or 7.5 μg H5N1 haemagglutinin antigen 21 days apart. Safety, immunogenicity (microneutralization [MN] and single radial haemolysis [SRH] at baseline and post-vaccination) and cross-reactivity against a heterologous clade 1 strain (A/Vietnam/1203/2004) of the vaccine were assessed. Pre-existing immunity to the vaccine strain was 14% which is higher than previously reported for these regions. Two vaccinations with either vaccine formulation induced high seroprotection rates (MN titre ≥ 1:20) against the vaccine strain A/Indonesia/05/2005: 82.7% and 86.5% in the 3.75 μg and 7.5 μg dose groups. Seroconversion rates and fold increase exceeded the CPMP criterion of >40% and >2.5 for MN and SRH in both dose groups after the second vaccination, while the seroprotection rate in the 7.5 μg dose group determined by SRH was only marginally lower (69.2%) than the CPMP criterion of >70%. Thus, 11 of 12 CHMP criteria were fulfilled. A cross-reactive antibody response against the heterologous A/Vietnam/1203/2004 strain was demonstrated after the second vaccination (>21% by MN and ≥ 25% by SRH). Persistence of antibodies against the vaccine strain was also demonstrated 6 months after the first vaccination, indicating that a booster vaccination would be effective in those who have received two priming doses. No serious adverse events were reported. The H5N1 influenza vaccine against clade 2.1 strain A/Indonesia/05/2005 was well tolerated and immunogenic after two vaccinations, and induced a cross-neutralizing antibody response, with no dose effect.

  • 8069.
    Tamm, Sandra
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nilsonne, Gustav
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    D'Onofrio, Paolo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Thuné, Hanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Petrovic, P.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Effect of partial sleep deprivation on empathy for pain in an fMRI experiment2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no S1, p. 62-62, article id 245Article in journal (Other academic)
  • 8070. Tan, Kristin H. X.
    et al.
    Barr, Elizabeth L. M.
    Koshkina, Vira
    Ma, Stefan
    Kowlessur, Sudhir
    Magliano, Dianna J.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Chia, Kee Seng
    Zimmet, Paul
    Lim, Wei-Yen
    Diabetes mellitus prevalence is increasing in South Asians but is stable in Chinese living in Singapore and Mauritius2017In: Journal of Diabetes, ISSN 1753-0393, E-ISSN 1753-0407, Vol. 9, no 9, p. 855-864Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Asia is experiencing a type 2 diabetes epidemic but prevalence differs by ethnicity and level of socio-economic development. Singapore and Mauritius have implemented comprehensive campaigns to address this public health problem. We compared diabetes and obesity prevalence trends among Chinese and South Asians living in Singapore and Mauritius to determine the contribution of ethnicity and economic development to diabetes.

    METHODS: Age-specific data from serial national population-based surveys in Singapore and Mauritius between 1987 and 2010 were used to estimate age-standardised diabetes and obesity prevalence. Modified Breslow-Cox Proportional hazard models were used to obtain rate ratios for diabetes risk factors.

    RESULTS: In Singapore, the age-standardised prevalence of diabetes remained stable for Chinese (men 14% in 1992 and 13% in 2010; women 12% in 1992 and 10% in 2010); however, increases were observed for South Asians (men 20% in 1992 and 26% in 2010; women 18% in 1992 and 20% in 2010). There were similar patterns in Mauritius. In both countries, obesity prevalence trends were stable for Chinese women, but increased for Chinese men and South Asians. Associations between obesity and diabetes were stronger in Chinese than South Asians irrespective of country.

    CONCLUSIONS: Despite different socio-economic settings in Singapore and Mauritius, we observed rising diabetes prevalence among South Asians but stable prevalence in Chinese in both countries. This provides further evidence that ethnicity contributes to the development of diabetes, and that there should be an increased emphasis on future prevention strategies targeting South Asian populations in these countries.

  • 8071.
    Tan, Monique
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Child obesity, a time bomb neglected in South-East Asia: a Framework Analysis of school policies and programmes2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: In the South-East Asian Region of the World Health Organization (WHO), development is hindered by the double burden of malnutrition. While still hosting 70% of the world’s undernourished children, rates of overweight and obesity are rapidly increasing. School-based interventions are a promising solution, and WHO produced a School Policy Framework that encourages schoolchildren to eat healthy and be physically active. The aim of this study is to inform on how these recommendations are adopted in the WHO South-East Asia Region and what the key gaps in policy development are.

    Method: Out of 11 Member States, 7 were purposively selected: Bangladesh, Bhutan, India, Indonesia, Maldives, Sri Lanka, and Thailand. The primary data sources were policy and programme documents, which were triangulated with data obtained from informal discussions with policymakers of each Member State and published reports. The data were analysed according to the Framework Analysis, a method designed for policy analysis.

    Findings: The seven Member States were at varying levels of recognition of the problem. Of the four who took action, the efforts against overweight and obesity were most often integrated into school health policies/programmes that tended to be geared towards curative services. The deficient monitoring and evaluation systems made it difficult for the Member States to identify priorities for action and set clear goals, which in turn hindered the collaboration between sectors and with non-governmental entities.

    Conclusion: This qualitative study showed that the recommendations of the School Policy Framework were unmet and that the guideline itself has never been mentioned.

  • 8072.
    Tanash, Hanan A.
    et al.
    Lund Univ, Skane Univ Hosp, Dept Resp Med, Lund, Sweden..
    Ringbaek, Thomas
    Hvidovre Univ Hosp, Resp Dept, Copenhagen, Denmark..
    Huss, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Univ Uppsala Hosp, Burn Ctr, Dept Plast & Maxillofacial Surg, Uppsala, Sweden.
    Ekstrom, Magnus
    Lund Univ, Skane Univ Hosp, Dept Resp Med, Lund, Sweden..
    Burn injury during long-term oxygen therapy in Denmark and Sweden: the potential role of smoking2017In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 12, p. 193-197Article in journal (Refereed)
    Abstract [en]

    Background: Long-term oxygen therapy (LTOT) increases life expectancy in patients with COPD and severe hypoxemia. Smoking is the main cause of burn injury during LTOT. Policy regarding smoking while on LTOT varies between countries. In this study, we compare the incidence of burn injury that required contact with a health care specialist, between Sweden (a country with a strict policy regarding smoking while on LTOT) and Denmark (a country with less strict smoking policy). Methods: This was a population-based, cohort study of patients initiating LTOT due to any cause in Sweden and Denmark. Data on diagnoses, external causes, and procedures were obtained from the Swedish and Danish National Patient Registers for inpatient and outpatient care. Patients were followed from January 1, 2000, until the first of the following: LTOT withdrawal, death, or study end (December 31, 2009). The primary end point was burn injury during LTOT. Results: A total of 23,741 patients received LTOT in Denmark and 7,754 patients in Sweden. Most patients started LTOT due to COPD, both in Sweden (74%) and in Denmark (62%). The rate of burn injury while on LTOT was higher in Denmark than in Sweden; 170 (95% confidence interval [CI], 126-225) vs 85 (95% CI, 44-148) per 100,000 person-years; rate ratio 2.0 (95% CI, 1.0-4.1). The risk remained higher after adjustment for gender, age, and diagnosis in multivariate Cox regression, hazard ratio 1.8 (95% CI, 1.0-3.5). Thirty-day mortality after burn injury was 8% in both countries. Conclusion: Compared to Sweden, the rate of burn injury was twice as high in Denmark where smoking is not a contraindication for prescribing LTOT.

  • 8073.
    Tancred, Tara
    et al.
    Ifakara Health Institute, Dar es Salaam, Tanzania.
    Mandu, Rogers
    Makerere Uniververisty School of Public Health, Kampala, Uganda.
    Hanson, Claudia
    Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
    Okuga, Monica
    Makerere University School of Public Health, Kampala, Uganda.
    Manzi, Fatuma
    Ifakara Health Institute, Dar es Salaam, Tanzania.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Schellenberg, Joanna
    Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
    Waiswa, Peter
    Makerere University School of Public Health, Kampala, Uganda.
    Marchant, Tanya
    Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
    How people-centred health systems can reach the grassroots: experiences implementing community-level quality improvement in rural Tanzania and Uganda2018In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 33, no 1, p. e1-e13Article in journal (Refereed)
    Abstract [en]

    Background

    Quality improvement (QI) methods engage stakeholders in identifying problems, creating strategies called change ideas to address those problems, testing those change ideas and scaling them up where successful. These methods have rarely been used at the community level in low-income country settings. Here we share experiences from rural Tanzania and Uganda, where QI was applied as part of the Expanded Quality Management Using Information Power (EQUIP) intervention with the aim of improving maternal and newborn health. Village volunteers were taught how to generate change ideas to improve health-seeking behaviours and home-based maternal and newborn care practices. Interaction was encouraged between communities and health staff.

    Aim

    To describe experiences implementing EQUIP’s QI approach at the community level.

    Methods

    A mixed methods process evaluation of community-level QI was conducted in Tanzania and a feasibility study in Uganda. We outlined how village volunteers were trained in and applied QI techniques and examined the interaction between village volunteers and health facilities, and in Tanzania, the interaction with the wider community also.

    Results

    Village volunteers had the capacity to learn and apply QI techniques to address local maternal and neonatal health problems. Data collection and presentation was a persistent challenge for village volunteers, overcome through intensive continuous mentoring and coaching. Village volunteers complemented health facility staff, particularly to reinforce behaviour change on health facility delivery and birth preparedness. There was some evidence of changing social norms around maternal and newborn health, which EQUIP helped to reinforce.

    Conclusions

    Community-level QI is a participatory research approach that engaged volunteers in Tanzania and Uganda, putting them in a central position within local health systems to increase health-seeking behaviours and improve preventative maternal and newborn health practices.

  • 8074.
    Tang, Jiaqi
    et al.
    Cent China Normal Univ, Coll Life Sci, Hubei Key Lab Genet Regulat & Integrat Biol, Sect Environm Biomed, Wuhan, Peoples R China..
    Yuan, Ye
    Cent China Normal Univ, Coll Life Sci, Hubei Key Lab Genet Regulat & Integrat Biol, Sect Environm Biomed, Wuhan, Peoples R China..
    Wei, Chenxi
    Cent China Normal Univ, Coll Life Sci, Hubei Key Lab Genet Regulat & Integrat Biol, Sect Environm Biomed, Wuhan, Peoples R China..
    Liao, Xiaomei
    Cent China Normal Univ, Coll Life Sci, Hubei Key Lab Genet Regulat & Integrat Biol, Sect Environm Biomed, Wuhan, Peoples R China..
    Yuan, Junlin
    Cent China Normal Univ, Coll Life Sci, Hubei Key Lab Genet Regulat & Integrat Biol, Sect Environm Biomed, Wuhan, Peoples R China..
    Nånberg, Eewa
    Zhang, Yinping
    Tsinghua Univ, Dept Bldg Sci, Beijing 100084, Peoples R China..
    Bornehag, Carl-Gustaf
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Yang, Xu
    Cent China Normal Univ, Coll Life Sci, Hubei Key Lab Genet Regulat & Integrat Biol, Sect Environm Biomed, Wuhan, Peoples R China..
    Neurobehavioral changes induced by di(2-ethylhexyl) phthalate and the protective effects of vitamin E in Kunming mice2015In: Toxicology research, ISSN 2045-452X, Vol. 4, no 4, p. 1006-1015Article in journal (Refereed)
    Abstract [en]

    Di(2-ethylhexyl) phthalate (DEHP) is a plasticizer commonly used in PVC that may leach into the environment, and has been shown to adversely affect the health of humans and animals. We undertook a study to ascertain the neurotoxicity of DEHP in Kunming mice. This study included three rounds of testing. In the first round, Kunming mice were exposed to different concentrations of DEHP (0, 5, 50, 500 mg kg(-1) per day) after which their cognitive ability was assessed using the Morris water maze (MWM) test. The reactive oxygen species (ROS) content in tissue and the malondialdehyde (MDA) content of brains were also measured. In the second round, vitamin E (50 mg kg(-1) per day) was given daily as an anti-oxidant via the intragastric route. Cognitive deficits and locomotor activity, as well as ROS and MDA contents were tested employing the same methods. In the third round, the depressive mood of mice after DEHP exposure (500 mg kg(-1) per day) was measured using the open field test, the tail suspension test, and the forced swim test. The main findings of this study include: (1) a statistical association exists between DEHP oral exposure and spatial learning (DEHP 500 mg kg(-1) per day) and memory (DEHP 50 mg kg(-1) per day) dysfunction as ascertained by an MWM test of Kunming mice. (2) A statistical association was also found between DEHP oral exposure (50 and 500 mg kg(-1) per day) and oxidative stress (ROS and MDA) of mouse brain tissue. (3) Co-administration of vitamin E (50 mg kg(-1) per day) diminishes the elevation of ROS and MDA induced by DEHP (50 mg kg(-1) per day) from significant levels to non-significant levels. (4) Co-administration of vitamin E (50 mg kg(-1) per day) protects against mouse memory dysfunction induced by DEHP (50 mg kg(-1) per day) from being significant to being not significant. (5) In the 5 mg kg(-1) per day DEHP exposure groups, oxidative stress in brain tissue, and neurobehavioral changes were not found. (6) High dose DEHP exposure (500 mg kg(-1) per day) may induce behavioral despair in mice. Conclusions: These data suggest that DEHP is neurotoxic with regard to cognitive ability and locomotor activity.

  • 8075.
    Tapesana, Billiart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Risk factors for teenage pregnancy in Zimbabwe: Results from the 2015 Zimbabwe Demographic and Health Survey (ZDHS)2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Teenage pregnancy remains a global problem, more so in sub-Saharan Africa where the rates are the highest. It has huge social implications to societies and is also associated with elevated levels of morbidity and mortality. The purpose of this study was to investigate the risk factors for teenage pregnancy in Zimbabwe focusing on selected background characteristics, issues to do with sexual and reproductive health and characteristics of potential partners to teenage girls. No studies have been done recently to that effect in Zimbabwe.

    Methods: Data from the 2015 Zimbabwe Demographic and Health Survey (ZDHS) was used for the present study. The sample included 2156 (weighted 2199) teenage girls between the ages of 15 and 19 years which were identified using a two-stage stratified clustered design. Crosstabulations for frequencies and Chi-square tests were used in descriptive statistics while multiple logistic regression models were used to examine risk factors for teenage pregnancy.

    Results: The prevalence of teenage pregnancy in the sample was 23% and the mean increased successively with age from 15 to 19 years. Older teenagers aged 18 and 19 years (AOR=4.11) and having ever used contraceptives (AOR=10.67) were significant risk factors for teenage pregnancy. In addition, teenagers with an early sexual debut (AOR=8.70), those currently and formerly in union (AOR= 5.68 and 65.83 respectively) and those with a non-teenage older partner (AOR=5.24) had higher odds for teenage pregnancy. Compared to the richest wealth quantile, so did those belonging to the poorest (AOR=3.21) and somewhat surprisingly the richer quantile (AOR=2.48). Attaining higher education (AOR=0.09) emerged as a significant protective factor.

    Conclusion: This study shows that risk factors for teenage pregnancy in Zimbabwe are multifactorial and should remain be a policy target for responsible authorities. Multilevel interventions involving all levels of communities, national and international organisations should be considered in a bid to lower the rates of teenage pregnancy.  These include but are not limited to ensuring education, respecting rights of women and poverty reduction strategies.

  • 8076.
    Tarekegne, Fitsum Eyayu
    et al.
    Mailman School of Public Health, Centre for International Programs, Columbia University, Addis Ababa, Ethiopia.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Schröders, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia.
    Sociodemographic and behavioral characteristics associated with self-reported diagnosed diabetes mellitus in adults aged 50+ years in Ghana and South Africa: results from the WHO-SAGE wave 12018In: BMJ Open Diabetes Research & Care, ISSN 2052-4897, Vol. 6, no 1, article id e000449Article in journal (Refereed)
    Abstract [en]

    Objective: The objective is to identify and describe thesociodemographic and behavioral characteristics of adults,aged 50 years and over, who self-reported having beendiagnosed and treated for diabetes mellitus (DM) in Ghanaand South Africa.

    Research design and methods: This is a cross-sectionalstudy based on the WHO Study on global AGEing and adulthealth (SAGE) wave 1. Information on sociodemographicfactors, health states, risk factors and chronic conditionsis captured from questionnaires administered in face-tofaceinterviews. Self-reported diagnosed and treated DM isconfirmed through a ‘yes’ response to questions regarding1having previously been diagnosed with DM, and2 havingtaken insulin or other blood sugar lowering medicines.Crude and adjusted logistic regressions test associationsbetween candidate variables and DM status. Analysesinclude survey sampling weights. The variance inflationfactor statistic tested for multicollinearity.

    Results: In this nationally representative sample ofadults aged 50 years and over in Ghana, after adjustingfor the effects of sex, residence, work status, bodymass index, waist-hip and waist-height ratios, smoking,alcohol, fruit and vegetable intake and householdwealth, WHO-SAGE survey respondents who were older,married, had higher education, very high-risk waistcircumference measurements and did not undertakehigh physical activity, were significantly more likelyto report diagnosed and treated DM. In South Africa,respondents who were older, lived in urban areas andhad high-risk waist circumference measurements weresignificantly more likely to report diagnosed andtreated DM.

    Conclusions: Countries in sub-Saharan Africa arechallenged by unprecedented ageing populations andtransition from communicable to non-communicablediseases such as DM. Information on those who arealready diagnosed and treated needs to be combinedwith estimates of those who are prediabetic or, as yet,undiagnosed. Multisectoral approaches that includesocioculturally appropriate strategies are needed toaddress diverse populations in SSA countries.

  • 8077.
    Tarko, Andrew
    et al.
    Purdue University.
    Romero, Mario
    Purdue University.
    Li, Mingyang
    Purdue University.
    Thomaz, Jose
    Purdue University.
    Shafiul, Azam
    Purdue University.
    SNIP2 - A tool for developing a strategic safety improvement plan by multiple agencies2013In: Proceedings of the 16th International Conference Road Safety on Four Continents: Beijing, China. 15-17 May 2013, Linköping: Statens väg- och transportforskningsinstitut, 2013Conference paper (Other academic)
    Abstract [en]

    This paper presents a method of systematic evaluation of road safety needs – the Safety Needs Identification Package (SNIP) and a concept called SNIP2 – an expansion that can match identified safety needs with safety interventions at the regional and city levels. SNIP and SNIP2 can be used by agencies involved in safety planning and management.

    This paper presents the SNIP concept and its implementation for safety planning on Indiana roads. SNIP utilizes GIS road and crash databases to help identify road locations that experience safety problems such as night crashes, right-angle crashes at signalized intersections, etc. It can also be applied to user-related safety needs such as drunken driving, motorcycle crashes, speeding, or young driver safety.

    SNIP2 involves two new key components: (1) a catalog of safety improvement programs and (2) a safety improvement program builder that identifies the most cost-effective safety improvement programs to address the safety needs identified with SNIP. The novelty of the proposed approach is in developing the safety improvement plan based on specific needs already identified for various locations, thereby providing a realistic approach to safety planning. The known safety effectiveness of the considered safety improvement programs and their unit costs allow planners to control the level of spending.

    To make the optimization problem tractable for large regions with multiple alternative safety interventions, an approximate greedy search is applied to the knapsack problem to optimize recurring annualized benefits and costs. This simplified approach fits well the long-term transportation planning where a long-term “static” solution is sough while providing identification of focus areas more realistic than the current practice of developing strategic safety plans.

    The paper presents the details of the catalog of safety improvements preliminarily developed for Indiana and formulation of the optimization program for selecting improvement programs. It discusses the implementation issues and the expected benefits from coordinating the development of the strategic safety plans by state agencies.

  • 8078. Taube, Jill
    et al.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Björn Ekblom's research group.
    Hellénius, Mai-Lis
    Karolinska institutet.
    Stillasittande och psykisk ohälsa2013In: Långvarigt stillasittande: en hälsofara i tiden / [ed] Elin Ekblom Bak, Studentlitteratur, 2013, p. 47-55Chapter in book (Other academic)
  • 8079. Taube, Jill
    et al.
    Kjellman, Bengt
    Jonsson, Bo
    Wahlgren, Lina
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, The Research Unit for Movement, Health and Environment.
    Oddsson, Kristjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, The Laboratory of Applied Sports Science (LTIV).
    Hultgren, Staffan
    Swedish School of Sport and Health Sciences, GIH.
    Andersson, Eva
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, The Laboratory of Applied Sports Science (LTIV).
    Improved perceived health and scored depression with a physical activity project.2010Conference paper (Refereed)
    Abstract [en]

    Background: Physical activity programs have shown a positive effect on health but also on depression that increases worldwide.

    Purpose: The purpose was to study perceived health and rated depression score with a physical activity project for persons with diagnosed depression or anxiety.

    Methods: Eighty-four persons (56 women, 28 men) with depression or anxiety disorders, recruited from psychiatric out-patient clinic participated. Mean age and BMI were 46 (21-80) yrs and 26 (17-41) kg/m2, respectively. Guided physical activity was given, in groups of 10-15, 1 hour twice a week for 8-12 weeks.

    Results: A significant improvement (p<0.05*) was seen regarding perceived physical health, several aspects of mental health and waking up thoroughly rested. Depression score significantly improved, both self-rated (PHQ-9, n=55) and by experts (MADRS, n=13), expect PHQ-9 for those with overweight.

    Conclusions: The project showed that patients with depression and anxiety can improve, in addition to increased physical activity level, both their perceived physical and several aspects of mental health and also depression score by joining a physical activity program.

     

     

  • 8080.
    Tausch, Arno
    et al.
    Innsbruck University.
    Heshmati, Almas
    Department of Food and Resource Economics, Korea University, Seoul, South Korea.
    Labour migration and ‘Smart Public Health’2014In: History & Mathematics: Trends and Cycles / [ed] Leonid Grinin, Andrey Korotayev, Volgograd: ‘Uchitel’ Publishing House , 2014Chapter in book (Other academic)
    Abstract [en]

    Public health research debates for two decades the effects of inequality on public health. More recent research also considered the additional effects of international trade and world economic openness. These investigations analyse public health outcomes in such terms as infant mortality rates, life expectancies, etc. But with the growing environmental crisis, ideas to weigh economic or social or public health progress by the ‘environmental input’ necessary to achieve it are increasingly gaining acceptance. We might call such a weighting of infant mortality rates, or life expectancies by the ‘environmental input’ necessary to achieve them ‘smart public health’. Which factors of social organization now contribute then to a responsible use of the resources of our planet Earth to achieve ‘smart public health’?

    We use standard OLS non-linear regressions of ecological footprints per capita and their square on combined public health performances. The residuals from this regression are our new measure of ‘smart public health’.

    Our research results suggest that not inequality, but migration is a very important determinant of ‘smart public health’. Migration sending countries find it relatively easy to enjoy combined good public health performances at a relatively small environmental price. Other drivers of ‘smart public health’ are the share of a country's population in world population, and the UNDP education index. The main bottleneck of ‘smart public health’ is constituted by the crowding-out effect of public education expenditures on smart health performance.

    In contrast to earlier research, we come to the conclusion that migration sending countries reap substantial benefits from receiving worker remittances, while inequality and globalization indicators hardly affect the smart public health performance of the sample countries (all countries with available data).

  • 8081.
    Tavosian, Alborz
    et al.
    University of Örebro, Sweden.
    Ström, Jakob
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. University of Örebro, Sweden.
    Appelros, Peter
    University of Örebro, Sweden.
    Incidence of Transient ischemic Attacks in Sweden2016In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 47, no 1, p. 20-25Article in journal (Refereed)
    Abstract [en]

    Background and Purpose: Stroke incidence may be on the decline in high-income countries. There may have been a shift from severe forms of cerebrovascular disease to less severe forms. No study regarding transient ischemic attack (TIA) incidence has been performed in Sweden since the 1980s. Methods:We used 2011 and 2012 data from the Swedish stroke register. A large proportion of Swedens 72 hospitals took part in the TIA register, meaning that 63 (2011) and 66 (2012) percent of the entire population were studied. Results: The number of TIA-cases was 13,880. The number of first ever TIA cases was 9098, 4,675 in men, and 4,423 in women, comprising 66% of all TIAs. The crude overall IR for first ever TIA was 74 per 100,000. The age- and sex-standardized IRs were 73 per 100,000 when standardized to the European population of 2013, and 47 per 100,000 when standardized to the European population 1976. Conclusions: The TIA incidence in Sweden is high, and no decline is seen when compared with previous studies. Better prevention may have caused a shift from severe forms of cerebrovascular disease to less severe forms. Fordemographic reasons, the health services will most likely face an increasing number of TIA patients in the coming years. (C) 2016 S. Karger AG, Basel

  • 8082.
    Tavosian, Alborz
    et al.
    Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ström, Jakob O.
    Örebro University, School of Medical Sciences. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Appelros, Peter
    Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Incidence of Transient ischemic Attacks in Sweden2016In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 47, no 1, p. 20-25Article in journal (Refereed)
    Abstract [en]

    Background and Purpose: Stroke incidence may be on the decline in high-income countries. There may have been a shift from severe forms of cerebrovascular disease to less severe forms. No study regarding transient ischemic attack (TIA) incidence has been performed in Sweden since the 1980s.

    Methods: We used 2011 and 2012 data from the Swedish stroke register. A large proportion of Sweden's 72 hospitals took part in the TIA register, meaning that 63 (2011) and 66 (2012) percent of the entire population were studied.

    Results: The number of TIA-cases was 13,880. The number of first ever TIA cases was 9098, 4,675 in men, and 4,423 in women, comprising 66% of all TIAs. The crude overall IR for first ever TIA was 74 per 100,000. The age- and sex-standardized IRs were 73 per 100,000 when standardized to the European population of 2013, and 47 per 100,000 when standardized to the European population 1976.

    Conclusions: The TIA incidence in Sweden is high, and no decline is seen when compared with previous studies. Better prevention may have caused a shift from severe forms of cerebrovascular disease to less severe forms. Fordemographic reasons, the health services will most likely face an increasing number of TIA patients in the coming years.

  • 8083. Tawatsupa, Benjawan
    et al.
    Dear, Keith
    Kjellström, Tord
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sleigh, Adrian
    The association between temperature and mortality in tropical middle income Thailand from 1999 to 20082014In: International journal of biometeorology, ISSN 0020-7128, E-ISSN 1432-1254, Vol. 58, no 2, p. 203-215Article in journal (Refereed)
    Abstract [en]

    We have investigated the association between tropical weather condition and age-sex adjusted death rates (ADR) in Thailand over a 10-year period from 1999 to 2008. Population, mortality, weather and air pollution data were obtained from four national databases. Alternating multivariable fractional polynomial (MFP) regression and stepwise multivariable linear regression analysis were used to sequentially build models of the associations between temperature variable and deaths, adjusted for the effects and interactions of age, sex, weather (6 variables), and air pollution (10 variables). The associations are explored and compared among three seasons (cold, hot and wet months) and four weather zones of Thailand (the North, Northeast, Central, and South regions). We found statistically significant associations between temperature and mortality in Thailand. The maximum temperature is the most important variable in predicting mortality. Overall, the association is nonlinear U-shape and 31 A degrees C is the minimum-mortality temperature in Thailand. The death rates increase when maximum temperature increase with the highest rates in the North and Central during hot months. The final equation used in this study allowed estimation of the impact of a 4 A degrees C increase in temperature as projected for Thailand by 2100; this analysis revealed that the heat-related deaths will increase more than the cold-related deaths avoided in the hot and wet months, and overall the net increase in expected mortality by region ranges from 5 to 13 % unless preventive measures were adopted. Overall, these results are useful for health impact assessment for the present situation and future public health implication of global climate change for tropical Thailand.

  • 8084. Tawatsupa, Benjawan
    et al.
    Lim, Lynette L-Y
    Kjellström, Tord
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Seubsman, Sam-Ang
    Sleigh, Adrian
    Association between occupational heat stress and kidney disease among 37 816 workers in the Thai Cohort Study (TCS)2012In: Journal of Epidemiology, ISSN 0917-5040, E-ISSN 1349-9092, Vol. 22, no 3, p. 251-260Article in journal (Refereed)
    Abstract [en]

    Background: We examined the relationship between self-reported occupational heat stress and incidence of self-reported doctor-diagnosed kidney disease in Thai workers.Methods: Data were derived from baseline (2005) and follow-up (2009) self-report questionnaires from a large national Thai Cohort Study (TCS). Analysis was restricted to full-time workers (n = 17 402 men and 20 414 women) without known kidney disease at baseline. We used logistic regression models to examine the association of incident kidney disease with heat stress at work, after adjustment for smoking, alcohol drinking, body mass index, and a large number of socioeconomic and demographic characteristics.Results: Exposure to heat stress was more common in men than in women (22% vs 15%). A significant association between heat stress and incident kidney disease was observed in men (adjusted odds ratio [OR] = 1.48, 95% CI: 1.01-2.16). The risk of kidney disease was higher among workers reporting workplace heat stress in both 2005 and 2009. Among men exposed to prolonged heat stress, the odds of developing kidney disease was 2.22 times that of men without such exposure (95% CI 1.48-3.35, P-trend <0.001). The incidence of kidney disease was even higher among men aged 35 years or older in a physical job: 2.2% exposed to prolonged heat stress developed kidney disease compared with 0.4% with no heat exposure (adjusted OR = 5.30, 95% CI 1.17-24.13).Conclusions: There is an association between self-reported occupational heat stress and self-reported doctor-diagnosed kidney disease in Thailand. The results indicate a need for occupational health interventions for heat stress among workers in tropical climates.

  • 8085. Tawatsupa, Benjawan
    et al.
    Yiengprugsawan, Vasoontara
    Kjellström, Tord
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Berecki-Gisolf, Janneke
    Seubsman, Sam-Ang
    Sleigh, Adrian
    Association between Heat Stress and Occupational Injury among Thai Workers: Findings of the Thai Cohort Study2013In: Industrial Health, ISSN 0019-8366, E-ISSN 1880-8026, Vol. 51, no 1, p. 34-46Article in journal (Refereed)
    Abstract [en]

    Global warming will increase heat stress at home and at work. Few studies have addressed the health consequences in tropical low and middle income settings such as Thailand. We report on the association between heat stress and workplace injury among workers enrolled in the large national Thai Cohort Study in 2005 (N=58,495). We used logistic regression to relate heat stress and occupational injury separately for males and females, adjusting for covariate effects of age, income, education, alcohol, smoking, Body Mass Index, job location, job type, sleeping hours, existing illness, and having to work very fast. Nearly 20% of workers experienced occupational heat stress which strongly and significantly associated with occupational injury (adjusted OR 2.12, 95%CI 1.87-2.42 for males and 1.89, 95%CI 1.64-2.18 for females). This study provides evidence connecting heat stress and occupational injury in tropical Thailand and also identifies several factors that increase heat exposure. The findings will be useful for policy makers to consider work-related heat stress problems in tropical Thailand and to develop an occupational health and safety program which is urgently needed given the looming threat of global warming.

  • 8086. Tawatsupa, Benjawan
    et al.
    Yiengprugsawan, Vasoontara
    Kjellström, Tord
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Seubsman, Sam-Ang
    Sleigh, Adrian
    Heat stress, health and well-being: findings from a large national cohort of Thai adults2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 6Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aims to examine the association between self-reported heat stress interference with daily activities (sleeping, work, travel, housework and exercise) and three graded-holistic health and well-being outcomes (energy, emotions and life satisfaction).

    DESIGN: A cross-sectional study.

    SETTING: The setting is tropical and developing countries as Thailand, where high temperature and high humidity are common, particularly during the hottest seasons.

    PARTICIPANTS: This study is based on an ongoing national Thai Cohort Study of distance-learning open-university adult students (N=60 569) established in 2005 to study the health-risk transition. PRIMARY AND SECONDARY OUTCOME MEASURES: Health impacts from heat stress in our study are categorised as physical health impacts (energy levels), mental health impacts (emotions) and well-being (life satisfaction). For each health and well-being outcome we report ORs and 95% CIs using multinomial logistic regression adjusting for a wide array of potential confounders.

    RESULTS: Negative health and well-being outcomes (low-energy level, emotional problems and low life satisfaction) associated with increasing frequency of heat stress interfering with daily activities. Adjusted ORs for emotional problems were between 1.5 and 4.8 and in general worse than energy level (between 1.31 and 2.91) and life satisfaction (between 1.10 and 2.49). The worst health outcomes were when heat interfered with sleeping, followed by interference with daily travel, work, housework and exercise.

    CONCLUSIONS: In tropical Thailand there already are substantial heat stress impacts on health and well-being. Increasing temperatures from climate change plus the ageing and urbanisation of the population could significantly worsen the situation. There is a need to improve public health surveillance and public awareness regarding the risks of heat stress in daily life.

  • 8087.
    Tayyab Minhas, Muhammad
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Prevalence of type 2 Diabetes Mellitus among HCV infected patients; A Literature Review2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
  • 8088.
    Tefera, Behailu
    Kristianstad University, School of Health and Society.
    Unga vuxnas upplevelser av Internet Communities: En studie om hur virtuell gemenskap kan utveckla socialt kapital och lärande2011Independent thesis Basic level (university diploma), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study was to examine the experiences of young adults concerning the virtual community of Internet communities and how it affects their health and learning. The study is based on public health educational perspective and was based on a qualitative study. During the execution of the study, eight individuals participated in individual interviews. In the background I illustrate how technological progress changes the social interaction in society. Increased communication through Internet community has contributed for peoples to have greater social network without physical barriers. The problem area was that the growing use of online communities can cause dependence, which in return can lead to sedentary lifestyles. Stress and lack of sleep were the symptoms that have been shown to be prevalent. In the literature review I illustrate the importance of social capital, physical health and even learning with multimedia. In the discussion I discuss the importance of social capital related to the virtual community and how it may affect health and learning. My conclusion is communication through the Internet comunities has become everyday issue and that it can affect people’s health and learning. Also that it may be an important factor for health and learning.

  • 8089.
    Tegler, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala County Council.
    Pless, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Blom Johansson, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Sonnander, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Speech and language pathologists’ perceptions and practises of communication partner training to support children’s communication with high-tech speech generating devices2018In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115Article in journal (Refereed)
    Abstract [en]

    Purpose: This study examined speech and language pathologists’ (SLPs’) perceptions and practices of communication partner training with high-tech speech generating devices (SGDs).

    Method: Fifteen SLPs were recruited throughout Sweden. The SLPs answered a study-specific questionnaire on communication partner training in relation to communication partners to children with severe cerebral palsy and intellectual disability. The results were analysed with descriptive statistics (closed-ended questions, responses on Likert scales) and content analysis (open-ended question) using ICF-CY.

    Results: Twelve SLPs completed the survey. Half had no or one training session with communication partners in the last year. One-third never used documents for goal-setting. Half seldom or never taught communication partner strategies. Three quarters only used verbal instructions. The main obstacles were environmental factors.

    Conclusions: This study contributes valuable knowledge about high-tech SGD interventions targeting communication partners. The high-tech SGD intervention may benefit from goal-setting, extended number of training sessions and a range of instructional approaches.

  • 8090.
    Tell, Johanna
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Olander, Ewy
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Implementation of a web-based national child health-care programme in a local context: A complex facilitator role2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 20_suppl, p. 80-86Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate child health-care coordinators’ experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. Methods: The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. Results: The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme ‘Being a facilitator: a complex role’ was formed to express the child health-care coordinators’ experiences. Conclusions: Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context. © 2018, © Author(s) 2018.

  • 8091.
    Tengelin, Ellinor
    et al.
    University West, Department of Health Sciences.
    Dahlborg Lyckhage, Elisabeth
    University West, Department of Nursing, Health and Culture, Division of Advanced Nursing.
    Nursing teachers’ reflections on their own norm-critical competence2016Conference paper (Other academic)
    Abstract [en]

    Background: Nursing education in Sweden generally lacks norm-critical perspectives, even though this could help unveil normative judgements of patients in nurses’ daily work. To pursue work-integrated learning about norm criticism for nursing teachers at a small university college in Sweden, all teachers involved in nursing education were offered the course Norm-Aware Caring.Aim: To describe how norm criticism in nursing education is constructed by nursing teachers’ discussions.Methods: After the course Norm-Aware Caring, 20 of the participating 33 nursing teachers were interviewed in five focus groups about their reflections on their new knowledge. The interview transcripts were analyzed on the basis of Fairclough’s discourse analysis, in which words and social practice are seen as mutually constituting each other.Results: Discursive constructions related to teaching, caring and learning were seen in the text. Norm critical teaching was constructed as a practice of much consideration not to insult any student. Norm criticism as a basic caring value was closely related to person-centered care. Their own, personal learning was expressed as fear to use their new knowledge in a wrong way. The teachers themselves considered norm-criticism as something to learn in order to improve the understanding of people who does not fit into majority norms. This perspective of tolerance was consistent in the construction of all discourses.Discussion: It appears that the teachers’ social practice is influenced by a perspective that divides the “normal” from the “deviant”. This may prevent an internalization of norm-critical knowledge, a perspective that aims to question categorizations of normality. Therefore, it is important to continuously scrutinize and reflect over the role of social norms as part of work-integrated learning for nursing teachers.

    References

    AGENCY FOR HEALTH CARE ANALYSIS 2014. A more equal care is possible. Analysis of unmotivated differences in care, encounters and treatment. Report 2014:7. Stockholm: Agency for Health Care Analysis.

    FAIRCLOUGH, N. 1989/2015. Language and power, London, Routledge.

    KIRKEVOLD, M. 2009. Nursing Science – epistemological deliberations]. In: ÖSTLINDER, G., SÖDERBERG, S. & ÖHLÉN, J. (eds.) Caring as an Academic Subject: Report from a Working Conference. Swedish Association for Nurses.

    VAN HERK, K. A., SMITH, D. & ANDREW, C. 2011. Examining our privileges and oppressions: incorporating an intersectionality paradigm into nursing. Nursing Inquiry, 18, 29-39.

  • 8092.
    Teoh, Boon-Teong
    et al.
    Malaysia.
    Sam, Sing-Sin
    Malaysia.
    Tan, Kim-Kee
    Malaysia.
    Danlami, Mohammed Bashar
    Malaysia.
    Shu, Meng-Hooi
    Malaysia.
    Johari, Jefree
    Malaysia.
    Hooi, Poh-Sim
    Malaysia.
    Brooks, David
    United Kingdom.
    Piepenburg, Olaf
    United Kingdom.
    Nentwich, Oliver
    United Kingdom.
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Franco, Leticia
    Spain.
    Tenorio, Antonio
    Spain.
    AbuBakar, Sazaly
    Malaysia.
    Early detection of the dengue virus using reverse transcription-recombinase polymerase amplification2015In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 53, no 3, p. 830-837Article in journal (Refereed)
    Abstract [en]

    A method for the rapid diagnosis of early dengue virus (DENV) infection is highly needed. Here, a prototype reverse transcription-recombinase polymerase amplification (RT-RPA) assay was developed. The assay detected DENV RNA in <20 minutes without the need for thermocycling amplification. The assay enabled the detection of as few as 10 copies of DENV RNA. The designed RT-RPA primers and exo-probe detected the DENV genome of at least 12 genotypes of DENV circulating globally without cross-reacting with other arboviruses. We assessed the diagnostic performance of the RT-RPA assay for the detection of DENV RNA in 203 sera of clinically suspected dengue patients. The sera were simultaneously tested for DENV using RT-loop-mediated isothermal amplification (RT-LAMP), quantitative RT-polymerase chain reaction (qRT-PCR), and IgM- and IgG-capture enzyme-linked immunosorbent assays (ELISA). Acute DENV infection was confirmed in 130 samples and 61 of the samples (46.9%) were classified as viremic with qRT-PCR. The RT-RPA assay showed good concordance (κ ≥ 0.723) with the RT-LAMP and qRT-PCR assays in detecting the dengue viremic samples. When used in combination with ELISA, both the RT-RPA and RT-LAMP assays increased the detection of acute DENV infection to ≥95.7% (≥45/47) in samples obtained within 5 days of illness. The results from the study suggest that the RT-RPA assay is the most rapid molecular diagnostic tool available for the detection of DENV. Hence, it is possible to use the RT-RPA assay in a laboratory to complement routine serology testing for dengue.

    IMPORTANCE: Nucleic acid detection methods are gradually being accepted as diagnostic platforms for the detection of DENV, especially in well-equipped diagnostic facilities. Their application in low-resource settings, however, is limited mostly due to the high cost and skill required. In this study, a novel RT-RPA assay was developed for the detection of DENV. The sensitivity and specificity of the RT-RPA assay were comparable to those of the RT-LAMP and qRT-PCR methods. The RT-RPA assay is rapid and simple to perform without the need for costly equipment or a high level of skill. Hence, it has the potential to be implemented as a routine diagnostic tool at health care centers and clinics in endemic regions where early detection of viremic dengue patients is needed for better treatment and outbreak control measures.

  • 8093. Tercero, F
    et al.
    Andersson, R
    Peña, Rodolfo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Department of Preventive Medicine, Health and Demography Research Centre, National Autonomous University of Nicaragua, León, Nicaragua.
    Rocha, J
    Castro, N
    The epidemiology of moderate and severe injuries in a Nicaraguan community: a household-based survey2006In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, no 2, p. 106-114Article in journal (Refereed)
    Abstract [en]

    Although injuries constitute a major public health problem worldwide, the magnitude and nature of this problem is difficult to establish in low-income settings due to the lack of valid and representative data. In Nicaragua, several parallel studies have been carried out attempting to assess levels and patterns of injury using various sources of information. The objective of this study was to describe the magnitude and profile of moderate and severe injuries in a well-defined community in Nicaragua. The study was conducted using a household-based survey design. Randomized cluster sampling provided information from 10,797 households (63,886 inhabitants). The outcomes included fatal and non-fatal injuries registered during a recall period of 6 weeks. Seven percent of all. injuries were classified as moderate or severe. The estimated annual incidence rate of moderate/severe injuries was 27.6 per 1000 [95% confidence intervals (CI): 26.4-29.2], white the mortality and impairment rates were 108.9 (95% CI: 83.5-134.4) and 95.3 (95% CI: 71.4-119.2) per 100,000 inhabitants, respectively. Home and traffic areas were the main environments associated with injury occurrence. The most affected groups were the elderly, children and mates. No differences were found between urban and rural areas. Only 9% of all cases, including minor injuries, sought hospital treatment. The main causes of non-fatal injuries were falls, traffic and cuts, whereas fatalities were largely associated with intentional injuries. For every death due to injury, there was one permanent disability, 25 moderate/severe injuries and 354 minor injuries. This study provides a broad description of injury magnitudes and patterns in a defined Nicaraguan community, and demonstrates the aggregate injury pyramid of the same community. It also identifies the issue of severity and concludes with a recommendation to apply different criteria of severity. Our results support the call for a careful evaluation of injury data sources and severity scores when planning injury prevention programmes.

  • 8094. Tercero, F
    et al.
    Andersson, Ragnar
    Measuring traffic injuries in a developing country: an application of the capture-recapture method2004In: Accid Anal Prev. 2004 Jan;36(1):13-20Article in journal (Refereed)
  • 8095. Tercero, F
    et al.
    Andersson, Ragnar
    Peña, R
    Rocha, J
    Castro, N
    The Epidemiology of Injury in a Local Community in Nicaragua: A Household-Based Survey2006In: Public Health, 2006 Feb;120(2):106-14Article in journal (Refereed)
  • 8096. Tercero, F
    et al.
    Andersson, Ragnar
    Rocha, J
    Castro, N
    Svanström, L
    On the epidemiology of injury in developing countries: A one year emergency room based surveillance experience from León, Nicaragua1999In: International Journal for Consumer and Product Safety, 1999, Vol. 6, No. 1, pp. 33-42Article in journal (Refereed)
  • 8097.
    Ternstedt, Amanda
    Mälardalen University, School of Health, Care and Social Welfare.
    På lika villkor: En kvalitativ studie om uppfattningar kring ensamkommande barns förutsättningar för god hälsa2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Since 2004, the amount of unaccompanied children in Sweden has increased and 2014 over 7000 children came here. An unaccompanied child is a child who is coming without its parents or someone who can act in their place. The most common health problem among unaccompanied children is mental illness, for instance because of traumatic incidents in their lives. The aim of this study is to describe the involved persons’ opinions about unaccompanied children’s opportunities for good health.

    The surveys for the study have been conducted by eight qualitative separate interviews. The persons interviewed were people who in some way have continuous contact with unaccompanied children in a smaller district in the middle of Sweden. The interviews were analyzed in a manifest content analysis. The ethic principles for research and trustworthiness have been observed during the study. The result shows that integration, support and engagement from the community, school and persons involved were experienced as conditions for unaccompanied childrens health. Several factors were considered influence unaccompanied children’s health, for example trauma, education, social relations and the possibility of recreational activities. The persons involved considered that these factors also could influence and be crucial for each other. The conclusions were that there are some factors that to a greater extent are experienced to influence unaccompanied children’s opportunities for good health. Even though the unaccompanied children in some degree are considered to have good opportunities, there are several ways of improving and increasing their possibilities for good health. 

  • 8098.
    Ternström, Elin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden..
    Haines, Helen
    Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Vic, Australia..
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Sundin, Örjan
    Mid Sweden Univ, Dept Psychol, Ostersund, Sweden..
    Ekdahl, Johanna
    Mid Sweden Univ, Dept Psychol, Ostersund, Sweden..
    Segebladh, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Sundsvall Hosp, Res & Dev Ctr, Sundsvall, Sweden..
    Rondung, Elisabet
    Mid Sweden Univ, Dept Psychol, Ostersund, Sweden..
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth: A study protocol2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, p. 75-82Article in journal (Refereed)
    Abstract [en]

    Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

  • 8099.
    Tersing, Linda
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Svenska elevhälsoteams erfarenheter kring hälsofrämjande arbete: fokus på samverkan och nätverk.2016Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
  • 8100.
    Tesfaye, Fikru
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Berhane, Y
    Bonita, R
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Association of Smoking and Khat (Catha edulis Forsk) Use With High Blood Pressure Among Adults in Addis Ababa, Ethiopia, 20062008In: Preventing chronic diseases, ISSN 1545-1151, Vol. 5, no 3Article in journal (Refereed)
    Abstract [en]

    Introduction We assessed the prevalence of substance use and its association with high blood pressure among adults in Addis Ababa, Ethiopia.

    Methods We employed a cross-sectional descriptive study design. The World Health Organization instrument for stepwise surveillance of risk factors for chronic diseases was applied on a probabilistic sample of 4001 men and women aged 25 to 64 years in Addis Ababa. We determined the prevalence of cigarette smoking, alcohol drinking, and khat (Catha edulis Forsk) chewing. We measured blood pressure by using a digital device and determined mean levels of systolic and diastolic blood pressure.

    Results Smoking cigarettes, drinking alcohol, and chewing khat were widely prevalent among men. Among men, the prevalence of current daily smoking was 11.0% (95% confidence interval [CI], 9.5%–12.5%). Binge drinking of alcohol was reported by 10.4% (95% CI, 9.0%–11.9%) of men. Similarly, 15.9% (95% CI, 14.1%–17.6%) of men regularly chewed khat. Consequently, 26.6% of men and 2.4% of women reported practicing one or more of the behaviors. Current daily smoking and regular khat chewing were significantly associated with elevated mean diastolic blood pressure (β = 2.1, P = .03 and β = 1.9, P = .02, respectively).

    Conclusion Cigarette smoking and khat chewing among men in Addis Ababa were associated with high blood pressure, an established risk factor for cardiovascular disease. Health promotion interventions should aim to prevent proliferation of such behaviors among young people and adoption by women. Surveillance for risk factors for cardiovascular disease should be implemented nationwide to provide information for policy decisions and to guide prevention and control programs.

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