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  • 9101.
    Tholander Hasselrot, Maria
    University of Skövde, School of Health and Education.
    Olika yrkeskategoriers följsamhet till basala hygienrutiner inom djursjukvården: En enkätstudie2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Infection control in animal health care is, as in human health care, most important to prevent and fight antibiotic resistance. Animal health can also influence public health. Basic hygiene routines; hand hygiene, routines for proper attire, and routines for personal protective equipment (PPE), such as protective aprons and gloves, represent the simplest and most important infection control and prevention measures. High compliance to these routines is important to achieve. However, due to few scientific publications in the animal health care arena, customized and efficient efforts have not been fully identified for this environment. Therefore, optimal oversight and compliance assessments are difficult to achieve. Similar to human health care, several infection control and prevention measures and responsibilities are addressed by nurses.

    Objectives: To study compliance to basic hygiene routines and assess whether compliance differs between different animal health care professions, such as nurses versus veterinarians.

    Method: A quantitative web-based survey about basic hygiene routines, was used to investigate compliance to basic hygiene routines among animal healthcare providers. The eligible respondent sample was comprised of 360-2600 providers. Difference in compliance among professions within animal health care was estimated using SPSS statistical analysis software.

    Results: Of a possible 360-2600 possible respondents, 313 animal healthcare providers responded to our web-based survey. Significant differences in compliance among professions were not found (between veterinarians and veterinary nurses with a degree, and veterinarians versus nurses without a degree). Higher compliance was observed at larger animal hospitals and among personnel educated at their work place in basic hygiene routines. Hand disinfectant use before contact with patients was most often missed, as well as not wearing a protective apron or coat if risk for contact with body fluids was evident.

    Conclusion: In contrast to previous practical experience and reports, our results showed no significant difference in compliance between animal healthcare veterinarians and nurses. Given our null findings, more studies are needed to identify hidden factors influencing compliance among animal health care workers, as well as attention to representative sampling. Even so, based on our results, potential interventions include enhanced work-based education programs on infection control and prevention, with attention to smaller (small to medium sized) animal health care clinics. Focus for such interventions should also address hand disinfection before contact with patients. In addition, more effective monitoring is required.

  • 9102.
    Thomas, Kristin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Implementation of coordinated healthy lifestyle promotion in primary care: Process and outcomes2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Implementation of healthy lifestyle promotion in routine primary has been suboptimal. There is emerging evidence that coordinating care can improve the efficiency and quality of care. However, more research is needed on the implementation of coordinated care in healthy lifestyle promotion, the role of patients in implementation and the long-term outcomes of implementation efforts.

    Overall aim: To investigate the implementation of coordinated healthy lifestyle promotion in primary care in terms of process and outcomes, from the perspectives of both staff and patients.

    Methods: In 2008, Östergötland county council commissioned primary care centres to implement a coordinated care initiative, lifestyle teams, to improve healthy lifestyle promotion routines. A lifestyle team protocol stipulated centres to: (1) create multi-professional teams, (2) appoint team managers, (3) hold team meetings, and (4) create in-house referral routines for at-risk patients. Paper I investigated the implementation process of three lifestyle teams during a two year period using a mixed method, convergent parallel design. A proposed theory of implementation process was used to analyse data from manager interviews, documents and questionnaires. Paper II explored patients’ role in implementation using grounded theory. Interview data from patients with varied experience of promotion was used. Paper III investigated implementation outcomes using a quasi-experimental, cross-sectional design that compared three intervention centres (lifestyle teams) with three control centres (no teams). Data were collected by staff and patient questionnaires and manager interviews at 3 and 5 years after commissioning. The RE-AIM framework was modified and used to define outcome variables: Reach of patients, Effectiveness (attitudes and competency among staff), Adoption among staff, Implementation fidelity to the lifestyle team protocol, and Maintenance of the results at 5-year follow-up.

    Results: Paper I: The implementation process was complex including multiple innovation components and groups of adopters. The conditions for implementation, e.g. resources varied between staff and team members which challenged the embedding of the teams and new routines. The lifestyle teams were continuously redefined by team members to accommodate contextual factors, features of the protocol and patients. The lifestyle team protocol presented an infrastructure for practice at the centres. Paper II: A grounded theory about being healthy with three interconnected subcategories emerged from data: (1) conditions, (2) managing, and (3) interactions regarding being healthy. Being healthy represented a process of approaching a health ideal which occurred simultaneously with, and could contradict, a process of maximizing well-being. A typology of four patient types (resigned, receivers, co-workers, and leaders) illustrated how processes before, during and after healthy lifestyle promotion were interconnected. Paper III: Reach: significantly more patients at control centres received promotion compared to intervention centres at 3-year (48% and 41% respectively) and 5-year followups (44% and 36% respectively). Effectiveness: At 3-year follow-up, after controlling for clustering by centres, intervention staff were significantly more positive concerning perceived need for lifestyle teams; that healthy lifestyle promotion was prioritized at their centre and that there was adequate competency at individual and centre level regarding lifestyle promotion. At 5-year follow-up, significant differences remained regarding prioritization of lifestyle promotion at centre level. The majority of both intervention and control staff were positive towards lifestyle promotion. Adoption: No significant differences were found between control and intervention centres at 3 years (59% and 47% respectively) or at 5 years (45% and 36% respectively). Implementation fidelity: all components of the lifestyle team protocol had been implemented at all the intervention centres and at none of the control centres.

    Conclusions: The implementation process was challenged by a complex interaction between groups of staff, innovation components and contextual factors. Although coordinated care are used for other conditions in primary care, the findings suggest that it is difficult to adopt similar routines for healthy lifestyle promotion. Findings suggest that the lifestyle team protocol did not fully consider social components of coordinated care or the varied conditions for change exhibited by adopters. Patients can be seen as coproducing implementation of healthy lifestyle promotion.

  • 9103.
    Thomas, Kristin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Marcus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Science & Engineering.
    Linderoth, Catharina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Müssener, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    mHealth smoking cessation intervention among high-school pupils (NEXit Junior): study protocol for a randomized controlled trial2018In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 19, article id 648Article in journal (Refereed)
    Abstract [en]

    BackgroundMobile health (mHealth) interventions, using text messages to support high-school pupils to quit smoking, could be a novel and cost-effective approach. However, more research is needed, specifically to investigate long-term effectiveness. The study aims to evaluate the effectiveness of a newly developed mHealth intervention targeting smoking cessation among high-school pupils.MethodsThe study is a two-arm, randomized controlled trial with an intervention group (mHealth intervention) and a control group (treatment as usual: national smoking cessation help line). Outcome measures will be investigated at baseline and at 3, 6, and 12months follow-up. Primary outcome measures will be: prolonged abstinence and 4-week point prevalence of smoking abstinence. Secondary outcome measures will be: 7-day point prevalence of smoking abstinence; mean number of quit attempts since taking part in the study; number of uses of other smoking cessation services since first invitation to the study and number of cigarettes smoked weekly if still smoking.DiscussionHigh schools in Sweden are bound by law to offer a smoke-free environment. However, little effort has been made to offer support to pupils who wish to quit smoking; rather the emphasis is on prevention of uptake. The study will examine the effectiveness of a stand-alone mHealth intervention targeting smokers among high-school pupils.Trial registrationThe trial was not retrospectively registered and has been registered at ISRCTN with the unique identification number ISRCTN15396225. The trial was registered on 13 October 2017.

  • 9104.
    Thomas, Kristin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Towards implementing coordinated healthy lifestyle promotion in primary care: a mixed method study2015In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 15, article id e030Article in journal (Refereed)
    Abstract [en]

    Background: Primary care is increasingly being encouraged to integrate healthy lifestyle promotion in routine care. However, implementation has been suboptimal. Coordinated care could facilitate lifestyle promotion practice but more empirical knowledge is needed about the implementation process of coordinated care initiatives. This study aimed to evaluate the implementation of a coordinated healthy lifestyle promotion initiative in a primary care setting.

    Methods: A mixed method, convergent, parallel design was used. Three primary care centres took part in a two-year research project. Data collection methods included individual interviews, document data and questionnaires. The General Theory of Implementation was used as a framework in the analysis to integrate the data sources.

    Results: Multi-disciplinary teams were implemented in the centres although the role of the teams as a resource for coordinated lifestyle promotion was not fully embedded at the centres. Embedding of the teams was challenged by differences among the staff, patients and team members on resources, commitment, social norms and roles.

    Conclusions: The study highlights the importance of identifying and engaging key stakeholders early in an implementation process. The findings showed how the development phase influenced the implementation and embedding processes, which add aspects to the General Theory of Implementation.

  • 9105. Thomas, Lisa-Marie
    et al.
    D'Ambruoso, Lucia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Balabanova, Dina
    Use of verbal autopsy and social autopsy in humanitarian crises2018In: BMJ Global Health, ISSN 2059-7908, Vol. 3, no 3, article id e000640Article in journal (Refereed)
    Abstract [en]

    Introduction: Two billion people live in countries affected by conflict, violence and fragility. These are exceptional situations in which mortality shifts dramatically and in which civil registration and vital statistics systems are often weakened or cease to function. Verbal autopsy and social autopsy (VA and SA) are methods used to assign causes of death and understand the contexts in which these occur, in settings where information is otherwise unavailable. This review sought to explore the use of VA and SA in humanitarian crises, with a focus on how these approaches are used to inform policy and programme responses.

    Methods: A rapid scoping review was conducted on the use of VA and SA in humanitarian crises in low and middle-income countries since 1991. Drawing on a maximum variation approach, two settings of application ('application contexts') were selected and investigated via nine semi-structured expert interviews.

    Results: VA can determine causes of death in crisis-affected populations where no other registration system is in place. Combined with SA and active community involvement, these methods can deliver a holistic view of obstacles to seeking and receiving essential healthcare, yielding context-specific information to inform appropriate responses. The contexts in which VA and SA are used require adaptations to standard tools, and new mobile developments in VA raise specific ethical considerations. Furthermore, collecting and sythesising data in a timely, continuous manner, and ensuring coordination and communication between agencies, is important to realise the potential of these approaches.

    Conclusion: VA and SA are valuable research methods to foster evidence-informed responses for populations affected by humanitarian crises. When coordinated and communicated effectively, data generated through these methods can help to identify levels, causes and circumstances of deaths among vulnerable groups, and can enable planning and allocating resources effectively, potentially improving health system resilience to future crises.

  • 9106. Thomas, Lisa-Marie
    et al.
    D'Ambruoso, Lucia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; RC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Balabanova, Dina
    Verbal autopsy in health policy and systems: a literature review2018In: BMJ Global Health, ISSN 2059-7908, Vol. 3, no 2, article id e000639Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Estimates suggest that one in two deaths go unrecorded globally every year in terms of medical causes, with the majority occurring in low and middle-income countries (LMICs). This can be related to low investment in civil registration and vital statistics (CRVS) systems. Verbal autopsy (VA) is a method that enables identification of cause of death where no other routine systems are in place and where many people die at home. Considering the utility of VA as a pragmatic, interim solution to the lack of functional CRVS, this review aimed to examine the use of VA to inform health policy and systems improvements.

    Methods: A literature review was conducted including papers published between 2010 and 2017 according to a systematic search strategy. Inclusion of papers and data extraction were assessed by three reviewers. Thereafter, thematic analysis and narrative synthesis were conducted in which evidence was critically examined and key themes were identified.

    Results: Twenty-six papers applying VA to inform health policy and systems developments were selected, including studies in 15 LMICs in Africa, Asia, the Middle East and South America. The majority of studies applied VA in surveillance sites or programmes actively engaging with decision makers and governments in different ways and to different degrees. In the papers reviewed, the value of continuous collection of cause of death data, supplemented by social and community-based investigations and underpinned by electronic data innovations, to establish a robust and reliable evidence base for health policies and programmes was clearly recognised.

    Conclusion: VA has considerable potential to inform policy, planning and measurement of progress towards goals and targets. Working collaboratively at sub-national, national and international levels facilitates data collection, aggregation and dissemination linked to routine information systems. When used in partnerships between researchers and authorities, VA can help to close critical information gaps and guide policy development, implementation, evaluation and investment in health systems.

  • 9107.
    Thomsen, S
    et al.
    Arnetz, Bengt
    Nolan, Peter
    Soares, Joaquim
    Dallender, Janie
    Individual and organisational well-being in psychiatric nursing: A cross-cultural study1999In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 30, no 3, p. 749-757Article in journal (Refereed)
    Abstract [en]

    Although health care systems around the world are undergoing rapid changes, there is an absence of comparative studies of how these changes affect nurses’ well-being and work life. The purpose of this study was (i) to identify and describe possible differences between the psycho-social work environments of English and Swedish mental health nurses, and (ii) to attempt to explain these differences. 1016 psychiatric nurses from Stockholm (Sweden) and Birmingham (England) responded to a postal questionnaire on their psycho-social work environment and feelings of professional fulfilment, mental energy and work-related exhaustion. The study was given ethical clearance in Stockholm and Birmingham. Results indicated that while the English nurses rated their organizational well-being more favourably, Swedish psychiatric nurses reported greater individual well-being than their counterparts. Multiple regression analyses indicated that self-esteem was important for explaining mental energy and work-related exhaustion, but less so for explaining professional fulfilment, which was predicted primarily by organizational factors. When controlling for self-esteem, which was higher amongst the Swedish nurses, the differences in professional fulfilment and mental health were no longer significant. Reasons for the differences in self-esteem and experiences of the workplace are discussed. Low response rate may have contributed to a selection bias.

  • 9108. Thomsen, Sarah
    et al.
    Biao, Xu
    Kusnanto, Hari
    Mavalankar, Dileep
    Malqvist, Mats
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Diwan, Vinod
    The world we want: focus on the most disadvantaged2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 20919-Article in journal (Other academic)
  • 9109. Thomsen, Sarah
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Biao, Xu
    Bondjers, Goran
    Kusnanto, Hari
    Liem, Nguyen Tanh
    Mavalankar, Dileep
    Malqvist, Mats
    Diwan, Vinod
    Bringing evidence to policy to achieve health-related MDGs for all: justification and design of the EPI-4 project in China, India, Indonesia, and Vietnam2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Background: The Millennium Development Goals (MDGs) are monitored using national-level statistics, which have shown substantial improvements in many countries. These statistics may be misleading, however, and may divert resources from disadvantaged populations within the same countries that are showing progress. The purpose of this article is to set out the relevance and design of the "Evidence for Policy and Implementation project (EPI-4)". EPI-4 aims to contribute to the reduction of inequities in the achievement of health-related MDGs in China, India, Indonesia and Vietnam through the promotion of research-informed policymaking. Methods: Using a framework provided by the Commission on the Social Determinants of Health (CSDH), we compare national-level MDG targets and results, as well as their social and structural determinants, in China, India, Indonesia and Vietnam. Results: To understand country-level MDG achievements it is useful to analyze their social and structural determinants. This analysis is not sufficient, however, to understand within-country inequities. Specialized analyses are required for this purpose, as is discussion and debate of the results with policymakers, which is the aim of the EPI-4 project. Conclusion: Reducing health inequities requires sophisticated analyses to identify disadvantaged populations within and between countries, and to determine evidence-based solutions that will make a difference. The EPI-4 project hopes to contribute to this goal.

  • 9110.
    Thomsen, Sarah
    et al.
    National Institute for Psychosocial Factors and Health, Stockholm, Sweden.
    Soares, Joaquim
    National Institute for Psychosocial Factors and Health, Stockholm, Sweden.
    Nolan, P
    Dallender, J
    Arnetz, B
    Feelings of professional fulfilment and exhaustion in mental health personnel: The importance of organisational and individual factors1999In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 68, no 3, p. 157-164Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mental health personnel are at high risk for mental illness, burnout and suicide. Previous studies of this group of professionals have indicated the importance of organisational factors in explaining burnout, or exhaustion, and work satisfaction. This study looks more systematically at the contribution of organisational and individual factors to work-related exhaustion and to professional fulfillment, an expanded version of job satisfaction.

    METHODS: A cross-sectional study of 1, 051 psychiatrists and mental health nurses in the city of Stockholm was carried out by postal questionnaire with a previously validated instrument. Multiple and logistic regressions were used to identify predictors of exhaustion and professional fulfillment.

    RESULTS: Organisational characteristics were found to be more important than individual characteristics in predicting exhaustion and professional fulfillment in mental health professionals.

    CONCLUSIONS: The results indicate that the psychosocial work environment and well-being of mental health professionals can be improved by concentrating on organisational factors such as efficiency, personal development and goal quality.

  • 9111. Thomson, H
    et al.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Thomas, S
    Housing improvement as a strategy to improve health and reduce health inequalities: a systematic review of best available evidence2007In: EUROPEAN JOURNAL OF PUBLIC HEALTH, Oxford University Press, 2007, p. 127-127Conference paper (Refereed)
  • 9112. Thomson, H.
    et al.
    Thomas, S.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Housing improvement and health: a systematic review of world literature (1900-2005)2006In: EUROPEAN JOURNAL OF PUBLIC HEALTH, 2006, Vol. 16, p. 93-93Conference paper (Refereed)
    Abstract [en]

    Improving living conditions, such as poor housing may be an important means of tackling the socio-economic roots of health inequalities. A systematic review of the health impacts of housing improvement carried out in 2000 identified 18 completed studies and 13 studies approaching completion in 2003. It is now appropriate to update this systematic review to incorporate recently completed studies. Published and unpublished studies dating from 1936, in any language or format, were identified from bibliographic databases, expert consultation and bibliographies. The review included studies where the physical fabric of the housing had improved and which had assessed a change in health status among residents. Improvements to reduce exposure to lead, allergens, or rodent/insect infestation were excluded. Rehousing on medical grounds and housing improvement restricted to furniture adaptations were also excluded. 32 eligible studies of housing improvement were identified dating from 1936; 11 studies used prospective controlled designs. Thirteen studies evaluated housing improvements which were accompanied by wider neighbourhood improvement; 13 studies assessed the health impacts of energy efficiency improvements. Unclear study methods and poor reporting made data interpretation difficult. A preliminary synthesis suggests that small improvements in health, particularly in mental health, were reported although occasionally health outcomes deteriorated following housing improvement. Few studies reported impacts on socio-economic determinants of health. The growing body of impact evaluation in this field is welcome, but it is disappointing that the evidence base for healthy housing policy remains weak.

  • 9113. Thomson, H
    et al.
    Thomas, S
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Petticrew, M
    Best available evidence on housing improvement and health: A systematic review: Meeting abstract2008In: JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2008, p. 11-11Conference paper (Refereed)
  • 9114.
    Thomson, Hilary
    et al.
    Medical research Unit, Glasgow University, Glasgow, UK.
    Thomas, Sean
    Medical research Unit, Glasgow University, Glasgow, UK.
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Petticrew, Mark
    Medical research Unit, Glasgow University, Glasgow, UK.
    The health impacts of housing improvement: a systematic review of intervention studies from 1887 to 20072009In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 99, no 3, p. 681-692Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We conducted a systematic review of the health impacts of housing improvement.

    METHODS: Forty-two bibliographic databases were searched for housing intervention studies from 1887 to 2007. Studies were appraised independently by H. T. and S. T. or E. S. for sources of bias. The data were tabulated and synthesized narratively, taking into account study quality.

    RESULTS: Forty-five relevant studies were identified. Improvements in general, respiratory, and mental health were reported following warmth improvement measures, but these health improvements varied across studies. Varied health impacts were reported following housing-led neighborhood renewal. Studies from the developing world suggest that provision of basic housing amenities may lead to reduced illness. There were few reports of adverse health impacts following housing improvement. Some studies reported that the housing improvement was associated with positive impacts on socioeconomic determinants of health.

    CONCLUSIONS: Housing improvements, especially warmth improvements, can generate health improvements; there is little evidence of detrimental health impacts. The potential for health benefits may depend on baseline housing conditions and careful targeting of the intervention. Investigation of socioeconomic impacts associated with housing improvement is needed to investigate the potential for longer-term health impacts.

  • 9115.
    Thomson, Hilary
    et al.
    MRC, Social & Publ Hlth Sci Unit, Glasgow G12 8RZ, Lanark, Scotland .
    Thomas, Sian
    MRC, Social & Publ Hlth Sci Unit, Glasgow G12 8RZ, Lanark, Scotland .
    Sellström, Eva
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Petticrew, Mark
    London Sch Hyg & Trop Med, Fac Publ Hlth & Policy, Dept Social & Environm Hlth Res, London WC1, England.
    Housing improvements for health and associated socio-economic outcomes2013In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 2, p. Art. No. CD008657-Article, review/survey (Refereed)
    Abstract [en]

    Background The well established links between poor housing and poor health indicate that housing improvement may be an important mechanism through which public investment can lead to health improvement. Intervention studies which have assessed the health impacts of housing improvements are an important data resource to test assumptions about the potential for health improvement. Evaluations may not detect long term health impacts due to limited follow-up periods. Impacts on socio-economic determinants of health may be a valuable proxy indication of the potential for longer term health impacts. Objectives To assess the health and social impacts on residents following improvements to the physical fabric of housing. Search methods Twenty seven academic and grey literature bibliographic databases were searched for housing intervention studies from 1887 to July 2012 (ASSIA; Avery Index; CAB Abstracts; The Campbell Library; CINAHL; The Cochrane Library; COPAC; DH-DATA: Health Admin; EMBASE; Geobase; Global Health; IBSS; ICONDA; MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; NTIS; PAIS; PLANEX; PsycINFO; RIBA; SCIE; Sociological Abstracts; Social Science Citations Index; Science Citations Index expanded; SIGLE; SPECTR). Twelve Scandinavian grey literature and policy databases (Libris; SveMed+; Libris uppsok; DIVA; Artikelsok; NORART; DEFF; AKF; DSI; SBI; Statens Institut for Folkesundhed; Social.dk) and 23 relevant websites were searched. In addition, a request to topic experts was issued for details of relevant studies. Searches were not restricted by language or publication status. Selection criteria Studies which assessed change in any health outcome following housing improvement were included. This included experimental studies and uncontrolled studies. Cross-sectional studies were excluded as correlations are not able to shed light on changes in outcomes. Studies reporting only socio-economic outcomes or indirect measures of health, such as health service use, were excluded. All housing improvements which involved a physical improvement to the fabric of the house were included. Excluded interventions were improvements to mobile homes; modifications for mobility or medical reasons; air quality; lead removal; radon exposure reduction; allergen reduction or removal; and furniture or equipment. Where an improvement included one of these in addition to an included intervention the study was included in the review. Studies were not excluded on the basis of date, location, or language. Data collection and analysis Studies were independently screened and critically appraised by two review authors. Study quality was assessed using the risk of bias tool and the Hamilton tool to accommodate non-experimental and uncontrolled studies. Health and socio-economic impact data were extracted by one review author and checked by a second review author. Studies were grouped according to broad intervention categories, date, and context before synthesis. Where possible, standardized effect estimates were calculated and statistically pooled. Where meta-analysis was not appropriate the data were tabulated and synthesized narratively following a cross-study examination of reported impacts and study characteristics. Qualitative data were summarized using a logic model to map reported impacts and links to health impacts; quantitative data were incorporated into the model. Main results Thirty-nine studies which reported quantitative or qualitative data, or both, were included in the review. Thirty-three quantitative studies were identified. This included five randomised controlled trials (RCTs) and 10 non-experimental studies of warmth improvements, 12 non-experimental studies of rehousing or retrofitting, three non-experimental studies of provision of basic improvements in low or mIddle Income countries (LMIC), and three non-experimental historical studies of rehousing from slums. Fourteen quantitative studies (42.4%) were assessed to be poor quality and were not included in the synthesis. Twelve studies reporting qualitative data were identified. These were studies of warmth improvements (n = 7) and rehousing (n = 5). Three qualitative studies were excluded from the synthesis due to lack of clarity of methods. Six of the included qualitative studies also reported quantitative data which was included in the review. Very little quantitative synthesis was possible as the data were not amenable tometa-analysis. This was largely due to extreme heterogeneity both methodologically as well as because of variations in the intervention, samples, context, and outcome; these variations remained even following grouping of interventions and outcomes. In addition, few studies reported data that were amenable to calculation of standardized effect sizes. The data were synthesised narratively. Data from studies of warmth and energy efficiency interventions suggested that improvements in general health, respiratory health, and mental health are possible. Studies which targeted those with inadequate warmth and existing chronic respiratory disease were most likely to report health improvement. Impacts following housing-led neighbourhood renewal were less clear; these interventions targeted areas rather than individual households in most need. Two poorer quality LMIC studies reported unclear or small health improvements. One better quality study of rehousing from slums (pre-1960) reported some improvement in mental health. There were few reports of adverse health impacts following housing improvement. A small number of studies gathered data on social and socioeconomic impacts associated with housing improvement. Warmth improvements were associated with increased usable space, increased privacy, and improved social relationships; absences from work or school due to illness were also reduced. Very few studies reported differential impacts relevant to equity issues, and what data were reported were not amenable to synthesis. Authors' conclusions Housing investment which improves thermal comfort in the home can lead to health improvements, especially where the improvements are targeted at those with inadequate warmth and those with chronic respiratory disease. The health impacts of programmes which deliver improvements across areas and do not target according to levels of individual need were less clear, but reported impacts at an area level may conceal health improvements for those with the greatest potential to benefit. Best available evidence indicates that housing which is an appropriate size for the householders and is affordable to heat is linked to improved health and may promote improved social relationships within and beyond the household. In addition, there is some suggestion that provision of adequate, affordable warmth may reduce absences from school or work. While many of the interventions were targeted at low income groups, a near absence of reporting differential impacts prevented analysis of the potential for housing improvement to impact on social and economic inequalities.

  • 9116.
    Thomtén, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden .
    Living with genital pain: Sexual function, satisfaction, and help-seeking among women living in Sweden2014In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    Background and aims: Female genital pain is a debilitating problem that negatively affects several aspects of the life of women. Several studies present figures of prevalence indicating that the problem affects nearly 20% of young women. However, many women fail to consult health care and the estimated prevalence therefore remains insecure. Historically, genital pain was commonly viewed as either physiological or psychosexual. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, less is known about the manifestation of the problem in everyday life and the experience of seeking health care among afflicted women. The objectives of the present study was to examine genital pain in a general female population living in Sweden cross-sectionally in terms of prevalence, sexual function, sexual satisfaction and help seeking, and to identify possible predictors of genital pain among women. Methods: The study was a population-based study using a postal questionnaire administered to 4052 women (age 18--35). Of these 944 (response rate: 23%) took part in the study. Results: Genital pain of six months duration was reported by 16.1% of the women. Women with pain more commonly reported fungal infections, other pain problems, sexual dysfunctions and symptoms of anxiety than pain-free women and in addition lower sexual satisfaction. There were no differences in sexual frequency. Pain was most commonly reported during sexual intercourse, but many women also experienced pain during non-sexual activities, with pain durations of several hours after the pain eliciting activity was interrupted. Of those reporting pain, 50% had sought care for their pain. The most common was to counsel a doctor and to receive topical treatment. However, the experienced effects of the treatments were on average low. In the explanatory model, fungal infections, and sexual dysfunctions were associated with genital pain. Conclusions: The study had a low response rate, but still indicates that genital pain is common and negatively affects several aspects of women' life, not just sexual activities. Although many women report pro-longed pain experiences, many fail to consult health care and among those who seek care the effects of treatment are on average poor. There are strong associations between sexual dysfunctions (lack of sexual arousal, vaginal muscle tension hindering intercourse) and genital pain that, based on previous findings in this field of research, might be viewed in terms of circular maintaining processes. Implications: Female genital pain is not just limited to the sexual context, but often negatively affects several situations in women' life. The size of the problem calls for immediate development of preventive interventions and treatment programs that focus on sexual education and to encourage a healthy sexuality among women and their partners. There is a need to identify methods in order to assemble evidence based interventions of female genital pain. Such methods are currently lacking, resulting in poor treatment options for women with pain. © 2013 Scandinavian Association for the Study of Pain.

  • 9117.
    Thomtén, Johanna
    Örebro University, School of Law, Psychology and Social Work. Avdelningen för psykologi, Mittuniversitetet, Östersund, Sweden.
    Living with genital pain: sexual function, satisfaction, and help-seeking among women living in Sweden2014In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    Background and aims: Female genital pain is a debilitating problem that negatively affects several aspects of the life of women. Several studies present figures of prevalence indicating that the problem affects nearly 20% of young women. However, many women fail to consult health care and the estimated prevalence therefore remains insecure. Historically, genital pain was commonly viewed as either physiological or psychosexual. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, less is known about the manifestation of the problem in everyday life and the experience of seeking health care among afflicted women. The objectives of the present study was to examine genital pain in a general female population living in Sweden cross-sectionally in terms of prevalence, sexual function, sexual satisfaction and help seeking, and to identify possible predictors of genital pain among women.

    Methods: The study was a population-based study using a postal questionnaire administered to 4052 women (age 18--35). Of these 944 (response rate: 23%) took part in the study.

    Results: Genital pain of six months duration was reported by 16.1% of the women. Women with pain more commonly reported fungal infections, other pain problems, sexual dysfunctions and symptoms of anxiety than pain-free women and in addition lower sexual satisfaction. There were no differences in sexual frequency. Pain was most commonly reported during sexual intercourse, but many women also experienced pain during non-sexual activities, with pain durations of several hours after the pain eliciting activity was interrupted. Of those reporting pain, 50% had sought care for their pain. The most common was to counsel a doctor and to receive topical treatment. However, the experienced effects of the treatments were on average low. In the explanatory model, fungal infections, and sexual dysfunctions were associated with genital pain.

    Conclusions: The study had a low response rate, but still indicates that genital pain is common and negatively affects several aspects of women' life, not just sexual activities. Although many women report pro-longed pain experiences, many fail to consult health care and among those who seek care the effects of treatment are on average poor. There are strong associations between sexual dysfunctions (lack of sexual arousal, vaginal muscle tension hindering intercourse) and genital pain that, based on previous findings in this field of research, might be viewed in terms of circular maintaining processes.

    Implications: Female genital pain is not just limited to the sexual context, but often negatively affects several situations in women' life. The size of the problem calls for immediate development of preventive interventions and treatment programs that focus on sexual education and to encourage a healthy sexuality among women and their partners. There is a need to identify methods in order to assemble evidence based interventions of female genital pain. Such methods are currently lacking, resulting in poor treatment options for women with pain.

    © 2013 Scandinavian Association for the Study of Pain.

  • 9118.
    Thomée, Suzanne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ensuring youth-friendly health services.: - A qualitative study on a Swedish youth health clinic2015Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction WHO has presented a framework for youth-friendly health services, health services should, to be acknowledged as youth-friendly, be 1) Accessible, 2) Acceptable, 3) Equitable, 4) Appropriate, and 5) Effective. Swedish youth health clinics have been responding to youths health needs for many years, and are, at a global scale, one of the best examples of developed youth-friendly health services. Lessons extracted from the implementation of youth health clinics in Sweden could be useful elsewhere. The challenges and strategies utilized by such youth-friendly health services could also be useful to enrich the domains defined by WHO. Therefore, the aim of this study was to explore experiences of how to ensure youth-friendly health services from the perspective of professionals working in a youth health clinic. Method Four professionals working in a youth health clinic were interviewed. WHO´s domains of youth-friendly health services were used as a conceptual framework during the interviews. Data collection was conducted during April 2015. Interviews were transcribed verbatim and analysed with a thematic analysis. Results Six themes emerged from the analysis of the interviews. Those were; It should be easy to get here, The focus here are youths, We do not place people in a box, Everything is connected, Guided by policy and experience, and Driven by a shared mission. The five first were related with WHO´s framework for youth-friendly health services, while the last one emerged as a new domain. Conclusions This study found that to ensure youth-friendly health services, certain strategies are needed, including 1) making sure that youths can reach the services easily, 2) ensuring youth-centered health services, 3) providing equal treatment, 4) having good collaboration both within the youth health clinic and with other agencies, 5) maintaining knowledge and experience, and 6) having political support to ensure sustainability for providing health services for youths. Challenges to ensure youth-friendly health services includes ensuring that all youths who need can access the youth health clinic, since access may be hindered through avoiding gender considerations or through stigma towards certain groups of youths. Differences between clinics, in terms of health services provided or interpretations of guidelines [regarding age limits, professions and skills] could also be a challenge to ensure youth-friendly health services.

  • 9119.
    Thomée, Suzanne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Malm, Desiré
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Waenerlund, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Challenges and strategies for sustaining youth-friendly health services: a qualitative study from the perspective of professionals at youth clinics in northern Sweden2016In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 13, article id 147Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Youth-friendly health-care services - those that are accessible, acceptable, equitable, appropriate and effective for different youth subpopulations - are beneficial for youth health, but not easy to implement and sustain. Sweden is among the few countries where youth-friendly health-care services have been integrated within the public health system and sustained for a long time. This study explores the challenges and strategies in providing sustainable youth-friendly health-care services, from the perspective of professionals working in youth clinics in northern Sweden.

    METHODS: Eleven semi-structured interviews with various health-care professionals working in youth clinics in northern Sweden were conducted. The interviews were transcribed verbatim, and analysed using thematic analysis in relation to the World Health Organization domains of youth friendliness.

    RESULTS: Four themes emerged from the analysis of the data: 1) 'Meeting youths on their own terms - the key to ensuring a holistic and youth-centred care' was related to the acceptability and appropriateness of the services; 2) 'Organizational challenges and strategies in keeping professionals' expertise on youth updated' referred to the domain of effectiveness; 3) 'Youth clinics are accessible for those who know and can reach them' was related to the domains of accessibility and equity, and 4) 'The challenge of combining strong directions and flexibility in diverse local realities' focused on the struggle to sustain the youth clinics organization and their goals within the broader health system.

    CONCLUSIONS: Professionals working in youth clinics are perceived as motivated, interested and knowledgeable about youth, and the clinics ensure confidentiality and a youth-centred and holistic approach. Challenges remain, especially in terms of ensuring equitable access to different youth subpopulations, improving monitoring routines and ensuring training and competence for all professionals, independently of the location and characteristics of the clinic. Youth clinics are perceived as an indisputable part of the Swedish health system, but organizational challenges are also pointed out in terms of weak clear directives and leadership, heavy workload, local/regional diversity and unequitable distribution of resources.

  • 9120.
    Thorn, Sara
    et al.
    University of Skövde, School of Health and Education.
    Wistrand, Nicole
    University of Skövde, School of Health and Education.
    Hantera och reducera stress med meditation/mindfulness: En litteraturstudie2017Independent thesis Basic level (university diploma), 5 credits / 7,5 HE creditsStudent thesis
    Abstract [en]

    Introduction: The society develops and sets high standards on individuals and that make the stress increase. Long-term stress can lead to public health diseases such exhaustion syndrome and depression. To provide stress’s negative effect on health there is a need of reducing programs and interventions such meditation/mindfulness that can be included in the everyday life.

    Aim: The aim of this literature study is to investigate what scientific evidence exists about how meditation / mindfulness can help individuals manage and reduce stress, and then increase well-being and health.

    Methods: The method is a literature study, which means that the articles that are included in the study have been critically reviewed in a literature review. Ten articles are included in this study and they are divided into four themes that are reported in the result.

    Results: Meditation / mindfulness can be effective methods of managing and reducing stress, but all studies were not assured. The result is divided into four different themes, positive with meditation / mindfulness, doubts about meditation / mindfulness efficiency, mindfulness-based stress reduction (MBSR) and online programs. Some studies suggested that it could increase well-being and reduce stress. While others were uncertain of its benefits. Mindfulness-based stress reduction (MBSR) showed clearer results about stress reduction programs and online programs. MBSR can be used by both sick and healthy people. Online programs are effective both cost-effectively and that the individual can reach the programs from home.

    Discussion: There was not as clear evidence of meditation/mindfulness effectiveness in stress management as expected. All studies did not agree that it had any effect but in spite of doubt, more research is needed before ruling out as a good method. How effective it is for an individual may vary because the programs require training, understanding and trust. Meditation/mindfulness doesn’t help every individuals to manage their stress, but for some it does and for some it may be a good method while waiting for professional help.

  • 9121.
    Thornell, Lars-Eric
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Lindström, Mona
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy.
    Renault, V
    Mouly, V
    Butler-Browne, G S
    Satellite cells and training in the elderly.2003In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 13, no 1, p. 48-55Article in journal (Refereed)
    Abstract [en]

    In the present review, we describe the effects of ageing on human muscle fibres, underlining that each human muscle is unique, meaning that the phenotype becomes specifically changed upon ageing in different muscles, and that the satellite cells are key cells in the regeneration and growth of muscle fibres. Satellite cells are closely associated with muscle fibres, located outside the muscle fibre sarcolemma but beneath the basement lamina. They are quiescent cells, which become activated by stimulation, like muscle fibre injury or increased muscle tension, start replicating and are responsible for the repair of injured muscle fibres and the growth of muscle fibres. The degree of replication is governed by the telomeric clock, which is affected upon excessive bouts of degeneration and regeneration as in muscular dystrophies. The telomeric clock, as in dystrophies, does not seem to be a limiting factor in ageing of human muscle. The number of satellite cells, although reduced in number in aged human muscles, has enough number of cell divisions left to ensure repair throughout the human life span. We propose that an active life, with sufficient general muscular activity, should be recommended to reduce the impairment of skeletal muscle function upon ageing.

  • 9122.
    Thorngren, Emelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    På egna ben: Vad hände efter deltagande i ett familjebaserat folkhälsoprogram?2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Past studies show that involving the whole family is a good support for a healthy lifestyle in children. However, there is a lack of knowledge on whether family living habits can be influenced through a public health programme (En Frisk Generation) with regular and extended involvement in physical activity and in eating together with other families.

    Purpose: The purpose of this study was to investigate what experiences parents have from participating in the public health program ‘En Frisk Generation’, and whether they experience that their family's living habits have changed ten months after their participation and, if so, in what way.

    Method: Data was collected through ten semi-structured interviews with parents who had participated in the activities of En Frisk Generation. The collected data was analyzed by qualitative content analysis.

    Main result: Ten months after the activity, many of the children were more physically active than before, several families prioritized more time together, many parents choose more active transportation and more families experienced closer relationships in the family than before. It also appears that some of the families ate more vegetables and fruits and drink less sweet drunks, compared to before they attended the program.

    Conclusion: En Frisk Generation's activities can be seen as an appropriate method for promoting healthy living habits such as physical activity in a group of people where the majority do not have previous experiences of being physically active.

  • 9123.
    Thorngren, Emelie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Träningsappar som verktyg i hälsofrämjande syfte: - Användares erfarenheter och upplevelser2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Physical inactivity is the fourth leading risk factor for global mortality. To prevent and change this the society need to develop good approaches and interventions to promote physical activity. The purpose of this thesis was to investigate which experience existing users have of smartphone training applications. Also to study if this can be a possible resource for health promotion. Six active users applied to participation after they had seen an ad in social media. The participants were interviewed with semi-structured interview. The result of the study showed that it is common that the use of the application is mainly for fun, and that the application´s visual documentation contributes to increased motivation to be physically active. The users also enjoy recording the physical activity and to collect all the activities at the same place makes it easy to go back and evaluate and compare the training results. The conclusion was that the use of these training applications can be seen as a free and accessible tool and can be a future tool in health promotion to provide greater motivation to be physical active. In order to ensure that the use of training applications contributes to increased physical activity, further studies are needed such as a randomized control study with larger sample groups and a longer period of study.

  • 9124.
    Thorogood, Margaret
    et al.
    Univ Warwick, Warwick Med Sch, Div Hlth Sci, Coventry CV4 7AL, W Midlands, England.
    Goudge, Jane
    Univ Witwatersrand, Sch Publ Hlth, Ctr Hlth Policy, Fac Hlth Sci, ZA-2193 Johannesburg, South Africa.
    Bertram, Melanie
    WHO, CH-1211 Geneva 27, Switzerland.
    Chirwa, Tobias
    Univ Witwatersrand, Sch Publ Hlth, Div Epidemiol & Biostat, Fac Hlth Sci, ZA-2193 Johannesburg, South Africa.
    Eldridge, Sandra
    Queen Mary Univ London, London E1 4NS, England.
    Gomez-Olive, Francesc Xavier
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Witwatersrand, Fac Hlth Sci, Sch Publ Hlth, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, ZA-2193 Johannesburg, South Africa.
    Limbani, Felix
    Univ Witwatersrand, Fac Hlth Sci, Sch Publ Hlth, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, ZA-2193 Johannesburg, South Africa.
    Musenge, Eustasius
    Univ Witwatersrand, Sch Publ Hlth, Div Epidemiol & Biostat, Fac Hlth Sci, ZA-2193 Johannesburg, South Africa.
    Myakayaka, Nokuzola
    Univ Witwatersrand, Fac Hlth Sci, Sch Publ Hlth, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, ZA-2193 Johannesburg, South Africa.
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Univ Witwatersrand, Fac Hlth Sci, Sch Publ Hlth, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, ZA-2193 Johannesburg, South Africa.
    Twine, Rhian
    Univ Witwatersrand, Fac Hlth Sci, Sch Publ Hlth, MRC Wits Rural Publ Hlth & Hlth Transit Res Unit, ZA-2193 Johannesburg, South Africa.
    The Nkateko health service trial to improve hypertension management in rural South Africa: study protocol for a randomised controlled trial2014In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 15, p. 435-Article in journal (Refereed)
    Abstract [en]

    Background: South Africa has a high and rising prevalence of hypertension. Many affected individuals are not using medication, and few have controlled blood pressure. Until recently, primary care clinics focused on maternal and child health and management of acute conditions, but new government initiatives have shifted the focus to chronic diseases, including HIV/AIDS and hypertension.

    Methods/Design: The Nkateko trial will test the effectiveness of clinic-based lay health workers (LHWs) in supporting hypertension management. It is a pragmatic, cluster randomised controlled trial based in the Agincourt subdistrict of northeast South Africa, and it is underpinned by long-term health and demographic surveillance. Eight primary care facilities, with their catchment communities, are randomised to usual care or the addition of LHWs focused on chronic care. All clinics (intervention and control) will be provided with a clerk to collect information on clinic attendees and will match them to preexisting surveillance records. Intervention clinics will have LHWs working alongside nursing staff and focusing on health care for people with chronic conditions, particularly hypertension. The LHWs will be supported by an implementation manager, who will work with clinic staff to develop the most effective role for the LHWs. Control clinics will continue to provide usual care. The primary outcome will be the change between two population surveys conducted before and after the intervention in the proportion of the population with uncontrolled hypertension and a risk profile indicating at least moderate risk of cardiovascular disease. A process evaluation will be based on a realist approach using patient exit interviews, clinic observations and interviews with health professionals, LHWs and patients to document the intervention and its implementation.

    Discussion: There are challenges in the design of this trial. Assessing change through population surveys may reduce measurable effects; however, we feel this is appropriate because we aim to attract those who currently do not use clinics, and we hope to improve care for clinic users. Clinics were randomised at an open meeting because we were concerned that a remote process of randomisation would not be trusted by the community. We are constantly working to achieve an effective balance between the intervention and process evaluations.

  • 9125.
    Thorsell, Anna
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Hur tar du dig till skolan?: En kvantitativ studie om elevers transportvanor till skolan2013Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte och frågeställningar:

    Syftet med studien är att kartlägga skolelevers transporter på en skola i en stödjande miljö.

    - Hur stor andel av eleverna använder aktiv transport?

    - Vilka faktorer påverkar de elever som inte använder aktiv transport till och från skolani en stödjande miljö?

    Metod:

    Studien genomfördes med en enkätundersökning som delades ut till sammanlagt 63 av 75 eleveri årskurs fyra på en skola i en söderförort till Stockholm. Det externa bortfallet bestod av deelever som av någon anledning inte var i skolan på undersökningsdagen. Skolan ligger i enstödjande miljö för fysik aktivitet. En pilotundersökning genomfördes på ca 60 elever i årskursfem där synpunkter kunde lyftas fram och enkäten reviderades innan den slutligaundersökningen.

    Resultat:

    50/63 elever använde någon form av aktiv transport till skolan. De 13 som använde passivtransport bodde i samma områden som minst en av de som använd aktiv transport. Samtliga 13ägde även en cykel och har samma förutsättningar för aktiv transport som övriga elever. Vidarevar de flesta eleverna fysiskt aktiva minst en gång/vecka och hade en positiv inställning tillfysisk aktivitet men detta verkade inte påverka huruvida eleverna använder aktiv respektivepassiv transport till skolan. Majoriteten av eleverna anser att de själva bestämmer över hur detar sig till skolan men en intressant korrelation finns dock mellan elevernas transportsätt tillskolan och deras föräldrars transportsätt till jobbet.

    Slutsats:

    I dagens samhälle är fysisk inaktivitet ett stort problem. Fysisk aktivitet måste bli en mernaturlig del av människors vardag då planerade aktiviteter inte är tillräckligt. Aktiv transportkan öka människors aktivitetsnivåer och bidra till ett aktivare liv. Valet av att använda aktivtransport styrs, utöver yttre faktorer (till exempel tillgång till en stödjande miljö) även avindividuella- och sociala faktorer. Dessa kommer både hemifrån, där föräldrarna har stortinflytande över sina barns levnadsvanor, och från samhället, där skolan spelar en viktig roll somsocial arena. Skolan har möjlighet att påverka sina elever till att välja aktiv transport somfärdmedel till skolan och på så sätt grunda ett beteende som kan följa med eleverna även i vuxenålder.

  • 9126.
    Thorsell, Lena
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Drogmissbrukare och psykisk hälsa2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study was to investigate the relationship between mental illness and socioeconomic factors such as education, age and gender among drug users. Descriptive and ANOVA analysis were performed to 68 structured interviews (Addiction Severity Index basic). Analysis addressed associations between drug usage and level of education, age and gender. Results showed gender differences in self-rated mental health with women drug users rating their mental health lower than men. In addition, there was no association between age, educational level and self-rated mental health. Further studies are warranted to investigate mental health among drug users.

  • 9127.
    Thorslund, Birgitta
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. VTI, Linköping.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Peters, Björn
    Linköping University, The Swedish Institute for Disability Research. VTI, Linköping.
    Lidestam, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Hearing Loss and transport2011Conference paper (Other academic)
    Abstract [en]

    Research regarding importance of auditory information in traffic situations is limited and not very up to date. Studies performed in several countries around 1980 state that hearing disorders or deafness should not be an exclusion criterion for driver’s license, since individuals with hearing loss are not considered as an increased risk to traffic safety. Research made tend to answer the question if road users with hearing loss pose a higher risk than road users with normal hearing. Possible risks which road users with a hearing disorder are exposed to have not yet been investigated.

     

    According to brief discussions with individuals with hearing loss, concerns include; signing while driving, trying to speech read passenger while driving, hearing emergency sirens, knowing the direction from which a sound is coming, hearing seatbelt warning or other warnings your car may give.

    Hearing loss is often age related. With longer life length and increasing transport habits of older people, the proportion of older road users (and road users with hearing loss) increase. Furthermore, support systems in cars tend to use auditory signals for warnings, which make them less accessible for users with hearing disorders. Other modalities for warning signals (light or vibration) could be a solution.

     

    Auditory information is an issue also for road users with normal hearing; cars tend to be more silent and could therefore be hard to notice for vulnerable road users, bicycle riders with music players more or less isolate themselves from surrounding impressions. This presentation invites to a discussion regarding traffic situations where auditory information is important and how support could be given if necessary.

  • 9128.
    Thorslund, Birgitta
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. VTI, Linköping .
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Peters, Björn
    Linköping University, The Swedish Institute for Disability Research. VTI, Linköping.
    Lidestam, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Hörselnedsättning, trafiksäkerhet och mobilitet: En enkätstudie2012Conference paper (Other academic)
    Abstract [en]

    Objective: To examine how road users with different degree of hearing loss experience safety and mobility in transport situations compared to road users without hearing loss.

    Methods: The participants were recruited from the local branch of HRF. A hearing control group, matched on age, gender and geographical location, was selected from a commercial database. The individuals with hearing hearing-loss were grouped into four groups according the degree of their hearing-loss.

    Results: Hearing loss affects some specific aspects regarding transport situations, while others remain unaffected. Individuals with hearing loss are not as likely to have a driving license, but for those who have, hearing loss has no effect on mileage per year. Loss of hearing has an effect on criteria for choosing transportation, but the use of each transportation mode is unaffected. Degree of hearing loss affects most questions regarding hearing in relation to driver abilities, while avoidance of specific traffic situations or environments is only associated with hearing loss in specific situations. Hearing loss has only minor effect on the factors causing inattention when driving and on the interest in a warning system for driver inattention. The general interest in a warning system for driver inattention is high.

    Conclusions: Hearing loss influences the prevalence of driving license and criteria for choosing transportation, however has no effect on the frequency of any transportation mode. In general, in this study, respondents with profound hearing loss are less concerned, indicating that they might be coping. The interest in warning system for inattention and the attitude towards strengthening of auditory information in traffic situations is high regardless of hearing category. This suggests further research on coping strategies and on design of support systems accessible for drivers with hearing loss.

  • 9129.
    Thorslund, Birgitta
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. VTI, Linköping.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Peters, Björn
    Linköping University, The Swedish Institute for Disability Research. VTI, Linköping.
    Lidestam, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Trafikanter med hörselnedsättning: En enkätstudie2012Conference paper (Other academic)
    Abstract [sv]

    Hörselintryckens betydelse för trafikanten är ett tämligen outforskat område. Studier som genomförts har främst handlat om exklusionskriterier för körkort och man har då kommit fram till att hörselskadade inte utgör en större risk än hörande bilförare. Således utgör inte hörselskada eller dövhet ett hinder för körkort. Det saknas dock forskning kring vilka risker individer utsätts för då hörselintrycken i trafiken helt eller delvis faller bort. Enligt SCB finns det 1.3 miljoner invånare i Sverige som har svårigheter att höra i en eller flera olika situationer. Den vanligaste typen av hörselnedsättning är åldersrelaterad. Ökad livslängd samt vanan att själv kunna transportera sig lätt, gör att vi får allt fler äldre bilförare och därmed även allt fler bilförare med nedsatt hörsel. En annan relevant aspekt handlar om den ökande andelen stödsystem i bilarna, vilka ofta använder sig av auditiva signaler (t.ex. varningar, GPS navigering). För maximal nytta av sådana system är det viktigt att de är tillgängliga för samtliga trafikantgrupper. Man bör därför undersöka möjligheten att använda sig av andra eller ytterligare signalmodaliteter, t.ex. ljus eller vibrationer. En ytterligare aspekt är att fordon blir allt tystare, vilket innebär att även trafikanter utan hörselnedsättning får mindre auditiv information eller feedback. Då kan det vara svårt att som oskyddad trafikant höra en bil som utgör en risk. Även oskyddade trafikanter med hörlurar kan gå miste om dylik information.

    På VTI har ett doktorandprojekt inletts tillsammans med forskarskolan HEAD (HEaring And Deafness) vid LiU i syfte att utreda hörselintryckens betydelse för trafiksäkerheten. Projektet inleds med en kartläggning av transportvanor hos olika grupper av individer med hörselnedsättning i Sverige med hjälp av en webenkät som skickats ut under maj 2011. Vid analysen kommer en kategorisering i grupper att göras på basis av deras hörsel (Audiogram). Projektet genomförs i samverkan med Hörselskadades Riksförbund (HRF) som ställt sig positiva till den här forskningen och de har varit behjälpliga med att rekrytera deltagare. Enkäten kommer även att skickas till en kontrollgrupp av hörande individer. Undersökning har genom gått etisk prövning. Resultaten av studien kommer att presenteras på Transportforum 2012.

  • 9130.
    Thorslund, Birgitta
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. VTI (Swedish National Road and Transport Research Institute), Linköping, Sweden .
    Peters, Björn
    Linköping University, The Swedish Institute for Disability Research. VTI (Swedish National Road and Transport Research Institute), Linköping, Sweden .
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Lidestam, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    The Influence of Hearing Loss on Transport Safety and Mobility2013In: European Transport Research Review, ISSN 1867-0717, E-ISSN 1866-8887, Vol. 5, no 3, p. 117-127Article in journal (Refereed)
    Abstract [en]

    Purpose

    To examine how road users with different degree of hearing loss experience safety and mobility in transport situations, compared to road users with normal hearing.

    Methods

    A questionnaire study was conducted with participants recruited from the local branch of The Swedish hard of hearing society. A normal hearing control group, matched on age, gender and geographical location, was selected from a commercial database. The response rate was 35 % (n = 194) in the group with Hearing Loss (HL) and 42 % (n = 125) in the group with Normal Hearing (NH). The individuals with hearing loss were grouped into four groups according to the degree of their hearing loss (mild, moderate, severe and profound).

    Results

    Hearing loss affected some specific aspects regarding transport situations, while others remained unaffected. Individuals with hearing loss were not as likely to have a driving license, but for those who have, hearing loss had no effect on mileage per year. Loss of hearing had an effect on criteria for choosing mode of transportation, but in the aggregate, no difference between the groups could be shown in the distribution of how much each mode of transportation was used. With a few exceptions, hearing loss did not affect the ratings of importance of hearing for different transportation modes. Hearing loss affected most questions regarding hearing and driver abilities, while avoidance of specific traffic situations was not associated with hearing loss. Hearing loss had only minor effects on the factors causing inattention when driving, and on the interest in a warning system for driver inattention. The interest in a warning system for driver inattention was high regardless of hearing category.

    Conclusions

    Hearing loss influences the prevalence of driving license and criteria for choosing mode of transportation, however has no effect on the distribution of how much each mode of transportation was used. In general, in this study, respondents with higher degree of hearing loss were less concerned about the effect of hearing loss, indicating that they might be using coping strategies. The interest in warning system for inattention and the attitude towards strengthening of auditory information in traffic situations is high regardless of hearing category. This suggests further research on coping strategies and on design of support systems accessible for drivers with hearing loss.

  • 9131. Thorsson, Sofia
    et al.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Konarska, Janina
    Lindberg, Fredrik
    Holmer, Björn
    Dousset, Bénédicte
    Rayner, David
    Mean radiant temperature: a predictor of heat related mortality2014In: Urban Climate, ISSN 2212-0955, E-ISSN 2212-0955, Vol. 10, no 2, p. 332-345Article in journal (Refereed)
    Abstract [en]

    Health studies have repeatedly used air temperature (Ta), sometimes adjusted for humidity, when analyzing the impact of weather on mortality. The aim of this study is to highlight the importance of mean radiant temperature (Tmrt) and its impact on heat related mortality. Tmrt is an essential meteorological parameter that influences the thermal comfort (heat load) of humans. It is useful when assessing the impact of weather, especially heat, on people’s health. Tmrt is directly influenced by urban geometry and surface material, which also makes it a good measure to identify urban hot spots. The performance of models using Ta and Tmrt for daily mortality is compared for Stockholm County, Sweden. It is demonstrated that Tmrt models fit heat related mortality better than Ta models, which implies that health studies should consider using Tmrt rather than Ta. The use of Tmrt models allows us to determine more accurate thresholds for increased risks of heat related mortality, and thus to better identify adverse weather conditions and heat prone urban geometries. Such information is needed to implement heat-warning systems and mitigate harmful effects of heat stress.

  • 9132.
    Thorsén, David
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Department of History of Science and Ideas.
    Epidemins aktörer: Patientkollektiv som maktfaktor: exemplet hiv/aids2015In: Socialmedicinsk Tidskrift, ISSN 0037-833XArticle in journal (Refereed)
  • 9133.
    Thorén, Ann-Britt
    et al.
    University of Borås, School of Health Science.
    Axelsson, Åsa
    Fridh, Isabell
    University of Borås, School of Health Science.
    Stöd till närstående i samband med plötslig hjärtdöd2012In: Kardiologisk omvårdnad / [ed] Bengt Fridlund, Jan Mårtensson, Dan Malm, Studentlitteratur , 2012, p. 265-281Chapter in book (Other academic)
    Abstract [sv]

    En nära anhörigs plötsliga död anses vara det starkaste trauma en människa kan drabbas av. Sjuksköterskan har en viktig funktion i stödet till de sörjande som blir kvar när en nära anhörig dör. Sorg kan ta sig olika uttryck och det kan vara djupt kränkande för de närstående om de förväntas reagera på ett visst sätt. Utbildad personal och lokala riktlinjer för en strukturerad omvårdnad vid plötslig död är ett stöd för sjuksköterskan i sin strävan att ge god omvårdnad och lindra de närståendes lidande.

  • 9134.
    Thorén, Annelie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Werner, Bo
    Lundholm, Cecilia
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    A rapid growth rate in early childhood is a risk factor for becoming overweight in late adolescence.2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 11Article in journal (Refereed)
    Abstract [en]

    AIM: We evaluated whether body mass index (BMI) and rapid growth in early life were associated with an increased risk of becoming overweight at 16 and 18 years of age.

    METHODS: The study population comprised all children born in Sweden on the 15th of each month in 1981. Individuals born on the 5th, 10th and 20th of every month were added for counties with low population densities. Information on weight and height was collected from birth up to 18 years of age for 98.6% of the 3537 children identified.

    RESULTS: Weight at 12 months of age was associated with being overweight at both 16 and 18 years of age. Rapid weight gain from birth to 12 months was associated with higher odds for being overweight later in life, and the weight gain between 18 months and four years of age was the strongest risk factor for being overweight in late adolescence in both sexes. There was no association between a birthweight of <2500 g or >4500 g and being overweight at 16 or 18 years of age.

    CONCLUSION: Fast growth during early childhood was associated with an increased risk of being overweight later in life, emphasising the importance of early prevention.

  • 9135.
    Throfast, Victoria
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    e-Learning for the elderly on drug utilization: a pilot study2019In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811Article in journal (Refereed)
    Abstract [en]

    This study explores the attitudes of elderly people to the use of electronic educational technology (e-learning) on drug utilization, with particular emphasis on the layout, usability, content, and level of knowledge in the tool. e-Learning modules were evaluated by a group of elderly people (aged ⩾65 years, n = 16) via a questionnaire comprising closed and open-ended questions. Both qualitative and quantitative analyses of the responses showed mostly positive reviews. The results indicate that the e-learning modules are a suitable tool for distributing information and education and that they can be managed by elderly individuals who are familiar with computers, allowing them to learn more about medication use.

  • 9136. Thuan, Nguyen Thi Bich
    et al.
    Löfgren, Curt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Chuc, Nguyen Thi Kim
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Are the estimates of catastrophic health expenditure among rural poopulation too high? A comparison of studies in Vietnam.2008In: Open Public Health Journal, ISSN 1874-9445, Vol. 1, p. 25-31Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the proportion of the households that experienced catastrophic health expenditure and to compare the magnitude of catastrophic health expenditure that is estimated from three different data sets in Vietnam.

    Methods: The study we are comparing with is based on data from the Vietnam Living Standard Survey (VLSS) 1997/98. We have used data from the 2001 re-survey. The FilaBavi sample consists of 11,089 households. We have also conducted a special survey from July 2001 to June 2002. The sample is smaller, 629 households, but they have been followed for an entire year with monthly interviews. For VLSS and FilaBavi, re-census survey households were interviewed once with a recall period of one month.

    Findings: In the VLSS data and in the FilaBavi re-census survey it was found that 9%-10% of the households experienced catastrophic healthcare spending. But, only 5% (average per month) and 1% (for the whole year) of the households in the special survey report catastrophic spending.

    Conclusions: We suggest that the major reason for the difference in the estimates is the different data collection methods. When doing a cross sectional study with a relatively short recall period there is a risk that households will tend to overestimate non-recurrent large expenditures as that for health.

  • 9137.
    Thuan, Nguyen Thi Bich
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Planning and Financing Department of Ministry of Health, Hanoi, Vietnam.
    Löfgren, Curt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Chuc, Nguyen Thi Kim
    Public Health Faculty, Hanoi Medical University, Hanoi, Vietnam .
    Choice of healthcare provider following reform in Vietnam2008In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 8, p. 162-Article in journal (Refereed)
    Abstract [en]

    Background: In Vietnam, the health-sector reforms since 1989 have lead to a rapid increase in out-of-pocket expenses. This paper examines the choice of medical provider and household healthcare expenditure for different providers in a rural district of Vietnam following healthcare reform.

    Methods: The study consisted of twelve monthly follow-up interviews of 621 randomly selected households. The households are part of the FilaBavi project sample – Health System Research Project. The heads of household were interviewed at monthly intervals from July 2001 to June 2002.

    Results: The use of private health providers and self-treatment are quite common for both episodes (60% and 23% of all illness episodes) and expenditure (60% and 12.8% of healthcare expenditure) The poor tend to use self-treatment more frequently than wealthier members of the community (31% vs. 14.5% of illness episodes respectively). All patients in this study often use private services before public ones. The poor use less public care and less care at higher levels than the rich do (8% vs.13% of total illness episodes, which decomposes into 3% vs. 7% at district level, and 1% vs. 3% at the provincial or central level, respectively). The education of the patients significantly affects healthcare decisions. Those with higher education tend to choose healthcare providers rather than self-treatment. Women tend to use drugs or healthcare services more often than men do. Patients in two highest quintiles use health services more than in the lowest quintile. Moreover, seriously ill patients frequently use more drugs, healthcare services, public care than those with less severe illness.

    Conclusion: The results are useful for policy makers and healthcare professionals to (i) formulate healthcare policies-of foremost importance are methods used to reduce self-treatment and no treatment; (ii) the management of private practices and maintaining public healthcare providers at all levels, particularly at the basic levels (district, commune) where the poor more easily can access healthcare services, is also important, as is the management of private practices and (iii) provide a background for further studies on both short and long-term health service strategies.

  • 9138.
    Thunander Sundbom, Lena
    et al.
    University of Gävle, Gävle, Sweden.
    Bingefors, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Isacson, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Self-Reported Depression and Prescription of Antidepressants; does Gender Matter?2015In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 18, no 3, p. A116-A116Article in journal (Other academic)
  • 9139.
    Thunberg, Charlotta
    University of Gävle, Faculty of Health and Occupational Studies.
    Socioeconomic Status and Depression among women in Stockholm County2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This thesis investigated the relationship between socioeconomic status (by occupation) and self-reported depression among women in Stockholm County. A quantitative study was conducted based on secondary data from the 2006 Stockholm County Public Health Survey. Data was analyzed using descriptive statistics and logistic regression analysis through SPSS statistical package. Results showed that low socioeconomic status (by occupation) increased the risk of reporting depression among women in Stockholm County. In addition, the study found that the relationship was to some extent explained by income and marital status. However, further studies are warranted of the relation between socioeconomic status (e.g. education and income) and depression among women in the Swedish population but particularly in Stockholm County.

  • 9140.
    Thuresson, Anna
    University of Gävle, Faculty of Health and Occupational Studies.
    Friskvårdstimmen - hur används den?: Erfarenheter hos vårdpersonal kring friskvårdstimmen och annan fysisk aktivitet2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 9141.
    Thuresson, Kent
    Mälardalen University, School of Health, Care and Social Welfare.
    Skademönster på Gotland: Kontaktorsak, skadeplats och skadeorsak med fokus på ålders – och könsskillnader2012Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Injuries are considered to be a major public health issue. More than 4600 people die each year and 10 % of all hospitalization in Sweden is related to injuries. The cost in a societal perspective is estimated to 59 billion a year. Injuries are possible to prevent. However it needs knowledge that the injury has occurred and the surrounding circumstances. This study used data from an accident and injury registration in outpatient health care, in the Swedish municipality of Gotland. The purpose of this study was to describe the injury patterns regarding place and cause of injury focused on age and gender differences. Data from the registration were categorized and statistically processed in SPSS after content analysis of narrative text.  Statistical measures used where frequencies, incidences and significances. The results show that there are more men than women who are injured in the ages 0-63 years. The largest number of injuries was found in the age group 0-19 years. Fall was the leading cause of injuries. Home was the most common place where injuries occurred. Existing statistics on a national level may have limited use in local injury prevention program. There could be specific determinants of injuries locally that have to be addressed. Local injury registration and analyzes that include demographic and socioeconomic factors could increase the potential for effective injury prevention.

  • 9142.
    Thörnquist, Annette
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economic History.
    Arbetarskydd och samhällsförändring i Sverige 1850-20052005In: Svenska folkets hälsa i historiskt perspektiv / [ed] Sundin J, Hogstedt C, Lindberg J & Moberg H, Stockholm: Statens Folkhälsoinstitut , 2005, p. 223-303Chapter in book (Other academic)
  • 9143. Ticinesi, Andrea
    et al.
    Lauretani, Fulvio
    Ceda, Gian Paolo
    Ruggiero, Carmelinda
    Ferrucci, Luigi
    Aloe, Rosalia
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Meschi, Tiziana
    Maggio, Marcello
    Uric acid and endothelial function in elderly community-dwelling subjects2017In: Experimental Gerontology, ISSN 0531-5565, E-ISSN 1873-6815, Vol. 89, p. 57-63Article in journal (Refereed)
    Abstract [en]

    The role of serum uric acid (SUA), an inflammatory agent and potential mediator of cardiovascular diseases, in endothelial function (EF) has been tested only in middle-aged subjects affected by specific diseases. Our aim was to assess the relationship between SUA and measures of EF in a cohort of elderly community-dwellers. This study involved 424 males and 426 females aged 70years from the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS), having complete data on SUA and EF assessed by flow-mediated vasodilation (FMD) and by intra-arterial infusion of acetylcholine (endothelium-dependent vasodilation, EDV) and sodium nitroprusside (endothelium-independent vasodilation, EIDV). Univariate and multivariate regression models obtained by backward selection from initial fully-adjusted models were built to assess the relationship between SUA and measures of EF in both genders. Cardiovascular risk factors, serum hormonal and metabolic mediators, and body composition were considered as potential confounders. In the univariate model, SUA was inversely associated in both genders with log(EDV) (β±SE males -0.39±0.17, p=0.03; females -0.57±0.19, p=0.003) and log(EIDV) (males -0.23±0.12, p=0.05; females -0.49±0.15, p=0.002), but not with log(FMD). After adjustment for BMI, only the association between SUA and log(EIDV) in females persisted, though attenuated (-0.32±0.16, p=0.049), and was no longer significant in the fully-adjusted multivariate model including waist/hip ratio. In conclusion, in older subjects, especially women, SUA is associated with EF not independently of a list of confounders including BMI and trunk fat mass, suggesting a role as surrogate metabolic marker rather than an active player in EF.

  • 9144.
    Tidstedt, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Första linjechefers förutsättningar för att utöva ett hållbart och hälsofrämjande ledarskap2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: First Line Managers are expected to create a health promoting work environment. Research has shown that the prerequisites for accomplishing a health promoting leadership are not always the best. Aim: The aim was to elucidate the prerequisites for a health promoting leadership as First Line Manager at a University hospital in Sweden based on competence, role, support structures and own durability. Results: First Line Managers at the chosen hospital seems to have rather good conditions for conducting a health promoting leadership. All respondents did have a university degree and most thought that their competence corresponded well with the role. Only two percent of the working time was spent on updating of skills, but all respondents (n=95) felt they developed in the role. The majority felt the role definition was good. Three out of four participants in the study spent less than two hours per week with their manager and half of them under one hour per week. Yet, most participants were satisfied with the managerial support and also with other support structures. The respondents health is good even though many regularly experiences some stress, fatigue or sleeping problem. Method: The study design was descriptive quantitative crossectional. The selection/sample was active first line managers at a University hospital in Sweden. The study was made with a web-based questionnaire. Some questions was taken from the Quality-Work-Competence-method and one from the Karolinska Sleep Questionnaire. Statistical evaluation was made with the Statistical Package for the Social Sciences. Data was analyzed with descriptive statistics, Chi-square test and Spearmans rank correlation test. Conclusion: First Line Managers are quite content with their working situation and have good conditions for conducting a health promoting leadership at the investigated University hospital. There are however developing potential for the First Line Managers durability and possibilities for performing a health promoting leadership, through developing competencies, managerial support and support structures.

  • 9145.
    Tigova, Olena
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Income-related inequalities in self-raported health across 29 European countries: Findings from the European Social Survey2014Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
    Abstract [en]

    Background: The degree of health variation among social groups is an important indicator of population health and the efficiency of economic and social systems. Previous studies revealed existence of health inequalities across Europe, however recent studies on the contribution of income to such inequalities are scarce.

    Aim: To investigate differences in self-reported health between the lowest and the highest income groups across Europe.

    Method: Data from the European Social Survey for 29 countries were examined. The absolute inequalities were calculated as differences in age-adjusted prevalence of poor self-reported health between the lowest and the highest income quintiles. The relative inequalities were measured by odds ratios for reporting poor health in the lowest income group compared to the highest one.

    Results: Income-related health inequalities were found in all countries. Larger relative inequalities among men were observed in Greece, Kosovo, Ireland, Israel, Iceland, and Slovenia; among women – in Lithuania, Denmark, Norway, Portugal, Cyprus, and Czech Republic.

    Conslusions: In Europe, income-related health inequalities persist, however, their degree varies across countries. Gender differences in income-related inequalities were observed within certain countries. For a comprehensive description of health situation in a country assessing both the prevalence of poor health and the inequality level is crucial. 

  • 9146. Tiikkaja, Sanna
    et al.
    Hemström, Örjan
    Vågerö, Denny
    Intergenerational class mobility and cardiovascular mortality among Swedish women: a population-based register study2009In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 68, p. 733-739Article in journal (Refereed)
    Abstract [en]

    Class inequalities in cardiovascular disease (CVD) mortality are well documented, but the impact of intergenerational class mobility on CVD mortality among women has not been studied thoroughly. We examined whether women's mobility trajectories might contribute to CVD mortality beyond what could be expected from their childhood and adult social class position. The Swedish Work and Mortality Data Base provided childhood (1960) and adulthood (1990) social indicators. Women born 1945–59 (N = 791 846) were followed up for CVD mortality 1990–2002 (2019 deaths) by means of logistic regression analysis. CVD mortality risks were estimated for 16 mobility trajectories. Gross and net impact of four childhood and four adult classes, based on occupation, were analysed for mortality in ischemic heart disease (IHD), stroke, other CVD, – and all CVD. Differences between the two most extreme trajectories were 10-fold, but the common trajectory of moving from manual to non-manual position was linked to only a slight excess mortality (OR = 1.26) compared to the equally common trajectory of maintaining a stable non-manual position (reference category). Moving into adult manual class resulted in an elevated CVD mortality whatever the childhood position (ORs varied between 1.42 and 2.24). After adjustment for adult class, childhood class had some effect, in particular there was a low risk of coming from a self-employed childhood class on all outcomes (all ORs around = 0.80). A woman's own education had a stronger influence on the mortality estimates than did household income. Social mobility trajectories among Swedish women are linked to their CVD mortality risk. Educational achievement seems to be a key factor for intergenerational continuity and discontinuity in class-related risk of CVD mortality among Swedish women. However, on mutual adjustment, adult class was much more closely related to CVD mortality than was class in childhood.

  • 9147. Tiikkaja, Sanna
    et al.
    Olsson, Marita
    Malki, Ninoa
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sparén, Pär
    Familial risk of premature cardiovascular mortality and the impact of intergenerational occupational class mobility2012In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 75, no 10, p. 1883-1890Article in journal (Refereed)
    Abstract [en]

    The negative impact of low social class on cardiovascular disease (CVD) and mortality has been consistently documented. However, less scientific consistency exists in terms of whether a unique health effect of social mobility from childhood to adulthood prevails. This study explored how childhood and adult social class and the transition between them (social mobility), are related to premature CVD mortality when familial aggregation of CVD among siblings is also considered. The study includes nearly 1.9 million Swedish residents born 1939-1959 distributed over 1,044,725 families, of whom 14,667 died prematurely from CVD in 1990-2003. Information on parental class (1960) and own mid-life occupational class (1990) was retrieved from the respective censuses. Odds ratios for premature CVD mortality according to trajectory-specific social mobility, along with pairwise mean odds ratios for sibling resemblance of premature CVD mortality, were calculated by means of alternating logistic regression. This model calculates the remaining dependency of CVD mortality within sibships after accounting for available risk factors (like parental and adult social class) in the population mean model. Results showed that premature CVD mortality was associated with both parental and own adult social class. A clear tendency for the downwardly mobile to have increased, and for the upwardly mobile to experience a decreased risk of premature DID mortality was found, as well as a corresponding unique effect of social mobility per se among the manual and non-manual classes. This effect was verified for men, but not for women, when they were analysed separately. The pairwise mean odds ratios for premature CVD mortality among full siblings were 1.78 (95% CI: 1.52-2.08), and were independent of parental CVD mortality and parental or adult occupational class.

  • 9148. Tiikkaja, Sanna
    et al.
    Sandin, Sven
    Hultman, Christina M.
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Malki, Ninoa
    Sparén, Pär
    Psychiatric disorder and work life: A longitudinal study of intra-generational social mobility2016In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 62, no 2, p. 156-166Article in journal (Refereed)
    Abstract [en]

    Background: Intra-generational social mobility, which describes the mobility within an individual’s own working life, is seldom studied among employees with psychiatric disorders (EPD). There is need of knowledge of the intra-generational mobility patterns, in a broader perspective, among EPD.

    Aims: To investigate intra-generational social mobility in employed individuals diagnosed with affective disorder, personality disorder, schizophrenia and drug dependence in a national Swedish cohort.

    Method: We identified a national sample of employed Swedish adults born in 1939–1949 (N = 876, 738), and among them individuals with a first-time hospital admission for affective psychosis, neurosis and personality disorder, alcoholism, drug dependence or schizophrenia in 1964–1980 (N = 18, 998). Employed individuals without hospital admission for such diagnoses were utilised as a comparison group (N = 866, 442). Intra-individual social class changes between 1980 and 1990 among EPD and the comparison group were described through summary statistics and graphs.

    Results: EPD more often held Low manual occupations at baseline in 1980 than the comparison group (44% vs. 28%), although parental social class was similar. In 1990, 19% of EPD and 4% of the comparison group had lost contact with the labour market. Social stability was less common among EPD (49 %) than in the comparison group (67%). Mobility out of the labour force increased and social stability decreased by number of inpatient admissions. Employees diagnosed with affective psychosis or neurosis and personality disorder fared better in the labour market than employees with schizophrenia.

    Conclusion: Employees suffering from psychiatric disorder do not maintain their social class or remain in the labour force to the same extent as individuals without those problems, irrespective of their parental class. Our results support the social drift hypothesis that individuals with poor psychiatric health move downward in the social hierarchy.

  • 9149. Tiikkaja, Sanna
    et al.
    Sandin, Sven
    Malki, Ninoa
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sparén, Pär
    Hultman, Christina M.
    Social Class, Social Mobility and Risk of Psychiatric Disorder - A Population-Based Longitudinal Study2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, article id e77975Article in journal (Refereed)
    Abstract [en]

    Objectives: This study explored how adult social class and social mobility between parental and own adult social class is related to psychiatric disorder.

    Material and Methods: In this prospective cohort study, over 1 million employed Swedes born in 1949-1959 were included. Information on parental class (1960) and own mid-life social class (1980 and 1990) was retrieved from the censuses and categorised as High Non-manual, Low Non-manual, High Manual, Low Manual and Self-employed. After identifying adult class, individuals were followed for psychiatric disorder by first admission of schizophrenia, alcoholism and drug dependency, affective psychosis and neurosis or personality disorder (N=24 659) from the Swedish Patient Register. We used Poisson regression analysis to estimate first admission rates of psychiatric disorder per 100 000 person-years and relative risks (RR) by adult social class (treated as a time-varying covariate). The RRs of psychiatric disorder among the Non-manual and Manual classes were also estimated by magnitude of social mobility.

    Results: The rate of psychiatric disorder was significantly higher among individuals belonging to the Low manual class as compared with the High Non-manual class. Compared to High Non-manual class, the risk for psychiatric disorder ranged from 2.07 (Low Manual class) to 1.38 (Low Non-manual class). Parental class had a minor impact on these estimates. Among the Non-manual and Manual classes, downward mobility was associated with increased risk and upward mobility with decreased risk of psychiatric disorder. In addition, downward mobility was inversely associated with the magnitude of social mobility, independent of parental class.

    Conclusions: Independently of parental social class, the risk of psychiatric disorder increases with increased downward social mobility and decreases with increased upward mobility.

  • 9150.
    Tiitinen Mekhail, Kirsi
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sträven efter stabilitet i livsvillkor som nybliven pappa i en mångkulturell förort:erfarenheter efter ett utökat föräldrastödprogram.2016Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
180181182183184185186 9101 - 9150 of 10346
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