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  • 1. Ahlbom, Anders
    et al.
    Feychting, Maria
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Johansson, Lars Age
    Mathiesen, Tiit
    Pettersson, David
    Schüz, Joachim
    Talbäck, Mats
    Comments on Hardell and Carlberg Increasing Rates of Brain Tumors in the Swedish National Inpatient Register and the Causes of Death Register. Int. J. Environ. Res. Public Health 2015, 12, 3793-3813.2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 9Article in journal (Refereed)
  • 2.
    Alm, Susanne
    et al.
    Stockholm Univ, Swedish Inst Social Res, SE-10691 Stockholm, Sweden.
    Laftman, Sara Brolin
    Stockholm Univ, Dept Publ Hlth Sci, Ctr Hlth Equity Studies CHESS, SE-10691 Stockholm, Sweden.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Stockholm Cty Council, Stockholm Hlth Care Serv, S-10422 Stockholm, Sweden.
    Poor Family Relationships in Adolescence and the Risk of Premature Death: Findings from the Stockholm Birth Cohort Study2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 10, article id 1690Article in journal (Refereed)
    Abstract [en]

    Poor family relationships during childhood have been shown to have long-term negative effects on an offspring's health. However, few studies have followed the offspring to retirement age, and relatedly, knowledge about the link between poor family relationships and premature death is scarce. The aim of this study was to examine the association between poor family relationships in adolescence and the risk of premature death, even when considering other adverse childhood conditions. Prospective data from the Stockholm Birth Cohort study were used, with 2636 individuals born in 1953 who were followed up until age 65. Information on family relations was based on interviews with the participants' mothers in 1968. Information on mortality was retrieved from administrative register data from 1969-2018. Cox proportional hazards regressions showed that poor family relationships in adolescence were associated with an increased risk of premature death, even when adjusting for childhood conditions in terms of household social class, household economic poverty, contact with the child services, parental alcohol abuse, and parental mental illness (Hazard Ratio (HR), 2.08, 95% Confidence Interval (CI), 1.40-3.09). The findings show that poor family relationships in adolescence can have severe and long-lasting health consequences, highlighting the importance of early interventions.

  • 3.
    Almquist, Ylva B.
    et al.
    Stockholm Univ, Dept Publ Hlth Sci, Ctr Hlth Equ Studies CHESS, Stockholm, Sweden.
    Landstedt, Evelina
    Umeå Univ, Norrland Univ Hosp, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, Umeå, Sweden.
    Jackisch, Josephine
    Stockholm Univ, Dept Publ Hlth Sci, Ctr Hlth Equ Studies CHESS, Stockholm, Sweden.
    Rajaleid, Kristiina
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1842Article in journal (Refereed)
    Abstract [en]

    Disadvantaged circumstances in youth tend to translate into poor health development. However, the fact that this is not always the case has been seen as indicative of differential resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status. This study was based on two waves of questionnaire data from the Northern Swedish Cohort. From the wave in 1981 (age 16), indicators of social and material conditions as well as factors related to school, peers, and spare time were derived. From the wave in 2008 (age 43), information about self-rated health was used. Ordinal logistic regression models (n = 908) showed that adversity in youth was associated with poorer self-rated health in midlife among men and women alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health. This suggests that health-promoting interventions may benefit from focusing on contexts outside the family in their effort to strengthen processes of resilience among disadvantaged youths.

  • 4.
    Aweko, Juliet
    et al.
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    De Man, Jeroen
    Inst Trop Med, Dept Publ Hlth, Antwerp, Belgium.
    Absetz, Pilvikki
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Joensuu, Finland.
    Östenson, Claes-Göran
    Karolinska Univ Hosp, Dept Mol Med & Surg, Stockholm, Sweden.
    Peterson, Stefan Swartling
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mölsted Alvesson, Helle
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Daivadanam, Meena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1810Article in journal (Refereed)
    Abstract [en]

    Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.

  • 5. Berglind, Niklas
    et al.
    Ljungman, Petter
    Möller, Jette
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Nyberg, Fredrik
    Rosenqvist, Mårten
    Pershagen, Göran
    Bellander, Tom
    Air Pollution Exposure: A Trigger for Myocardial Infarction?2010In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 7, no 4, p. 1486-1499Article in journal (Refereed)
    Abstract [en]

    The association between ambient air pollution exposure and hospitalization for cardiovascular events has been reported in several studies with conflicting results. A case-crossover design was used to investigate the effects of air pollution in 660 first-time myocardial infarction cases in Stockholm in 1993-1994, interviewed shortly after diagnosis using a standard protocol. Air pollution data came from central urban background monitors. No associations were observed between the risk for onset of myocardial infarction and two-hour or 24-hour air pollution exposure. No evidence of susceptible subgroups was found. This study provides no support that moderately elevated air pollution levels trigger first-time myocardial infarction.

  • 6.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Andersén, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Carlsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, SE-17177 Stockholm, Sweden.
    Multidisciplinary Intervention and Acceptance and Commitment Therapy for Return-to-Work and Increased Employability among Patients with Mental Illness and/or Chronic Pain: A Randomized Controlled Trial2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 11, article id 2424Article in journal (Refereed)
    Abstract [en]

    Background: People on long-term sick leave often have a long-lasting process back to work, where the individuals may be in multiple and recurrent states; i.e., receiving different social security benefits or working, and over time they may shift between these states. The purpose of this study was to evaluate the effects of two vocational rehabilitation programs, compared to a control, on return-to-work (RTW) or increased employability in patients on long-term sick leave due to mental illness and/or chronic pain. Methods: In this randomized controlled study, 427 women and men were allocated to either (1) multidisciplinary team management, i.e., multidisciplinary assessments and individual rehabilitation management, (2) acceptance and commitment therapy (ACT), or (3) control. A positive outcome was defined as RTW or increased employability. The outcome was considered negative if the (part-time) wage was reduced or ceased, or if there was an indication of decreased employability. The outcome was measured one year after entry in the project and analyzed using binary and multinomial logistic regressions. Results: Participants in the multidisciplinary team group reported having RTW odds ratio (OR) 3.31 (95% CI 1.39-7.87) compared to the control group in adjusted models. Participants in the ACT group reported having increased employability OR 3.22 (95% CI 1.13-9.15) compared to the control group in adjusted models. Conclusions: This study of vocational rehabilitation in mainly female patients on long-term sick leave due to mental illness and/or chronic pain suggests that multidisciplinary team assessments and individually adapted rehabilitation interventions increased RTW and employability. Solely receiving the ACT intervention also increased employability.

  • 7.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Active Traveling and Its Associations with Self-Rated Health, BMI and Physical Activity: A Comparative Study in the Adult Swedish Population2016In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 13, no 5, article id 455Article in journal (Refereed)
    Abstract [en]

    Active traveling to a daily occupation means that an individual uses an active way of traveling between two destinations. Active travel to work or other daily occupations offers a convenient way to increase physical activity levels which is known to have positive effects on several health outcomes. Frequently used concepts in city planning and regional planning today are to create environments for active commuting and active living. Even then, little research has focused on traveling modes and subjective health outcomes such as self-rated health (SRH). This study aimed to explore and investigate associations between travel mode and health-related outcomes, such as self-rated health (SRH), body mass index (BMI) and overall physical activity, in an adult population in Sweden. A cross-sectional study was conducted in a randomly selected population-based sample (n = 1786, age 45-75 years); the respondents completed a questionnaire about their regular travel mode, demographics, lifestyle, BMI and SRH. Chi-square tests and logistic regressions found that inactive traveling was associated with poor SRH, a greater risk of obesity or being overweight and overall physical inactivity. In addition, lifestyle factors, such as choice of food and smoking habits, were associated with SRH, BMI and overall physical activity.

  • 8.
    Comasco, Erika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neuro-psycho-pharmacology.
    Todkar, Aniruddha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neuro-psycho-pharmacology.
    Granholm, Linnea
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Nylander, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Alpha 2a-Adrenoceptor Gene Expression and Early Life Stress-Mediated Propensity to Alcohol Drinking in Outbred Rats2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 7, p. 7154-7171Article in journal (Refereed)
    Abstract [en]

    Stressful events early in life, later high alcohol consumption and vulnerability to alcohol use disorder (AUD) are tightly linked. Norepinephrine is highly involved in the stress response and the alpha 2A-adrenoceptor, which is an important regulator of norepinephrine signalling, is a putative target in pharmacotherapy of AUD. The aim of the present study was to investigate the effects of early-life stress and adult voluntary alcohol drinking on the alpha 2A-adrenoceptor. The relative expression and promoter DNA methylation of the Adra2a gene were measured in the hypothalamus, a key brain region in stress regulation. A well-characterized animal model of early-life stress was used in combination with an episodic voluntary drinking in adulthood. Alcohol drinking rats with a history of early-life stress had lower Adra2a expression than drinking rats not exposed to stress. Alcohol intake and Adra2a gene expression were negatively correlated in high-drinking animals, which were predominantly rats subjected to early-life stress. The results provide support for a link between early-life stress, susceptibility for high alcohol consumption, and low Adra2a expression in the hypothalamus. These findings can increase our understanding of the neurobiological basis for vulnerability to initiate risk alcohol consumption and individual differences in the response to 2A-adrenoceptor agonists.

  • 9.
    Gainotti, Sabina
    et al.
    Ist Super Sanita, Bioeth Unit, I-00161 Rome, Italy.
    Mascalzoni, Deborah
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Bros-Facer, Virginie
    EURORDIS Rare Dis Europe, F-75014 Paris, France.
    Petrini, Carlo
    Ist Super Sanita, Bioeth Unit, I-00161 Rome, Italy.
    Floridia, Giovanna
    Ist Super Sanita, Bioeth Unit, I-00161 Rome, Italy.
    Roos, Marco
    Leiden Univ, Med Ctr, NL-2333 Leiden, Netherlands.
    Salvatore, Marco
    Ist Super Sanita, Natl Ctr Rare Dis, I-00161 Rome, Italy.
    Taruscio, Domenica
    Ist Super Sanita, Natl Ctr Rare Dis, I-00161 Rome, Italy.
    Meeting Patients' Right to the Correct Diagnosis: Ongoing International Initiatives on Undiagnosed Rare Diseases and Ethical and Social Issues2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 10, article id 2072Article, review/survey (Refereed)
    Abstract [en]

    The time required to reach a correct diagnosis is a key concern for rare disease (RD) patients. Diagnostic delay can be intolerably long, often described as an odyssey and, for some, a diagnosis may remain frustratingly elusive. The International Rare Disease Research Consortium proposed, as ultimate goal for 2017-2027, to enable all people with a suspected RD to be diagnosed within one year of presentation, if the disorder is known. Subsequently, unsolved cases would enter a globally coordinated diagnostic and research pipeline. In-depth analysis of the genotype through next generation sequencing, together with a standardized in-depth phenotype description and sophisticated high-throughput approaches, have been applied as diagnostic tools to increase the chance of a timely and accurate diagnosis. The success of this approach is evident in the Orphanet database. From 2010 to March 2017 over 600 new RDs and roughly 3600 linked genes have been described and identified. However, combination of -omics and phenotype data, as well as international sharing of this information, has raised ethical concerns. Values to be assessed include not only patient autonomy but also family implications, beneficence, non-maleficence, justice, solidarity and reciprocity, which must be respected and promoted and, at the same time, balanced among each other. In this work we suggest that, to maximize patients' involvement in the search for a diagnosis and identification of new causative genes, undiagnosed patients should have the possibility to: (1) actively participate in the description of their phenotype; (2) choose the level of visibility of their profile in matchmaking databases; (3) express their preferences regarding return of new findings, in particular which level of Variant of Unknown Significance (VUS) significance should be considered relevant to them. The quality of the relationship between individual patients and physicians, and between the patient community and the scientific community, is critically important for optimizing the use of available data and enabling international collaboration in order to provide a diagnosis, and the attached support, to unsolved cases. The contribution of patients to collecting and coding data comprehensively is critical for efficient use of data downstream of data collection.

  • 10. Haeger-Eugensson, Marie
    et al.
    Ferm, Martin
    Elfman, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Use of a 3-D Dispersion Model for Calculation of Distribution of Horse Allergen and Odor around Horse Facilities2014In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 11, no 4, p. 3599-3617Article in journal (Refereed)
    Abstract [en]

    The interest in equestrian sports has increased substantially during the last decades, resulting in increased number of horse facilities around urban areas. In Sweden, new guidelines for safe distance have been decided based on the size of the horse facility (e.g., number of horses) and local conditions, such as topography and meteorology. There is therefore an increasing need to estimate dispersion of horse allergens to be used, for example, in the planning processes for new residential areas in the vicinity of horse facilities. The aim of this study was to develop a method for calculating short- and long-term emissions and dispersion of horse allergen and odor around horse facilities. First, a method was developed to estimate horse allergen and odor emissions at hourly resolution based on field measurements. Secondly, these emission factors were used to calculate concentrations of horse allergen and odor by using 3-D dispersion modeling. Results from these calculations showed that horse allergens spread up to about 200 m, after which concentration levels were very low (<2 U/m(3)). Approximately 10% of a study-group detected the smell of manure at 60m, while the majority80%-90%detected smell at 60 m or shorter distance from the manure heap. Modeling enabled horse allergen exposure concentrations to be determined with good time resolution.

  • 11.
    Harris, Leona
    et al.
    Univ Canterbury, E Learning Res Lab, Christchurch 8041, New Zealand;Univ Canterbury, Child Well Being Res Inst, Christchurch 8041, New Zealand.
    Davis, Niki
    Univ Canterbury, E Learning Res Lab, Christchurch 8041, New Zealand;Univ Canterbury, Child Well Being Res Inst, Christchurch 8041, New Zealand.
    Cunningham, Una
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Educational Sciences, Department of Education.
    de Vocht, Lia
    Univ Canterbury, E Learning Res Lab, Christchurch 8041, New Zealand.
    Macfarlane, Sonja
    Univ Canterbury, Te Ru Rangahau Maori Res Lab, Christchurch 8041, New Zealand.
    Gregory, Nikita
    Univ Canterbury, Child Well Being Res Inst, Christchurch 8041, New Zealand.
    Aukuso, Saili
    Univ Canterbury, E Learning Res Lab, Christchurch 8041, New Zealand;Univ Canterbury, Child Well Being Res Inst, Christchurch 8041, New Zealand.
    Taleni, Tufulasifa'atafatafa Ova
    Univ Canterbury, Child Well Being Res Inst, Christchurch 8041, New Zealand.
    Dobson, Jan
    Minist Educ, Sect Enablement & Support, Christchurch 8013, New Zealand.
    Exploring the Opportunities and Challenges of the Digital World for Early Childhood Services with Vulnerable Children2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 11, article id 2407Article in journal (Refereed)
    Abstract [en]

    Potentially addictive behaviours supported by the internet and mobile phones raise concerns in education services for early childhood. Although there is evidence that screen media can distract the attention of young children, there was a massive uptake of digital devices by early childhood centres (ECCs). We investigated practices of families (n = 85) and of six ECCs serving vulnerable children in New Zealand, many of whom are emergent bilinguals. Descriptions of the limited and exemplary choice of screen media of the ECCs include digital portfolios containing children's learning stories in multiple languages illustrated with digital photos. This was facilitated by increasing partnership with the families and the inclusion of their languages in the physical and digital landscapes of the ECCs. However, these families and the ECCs are seeking additional guidance to face the complex challenges of the digital world. These early findings from our national research programme, A Better Start, E Tipu E Rea, already informed significant changes in the ECCs; we also identified the potential for young children to act as agents of change.

  • 12.
    Joshi, Sudhir Chandra
    et al.
    RD Gardi Med Coll, Dept Community Med, Ujjain, Madhya Pradesh, India.
    Diwan, Vishal
    RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain, Madhya Pradesh, India; Ujjain Charitable Trust Hosp & Res Ctr, Int Ctr Hlth Res, Ujjain, Madhya Pradesh, India; Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden.
    Joshi, Rita
    RD Gardi Med Coll, Dept Microbiol, Ujjain, Madhya Pradesh, India.
    Sharma, Megha
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden; RD Gardi Med Coll, Dept Pharmacol, Ujjain, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden; RD Gardi Med Coll, Dept Pediat, Ujjain, Madhya Pradesh, India.
    Shah, Harshada
    RD Gardi Med Coll, Dept Microbiol, Ujjain, Madhya Pradesh, India.
    Tamhankar, Ashok J.
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden; RD Gardi Med Coll, Indian Initiat Management Antibiot Resistance, Dept Environm Med, Ujjain, Madhya Pradesh, India.
    Stålsby Lundborg, Cecilia
    Karolinska Inst, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Stockholm, Sweden.
    “How Can the Patients Remain Safe, If We Are Not Safe and Protected from the Infections”? A Qualitative Exploration among Health-Care Workers about Challenges of Maintaining Hospital Cleanliness in a Resource Limited Tertiary Setting in Rural India2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id E1942Article in journal (Refereed)
    Abstract [en]

    Background: Health care-associated infections (HAIs) result in treatment delays as well as failures and financial losses not only to patients but also to the treating hospital and overall health-care delivery system. Due to hospital-acquired infections, there are problems of increase in morbidity and mortality, additional diagnostic and therapeutic interventions and ultimately antimicrobial resistance. Proper understanding among health-care workers about the ill effects of HAIs is very important to address this issue. The present study is a qualitative exploration aimed at understanding various aspects of hospital environmental hygiene and Infection prevention control program, by exploring the staff perception regarding the challenges, facilitators and barriers as well as feasible measures towards improvement in a rural tertiary teaching hospital in central India.

    Method: A qualitative study was conducted using 10 focus group discussions (FGDs) among five different professional groups, which included hospital administrators, doctors, nurses, environmental cleaning staff, and undergraduate medical students. The FGD guide included the following topics: (1) opinion about the status of cleanliness, (2) concepts and actual practices prevailing of hospital environmental hygiene, (3) Barriers, constraints, and problems in maintaining hospital environmental hygiene, (4) Suggestions for improvements. The data were analyzed manually using the content (thematic) analysis method.

    Results: Two themes were identified: Theme 1: “Prevailing practices and problems related to hospital surface/object contamination and hospital infection control”. Theme 2: “Measures suggested for improving hospital cleanliness within the existing constraints”. The participants emphasized the influence of resource constraints and needed inputs. They brought up the consequent prevailing practices and problems related, on one hand, to various stakeholders (service consumers, hospital personnel including the management), on the other, to specific infection prevention and control processes. They also suggested various measures for improvement.

    Conclusions: The study has revealed prevailing practices, problems, and suggested measures related to hospital environmental hygiene, particularly hospital cleanliness and HAI prevention and control processes. These insights and assertions are important for developing future behavioral and structural interventions in resource-limited settings. This study recommends a nationwide reliable HAI surveillance system and a robust infection prevention and control program in each health-care institution.

  • 13.
    Kodra, Yllka
    et al.
    Ist Super Sanita, Natl Ctr Rare Dis, I-00162 Rome, Italy.
    Weinbach, Jerome
    Hop Trousseau, INSERM, RaDiCo,French Natl Programme Rare Dis Cohorts, Natl Inst Hlth & Med Res,UMR S933, F-75018 Paris, France.
    Posada-de-la-Paz, Manuel
    RDR, ISCIII, Inst Rare Dis Res, Madrid 28029, Spain;CIBERER, Madrid 28029, Spain.
    Coi, Alessio
    CNR, Inst Clin Physiol, I-56124 Pisa, Italy;FTGM, I-56124 Pisa, Italy.
    Lemonnier, S. Lydie
    RD Connect & Vaincre Mucoviscidose French Cyst Fi, Patient Advisory Council, F-75013 Paris, France.
    van Enckevort, David
    Univ Groningen, UMCG, Dept Genet, NL-9700 RB Groningen, Netherlands.
    Roos, Marco
    Leiden Univ, Med Ctr, NL-2333 ZA Leiden, Netherlands.
    Jacobsen, Annika
    Leiden Univ, Med Ctr, NL-2333 ZA Leiden, Netherlands.
    Cornet, Ronald
    Univ Amsterdam, Amsterdam UMC, Amsterdam Publ Hlth Res Inst, Med Informat, NL-1105 AZ Amsterdam, Netherlands.
    Ahmed, S. Faisal
    Univ Glasgow, Royal Hosp Children, Off Rare Condit, Glasgow G51 4TF, Lanark, Scotland.
    Bros-Facer, Virginie
    Patient Advisory Council RD Connect & EURORDIS Ra, F-75014 Paris, France.
    Popa, Veronica
    RD Connect & MCT8 AHDS Fdn, Patient Advisory Council, Oklahoma City, OK 74464 USA.
    Van Meel, Marieke
    RD Connect & NephcEurope Fdn, Patient Advisory Council, NL-2411 DW Bodegraven, Netherlands.
    Renault, Daniel
    Patient Advisory Council RD Connect, B-1200 Brussels, Belgium;FEDERG, B-1200 Brussels, Belgium.
    von Gizycki, Rainald
    Patient Advisory Council RD Connect, D-53113 Bonn, Germany;PRO RETINA Deutschland, D-53113 Bonn, Germany.
    Santoro, Michele
    CNR, Inst Clin Physiol, I-56124 Pisa, Italy;FTGM, I-56124 Pisa, Italy.
    Landais, Paul
    Hop Trousseau, INSERM, RaDiCo,French Natl Programme Rare Dis Cohorts, Natl Inst Hlth & Med Res,UMR S933, F-75018 Paris, France;Montpellier Univ, Clin Res Inst, EA2415, F-34093 Montpellier, France.
    Torreri, Paola
    Ist Super Sanita, Natl Ctr Rare Dis, I-00162 Rome, Italy.
    Carta, Claudio
    Ist Super Sanita, Natl Ctr Rare Dis, I-00162 Rome, Italy.
    Mascalzoni, Deborah
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Gainotti, Sabina
    Ist Super Sanita, Off President, Bioeth Unit, I-00162 Rome, Italy.
    Lopez, Estrella
    RDR, ISCIII, Inst Rare Dis Res, Madrid 28029, Spain;CIBERER, Madrid 28029, Spain.
    Ambrosini, Anna
    Fdn Telethon, I-20129 Milan, Italy.
    Muller, Heimo
    Med Univ Graz, Diagnost & Res Ctr Mol BioMed, A-8010 Graz, Austria.
    Reis, Robert
    Med Univ Graz, Diagnost & Res Ctr Mol BioMed, A-8010 Graz, Austria.
    Bianchi, Fabrizio
    CNR, Inst Clin Physiol, I-56124 Pisa, Italy;FTGM, I-56124 Pisa, Italy.
    Rubinstein, Yaffa R.
    NIH, Natl Lib Med, Bethesda, MD 20892 USA.
    Lochmueller, Hanns
    Univ Freiburg, Fac Med, Dept Neuropediat, D-79160 Freiburg, Germany;Univ Freiburg, Fac Med, Muscle Disorders Med Ctr, D-79160 Freiburg, Germany;BIST, CRG, CNAG, Barcelona 08028, Spain.
    Mueller, Heimo
    Taruscio, Domenica
    Ist Super Sanita, Natl Ctr Rare Dis, I-00162 Rome, Italy.
    Recommendations for Improving the Quality of Rare Disease Registries2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 8, article id 1644Article, review/survey (Refereed)
    Abstract [en]

    Rare diseases (RD) patient registries are powerful instruments that help develop clinical research, facilitate the planning of appropriate clinical trials, improve patient care, and support healthcare management. They constitute a key information system that supports the activities of European Reference Networks (ERNs) on rare diseases. A rapid proliferation of RD registries has occurred during the last years and there is a need to develop guidance for the minimum requirements, recommendations and standards necessary to maintain a high-quality registry. In response to these heterogeneities, in the framework of RD-Connect, a European platform connecting databases, registries, biobanks and clinical bioinformatics for rare disease research, we report on a list of recommendations, developed by a group of experts, including members of patient organizations, to be used as a framework for improving the quality of RD registries. This list includes aspects of governance, Findable, Accessible, Interoperable and Reusable (FAIR) data and information, infrastructure, documentation, training, and quality audit. The list is intended to be used by established as well as new RD registries. Further work includes the development of a toolkit to enable continuous assessment and improvement of their organizational and data quality.

  • 14.
    Mathur, Aditya
    et al.
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Baghel, Devendra
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Jaat, Jitendra
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Diwan, Vishal
    Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, SE-17176 Stockholm, Sweden;RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain 456006, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, SE-17176 Stockholm, Sweden.
    Community-Based Participatory Research and Drug Utilization Research to Improve Childhood Diarrhea Case Management in Ujjain, India: A Cross-Sectional Survey2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 9, article id 1646Article in journal (Refereed)
    Abstract [en]

    Childhood diarrhea continues to be a major cause of under-five (U-5) mortality globally and in India. In this study, 1571 U-5 children residing in nine rural villages and four urban slums in Ujjain, India were included with the objective to use community participation and drug utilization research to improve diarrheal case management. The mean age was 2.08 years, with 297 (19%), children living in high diarrheal index households. Most mothers (70%) considered stale food, teething (62%), and hot weather (55%) as causes of diarrhea. Water, sanitation, and hygiene (WASH)-related characteristics revealed that most (93%) households had toilets, but only 23% of the children used them. The study identified ineffective household water treatment by filtration through cloth by most (93%) households and dumping of household waste on the streets (89%). The results revealed low community awareness of correct causes of diarrhea (poor hand hygiene, 21%; littering around the household, 15%) and of correct diarrhea treatment (oral rehydration solution (ORS) and zinc use, 29% and 11%, respectively) and a high antibiotic prescription rate by healthcare providers (83%). Based on the results of the present study, context-specific house-to-house interventions will be designed and implemented.

  • 15. Nerkar, Sandeep S.
    et al.
    Pathak, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lundborg, Cecilia Stalsby
    Tamhankar, Ashok J.
    Can Integrated Watershed Management Contribute to Improvement of Public Health?: A Cross-Sectional Study from Hilly Tribal Villages in India2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 3, p. 2653-2669Article in journal (Refereed)
    Abstract [en]

    Tribal people living in hilly areas suffer from water scarcity in many parts of the world, including India. Water scarcity adversely impacts all aspects of life, including public health. Implementation of an Integrated Watershed Management Programme (IWMP) can help solve the problems arising out of water scarcity in such areas. However, the knowledge about and views of the water scarcity sufferers on the public health implications of IWMP have not been well documented. This cross-sectional study was performed in six purposively selected tribal villages located in Maharashtra, India. In three of the villages IWMP had been implemented (IWMV), but not in the other three (NWMV). The head of each household in all villages was interviewed using a questionnaire covering various public health aspects relevant to the villages. A total of 286/313 (92%) households participated in the study. Compared to NWMV, respondents in IWMV experienced significantly lesser prolonged water scarcity (OR = 0.39), had greater number of toilets (OR = 6.95), cultivated more variety of crops (OR = 2.61), had lower migration (OR = 0.59), higher number of girls continuing education (OR = 3.04) and better utilized modern healthcare facilities in the antenatal, natal and postnatal period (OR = 3.75, 2.57, 4.88 respectively). Thus, tribal people in IWMP-implemented villages reported advantages in many aspects of public health.

  • 16.
    Nurmela, Kirsti
    et al.
    Univ Tampere, Fac Social Sci, Hlth Sci, Tampere 33014, Finland;Mental Hlth & Subst Abuse Serv, Tampere 33900, Finland.
    Mattila, Aino
    Univ Tampere, Fac Social Sci, Hlth Sci, Tampere 33014, Finland;Tampere Univ Hosp, Dept Adult Psychiat, Tampere 33521, Finland.
    Heikkinen, Virpi
    Tampere Univ Hosp, Dept Neurosci & Rehabil, Tampere 33521, Finland.
    Uitti, Jukka
    Univ Tampere, Fac Med & Life Sci, Tampere 33521, Finland;Tampere Univ Hosp, Clin Occupat Med, Tampere 33521, Finland;Finnish Inst Occupat Hlth, Tampere 33100, Finland.
    Ylinen, Aarne
    Univ Helsinki, Fac Med, Dept Neurol Sci, SF-00100 Helsinki, Finland;Univ Helsinki, Cent Hosp, Dept Neurol, Helsinki 00260, Finland.
    Virtanen, Pekka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Univ Tampere, Fac Social Sci, Hlth Sci, Tampere 33014, Finland.
    Identification of Depression and Screening for Work Disabilities among Long-Term Unemployed People2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 5, article id 909Article in journal (Refereed)
    Abstract [en]

    The study explores whether clinical screening targeted at work disabilities among long-term unemployed people reveals eligible individuals for a disability pension and the importance of depression in granting the disability pensions. A total of 364 participants of the screening project were considered as eligible to apply for disability pension. Among them, 188 were diagnosed as clinically depressed. They were classified into those with earlier depression diagnosis (n = 85), those whose depression had not been diagnosed earlier (n = 103), and those without diagnosed depression (n = 176). The association of this Depression identification pattern' with being granted a disability pension was explored by logistic regression analyses. Compared to those with earlier diagnosis, those whose depression had not been diagnosed earlier were granted disability pension more commonly (72% vs. 54% OR 2.2, p = 0.012). Corresponding figures of the undepressed were 73%, OR 2.3, p = 0.002. The adjustments did not affect the results. Clinical examination of the long-term unemployed people in terms of work disability seems to be worthwhile. In particular, the examination reveals new depression diagnoses, which contribute more to the award of disability pension than depression diagnosed earlier by regular health care. Novel ways to detect depression among the unemployed should be implemented in the health and employment services.

  • 17. Odland, Maria Lisa
    et al.
    Membe-Gadama, Gladys
    Kafulafula, Ursula
    Jacobsen W, Geir
    Kumwenda, James
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration. Department of Public Health and Nursing, Norwegian University of Science and Technology,Trondheim, Norway; Department of Gynecology, St. Olav´s Hospital, NO-7030 Trondheim, Norway.
    The Use of Manual Vacuum Aspiration in the Treatment of Incomplete Abortions: A Descriptive Study from Three Public Hospitals in Malawi2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 2, article id 370Article in journal (Refereed)
    Abstract [en]

    Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a restrictive abortion law in place. This leads to complications, such as incomplete abortions, which need to be treated to avoid further harm. Although manual vacuum aspiration (MVA) is a safe and cheap method of evacuating the uterus, the most commonly used method in Malawi is curettage. Medical treatment is used sparingly in the country, and the Ministry of Health has been trying to increase the use of MVA. The aim of this study was to investigate the treatment of incomplete abortions in three public hospitals in Southern Malawi during a three-year period. All medical files from the female/gynecological wards from 2013 to 2015 were reviewed. In total, information on obstetric history, demographics, and treatment were collected from 7270 women who had been treated for incomplete abortions. The overall use of MVA at the three hospitals during the study period was 11.4% (95% CI, 10.7–12.1). However, there was a major increase in MVA application at one District Hospital. Why there was only one successful hospital in this study is unclear, but may be due to more training and dedicated leadership at this particular hospital. Either way, the use of MVA in the treatment of incomplete abortions continues to be low in Malawi, despite recommendations from the World Health Organization (WHO) and the Malawi Ministry of Health.

  • 18.
    Oppong-Darko, Prince
    et al.
    Norwegian Univ Sci & Technol, NTNU, Dept Publ Hlth & Nursing, N-7491 Trondheim, Norway.
    Amponsa-Achiano, Kwame
    Ghana Hlth Serv, Publ Hlth Div, Accra, Ghana.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian Univ Sci & Technol, NTNU, Dept Publ Hlth & Nursing, N-7491 Trondheim, Norway; St Olavs Hosp, Dept Obstet & Gynecol, N-7030 Trondheim, Norway.
    "I Am Ready and Willing to Provide the Service … Though My Religion Frowns on Abortion"-Ghanaian Midwives' Mixed Attitudes to Abortion Services: A Qualitative Study2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 12, article id 1501Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Unsafe abortion is a major preventable public health problem and contributes to high mortality among women. Ghana has ratified international conventions to prevent unwanted pregnancies and provide safe abortion services, legally authorizing midwives to provide induced abortion services in certain circumstances.

    OBJECTIVE: The aim of the study was to understand midwives' readiness to be involved in legal induced abortions, should the law become less restricted in Ghana.

    METHODS: A qualitative study design, with a topic guide for individual in-depth interviews of selected midwives, was adopted. The interviews were tape-recorded and analyzed using content analysis.

    RESULTS: Participants emphasized their willingness to reduce maternal mortalities, their experiences of maternal deaths, and their passion for the health of pregnant women. Knowledge of Ghana's abortion law was generally low. Different views were expressed regarding readiness to engage in abortion services. Some expressed it as being sinful and against their religion to assist in abortion care, whilst others felt it was good to save the lives of women.

    CONCLUSION: The midwives made it clear that unsafe abortions are common, stigmatizing and contributing to maternal mortality, issues that must be addressed. They made various suggestions to reduce this preventable tragedy.

  • 19.
    Proos, Lemm A.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Gustafsson, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Is Early Puberty Triggered by Catch-Up Growth Following Undernutrition?2012In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 9, no 5, p. 1791-1809Article, review/survey (Refereed)
    Abstract [en]

    Undernutrition during fetal and postnatal life is still a major problem in many low- and middle-income countries. Even in high-income countries malnutrition may exist in cases of intrauterine growth retardation, as well as in chronic conditions such as anorexia nervosa and inflammatory bowel disease. Children adopted from developing countries are often chronically malnourished. Nutritional rehabilitation, resulting in catch-up growth, is often complicated by influences originating in fetal life as well as during postnatal growth. This may result in hormonal and metabolic changes as well as alterations in pubertal development. The present review focuses on fetal, postnatal and fetal-postnatal undernutrition and subsequent catch-up growth as well as catch-up growth in relation to pubertal development. Catch-up growth in children can be associated with early puberty following fetal or combined fetal-postnatal undernutrition. However, early puberty does not seem to occur following catch-up growth after isolated postnatal undernutrition. Gonadotropins have been reported to be elevated in prepubertal adopted girls as well as during catch-up growth in animals. Even if other factors may contribute, linear catch-up growth seems to be associated with the timing of pubertal development. The mechanisms behind this are still unknown. Future research may elucidate how to carry out nutritional rehabilitation without risk for early pubertal development.

  • 20.
    Sahoo, Krushna Chandra
    et al.
    Department of Public Health Sciences (Global health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Sahoo, Soumyakanta
    Department of Microbiology, Kalinga Institute of Medical Sciences (KIMS), Super Religare Laboratories Limited, Bhubaneswar, India.
    Marrone, Gaetano
    Department of Public Health Sciences (Global health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Pathak, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lundborg, Cecilia Stålsby
    Department of Public Health Sciences (Global health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Tamhankar, Ashok J
    Department of Public Health Sciences (Global health/IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Climatic Factors and Community - Associated Methicillin-Resistant Staphylococcus aureus Skin and Soft-Tissue Infections: A Time-Series Analysis Study2014In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 11, no 9, p. 8996-9007Article in journal (Refereed)
    Abstract [en]

    Skin and soft tissue infections caused by Staphylococcus aureus (SA-SSTIs) including methicillin-resistant Staphylococcus aureus (MRSA) have experienced a significant surge all over the world. Changing climatic factors are affecting the global burden of dermatological infections and there is a lack of information on the association between climatic factors and MRSA infections. Therefore, association of temperature and relative humidity (RH) with occurrence of SA-SSTIs (n = 387) and also MRSA (n = 251) was monitored for 18 months in the outpatient clinic at a tertiary care hospital located in Bhubaneswar, Odisha, India. The Kirby-Bauer disk diffusion method was used for antibiotic susceptibility testing. Time-series analysis was used to investigate the potential association of climatic factors (weekly averages of maximum temperature, minimum temperature and RH) with weekly incidence of SA-SSTIs and MRSA infections. The analysis showed that a combination of weekly average maximum temperature above 33 °C coinciding with weekly average RH ranging between 55% and 78%, is most favorable for the occurrence of SA-SSTIs and MRSA and within these parameters, each unit increase in occurrence of MRSA was associated with increase in weekly average maximum temperature of 1.7 °C (p = 0.044) and weekly average RH increase of 10% (p = 0.097).

  • 21.
    Sigvardsdotter, Erika
    et al.
    Department of Health Sciences, The Swedish Red Cross University College, 14121 Huddinge, Sweden.
    Nilsson, Henrik
    Department of Health Sciences, The Swedish Red Cross University College, 14121 Huddinge, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden; Swedish Red Cross Center for Persons Affected by War and Torture, 20121 Malmö, Sweden.
    Malm, Andreas
    Department of Health Sciences, The Swedish Red Cross University College, 14121 Huddinge, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden; Swedish Red Cross Center for Persons Affected by War and Torture, 20121 Malmö, Sweden.
    Tinghög, Petter
    Department of Health Sciences, The Swedish Red Cross University College, 14121 Huddinge, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden.
    Gottvall, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Department of Health Sciences, The Swedish Red Cross University College, 14121 Huddinge, Sweden.
    Vaez, Marjan
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden.
    Saboonchi, Fredrik
    Department of Health Sciences, The Swedish Red Cross University College, 14121 Huddinge, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden.
    Development and Preliminary Validation of Refugee Trauma History Checklist (RTHC): A Brief Checklist for Survey Studies2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 10, article id E1175Article in journal (Refereed)
    Abstract [en]

    A high proportion of refugees have been subjected to potentially traumatic experiences (PTEs), including torture. PTEs, and torture in particular, are powerful predictors of mental ill health. This paper reports the development and preliminary validation of a brief refugee trauma checklist applicable for survey studies.

    Methods: A pool of 232 items was generated based on pre-existing instruments. Conceptualization, item selection and item refinement was conducted based on existing literature and in collaboration with experts. Ten cognitive interviews using a Think Aloud Protocol (TAP) were performed in a clinical setting, and field testing of the proposed checklist was performed in a total sample of n = 137 asylum seekers from Syria.

    Results: The proposed refugee trauma history checklist (RTHC) consists of 2 × 8 items, concerning PTEs that occurred before and during the respondents' flight, respectively. Results show low item non-response and adequate psychometric properties

    Conclusion: RTHC is a usable tool for providing self-report data on refugee trauma history surveys of community samples. The core set of included events can be augmented and slight modifications can be applied to RTHC for use also in other refugee populations and settings.

  • 22. Simpson, Claire L
    et al.
    Goldenberg, Aaron J
    Culverhouse, Rob
    Daley, Denise
    Igo, Robert P
    Jarvik, Gail P
    Mandal, Diptasri M
    Mascalzoni, Deborah
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Montgomery, Courtney Gray
    Pierce, Brandon
    Plaetke, Rosemarie
    Shete, Sanjay
    Goddard, Katrina A B
    Stein, Catherine M
    Practical barriers and ethical challenges in genetic data sharing2014In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 11, no 8, p. 8383-8398Article in journal (Refereed)
    Abstract [en]

    The underlying ethos of dbGaP is that access to these data by secondary data analysts facilitates advancement of science. NIH has required that genome-wide association study data be deposited in the Database of Genotypes and Phenotypes (dbGaP) since 2003. In 2013, a proposed updated policy extended this requirement to next-generation sequencing data. However, recent literature and anecdotal reports suggest lingering logistical and ethical concerns about subject identifiability, informed consent, publication embargo enforcement, and difficulty in accessing dbGaP data. We surveyed the International Genetic Epidemiology Society (IGES) membership about their experiences. One hundred and seventy five (175) individuals completed the survey, a response rate of 27%. Of respondents who received data from dbGaP (43%), only 32% perceived the application process as easy but most (75%) received data within five months. Remaining challenges include difficulty in identifying an institutional signing official and an overlong application process. Only 24% of respondents had contributed data to dbGaP. Of these, 31% reported local IRB restrictions on data release; an additional 15% had to reconsent study participants before depositing data. The majority of respondents (56%) disagreed that the publication embargo period was sufficient. In response, we recommend longer embargo periods and use of varied data-sharing models rather than a one-size-fits-all approach.

  • 23.
    Timm, Signe
    et al.
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, DK-8000 Aarhus C, Denmark..
    Frydenberg, Morten
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, DK-8000 Aarhus C, Denmark..
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Campbell, Brittany
    Univ Melbourne, Melbourne Sch Populat & Global Hlth, Ctr Epidemiol & Biostat, Allergy & Lung Hlth Unit, Melbourne, Vic 3010, Australia..
    Forsberg, Bertil
    Umea Univ, Dept Publ Hlth & Clin Med, Div Occupat & Environm Med, S-90187 Umea, Sweden..
    Gislason, Thorarinn
    Landspitali Univ Hosp, Dept Resp Med & Sleep, IS-108 Reykjavik, Iceland.;Univ Iceland, Fac Med, IS-101 Reykjavik, Iceland..
    Holm, Mathias
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, S-40530 Gothenburg, Sweden..
    Jogi, Rain
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Tartu Univ Hosp, Lung Clin, EE-50406 Tartu, Estonia..
    Omenaas, Ernst
    Univ Bergen, Inst Clin Sci, N-5020 Bergen, Norway..
    Sigsgaard, Torben
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, DK-8000 Aarhus C, Denmark..
    Svanes, Cecilie
    Univ Bergen, Inst Clin Sci, N-5020 Bergen, Norway..
    Schlunssen, Vivi
    Aarhus Univ, Danish Ramazzini Ctr, Dept Publ Hlth, DK-8000 Aarhus C, Denmark.;Natl Res Ctr Working Environm, DK-2100 Copenhagen, Denmark..
    The Urban-Rural Gradient In Asthma: A Population-Based Study in Northern Europe2016In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 13, no 1, article id UNSP 93Article in journal (Refereed)
    Abstract [en]

    The early life environment appears to have a persistent impact on asthma risk. We hypothesize that environmental factors related to rural life mediate lower asthma prevalence in rural populations, and aimed to investigate an urban-rural gradient, assessed by place of upbringing, for asthma. The population-based Respiratory Health In Northern Europe (RHINE) study includes subjects from Denmark, Norway, Sweden, Iceland and Estonia born 1945-1973. The present analysis encompasses questionnaire data on 11,123 RHINE subjects. Six categories of place of upbringing were defined: farm with livestock, farm without livestock, village in rural area, small town, city suburb and inner city. The association of place of upbringing with asthma onset was analysed with Cox regression adjusted for relevant confounders. Subjects growing up on livestock farms had less asthma (8%) than subjects growing up in inner cities (11%) (hazard ratio 0.72 95% CI 0.57-0.91), and a significant urban-rural gradient was observed across six urbanisation levels (p = 0.02). An urban-rural gradient was only evident among women, smokers and for late-onset asthma. Analyses on wheeze and place of upbringing revealed similar results. In conclusion, this study suggests a protective effect of livestock farm upbringing on asthma development and an urban-rural gradient in a Northern European population.

  • 24.
    Travert, Anne-Sophie
    et al.
    Sci Po, Sch Publ Affairs, F-75007 Paris, France; Karolinska Inst, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden.
    Annerstedt, Kristi Sidney
    Karolinska Inst, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden.
    Daivadanam, Meena
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Dept Publ Hlth Sci, S-17177 Stockholm, Sweden.
    Built Environment and Health Behaviors: Deconstructing the Black Box of Interactions — A Review of Reviews2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 8, article id 1454Article, review/survey (Refereed)
    Abstract [en]

    A review of reviews following a scoping review study design was conducted in order to deconstruct the black box of interactions between the built environment and human behaviors pertaining to physical activity and/or diet. In the qualitative analysis 107 records were included, 45 of which were also coded. Most review papers confirmed the influence of the built environment on the behaviors of interest with some noting that a same built environment feature could have different behavioral outcomes. The conceptual model developed sheds light on these mixed results and brings out the role of several personal and behavioral factors in the shift from the measured to the perceived built environment. This shift was found to shape individuals' behaviors critically and to have the power of redefining the strength of every interaction. Apart from its theoretical relevance, this model has high practical relevance especially for the design and implementation of interventions with a behavioral component. Intervention researchers can use the model developed to identify and label the built environment and individual factors that can be measured objectively or perceived as facilitators, concurrent options and barriers, in order to develop comprehensive and multi-component intervention strategies.

  • 25.
    Urke, Helga Björnöy
    et al.
    Univ Bergen, Dept Hlth Promot & Dev, N-5020 Bergen, Norway.
    Contreras, Mariela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). GOAL Honduras, Tegucigalpa 11101, Honduras.
    Matanda, Dennis Juma
    Populat Council, Ave 5,Rose Ave,POB 17643-00500, Nairobi, Kenya.
    The Influence of Maternal and Household Resources, and Parental Psychosocial Child Stimulation on Early Childhood Development: A Cross-Sectional Study of Children 36-59 Months in Honduras2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 5, article id 926Article in journal (Refereed)
    Abstract [en]

    Optimal early childhood development (ECD) is currently jeopardized for more than 250 million children under five in low- and middle-income countries. The Sustainable Development Goals has called for a renewed emphasis on children's wellbeing, encompassing a holistic approach that ensures nurturing care to facilitate optimal child development. In vulnerable contexts, the extent of a family's available resources can influence a child's potential of reaching its optimal development. Few studies have examined these relationships in low- and middle-income countries using nationally representative samples. The present paper explored the relationships between maternal and paternal psychosocial stimulation of the child as well as maternal and household resources and ECD among 2729 children 36-59 months old in Honduras. Data from the Demographic and Health Surveys conducted in 2011-2012 was used. Adjusted logistic regression analyses showed that maternal psychosocial stimulation was positively and significantly associated with ECD in the full, rural, and lowest wealth quintile samples. These findings underscore the importance of maternal engagement in facilitating ECD but also highlight the role of context when designing tailored interventions to improve ECD.

  • 26.
    Westerholm, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Remaéus, Bertil
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    The Tale of Asbestos in Sweden 1972-1986: The Pathway to a Near-Total Ban2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 11, article id E1433Article in journal (Refereed)
    Abstract [en]

    This paper provides a narrative of the national intervention strategy in Sweden aimed to restrict the industrial use of asbestos. For many years, asbestos was imported for widespread industrial use, resulting in large amounts throughout Swedish society. In 1972, the whistle was blown in a Communist Party parliamentary motion describing asbestos as a health hazard and requesting action to prohibit its use. Although the motion was rejected, it initiated the extensive charting of asbestos sources on a tripartite basis, involving government agencies, and employer and trade-union organizations. Restrictive asbestos management practices were enforced from July 1982. The year 1985 saw the Government Asbestos Commission review, covering use-determining factors, international regulations, and assessments of cancer risks. The relative risks of chrysotile and amphibole were considered internationally (by the IARC), since chrysotile (a Canadian export) was regarded as unharmful in Canada at that time. Prohibiting asbestos use resulted in its virtual disappearance as an import to Sweden from the early 1980s. However, asbestos has undergone a transition from an occupational to a public-health hazard (although some work-related hazards, such as handling and disposal, remain). The transition reflects the public's exposure to existing stocks, in homes, workplaces, etc. Mesothelioma incidence has come to be regarded as an indicator of prevention effectiveness.

  • 27.
    Wijnhoven, Trudy M A
    et al.
    Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark .
    van Raaij, Joop M A
    Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands .
    Sjöberg, Agneta
    Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Eldin, Nazih
    Health Promotion Department, Health Service Executive, Railway Street, Navan, County Meath, Ireland; National Nutrition Surveillance Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland .
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Kunešová, Marie
    Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic .
    Starc, Gregor
    Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia .
    Rito, Ana I
    National Health Institute Doutor Ricardo Jorge, Av. Padre Cruz, Lisbon, Portugal.
    Duleva, Vesselka
    Department of Food and Nutrition, National Centre of Public Health and Analyses, Sofia, Bulgaria .
    Hassapidou, Maria
    Department of Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece .
    Martos, Eva
    National Institute for Food and Nutrition Science, Budapest, Hungary .
    Pudule, Iveta
    Centre for Disease Prevention and Control, Riga, Latvia.
    Petrauskiene, Ausra
    Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania .
    Sant'Angelo, Victoria Farrugia
    Primary Health Care Department, Malta .
    Hovengen, Ragnhild
    Department of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway.
    Breda, João
    Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark.
    WHO European Childhood Obesity Surveillance Initiative: School Nutrition Environment and Body Mass Index in Primary Schools2014In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 11, no 11, p. 11261-11285Article in journal (Refereed)
    Abstract [en]

    Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention.

    Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries.

    Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children's weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children's BMI/A Z-scores was calculated.

    Results: Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed.

    Conclusions: Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the "unhealthy" school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.

  • 28.
    Xu, Feng
    et al.
    Fudan Univ, Shanghai Med Coll, Huashan Hosp, Dept Dermatol, Shanghai 200040, Peoples R China..
    Yan, Shuxian
    Fudan Univ, Shanghai Med Coll, Huashan Hosp, Dept Dermatol, Shanghai 200040, Peoples R China..
    Zheng, Qile
    Fujian Med Univ, Dept Dermatol, Affiliated Hosp 1, Fuzhou 350000, Peoples R China..
    Li, Fei
    Fudan Univ, Shanghai Med Coll, Huashan Hosp, Dept Dermatol, Shanghai 200040, Peoples R China..
    Chai, Weihan
    Jiading Dist Tradit Chinese Med Hosp, Dept Dermatol, Shanghai 201800, Peoples R China..
    Wu, Minmin
    Fudan Univ, Minist Educ, Key Lab Publ Hlth Safety, Sch Publ Hlth, Shanghai 200032, Peoples R China.;Fudan Univ, Minist Hlth, Key Lab Hlth Technol Assessment, Shanghai 200032, Peoples R China..
    Kan, Haidong
    Fudan Univ, Minist Educ, Key Lab Publ Hlth Safety, Sch Publ Hlth, Shanghai 200032, Peoples R China.;Fudan Univ, Minist Hlth, Key Lab Hlth Technol Assessment, Shanghai 200032, Peoples R China..
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Xu, Jinhua
    Fudan Univ, Shanghai Med Coll, Huashan Hosp, Dept Dermatol, Shanghai 200040, Peoples R China..
    Zhao, Zhuohui
    Fudan Univ, Minist Educ, Key Lab Publ Hlth Safety, Sch Publ Hlth, Shanghai 200032, Peoples R China.;Fudan Univ, Minist Hlth, Key Lab Hlth Technol Assessment, Shanghai 200032, Peoples R China..
    Residential Risk Factors for Atopic Dermatitis in 3-to 6-Year Old Children: A Cross-Sectional Study in Shanghai, China2016In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 13, no 6, article id 537Article in journal (Refereed)
    Abstract [en]

    Background: Atopic dermatitis (AD) is common among pre-school children in Shanghai. This study aimed to identify the risk factors for childhood AD from the perspectives of home environment, demographics and parents-grandparents' atopic disease. Methods: A cross-sectional study was conducted in Shanghai in April-June, 2010. Preschool children's parents or guardians were invited to participate a questionnaire survey in six districts (two urban and four suburban/rural) and 6624 children were finally recruited (51.3% boys). AD diagnosis was based on the U.K. Working Party's (UKWP) criteria. Adjusted odds ratios (AOR) with 95% confidence intervals (95% CI) were calculated by multiple logistic regression. Results: A total of 8.5% of children ever had AD. Around 10.2% of the mothers had lived in newly renovated/decorated homes (NRDH) during the prenatal period (one year before or during pregnancy) and 9.5% got new home furniture (NHF) during the same period. AD was more common in children when mothers had lived in NRDH homes during the prenatal period (AOR = 1.41; 95% CI 1.03-1.93), the current home had indoor mold (2.00, 1.48-2.70), parents-grandparents' had atopic diseases (3.85, 3.05-4.87), the children had food allergy (3.40, 2.63-4.40) or children lived in urban area (1.52, 1.18-1.96). Associations between AD and NRDH, NHF and indoor molds were only significant in children without parents-grandparents' atopic diseases. There was an interaction effect between parents-grandparents' atopic diseases and NRDH (p < 0.05). Conclusions: Home renovation/redecoration, new furniture and indoor mold, urban residency, heredity disposition and food allergy can be risk factors for childhood AD in Shanghai.

  • 29.
    Zander, Viktoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Univ Hosp Solna, Dept Womens & Childrens Hlth, Karolinska Inst, S-17176 Stockholm, Sweden..
    Eriksson, Henrik
    Swedish Red Cross Univ Coll, Dept Nursing & Care, S-11428 Stockholm, Sweden..
    Christensson, Kyllike
    Karolinska Univ Hosp Solna, Dept Womens & Childrens Hlth, Karolinska Inst, S-17176 Stockholm, Sweden..
    Mullersdorf, Maria
    Malardalen Univ, Sch Hlth Care & Social Welf, S-63105 Eskilstuna, Sweden..
    Development of an Interview Guide Identifying the Rehabilitation Needs of Women from the Middle East Living with Chronic Pain2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 10, p. 12043-12056Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to develop an interview guide for use by primary healthcare professionals to support them in identifying the rehabilitation needs of forced resettled women from the Middle East living with chronic pain. Previous findings together with the existing literature were used as the basis for developing the interview guide in three steps: item generation, cognitive interviews, and a pilot study. The study resulted in a 16-item interview guide focusing on patients' concerns and expectations, with consideration of pre-migration, migration, and post-migration factors that might affect their health. With the help of the guide, patients were also invited to identify difficulties in their daily activities and to take part in setting goals and planning their rehabilitation. The current interview guide provides professional guidance to caretakers, taking a person-centered participative point of departure when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staff members working in primary healthcare, with the aim of contributing to continuity of care and multi-professional collaboration.

  • 30.
    Åberg, Anna Cristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Halvorsen, Kjartan
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Systems and Control. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Automatic control.
    From, Ingrid
    Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden.
    Bergman Bruhn, Åsa
    Dalarna Univ, Sch Educ Hlth & Social Studies, SE-79188 Falun, Sweden.
    Oestreicher, Lars
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Melander-Wikman, Anita
    Lulea Univ Technol, Div Hlth & Rehab, Dept Hlth Sci, SE-97187 Lulea, Sweden.
    A study protocol for applying user participation and co-learning: Lessons learned from the eBalance project2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 5, article id 512Article in journal (Refereed)
    Abstract [en]

    The eBalance project is based on the idea that serious exergames-i.e., computer gaming systems with an interface that requires physical exertion to play-that are well adapted to users, can become a substantial part of a solution to recognized problems of insufficient engagement in fall-prevention exercise and the high levels of fall-related injuries among older people. This project is carried out as a collaboration between eight older people who have an interest in balance training and met the inclusion criteria of independence in personal activities of daily living, access to and basic knowledge of a computer, four staff working with the rehabilitation of older adults, and an interdisciplinary group of six research coordinators covering the areas of geriatric care and rehabilitation, as well as information technology and computer science. This paper describes the study protocol of the project's initial phase which aims to develop a working partnership with potential users of fall-prevention exergames, including its conceptual underpinnings. The qualitative methodology was inspired by an ethnographical approach implying combining methods that allowed the design to evolve through the study based on the participants' reflections. A participatory and appreciative action and reflection (PAAR) approach, accompanied by inquiries inspired by the Normalization Process Theory (NPT) was used in interactive workshops, including exergame testing, and between workshop activities. Data were collected through audio recordings, photos, and different types of written documentation. The findings provide a description of the methodology thus developed and applied. They display a methodology that can be useful for the design and development of care service and innovations for older persons where user participation is in focus.

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