| 1. |
- Tong, Tammy Y. N., et al.
(författare)
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Dietary amino acids and risk of stroke subtypes : a prospective analysis of 356,000 participants in seven European countries
- 2024
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Ingår i: European Journal of Nutrition. - : Springer Nature. - 1436-6207 .- 1436-6215. ; 63, s. 209-220
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Previously reported associations of protein-rich foods with stroke subtypes have prompted interest in the assessment of individual amino acids. We examined the associations of dietary amino acids with risks of ischaemic and haemorrhagic stroke in the EPIC study.Methods: We analysed data from 356,142 participants from seven European countries. Dietary intakes of 19 individual amino acids were assessed using validated country-specific dietary questionnaires, calibrated using additional 24-h dietary recalls. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of ischaemic and haemorrhagic stroke in relation to the intake of each amino acid. The role of blood pressure as a potential mechanism was assessed in 267,642 (75%) participants.Results: After a median follow-up of 12.9 years, 4295 participants had an ischaemic stroke and 1375 participants had a haemorrhagic stroke. After correction for multiple testing, a higher intake of proline (as a percent of total protein) was associated with a 12% lower risk of ischaemic stroke (HR per 1 SD higher intake 0.88; 95% CI 0.82, 0.94). The association persisted after mutual adjustment for all other amino acids, systolic and diastolic blood pressure. The inverse associations of isoleucine, leucine, valine, phenylalanine, threonine, tryptophan, glutamic acid, serine and tyrosine with ischaemic stroke were each attenuated with adjustment for proline intake. For haemorrhagic stroke, no statistically significant associations were observed in the continuous analyses after correcting for multiple testing.Conclusion: Higher proline intake may be associated with a lower risk of ischaemic stroke, independent of other dietary amino acids and blood pressure.
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| 2. |
- Andersson, Elin M., et al.
(författare)
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Cognitive and emotional reactions to pictorial-based risk communication on subclinical atherosclerosis : a qualitative study within the VIPVIZA trial
- 2023
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 41:1, s. 69-80
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Tidskriftsartikel (refereegranskat)abstract
- Objectives, setting and subjects: Atherosclerosis screening with ultrasound is non-invasive and can be used as part of risk communication. The potential of personalised and pictorial-based risk communication is assessed in VIPVIZA, a population-based randomised controlled trial that aims at optimising cardiovascular disease (CVD) prevention by investigating the impact of visualisation of subclinical atherosclerosis. The present aim was to explore cognitive and emotional reactions evoked by the intervention as well as attitudes to any implemented life style changes in VIPVIZA participants in the intervention group with improved health status and furthermore to study possible interactions between these factors. Understanding mechanisms of action was central since non-adherence to preventive guidelines are often faced in clinical practice. Design: In-depth interviews with 14 individuals were analysed with qualitative content analysis. Results: Cognitive and emotional processes were highly interlinked and described by the main theme Cognitive and emotional reactions in strong interplay for orchestration of health oriented behavioural change. The informants’ descriptions revealed two distinctly different psychological processes which constituted the two subthemes, Problem-focused coping and Encouragement-driven process. Conclusions: The results highlight that an interaction between emotional reactions and efficacy beliefs is important in facilitating behavioural change. Furthermore, the results underscore the importance of the risk message being perceived as clear, accurate, reliable and also emotionally engaging and thereby show why atherosclerosis screening and pictorial-based risk communication have the potential to contribute to effective CVD prevention strategies and shared decision making in primary care.
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| 3. |
- Andersson, Elin M, et al.
(författare)
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Does a multi-component intervention including pictorial risk communication about subclinical atherosclerosis improve perceptions of cardiovascular disease risk without deteriorating efficacy beliefs?
- 2024
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 341
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pictorial communication about subclinical atherosclerosis can improve cardiovascular disease (CVD) risk, but whether it leads to long-term shifts in self-rated CVD risk (risk perception) and beliefs about possibility to influence personal risk (efficacy beliefs) is unknown.Purpose: To study the impact of personalized color-coded and age-related risk communication about atherosclerosis and motivational conversation, compared to traditional risk factor-based communication, on risk perception and efficacy beliefs. Also, whether risk perception increases with message severity.Method: The effect of the pragmatic RCT Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA) was analyzed using a linear mixed effects model with risk perception and efficacy believes at 1-year and 3-year follow up as dependent variables. Participants’ (n = 3532) CVD risk perception and efficacy beliefs were assessed with visual analog scales (0–10). Fixed effects were group (intervention vs control), time point (1 year or 3 years) and interaction between group and time point. Further, the models were adjusted for corresponding baseline measurement of the dependent variable and a baseline × time point interaction. Effect of pictorial color-coded risk in the intervention group was investigated using a corresponding mixed effects model, but with pictorial risk group (message severity) as exposure instead of intervention group.Results: After one year, the intervention group rated their CVD risk as higher (m = 0.46, 95% CI 0.32–0.59), with an effect also after 3 years (m = 0.57, 95% CI 0.43–0.70). The effect was consistent in stratified analyses by sex and education. Overall, no effect on efficacy beliefs was observed. In the intervention group, differences in CVD risk perception were found between participants with different color-coded risk messages on atherosclerosis status.Conclusion: Personalized, color-coded and age-related risk communication about atherosclerosis had an effect on risk perception with an effect also after 3 years, whereas overall, no effect on efficacy beliefs was observed.
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| 4. |
- Andersson, Elin M., et al.
(författare)
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From risk communication about asymptomatic atherosclerosis to cognitive and emotional reactions and lifestyle modification
- 2024
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Ingår i: BMC Psychology. - : BioMed Central (BMC). - 2050-7283. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Non-adherence in the general population to preventive guidelines on cardiovascular disease calls for an interdisciplinary approach acknowledging psychological factors of relevance for risk communication and lifestyle modification. Evidence is building up regarding the advantage of sharing arterial imaging evidence of subclinical atherosclerosis with asymptomatic individuals, but there is limited understanding of how this relates to mechanisms of importance for behavioural change. Longitudinal studies on associations between patients’ reactions and lifestyle modification are missing. The population-based randomized controlled trial VIPVIZA investigates the impact of pictorial information about subclinical atherosclerosis, added to traditional risk factor-based communication. The intervention includes a personalized, colour-coded and age-related risk communication strategy and a motivational conversation, and has been shown to reduce cardiovascular disease risk. Methods: In the present study we assessed cognitive and emotional reactions to the intervention, and how these reactions are associated to lifestyle modification. The participants’ evaluation of the risk communication was assessed in the intervention group (n=1749). Lifestyle modification was assessed with a lifestyle index based on physical activity, diet, smoking and alcohol consumption at baseline and after 3 years. Associations between cognitive and emotional response and lifestyle modification were tested with analyses of covariance in a subset of participants (n=714-857).Results: The intervention increased understanding of personal CVD risk, the possibility to influence the risk, and how to influence the risk. Severity of atherosclerosis was associated with emotional reactions, but emotions of strong negative valence were uncommon. Cognitive response and emotional arousal evoked by the intervention were positively associated with lifestyle modification, whereas negative emotions in isolation were not. High level of cognitive response in combination with high level of emotional arousal was found to be most beneficial for lifestyle modification.Conclusions: The results demonstrate the potential of communicating asymptomatic atherosclerosis with a pictorial, colour-coded and age-related strategy, also including a motivational conversation. Furthermore, the results show the importance of CVD risk communication evoking engagement, and that an interaction between cognitive and emotional reactions might be central for sustained lifestyle modification. Our results also indicate that, in an asymptomatic population, atherosclerosis screening may strengthen disease prevention and health promotion.
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| 5. |
- Bashir, Fatima, et al.
(författare)
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The realities of HIV prevention. A closer look at facilitators and challenges faced by HIV prevention programmes in Sudan and Yemen
- 2019
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Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: HIV/AIDS prevention has historically encountered many obstacles. Understanding the factors affecting HIV/AIDS prevention is central to designing and implementing suitable context-specific interventions. Research relating to HIV prevention in the Middle East and North African region is required to address the gradually increasing HIV epidemic.Objective: This study aimed to explore the perspectives of employees/health care professionals who are working or have worked within HIV prevention in Sudan and Yemen on the challenges and facilitating factors facing HIV prevention.Methods: A qualitative approach was employed using an open-ended questionnaire. Sixteen stakeholders from governmental and non-governmental agencies participated in the study. The questionnaire focused on the various challenges and facilitating factors facing HIV prevention as well as proposed possible solutions from the perspectives of the participants. The data were analysed using thematic analysis.Results: The study illustrated the similarities in context and HIV prevention systems between Sudan and Yemen. Thematic analysis resulted in three main themes: I) much is achieved despite difficulties; II) a programme left to be paralysed; this theme addressed the main obstacles facing HIV prevention in Sudan and Yemen generating a total of six sub-themes; III) comprehensive change is needed. The participants drew focus and attention to vital changes required to improve the delivery of HIV prevention services. Conclusion: Increased financial support for HIV prevention in Sudan and Yemen is urgently needed. De-stigmatisation and increased political support, advocacy and improved legislation for people living with HIV (PLHIV) are required for the sustainability and effectiveness of HIV prevention programmes in Sudan and Yemen. Civil society organisations must be aided and supported in their role in engaging key populations.
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| 6. |
- Bengtsson, Anna, 1973-, et al.
(författare)
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Increased knowledge makes a difference!–general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial
- 2021
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 39:1, s. 77-84
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors.Design, setting and subjects: Fifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis.Results: Three categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result–A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action.Conclusion and implications: Pictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures.Trial registration: https://clinicaltrials.gov/ct2/show/NCT01849575.KEY POINTS: Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention:Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measuresGPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-makingGPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis.
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| 7. |
- Kilbo Edlund, Karl, et al.
(författare)
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High-resolution dispersion modelling of PM2.5, PM10, NOx and NO2 exposure in metropolitan areas in Sweden 2000‒2018 – large health gains due to decreased population exposure
- 2024
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Ingår i: Air Quality, Atmosphere and Health. - 1873-9318 .- 1873-9326.
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Tidskriftsartikel (refereegranskat)abstract
- Ambient air pollution remains the major environmental cause of disease. Accurate assessment of population exposure and small-scale spatial exposure variations over long time periods is essential for epidemiological studies. We estimated annual exposure to fine and coarse particulate matter (PM2.5, PM10), and nitrogen oxides (NOx, NO2) with high spatial resolution to examine time trends 2000‒2018, compliance with the WHO Air Quality Guidelines, and assess the health impact. The modelling area covered six metropolitan areas in Sweden with a combined population of 5.5 million. Long-range transported air pollutants were modelled using a chemical transport model with bias correction, and locally emitted air pollutants using source-specific Gaussian-type dispersion models at resolutions up to 50 × 50m. The modelled concentrations were validated using quality-controlled monitoring data. Lastly, we estimated the reduction in mortality associated with the decrease in population exposure. The validity of modelled air pollutant concentrations was good (R2 for PM2.5 0.84, PM10 0.61, and NOx 0.87). Air pollution exposure decreased substantially, from a population weighted mean exposure to PM2.5 of 12.2µgm−3 in 2000 to 5.4µgm−3 in 2018. We estimated that the decreased exposure was associated with a reduction of 2719 (95% CI 2046–3055) premature deaths annually. However, in 2018, 65%, 8%, and 42% of residents in the modelled areas were still exposed to PM2.5, PM10, or NO2 levels, respectively, that exceeded the current WHO Air Quality Guidelines for annual average exposure. This emphasises the potential public health benefits of reductions in air pollution emissions.
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| 8. |
- Lindahl, Bernt, et al.
(författare)
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Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk
- 2020
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Ingår i: European Journal of Preventive Cardiology. - : Sage Publications. - 2047-4873 .- 2047-4881. ; 27:2, s. 209-215
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Health literacy, the degree to which individuals understand and act upon health information, may have a pivotal role in the prevention of cardiovascular disease (CVD), with low health literacy potentially explaining poorer adherence to prevention guidelines. We investigated the associations between health literacy, ultrasound-detected carotid atherosclerosis and cardiovascular risk factors.Methods: Baseline data (cross-sectional analysis) from a randomized controlled trial, integrated within the Västerbotten Intervention Program, Northern Sweden, was used. We included 3459 individuals, aged 40 or 50 years with ≥1 conventional risk factor or aged 60 years old. The participants underwent clinical examination, blood sampling, carotid ultrasound assessment of intima-media wall thickness (CIMT) and plaque formation, and answered a questionnaire on health literacy – the Brief Health Literacy Screen. The European Systematic Coronary Risk Evaluation and Framingham Risk Score were calculated.Results: About 20% of the participants had low health literacy. Low health literacy was independently associated with the presence of ultrasound-detected carotid artery plaques after adjustment for age and education, odds ratio (95% confidence interval) 1.54 (1.28–1.85), demonstrating a similar level of risk as for smoking. Health literacy was associated with CIMT in men. Low health literacy was associated with higher CVD risk scores. Sensitivity analyses with low health literacy set to 9% or 30% of the study sample, respectively, yielded essentially the same results.Conclusions: Low health literacy was independently associated with carotid artery plaques and a high level of CVD risk scores. Presenting health information in a fashion that is understood by all patients may improve preventive efforts.
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| 9. |
- Lindgren, Helena, et al.
(författare)
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The STAR-C Intelligent Coach : a Cross- Disciplinary Design Process of a Behaviour Change Intervention in Primary Care
- 2020
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Ingår i: pHealth 2020. - : IOS Press. - 9781643681122 ; , s. 203-208
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Konferensbidrag (refereegranskat)abstract
- A broad range of aspects are needed to be taken into consideration in the design and development of personalized coaching systems based on artificial intelligence methodologies. This research presents the initial phase of joining different professional and stakeholder perspectives on behavior change technologies into a flexible design proposal for a digital coaching system. The diversity and sometimes opposed views on content, behavior, purposes and context were managed using a structured argument-based design approach, which also feed into the behavior of the personalized system. Results include a set of personalization strategies that will be further elaborated with the target user group to manage sensitive issues such as ethics, social norms, privacy, motivation, autonomy and social relatedness.
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| 10. |
- Lindvall, Kristina, 1981-
(författare)
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Being able to be stable : exploring primary weight maintenance as a public health strategy for obesity prevention
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Overweight and obesity are considerable public health issues internationally as well as in Sweden. On a global level, the obesity prevalence has nearly doubled over the last 30 years. Currently in Sweden, more than one third of all women, and slightly more than half of all men, are either overweight or obese. The long-term results of obesity treatment programs are modest as reported by other studies. The importance of extending the focus to not only obesity treatment, but also prevention of weight gain, has therefore been emphasized.Aim The overall aim of this thesis is to explore the concept of primary weight maintenance (PWM) and to increase the knowledge of the attitudes, behaviours, strategies and surrounding circumstances that are important for PWM in a Swedish middle-aged population.Material and methods All study participants were recruited based on their previous participation in a health survey in their home setting; The Västerbotten Intervention Programme (VIP) in Västerbotten Sweden (paperI-IV), or the Upstate Health and Wellness Study in Upstate New York (IV), USA. All subjects had participated twice, with a time period of ten years between health surveys. The prevalence of obesity between the years 1990-2004 was calculated for VIP participants (paper I). Ten-year non-gain (lost weight or maintained body weight within 3% of baseline weight) or weightgain (≥3%) was calculated for individuals aged 30, 40, or 50 years at baseline. A multivariate logistic regression model was built to predict weight non-gain. In-depth interviews were conducted with 23 maintainers and four slight gainers in Sweden and analysed using Grounded Theory (paper II). A questionnaire study was conducted including 2138 Swedish and 2134 US participants (paper III and IV). Analysis of variance (ANOVA), correlation, and linear regression were performed to identify attitudes, strategies, and behaviours that are predictive of PWM in different age, sex and BMI subgroups in Sweden (paper III). Further, the pattern of ten-year weightchange (% and kg) in 1999-2009 was calculated for Swedish and US women within different subgroups (paper IV). ANOVA, correlation and chi-squaretests were conducted to contrast eating and exercise habits between the two countries that may explain the differences in weight change.Results The prevalence of obesity (BMI ≥30) in Västerbotten increased from 9.4% in 1990 to 17.5% in 2004 (I). Older age, being female, being overweight at baseline, later survey year, baseline diagnosis of diabetes, and lack of snuff use increased the chances of not gaining weight. Based on the in-depth interviews, describing attitudes, behaviours and strategies of importance for PWM, a model was constructed (II). Weight maintenance was characterized as “a tightrope walk” and four strategies of significance for PWM were described as “to rely on heritage”, “to find the joy”, “to find the routine” and “to be in control”. The questionnaire study aimed at identifying predictors of PWM in different age, sex and BMI groups (III). The pattern of significant predictors was widely disparate between different subgroups. Of 166 predictors tested, 152 (91.6%) were predictive of PWM in at least one subgroup. However, only 4.6% of these were significant in half of the subgroups or more. The mean percent weight changes (in all cases weightgain), between 1999-2009 for Swedish and US women, were 4.9% (SD=5.8) and 9.1% (SD=13.7) respectively (p for t-test˂0.001) (IV). For the US women, the largest weight change occurred among the 30 year olds for all three BMI strata. For the Swedish, it was seen among overweight and obese 30 year old women. The largest difference in ten-year weight change between the two countries for any two matched subgroups was seen in normal weight 30 year olds. Significantly more of the women in this Swedish subgroup stated having more of healthy behaviours. However, there was a tendency for unhealthy behaviours to be strongly associated with greater weight gain in the US, but much less so in Sweden.Conclusion: Younger individuals, those of normal body weight, and those without health conditions (e.g. diabetes type 2) and cardiovascular riskfactors – were the least likely to maintain their weight over the 10 year period (I). Educational efforts on the prevention of overweight and obesity should therefore be broadened to include those individuals. The in-depth interview study showed great variety with regard to attitudes, strategies and behaviours important for PWM (II). The results from this study informs health personnel about the need to tailor advice related to body weight, not only to different sub-groups of individuals trying to lose weight but also to subgroups of primary weight maintainers who are trying to maintain weight. This statement was also supported by the questionnaire data, where the large disparity in the pattern of significant variables between subgroups suggests that these interventions should be tailored to the person’s demographic (age,sex and BMI) (III). Paper IV showed that even though the prevalence of obesity among Swedish women has increased substantially during these ten years, it has not kept pace with the increase in the US. One explanation for this may be that normal 30 year old Swedish women have more healthy behaviours than do US women. However, the insensitivity of the Swedish women to weight gain for healthy versus unhealthy alternatives may also be a factor. If the exact reason behind this phenomenon can be identified this may contribute to a deeper understanding of PWM both in Sweden and the US.
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| 11. |
- Lindvall, Kristina, 1981-, et al.
(författare)
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Feasibility, reliability and validity of the health-related quality of life instrument Child Health Utility 9D (CHU9D) among school-aged children and adolescents in Sweden
- 2021
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Ingår i: Health and Quality of Life Outcomes. - : BioMed Central. - 1477-7525. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study was conducted in a general population of schoolchildren in Sweden, with the aim to assess the psychometric properties of a generic preference-based health related quality of life (HRQoL) instrument, the Swedish Child Health Utility 9D (CHU9D), among schoolchildren aged 7–15 years, and in subgroups aged 7–9, 10–12 and 13–15 years.Methods: In total, 486 school aged children, aged 7–15 years, completed a questionnaire including the CHU9D, the Pediatric quality of life inventory 4.0 (PedsQL), KIDSCREEN-10, questions on general health, long-term illness, and sociodemographic characteristics. Psychometric testing was undertaken of feasibility, internal consistency reliability, test–retest reliability, construct validity, factorial validity, concurrent validity, convergent validity and divergent validity.Results: The CHU9D evidenced very few missing values, minimal ceiling, and no floor effects. The instrument achieved satisfactory internal consistency (Cronbach’s Alfa > 0.7) and strong test–retest reliability (r > 0.6). Confirmatory factor analyses supported the proposed one-factor structure of the CHU9D. For child algorithm, RMSEA = 0.05, CFI = 0.95, TLI = 0.94, and SRMR = 0.04. For adult algorithm RMSEA = 0.04, CFI = 0.96, TLI = 0.95, and SRMR = 0.04. The CHU9D utility value correlated moderately or strongly with KIDSCREEN-10 and PedsQL total scores (r > 0.5–0.7). The CHU9D discriminated as anticipated on health and on three of five sociodemographic characteristics (sex, age, and custody arrangement, but not socioeconomic status and ethnic origin).Conclusions: This study provides evidence that the Swedish CHU9D is a feasible, reliable and valid measure of preference-based HRQoL in children. The study furthermore suggests that the CHU9D is appropriate for use among children 7–15 years of age in the general population, as well as among subgroups aged 7– 9, 10–12 and 13–15 years.
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| 12. |
- Lindvall, Kristina, 1981-, et al.
(författare)
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Health counselling in dental care for expectant parents : a qualitative study
- 2020
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Ingår i: International Journal of Dental Hygiene. - : John Wiley & Sons. - 1601-5029 .- 1601-5037. ; 18:4, s. 384-395
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Interventions during pregnancy and early childhood have been shown to impact dental health. Thus, Antenatal Care and Dental Care collaborated in an intervention called Health Counselling in Dental Care (HCDC). HCDC was offered free of charge to first-time expectant parents and was aimed at reducing the frequency of dental caries in children and their parents. However, the intervention reached less than 50% of the parents. The aim of this study was to explore facilitators of, barriers to, and suggestions for increased participation in HCDC.METHODS: Data was collected through semi-structured, face-to-face interviews with expectant parents. Participants were purposively sampled based on having been invited to HCDC and to achieve a variation in socio-demographics. Interviews were audio recorded, transcribed verbatim, and analysed using conventional qualitative content analysis.RESULTS: In total, 16 interviews were conducted (10 women, 6 men). Six categories representing three facilitators and three barriers for participation emerged. The facilitators were the midwife's crucial role for disseminating information about HCDC and motivating participation, that the parents perceived HCDC as valuable for themselves and their offspring, and a desire for new or more knowledge. The barriers included a shortage of information regarding the counselling, a perceived lack of value for the parents and offspring, and the timing of the counselling during pregnancy.CONCLUSIONS: The midwives were crucial in providing information and motivation for HCDC participation. To increase attendance, sufficient information regarding the benefits of counselling is required, and the timing needs to be flexible and family-centred.
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| 13. |
- Lindvall, Kristina, 1981-, et al.
(författare)
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Health Status and Health Care Needs of Drought-Related Migrants in the Horn of Africa : A Qualitative Investigation
- 2020
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:16
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Tidskriftsartikel (refereegranskat)abstract
- Somalia, Kenya and Ethiopia, situated in the Horn of Africa, are highly vulnerable to climate change, which manifests itself through increasing temperatures, erratic rains and prolonged droughts. Millions of people have to flee from droughts or floods either as cross-border refugees or as internally displaced persons (IDPs). The aim of this study was to identify knowledge status and gaps regarding public health consequences of large-scale displacement in these countries. After a scoping review, we conducted qualitative in-depth interviews during 2018 with 39 stakeholders from different disciplines and agencies in these three countries. A validation workshop was held with a selection of 13 interviewees and four project partners. Malnutrition and a lack of vaccination of displaced people are well-known challenges, while mental health problems and gender-based violence (GBV) are less visible to stakeholders. In particular, the needs of IDPs are not well understood. The treatment of mental health and GBV is insufficient, and IDPs have inadequate access to essential health services in refugee camps. Needs assessment and program evaluations with a patients’ perspective are either lacking or inadequate in most situations. The Horn of Africa is facing chronic food insecurity, poor population health and mass displacement. IDPs are an underserved group, and mental health services are lacking. A development approach is necessary that moves beyond emergency responses to the building of long-term resilience, the provision of livelihood support and protection to reduce displacement by droughts.
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| 14. |
- Ng, Nawi, 1974, et al.
(författare)
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Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme
- 2021
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Ingår i: Frontiers in Public Health. - : Frontiers Media SA. - 2296-2565. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Vasterbotten Intervention Programme (VIP) in the Region Vasterbotten Sweden is one of the very few cardiovascular disease (CVD) prevention programmes globally that is integrated into routine primary health care. The VIP has been shown as a cost-effective intervention to significantly reduce CVD mortality. However, little is known about the effectiveness of a digital solution to tailor risk communication strategies for supporting behavioral change. STAR-C aims to develop and evaluate a technical platform for personalized digital coaching that will support behavioral change aimed at preventing CVD. Methods: STAR-C employs a mixed-methods design in seven multidisciplinary projects, which runs in two phases during 2019-2024: (i) a formative intervention design and development phase, and (ii) an intervention implementation and evaluation phase. In the 1st phase, STAR-C will model the trajectories of health behaviors and their impact on CVDs (Project 1), evaluate the role of the social environment and social networks on behavioral change (Project 2) and assess whether and how social media facilitates the spread of health information beyond targeted individuals and stimulates public engagement in health promotion (Project 3). The findings will be utilized in carrying out the iterative, user-centered design, and development of a person-tailored digital coaching platform (Project 4). In the 2nd phase, STAR-C will evaluate the implementation of the coaching programme and its effectiveness for promoting behavioral change and the spreading of health information across social networks and via social media (Project 5). The cost-effectiveness (Project 6) and ethical issues (Project 7) related to the coaching programme intervention will be evaluated. Discussion: The STAR-C research programme will address the knowledge and practice research gaps in the use of information technologies in health promotion and non-communicable disease (NCD) prevention programmes in order to narrow the health inequality gaps. Ethics: STAR-C has received approval from the Swedish Ethical Review Authority (Dnr. 2019-02924;2020-02985). Dissemination: The collaboration between Umea University and Region Vasterbotten will ensure the feasibility of STAR-C in the service delivery context. Results will be communicated with decision-makers at different levels of society, stakeholders from other regions and healthcare professional organizations, and through NGOs, local and social media platforms.
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| 15. |
- Nordin, Steven, 1960-, et al.
(författare)
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Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age
- 2023
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Ingår i: Psychology and Health. - : Routledge. - 0887-0446 .- 1476-8321.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To test the hypothesis of low emotional support being associated with lifestyle and biomedical cardiovascular disease (CVD) risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults.Methods and measures: Cross-sectional data were obtained from participants aged 40–60 years who had one or more conventional CVD risk factor. They underwent assessment based on questionnaires, clinical examination, blood sampling, and carotid ultrasound of plaque formation and carotid intima-media wall thickness (cIMT). Based on the Interview Schedule for Social Interaction, the participants were categorised as either low in emotional support (n = 884) or as a referent (n = 2570). Logistic regression analyses were conducted to study the associations.Results: Logistic regression analyses showed that low emotional support was significantly associated with smoking, alcohol consumption and physical inactivity (OR = 1.53 − 1.94), estimated risk of CVD morbidity and mortality (OR = 1.56 − 1.68), and plaque formation (OR = 1.39). No significant associations were found regarding biomedical CVD risk factors or cIMT.Conclusion: The findings suggest that low social support is associated with lifestyle CVD risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults, encouraging causal evaluation with longitudinal data investigating an impact of emotional support on mechanisms underlying CVD.
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| 16. |
- Näslund, Ulf, et al.
(författare)
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Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) : a pragmatic, open-label, randomised controlled trial
- 2019
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 393:10167, s. 133-142
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.
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| 22. |
- Scribani, Melissa, et al.
(författare)
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Sex-specific associations between body mass index and death before life expectancy : a comparative study from the USA and Sweden
- 2019
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Understanding the impact of obesity on premature mortality is critical, as obesity has become a global health issue.OBJECTIVE: To contrast the relationship between body mass index (BMI) and premature death (all-cause; circulatory causes) in New York State (USA) and Northern Sweden.METHODS: Baseline data were obtained between 1989 and 1999 via questionnaires (USA) and health exams (Sweden), with mortality data from health departments, public sources (USA) and the Swedish Death Register. Premature death was death before life expectancy based on sex and year of birth. Within country and sex, time to premature death was compared across BMI groups (18.5-24.9 kg/m2 (reference), 25-29.9 kg/m2, 30.0-34.9 kg/m2, ≥35.0 kg/m2) using Proportional Hazards regression. Absolute risk (deaths/100,000 person-years) was compared for the same stratifications among nonsmokers.RESULTS: 60,600 Swedish (47.8% male) and 31,198 US subjects (47.7% male) were included. Swedish males with BMI≥30 had increased hazards (HR) of all-cause premature death relative to BMI 18.5-24.9 (BMI 30-34.9, HR = 1.71 (95% CI: 1.44, 2.02); BMI≥35, HR = 2.89 (2.16, 3.88)). BMI≥25 had increased hazards of premature circulatory death (BMI 25-29.9, HR = 1.66 (1.32, 2.08); BMI 30-34.9, HR = 3.02 (2.26, 4.03); BMI≥35, HR = 4.91 (3.05, 7.90)). Among US males, only BMI≥35 had increased hazards of all-cause death (HR = 1.63 (1.25, 2.14)), while BMI 30-34.9 (HR = 1.83 (1.20, 2.79)) and BMI≥35 (HR = 3.18 (1.96, 5.15)) had increased hazards for circulatory death. Swedish females showed elevated hazards with BMI≥30 for all-cause (BMI 30-34.9, HR = 1.42 (1.18, 1.71) and BMI≥35, HR = 1.61 (1.21, 2.15) and with BMI≥35 (HR = 3.11 (1.72, 5.63)) for circulatory death. For US women, increased hazards were observed among BMI≥35 (HR = 2.10 (1.60, 2.76) for all-cause and circulatory HR = 3.04 (1.75, 5.30)). Swedish males with BMI≥35 had the highest absolute risk of premature death (762/100,000 person-years).CONCLUSIONS: This study demonstrates a markedly increased risk of premature death associated with increasing BMI among Swedish males, a pattern not duplicated among females.
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- Tinc, Pamela J., et al.
(författare)
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An exploration of rollover protective structures (ROPS) rebate program media coverage : strategies for implementation and sustainment
- 2019
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Ingår i: BMC Public Health. - : Springer. - 1471-2458. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Media advocacy plays an important role in public health initiatives, as it can provide vital information to target populations, policy makers, or other relevant stakeholders. Unfortunately, little is currently known about the use of media advocacy to promote occupational safety and health programs. This study explores media coverage related to the Rollover Protection Structure (ROPS) Rebate Programs, which were designed to encourage the use of rollover protection on agricultural tractors, thus reducing the risk of tractor overturn fatalities. The Program’s portrayal in the media, as well as the role that the media has played in implementing and sustaining these Programs.Methods: Media articles pertaining to any of the state-based or National ROPS Rebate Programs and published between November 1, 2006 and October 31, 2018 were included for review. Discourse analysis was used to understand the messages portrayed by the media and how those messages shaped the outcomes of the ROPS Rebate Programs.Results: During the study period, 212 unique articles were published about the ROPS Rebate Programs. While these articles all portrayed the ROPS Rebate Programs in a largely positive light, they were used at different stages, from pre-implementation through sustainment of the ROPS Rebate Programs, and to different extents.Conclusions: Media articles have played an important role in implementing and sustaining the ROPS Rebate Programs. Based on the results of this study, more robust and continuous media coverage are important for the longevity and success of public health programs.
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- Tinc, Pamela J., et al.
(författare)
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Applying the Consolidated Framework for implementation research to agricultural safety and health : Barriers, facilitators, and evaluation opportunities
- 2018
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Ingår i: Safety Science. - : Elsevier. - 0925-7535 .- 1879-1042. ; 107, s. 99-108
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Within agriculture, forestry, and fishing safety and health research, little progress has been made to implement evidence-based interventions into practice. Beginning in the early 2000s, much work has been done to address the leading cause of agricultural fatalities: tractor overturns. In this time a Rollover Protective Structure Rebate Program has been developed to assist farmers in installing safety equipment to prevent these fatalities. In the current study, the Consolidated Framework for Implementation Research is adapted so that it may be used to evaluate and improve the scaling up of this intervention. Methods: Each construct specified in the Consolidated Framework for Implementation Research was incorporated into a survey, which was distributed to a 77 member Coalition of agricultural stakeholders. Stakeholders were asked to rate each construct based on how important the individual felt it was to the implementation of the National ROPS Rebate Program on a scale of 1 (not at all important) to 5 (extremely important). Results: Using the mean score for each construct as a starting point, 23 constructs were selected for inclusion in an evaluation tool which will be used, in future studies, to evaluate the implementation of the National ROPS Rebate Program. Conclusions: Though the Consolidated Framework for Implementation Research was designed for use in the clinical setting, this study is a first step in applying it to occupational health and safety. The insight gained through this study will provide a foundation for future work on this initiative, as well as in public health.
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| 26. |
- Tinc, Pamela J., et al.
(författare)
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Key factors for successful implementation of the National Rollover Protection Structure Rebate Program : A correlation analysis using the consolidated framework for implementation research
- 2020
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health (NOROSH). - 0355-3140 .- 1795-990X. ; 46:1, s. 85-95
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: On US farms, tractor overturns are the leading cause of death; however, these fatalities are preventable with the use of a rollover protection structure (ROPS). A ROPS rebate program was established in New York in 2006 to address these fatalities. Due to its success, the program expanded to six additional states before being implemented as the National ROPS Rebate Program (NRRP) in 2017. The aim of this study was to evaluate the success of the NRRP implementation using short- and long-term ROPS outcome measures and identify which components of the consolidated framework for implementation research (CFIR) correlate with these outcomes.Methods: Stakeholders involved in the NRRP implementation were surveyed at four time points, beginning at the time of the NRRP launch and then every six months. These surveys measured 14 relevant CFIR constructs. Correlations between CFIR survey items (representing constructs) and three outcome measures (intakes, funding progress, and retrofits) were used to identify CFIR survey items that are predictive of the outcomes.Results: Eight CFIR survey items were highly correlated (rho ≥0.50) with at least one of the three outcome measures. These eight CFIR survey items included four constructs: access to knowledge and information, leadership engagement, engaging (in fundraising and funding requests), and reflecting and evaluating.Conclusions: The results of this study provide important guidance for continuing the implementation of the NRRP. Similarly, these findings can inform the evaluation of other similarly structured implementation efforts and the application of CFIR in a variety of settings.
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- Tinc, Pamela J., 1989-
(författare)
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Raising the (roll)bar : exploring barriers and facilitators to research translation in US public health
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background In public health, implementation science work is crucial to protecting the safety and health of populations. Despite this, such efforts have been extremely limited within the specific public health field of occupational safety and health. The overall aim of this thesis is to examine the concept of research translation, the barriers and facilitators that researchers have faced in translating research to the worker environment, and the process of scaling up an evidence-based agricultural safety program. Additionally, this study will provide an opportunity to adapt the clinically based Consolidated Framework for Implementation Research (CFIR), as well as the Proctor Taxonomy (of implementation outcomes), to occupational safety settings.The implementation research conducted within this dissertation is focused on a case study in agricultural safety. With an annual fatality rate seven times higher than the all-worker fatality rate, agriculture is one of the most dangerous occupations to work in. Though nearly all aspects of farming can be considered dangerous, tractor overturns claim the greatest number of lives. Rollover protective systems (ROPS) are 99% effective in preventing death and disability in the event of an overturn when used with seatbelts. The ROPS Rebate Program was developed in 2006 to encourage the installation of retrofit ROPS in New York State and has been shown to be effective in this goal and in the long-term goal of reducing overturn fatalities. After expanding to six additional states, the National Tractor Safety Coalition was formed in order to facilitate the scaling up of the ROPS Rebate Programs. The National ROPS Rebate Program (NRRP) was formally announced in June 2017, though implementation of it is currently ongoing. Methods This dissertation is composed of five sub-studies which applied a mixed methods approach. Sub-study I consisted of a scoping literature review. Manuscripts were identified through six databases to explore how research translation is discussed among the research community. In addition, the review aimed at assessing the T0-T4 model of research translation (first developed by the National Institutes of Health) as it applies to agriculture, forestry, and fishing safety and health and used knowledge gained through the review to make modifications to this model.To apply the CFIR and Proctor Taxonomy to agricultural safety settings (sub-study II), a survey was developed to assess the relevance of the constructs included in each framework to the NRRP implementation. The final survey was distributed to members of the National Tractor Safety Coalition. Using the results from this survey, quantitative and qualitative evaluation tools were developed.Sub-study III utilized a repeat measure survey collected at four time points to capture changes in CFIR and Proctor constructs over time. Correlational analyses were conducted to compare each survey item to three outcome measures: state progress toward securing rebate funding for the Program, farmers intakes into the Program, and completed retrofits. Thirteen individuals participated in qualitative research interviews for sub-study IV; nine of these individuals also participated in follow-up interviews. Interview guides were developed based on the survey results in sub-study III. Grounded Theory Situational Analysis was used to analyze each set of data. Sub-study V was developed as a result of missing data from sub-studies III and IV. To conduct this analysis, media reports published about the ROPS Rebate Programs were collected. Discourse analysis for print media was used to assess the media reports in comparison to the ROPS Rebate Program trajectory in each state and nationally. ResultsSub-study I led to the development of a modified T0-T4 research translation model, which takes into account the real-life challenges in moving proven innovations into widespread practice. The remaining sub-studies in this dissertation focused in the T3 phase of this model (widespread adoption). Sub-study II led to the identification of 21 CFIR and Proctor constructs that National Tractor Safety Coalition members believed would be important to the NRRP implementation. Sub-study III demonstrated that eight CFIR and Proctor constructs were highly correlated (rho ≥ 0.5) with at least one of the outcome measures (progress, intakes, or retrofits). Two primary themes were developed from the qualitative portion of the study (sub-study IV): 1) the implementation strategy evolved inconsistently across stakeholders, and 2) stakeholder engagement is a function of perceived feasibility and "small wins." Finally, sub-study V identified components of successful media strategies for implementation including diversity in actors and messages, timing, and frequency. In total, sub-studies III-V identified 27 CFIR and Proctor constructs that were relevant to the implementation of the NRRP, 10 of which were identified in more than one study. ConclusionsThis dissertation has served to examine, specifically, the implementation of the NRRP, and more generally, the field of implementation science as it applies to occupational safety and health. The methods applied in this study as well as the findings have resulted in: application of implementation frameworks to the field of agricultural safety and health, assessment of the unique challenges associated with initiatives to scale up innovations, assessment of implementation from the perspective of the CFIR and Proctor Taxonomy, and assessment of the use of media advocacy as an implementation strategy. The knowledge gained through this research will be helpful in improving the implementation of the NRRP and in developing implementation science efforts within the specific public health field of occupational safety and health.
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| 28. |
- Tinc, Pamela J., et al.
(författare)
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Understanding Stakeholder Experiences Implementing a National ROPS Rebate Program : A Grounded Theory Situational Analysis
- 2020
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Ingår i: SAGE Open. - : SAGE Open. - 2158-2440. ; 10:2, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Currently, little is known about what works, or does not work, in occupational safety implementation efforts. The aim of this study is to (a) explore what works and what does not in scaling up an agricultural safety intervention, and (b) explore these findings in terms of the Consolidated Framework for Implementation Research. A total of 13 stakeholders were interviewed about their experiences with the National Rollover Protective Structures (ROPS) Rebate Program implementation. Nine of these individuals also participated in follow-up interviews one year later. A Grounded Theory Situational Analysis approach was used for data collection and analysis. Two themes emerged from the data. First, the implementation strategy has evolved inconsistently across stakeholders (a barrier to implementation). Second, stakeholder engagement in the implementation is a function of perceived feasibility and “small wins” (an opportunity for improving implementation efforts). Based on the results of this study, two areas of needed improvement to the National ROPS Rebate Program implementation strategy were identified: (a) appropriateness and feasibility of inner setting stakeholder engagement, and (b) receptivity of outer setting stakeholders and potential funders. These findings will be helpful for increasing the success of the implementation, and can also provide guidance to others working on large-scale implementation studies.
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| 29. |
- Usher-Smith, Juliet A., et al.
(författare)
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Impact of achievement and change in achievement of lifestyle recommendations in middle-age on risk of the most common potentially preventable cancers
- 2021
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Ingår i: Preventive Medicine. - : Elsevier. - 0091-7435 .- 1096-0260. ; 153
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to assess the association between achievement, and within-person change in achievement, of lifestyle recommendations in middle-age and incidence of the most common potentially preventable cancers. We used data from 44,572 participants from the Swedish Västerbotten Intervention Programme who had attended at least two health checks 9-11 years apart. We assessed the association between the mean number of healthy lifestyle recommendations achieved (lifestyle score), and change in lifestyle score between the health checks, and risk of one or more of the eight most common potentially preventable cancers using Cox regression. Participants were followed-up for 11.0 (SD 4.9) years. A higher mean lifestyle score was associated with a lower hazard of cancer in men (HR 0.81 (95%CI 0.74-0.90) per unit increase) and women (HR 0.90 (0.84-0.96)). There was no evidence of a linear association between change in lifestyle score and risk (HR 0.93 (0.85-1.03) and HR 1.004 (0.94-1.07) per unit change for men and women respectively). When comparing those with an increase in lifestyle score of ≥2 with those who improved less or declined in achievement the HR was 0.74 (0.54-1.00) and 1.02 (0.84-1.24) for men and women respectively. These findings support the inclusion of lifestyle recommendations in cancer prevention guidelines. They further suggest that interventions to change health behaviours in middle-age may reduce risk of the most common preventable cancers in men, but this association was not observed in women. Strategies to encourage healthy lifestyles earlier in the life course may be more effective.
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