| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Kahn, Kathleen, 1960-
(författare)
-
Dying to make a fresh start : mortality and health transition in a new South Africa
- 2006
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rationale: Vital registration is lacking in developing settings where health and development problems are most pressing. Policy-makers confront an “information paradox”: the critical need for information on which to base priorities and monitor progress, and the profound shortage of such information. Aims: To better understand the dynamics of mortality transition in rural South Africa over a decade of profound socio-political change coupled with emerging HIV/AIDS. Thereby to inform health and development programming, policy formulation, and the research agenda; and contribute to debate on the nature of the ‘health transition’. Methods: The Agincourt health and demographic surveillance system is based on continuous monitoring of the Agincourt sub-district population in rural north-east South Africa. This involves annual recording of all vital events, specifically deaths, births and migrations in 11,700 households comprising some 70,000 persons. A “verbal autopsy” is conducted on every death, and special modules provide additional data. Key findings: A major health transition has occurred over the past decade, with marked changes in population structure and rapidly escalating mortality particularly among children and younger adults. A quadruple burden of disease is evident with persisting infectious disease and malnutrition in children, emerging non-communicable disease in the middle-aged and older, high levels of violence in an apparently peaceful community, and rapidly escalating HIV/AIDS and tuberculosis. There is evidence of sex differences and socio-economic differentials in mortality; vulnerable sub-groups include the children of Mozambican immigrants and recently returned labour migrants. Implications: With respect to health transition, empirical data demonstrate a marked “counter transition” with mortality increasing in children and young adults; “epidemiologic polarization” is evident with the most vulnerable experiencing a higher mortality burden; and a “protracted transition” is reflected in the co-existence of persisting infectious disease and malnutrition, emerging HIV/AIDS, and increasing chronic non-communicable disease. With respect to health policy and practice there is urgent need to: strengthen HIV/AIDS prevention, treatment and care; offer effective long-term care to control the rising burden of chronic illness and related risk; maintain and improve maternal and child health services; and address differential access to care. This poses a substantial challenge to a severely stretched health system.
|
|
| 6. |
- Lagerqvist, Carina, et al.
(författare)
-
Antigliadin immunoglobulin A best in finding celiac disease in children younger than 18 months of age
- 2008
-
Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - 0277-2116 .- 1536-4801. ; 47:4, s. 428-35
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim was to investigate age-dependent serum levels and occurrence of elevated celiac disease (CD)-related antibodies in young children, to define the optimal serological procedure when selecting for small intestinal biopsy. PATIENTS AND METHODS: Included were 428 children with biopsy verified CD (median age 16 months; range 7.5 months-14 years) and 216 controls (median age 2.7 years; range 8.5 months-14.6 years). Immunoglobulin (Ig) A antibodies against gliadin (AGA-IgA), tissue transglutaminase (tTG-IgA), and endomysium (EMA-IgA) were analysed. RESULTS: Increased serum AGA-IgA levels were found in 411 of 428 CD cases, tTG-IgA in 385 of 428, and EMA-IgA in 383 of 428. In the control group, 11 of 216 had increased levels of AGA-IgA, 5 of 216 of tTG-IgA, and 8 of 216 of EMA-IgA. In CD children younger than 18 months, elevated AGA-IgA occurred in 97% and elevated tTG-IgA and EMA-IgA were found in 83% of the cases. Conversely, in CD children older than 18 months, elevated AGA-IgA occurred in 94%, and elevated tTG-IgA and EMA-IgA were found in 99% of the cases. CONCLUSIONS: In children older than 18 months, both tTG-IgA and EMA-IgA are sufficiently accurate to be used as a single antibody marker, whereas a large proportion of younger children with CD lack these antibodies. Therefore, when selecting children for small intestinal biopsy, the detection of a combination of AGA-IgA and tTG-IgA is optimal for identifying untreated CD in children younger than 18 months.
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
- Myléus, Anna, 1978-, et al.
(författare)
-
Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic
- 2009
-
Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - New York : Raven P. - 0277-2116 .- 1536-4801. ; 49:2, s. 170-176
-
Tidskriftsartikel (refereegranskat)abstract
- Objetive: Sweden experienced a marked epidemic of celiac disease between 1984 and 1996 in children younger than 2 years of age, partly explained by changes in infant feeding. The objective of this study was to determine the prevalence of celiac disease in 12-year-olds born during the epidemic (1993), including both symptomatic and screening detected cases.Patients and methods: All sixth-grade children in participating schools were invited (n = 10,041). Symptomatic and, therefore, previously diagnosed celiac disease cases were ascertained through the National Swedish Childhood Celiac Disease Register and/or medical records. All serum samples were analyzed for antihuman tissue transglutaminase (tTG)-IgA (Celikey), and serum-IgA, and some for tTG-IgG and endomysial antibodies. A small intestinal biopsy was recommended for all children with suspected undiagnosed celiac disease.Results: Participation was accepted by 7567 families (75%). Previously diagnosed celiac disease was found in 67 children; 8.9/1000 (95% confidence interval [CI] 6.7-11). In another 192 children, a small intestinal biopsy was recommended and was performed in 180. Celiac disease was verified in 145 children, 20/1000 (95% CI 17-23). The total prevalence was 29/1000 (95% CI 25-33).Conclusions: The celiac disease prevalence of 29/1000 (3%)-with two thirds of cases undiagnosed before screening-is 3-fold higher than the usually suggested prevalence of 1%. When these 12-year-olds were infants, the prevailing feeding practice was to introduce gluten abruptly, often without ongoing breast-feeding, which might have contributed to this unexpectedly high prevalence.
|
|
| 10. |
- Nyström, Monica E., et al.
(författare)
-
The challenges of developing health promotion in health care – Investigating the process of learning and change
- 2009
-
Ingår i: XIth European Conference on Organizational Psychology and Human Service Work.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Traditional views on the spread of knowledge and learning in health care have been criticized as being overly linear, simplified and rational, leading to a slow progress of clinical praxis. Accelerating change in health promotion is a special challenge. The objective of the study was to examine learning and change processes in a countywide multi-professional, multi-organizational health promoting program for children, named Salut. The involved county council facilitators used an improvement approach built on theory regarding how to accomplish change in complex systems. The program involved active cooperation between researchers, process facilitators and professionals in a pilot area process. Interviews, observations, survey and archival data were used in analyses of the program's progress (2004-2008) and the actors' views on the learning and change processes introduced. Results indicate differences in perspectives, focus, aims and understanding between groups of actors, and between steering and operational levels of the project organization. The facilitators' views differed most compared to the others regarding aspects of learning and process focus. The views on learning changed as the program progressed and were at the end of 2008 under new strategic consideration. A model of development and learning, from medical knowledge to health improvements, was developed, describing several sub-processes. It also illustrates different scientific focuses on health intervention and change. A main conclusion is the importance of including intermediate processes when designing health promoting programs and acknowledgement of relations between evidence based medical knowledge, the processes of producing and selecting interventions, intervention design, type of implementation process and its effects on sustainability; the learning-in-context by professionals and parent/child and its connection to sustainability; the cognitive processes involved in learning and behavioral change; life-style changes and their effects on health. A good pilot example can hardly spread without a strategic change plan and an understanding of the dynamics of context and processes over time. The model has become a central tool in continuing the process of the Salut program and might also be of aid to other development projects.
|
|
