| 1. |
- Blomstedt, Yulia, et al.
(författare)
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Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al
- 2019
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- An evaluation of Vasterbotten Intervention Programme (VIP) was recently conducted by San Sebastian et al. (BMC Public Health 19:202, 2019). Evaluation of health care interventions of this kind require 1) an understanding of both the design and the nature of the intervention, 2) correct definition of the target population, and 3) careful choice of the appropriate evaluation method. In this correspondence, we review the approach used by San Sebastian et al. as relates to these three criteria. Within this framework, we suggest important explanations for why the conclusions drawn by these authors contradict a large body of research on the effectiveness of the VIP.
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| 2. |
- Blomstedt, Yulia, et al.
(författare)
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Impact of a combined community and primary care prevention strategy on all-cause and cardiovascular mortality : a cohort analysis based on 1 million person-years of follow-up in Västerbotten County, Sweden, during 1990-2006
- 2015
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 5:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the impact of the Västerbotten Intervention Programme (VIP) by comparing all eligible individuals (target group impact) according to the intention-to-treat principle and VIP participants with the general Swedish population.DESIGN: Dynamic cohort study.SETTING/PARTICIPANTS: All individuals aged 40, 50 or 60 years, residing in Västerbotten County, Sweden, between 1990 and 2006 (N=101 918) were followed from their first opportunity to participate in the VIP until age 75, study end point or prior death.INTERVENTION: The VIP is a systematic, long-term, county-wide cardiovascular disease (CVD) intervention that is performed within the primary healthcare setting and combines individual and population approaches. The core component is a health dialogue based on a physical examination and a comprehensive questionnaire at the ages of 40, 50 and 60 years.PRIMARY OUTCOMES: All-cause and CVD mortality.RESULTS: For the target group, there were 5646 deaths observed over 1 054 607 person-years. Compared to Sweden at large, the standardised all-cause mortality ratio was 90.6% (95% CI 88.2% to 93.0%): for women 87.9% (95% CI 84.1% to 91.7%) and for men 92.2% (95% CI 89.2% to 95.3%). For CVD, the ratio was 95.0% (95% CI 90.7% to 99.4%): for women 90.4% (95% CI 82.6% to 98.7%) and for men 96.8% (95% CI 91.7 to 102.0). For participants, subject to further impact as well as selection, when compared to Sweden at large, the standardised all-cause mortality ratio was 66.3% (95% CI 63.7% to 69.0%), whereas the CVD ratio was 68.9% (95% CI 64.2% to 73.9%). For the target group as well as for the participants, standardised mortality ratios for all-cause mortality were reduced within all educational strata.CONCLUSIONS: The study suggests that the VIP model of CVD prevention is able to impact on all-cause and cardiovascular mortality when evaluated according to the intention-to-treat principle.
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| 3. |
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| 4. |
- Dalmar, Abdirisak Ahmed, et al.
(författare)
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Rebuilding research capacity in fragile states : the case of a Somali-Swedish global health initiative
- 2017
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Ingår i: Global Health Action. - Abingdon : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents an initiative to revive the previous Somali-Swedish Research Cooperation, which started in 1981 and was cut short by the civil war in Somalia. A programme focusing on research capacity building in the health sector is currently underway through the work of an alliance of three partner groups: six new Somali universities, five Swedish universities, and Somali diaspora professionals. Somali ownership is key to the sustainability of the programme, as is close collaboration with Somali health ministries. The programme aims to develop a model for working collaboratively across regions and cultural barriers within fragile states, with the goal of creating hope and energy. It is based on the conviction that health research has a key role in rebuilding national health services and trusted institutions.
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| 5. |
- Fredén, Lars, et al.
(författare)
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Vilken inriktning och kvalitet har examensarbeten i svenska folkhälsovetenskapliga utbildningar?
- 2017
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Ingår i: Socialmedicinsk Tidskrift. - 0037-833X .- 2000-4192. ; 94:3, s. 293-300
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Tidskriftsartikel (refereegranskat)abstract
- Den andra nationella utvärderingen av samtliga 23 utbildningsprogram på kandidat-, magister- och masternivå i folkhälsovetenskap genomfördes 2011-2012. Här presenteras en översikt av de examensarbeten som utvärderingen baserades på. Det är 218 slumpmässigt utvalda uppsatser, 67 från kandidatnivå, 55 från magisternivå och 76 från mastersnivå. Högskoleverkets hårt reglerade format medgav inte någon innehållsmässig analys av hur folkhälsovetenskapen speglades i uppsatserna. Vi åtta i bedömargruppen var dock eniga om att vidga ramarna. Vår fördjupning kom att fokuseras på vilka tillämpningsområden som studenterna valde, vilka forskningsdesigner som tillämpades och hur kvaliteten bedömdes i relation till ämne, metod och fakultetsområde. Av de nio folkhälsovetenskapliga områden som förekommer i uppsatserna var de vanligaste Hälsofrämjande och Hälsans bestämningsfaktorer. Ämnesinnehåll och olika examensnivåer varierade stort mellan de olika lärosätena. En slutsats är att utbildningen i folkhälsovetenskap har svårigheter att balansera det flervetenskapliga med att nå ett fördjupat kunskapsinnehåll.
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| 6. |
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| 7. |
- Nordin, Per, 1964-
(författare)
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Control or elimination : terms for public health interventions against tungiasis and schistosomiasis haematobium
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis revolves around diagnosis and treatment of tungiasis (sand flea disease) and schistosomiasis haematobium. The causing parasites, Tunga penetrans and Schistosoma haematobium, both have the ability to penetrate intact skin.Tungiasis is a neglected parasitic skin disease, prevalent in resource-poor communities in sub-Saharan Africa, South America and the Caribbean. Its global prevalence has never been properly assessed. The prevalence may be as high as 60 percent in resource-poor urban settings. Repeated infections result in disfigurement and mutilations foremost of the feet, eventually leading to impaired mobility. Schistosomiasis haematobium, or urogenital schistosomiasis, is prevalent above all in Africa with around 100 million infected individuals. It causes damage to internal organs and could lead to serious sequelae in the urogenital tract.The aim is to examine aspects and prerequisites for control and elimination of the two diseases in an east African context. Even if both diseases are caused by a parasite and associated with poverty, they exhibit distinct differences for public health interventions, especially considering control and elimination.The thesis contains a dialectic comparison of diagnoses and treatments problematising possibilities and hindrances for public health interventions in rural locations in Uganda, Kenya and Tanzania, from where the empirical data are collected in the four encompassing studies. Two deal with treatment of tungiasis, where the idea is to use silicon-based oils in order to suffocate the parasite. Rigorous clinical treatment trials on humans are so far lacking. The conclusion is that the tested substance works much better than current treatments. It is also shown that an efficient, yet parsimonious treatment procedure can be successful, even in resource-poor settings.WHO promotes a dose-pole for determining the number of praziquantel tablets in mass treatment campaigns of schistosomiasis. An alternative dosage procedure is proposed to avoid side-effects and promote compliance. Since mass treatment campaigns currently target children and adults at risk in endemic areas, the choice of diagnostic method will have consequences. Prevailing parasitological methods for field surveys are not sensitive enough, especially where the prevalence is seemingly low. The suggested more sensitive diagnostic method, that detects the level of urogenital schistosomiasis in population groups, is a both affordable and manageable approach in resource-poor settings.Is control or elimination possible for tungiasis and urogenital schistosomiasis? The conclusion is that elimination cannot be achieved without environmental interventions, use of repellants, vaccines and ultimately a fight against poverty. A multidisciplinary approach is needed to understand and sustainably resolve the problems. Important disciplines for this public health endeavour are epidemiology, sociology and ethics.
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| 8. |
- Schröders, Julia, et al.
(författare)
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How is Indonesia coping with its epidemic of chronic noncommunicable diseases? : A systematic review with meta-analysis
- 2017
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Ingår i: PLOS ONE. - : Public Library Science. - 1932-6203. ; 12:6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic noncommunicable diseases (NCDs) have emerged as a huge global health problem in low- and middle-income countries. The magnitude of the rise of NCDs is particularly visible in Southeast Asia where limited resources have been used to address this rising epidemic, as in the case of Indonesia. Robust evidence to measure growing NCD-related burdens at national and local levels and to aid national discussion on social determinants of health and intra-country inequalities is needed. The aim of this review is (i) to illustrate the burden of risk factors, morbidity, disability, and mortality related to NCDs; (ii) to identify existing policy and community interventions, including disease prevention and management strategies; and (iii) to investigate how and why an inequitable distribution of this burden can be explained in terms of the social determinants of health.METHODS: Our review followed the PRISMA guidelines for identifying, screening, and checking the eligibility and quality of relevant literature. We systematically searched electronic databases and gray literature for English- and Indonesian-language studies published between Jan 1, 2000 and October 1, 2015. We synthesized included studies in the form of a narrative synthesis and where possible meta-analyzed their data.RESULTS: On the basis of deductive qualitative content analysis, 130 included citations were grouped into seven topic areas: risk factors; morbidity; disability; mortality; disease management; interventions and prevention; and social determinants of health. A quantitative synthesis meta-analyzed a subset of studies related to the risk factors smoking, obesity, and hypertension.CONCLUSIONS: Our findings echo the urgent need to expand routine risk factor surveillance and outcome monitoring and to integrate these into one national health information system. There is a stringent necessity to reorient and enhance health system responses to offer effective, realistic, and affordable ways to prevent and control NCDs through cost-effective interventions and a more structured approach to the delivery of high-quality primary care and equitable prevention and treatment strategies. Research on social determinants of health and policy-relevant research need to be expanded and strengthened to the extent that a reduction of the total NCD burden and inequalities therein should be treated as related and mutually reinforcing priorities.
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| 9. |
- Schröders, Julia, et al.
(författare)
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Millennium Development Goal Four and Child Health Inequities in Indonesia : A Systematic Review of the Literature
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:5
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Forskningsöversikt (refereegranskat)abstract
- Introduction Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework?Methods and Findings We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable "disadvantaged populations" was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities.Conclusion This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.
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