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1.	Baldursdottir, Birna, et al. (author) Impact of a physical activity intervention on adolescents' subjective sleep quality : a pilot study 2017 In: Global Health Promotion. - : Sage Publications. - 1757-9759 .- 1757-9767. ; 24:4, s. 14-22 Journal article (peer-reviewed)abstract BACKGROUND: The aim of this pilot study was to examine the impact of a brief physical activity intervention on adolescents' subjective sleep quality. Cross-sectional studies indicate that physically active adolescents have better subjective sleep quality than those with more sedentary habits. However, less is known about the effectiveness of physical activity interventions in improving adolescents' subjective sleep quality.METHODS: In a three-week physical activity intervention, four Icelandic upper secondary schools were randomized to either an intervention group with pedometers and step diaries or a control group without pedometers and diaries. Out of 84, a total of 53 students, aged 15-16 years, provided complete data or a minimum of two days step data (out of three possible) as well as sleep quality measures at baseline and follow-up. Subjective sleep quality, the primary outcome in this study, was assessed with four individual items: sleep onset latency, nightly awakenings, general sleep quality, and sleep sufficiency. Daily steps were assessed with Yamax CW-701 pedometers.RESULTS: The intervention group (n = 26) had significantly higher average step-count (p = 0.03, partial η(2) = 0.093) compared to the control group (n = 27) at follow-up. Subjective sleep quality improved (p = 0.02, partial η(2) = 0.203) over time in the intervention group but not in the control group.CONCLUSIONS: Brief physical activity interventions based on pedometers and step diaries may be effective in improving adolescents' subjective sleep quality. This has important public health relevance as the intervention can easily be disseminated and incorporated into school curricula.
2.	Choulagai, Bishnu, et al. (author) Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants 2015 In: Global Health Action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 8 Journal article (peer-reviewed)abstract Background: Estimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted at the end of 2010. We also report on the use of skilled birth attendants (SBAs) and associated factors in the JD-HDSS at the follow-up point. Design: We used a structured questionnaire to survey 3,505 households in the JD-HDSS, Bhaktapur, Nepal. To investigate the use of SBAs, we interviewed 434 women who had delivered a baby within the prior 2 years. We compared demographic and health indicators at baseline and follow-up and assessed the association of SBA services with background variables. Results: Due to rising in-migration, the total population and number of households in the JD-HDSS increased (13,669 and 2,712 in 2010 vs. 16,918 and 3,505 in 2012). Self-reported morbidity decreased (11.1% vs. 7.1%, respectively), whereas accidents and injuries increased (2.9% vs. 6.5% of overall morbidity, respectively). At follow-up, the proportion of institutional delivery (93.1%) exceeded the national average (36%). Women who accessed antenatal care and used transport (e.g. bus, taxi, motorcycle) to reach a health facility were more likely to access institutional delivery. Conclusions: High in-migration increased the total population and number of households in the JD-HDSS, a peri-urban area where most health indicators exceed the national average. Major morbidity conditions (respiratory diseases, fever, gastrointestinal problems, and bone and joint problems) remain unchanged. Further investigation of reasons for increased proportion of accidents and injuries are recommended for their timely prevention. More than 90% of our respondents received adequate antenatal care and used institutional delivery, but only 13.2% accessed adequate postnatal care. Availability of transport and use of antenatal care was associated positively with institutional delivery.
3.	Choulagai, Bishnu P., et al. (author) A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal 2017 In: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 32:8, s. 1092-1101 Journal article (peer-reviewed)abstract Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. The eligible participants for the survey were women that had delivered a baby within the past 12 months preceding the survey. Implementation was administered by trained health volunteers, youth groups, mothers' groups and health facility management committee members. Post-intervention, we used difference-in-differences and mixed-effects regression models to assess and analyse any increase in the utilization of skilled birth care and antenatal care (ANC) services. All analyses were done by intention to treat. Our trial registration number was ISRCTN78892490 (http://www.isrctn.com/ISRCTN78892490). Interviewees included 1746 and 2098 eligible women in the intervention and control groups, respectively. The 1-year intervention was effective in increasing the use of skilled birth care services (OR = 1.57; CI 1.19-2.08); however, the intervention had no effect on the utilization of ANC services. Expanding the intervention with modifications, e.g. mobilizing more active and stable community groups, ensuring adequate human resources and improving quality of services as well as longer or repeated interventions will help achieve greater effect in increasing the utilization of SBA.
4.	Fagman, Johan Bourghardt, 1980, et al. (author) The androgen receptor confers protection against diet-induced atherosclerosis, obesity, and dyslipidemia in female mice. 2015 In: FASEB journal : official publication of the Federation of American Societies for Experimental Biology. - : Wiley. - 1530-6860 .- 0892-6638. ; 29:4, s. 1540-1550 Journal article (peer-reviewed)abstract Androgens have important cardiometabolic actions in males, but their metabolic role in females is unclear. To determine the physiologic androgen receptor (AR)-dependent actions of androgens on atherogenesis in female mice, we generated female AR-knockout (ARKO) mice on an atherosclerosis-prone apolipoprotein E (apoE)-deficient background. After 8 weeks on a high-fat diet, but not on a normal chow diet, atherosclerosis in aorta was increased in ARKO females (+59% vs. control apoE-deficient mice with intact AR gene). They also displayed increased body weight (+18%), body fat percentage (+62%), and hepatic triglyceride levels, reduced insulin sensitivity, and a marked atherogenic dyslipidemia (serum cholesterol, +52%). Differences in atherosclerosis, body weight, and lipid levels between ARKO and control mice were abolished in mice that were ovariectomized before puberty, consistent with a protective action of ovarian androgens mediated via the AR. Furthermore, the AR agonist dihydrotestosterone reduced atherosclerosis (-41%; thoracic aorta), subcutaneous fat mass (-44%), and cholesterol levels (-35%) in ovariectomized mice, reduced hepatocyte lipid accumulation in hepatoma cells in vitro, and regulated mRNA expression of hepatic genes pivotal for lipid homeostasis. In conclusion, we demonstrate that the AR protects against diet-induced atherosclerosis in female mice and propose that this is mediated by modulation of body composition and lipid metabolism.-Fagman, J. B., Wilhelmson, A. S., Motta, B. M., Pirazzi, C., Alexanderson, C., De Gendt, K., Verhoeven, G., Holmäng, A., Anesten, F., Jansson, J. -O., Levin, M., Borén, J., Ohlsson, C., Krettek, A., Romeo, S., Tivesten, A. The androgen receptor confers protection against diet-induced atherosclerosis, obesity, and dyslipidemia in female mice.
5.	Kharkova, Olga A., et al. (author) Effect of Smoking Behavior before and during Pregnancy on Selected Birth Outcomes among Singleton Full-Term Pregnancy : A Murmansk County Birth Registry Study 2017 In: International Journal of Environmental Research and Public Health. - : M D P I AG. - 1661-7827 .- 1660-4601. ; 14:8, s. 1-11 Journal article (peer-reviewed)abstract The aim of our study was to assess associations between smoking behavior before and during pregnancy and selected adverse birth outcomes. This study is based on the Murmansk County Birth Registry (MCBR). Our study includes women who delivered a singleton pregnancy after 37 weeks of gestation (N = 44,486). Smoking information was self-reported and assessed at the first antenatal visit during pregnancy. We adjusted for potential confounders using logistic regression. The highest proportion of infants with low values of birth weight, birth length, head circumference, ponderal index and of the Apgar score at 5 min was observed for women who smoked both before and during pregnancy. We observed a dose-response relationship between the number of cigarettes smoked per day during pregnancy and the odds of the aforementioned adverse birth outcomes; neither were there significant differences in their occurrences among non-smokers and those who smoked before but not during pregnancy. Moreover, smoking reduction during pregnancy relative to its pre-gestation level did not influence the odds of the adverse birth outcomes. Our findings emphasize a continued need for action against tobacco smoking during pregnancy.
6.	Kharkova, O. A., et al. (author) First-trimester smoking cessation in pregnancy did not increase the risk of preeclampsia/eclampsia: A Murmansk County Birth Registry study 2017 In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 12:8 Journal article (peer-reviewed)abstract Background Although prior studies have shown that smoking reduces preeclampsia/eclampsia risk, the consequence of giving up this habit during pregnancy should be assessed. The aims of the current study were threefold: (i) describe maternal characteristics of women with preeclampsia/ eclampsia; (ii) examine a possible association between the number of cigarettes smoked daily during pregnancy and the development of this affliction; and (iii) determine if first-trimester discontinuation of smoking during pregnancy influences the risk. A registry-based study was conducted using data from the Murmansk County Birth Registry (MCBR). It included women without pre-existing hypertension, who delivered a singleton infant during 2006-2011 and had attended the first antenatal visit before 12 week of gestation. We adjusted for potential confounders using logistic regression. The prevalence of preeclampsia/eclampsia was 8.3% (95% CI: 8.0-8.6). Preeclampsia/ eclampsia associated with maternal age, education, marital status, parity, excessive weight gain and body mass index at the first antenatal visit. There was a dose-response relationship between the number of smoked cigarettes per day during pregnancy and the risk of preeclampsia/ eclampsia (adjusted OR1-5 cig/day = 0.69 with 95% CI: 0.56-0.87; OR6-10 cig/day = 0.65 with 95% CI: 0.51-0.82; and OR (>= 11 cig/day) = 0.49 with 95% CI: 0.30-0.81). There was no difference in this risk among women who smoked before and during pregnancy and those who did so before but not during pregnancy (adjusted OR = 1.10 with 95% CI: 0.91-1.32). Preeclampsia/eclampsia was associated with maternal age, education, marital status, parity, excessive weight gain, and body mass index at the first antenatal visit. There was a negative dose-response relationship between the number of smoked cigarettes per day during pregnancy and the odds of preeclampsia/eclampsia. However, women who gave up smoking during the first trimester of gestation had the same risk of preeclampsia/eclampsia as those who smoked while pregnant. Consequently, antenatal clinic specialists are advised to take these various observations into account when counselling women on smoking cessation during pregnancy.
7.	Kharkova, O. A., et al. (author) Prevalence of smoking before and during pregnancy and changes in this habit during pregnancy in Northwest Russia: a Murmansk county birth registry study 2016 In: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 13:18 Journal article (peer-reviewed)abstract Background: Smoking during pregnancy leads to adverse maternal and birth outcomes. However, the prevalence of smoking among women in Russia has increased from <5 % in the 1980s to >20 % in the 2000s. We conducted a registry-based study in Murmansk County, Northwest Russia. Our aims were twofold: (i) assess the prevalence of smoking before and during pregnancy; and (ii) examine the socio-demographic factors associated with giving up smoking or reducing the number of cigarettes smoked once pregnancy was established. Methods: This study employs data from the population-based Murmansk County Birth Registry (MCBR) collected during 2006-2011. We used logistic regression to investigate associations between women's socio-demographic characteristics and changes in smoking habit during pregnancy. To avoid departure from uniform risk within specific delivery departments, we employed clustered robust standard errors. Results: Of all births registered in the MCBR, 25.2 % of the mothers were smokers before pregnancy and 18.9 % continued smoking during pregnancy. Cessation of smoking during pregnancy was associated with education, marital status and parity but not with maternal age, place of residence, and ethnicity. Women aged <= 20-24 years had higher odds of reducing the absolute numbers of cigarettes smoked per day during pregnancy than those aged <= 30-34 years. Moreover, smoking nulliparae and pregnant women who had one child were more likely to reduce the absolute numbers of cigarettes smoked per day compared to women having >= 2 children. Conclusions: About 25.0 % of smoking women in the Murmansk County in Northwest Russia quit smoking after awareness of the pregnancy, and one-third of them reduced the number cigarettes smoked during pregnancy. Our study demonstrates that women who have a higher education, husband, and are primiparous are more likely to quit smoking during pregnancy. Maternal age and number of children are indicators that influence reduction in smoking during pregnancy. Our findings are useful in identifying target groups for smoking intervention campaigns.
8.	Kovalenko, A. A., et al. (author) Risk Factors for hypospadias in Northwest Russia: A Murmansk County Birth Registry Study 2019 In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 14:4 Journal article (peer-reviewed)abstract Background Hypospadias is the most common congenital anomaly of the penis, but its causes are mainly unknown. Of the risk factors identified, the most plausible are hormonal and genetic. The aim of this study was to identify risk factors for hypospadias in Northwest Russia based on registry data. The study population included male infants registered in the Murmansk County Birth Registry between 1 January 2006 and 31 December 2011 (n = 25 475). These infants were followed-up for 2 years using the Murmansk Regional Congenital Defects Registry to identify cases of hypospadias not diagnosed at birth. We used logistic regression analysis to examine the contributions of hypospadias risk factors. Out of 25 475 male infants born during the study period, 148 had isolated hypospadias. The overall prevalence rate was 54.2 (95% CI 53.6-54.8) per 10 000 male infants. Those born to mothers with preeclampsia (OR = 1.65; 95% CI 1.03-2.66) or infant birthweight < 2500 g (OR = 2.06; 95% CI 1.18-3.60) exhibited increased risk for hypospadias. Maternal age, smoking during pregnancy, folic acid intake during pregnancy or hepatitis B surface antigen positivity did not associate with increased risk of hypospadias. Combining data from a birth registry with those from a congenital defects registry provided optimal information about the prevalence of hypospadias and its association with low infant birthweight and preeclampsia. These factors have in common changes in hormone levels during pregnancy, which in turn may have contributed to hypospadias development.
9.	Kovalenko, A. A., et al. (author) Risk Factors for Ventricular Septal Defects in Murmansk County, Russia: A Registry-Based Study 2018 In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601 .- 1661-7827. ; 15:7 Journal article (peer-reviewed)abstract Cardiovascular malformations are one of the most common birth defects among newborns and constitute a leading cause of perinatal and infant mortality. Although some risk factors are recognized, the causes of cardiovascular malformations (CVMs) remain largely unknown. In this study, we aim to identify risk factors for ventricular septal defects (VSDs) in Northwest Russia. The study population included singleton births registered in the Murmansk County Birth Registry (MCBR) between 1 January 2006 and 31 December 2011. Infants with a diagnosis of VSD in the MCBR and/or in the Murmansk Regional Congenital Defects Registry (up to two years post-delivery) constituted the study sample. Among the 52,253 infants born during the study period there were 744 cases of septal heart defects (SHDs), which corresponds to a prevalence of 14.2 [95% confidence interval (CI) of 13.2-15.3] per 1000 infants. Logistic regression analyses were carried out to identify VSD risk factors. Increased risk of VSDs was observed among infants born to mothers who abused alcohol [OR = 4.83; 95% CI 1.88-12.41], or smoked during pregnancy [OR = 1.35; 95% CI 1.02-1.80]. Maternal diabetes mellitus was also a significant risk factor [OR = 8.72; 95% CI 3.16-24.07], while maternal age, body mass index, folic acid and multivitamin intake were not associated with increased risk. Overall risks of VSDs for male babies were lower [OR = 0.67; 95% CI 0.52-0.88].
10.	Kovalenko, A. A., et al. (author) Under-reporting of major birth defects in Northwest Russia: a registry-based study 2017 In: International Journal of Circumpolar Health. - : Informa UK Limited. - 1239-9736 .- 2242-3982. ; 76 Journal article (peer-reviewed)abstract The objective was to assess the prevalence of selected major birth defects, based on data from two medical registries in Murmansk County, and compare the observed rates with those available for Norway and Arkhangelsk County, Northwest Russia. It included all newborns (>= 22 completed weeks of gestation) registered in the Murmansk County Birth Registry (MCBR) and born between 1 January 2006 and 31 December 2009 (n=35,417). The infants were followed-up post-partum for 2 years through direct linkage to the Murmansk Regional Congenital Defects Registry (MRCDR). Birth defects identified and confirmed in both registries constituted the "cases" and corresponded to one or more of the 21 birth defect types reportable to health authorities in Moscow. The overall prevalence of major birth defects recorded in the MRCDR was 50/10,000 before linkage and 77/10,000 after linkage with the MCBR. Routine under-reporting to the MRCDR of 40% cases was evident. This study demonstrates that birth registry data improved case ascertainment and official prevalence assessments and reduced the potential of under-reporting by physicians. The direct linkage of the two registries revealed that hypospadias cases were the most prevalent among the major birth defects in Murmansk County.
11.	Krettek, Alexandra, 1968-, et al. (author) Apropå! »Alla vet att man ska äta frukt och grönt och röra på sig« 2018 In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 115 Journal article (pop. science, debate, etc.)
12.	Krettek, Alexandra, 1968-, et al. (author) Folkhälsovetenskaplig utbildning på distans med unik profil för framtiden 2017 In: Socialmedicinsk Tidskrift. - : Stiftelsen Socialmedicinsk Tidskrift. - 0037-833X .- 2000-4192. ; 94:3, s. 327-339 Journal article (peer-reviewed)abstract Vid Högskolan i Skövde har ämnet folkhälsovetenskap utvecklats kraftigt de senaste två åren och förväntas fortsätta expandera som en strategisk satsning från lärosätet. Ämnets ambition är att erbjuda utbildningar med unik profil som ger studenterna god anställningsbarhet och rustar dem för både nuvarande och framtida hälsoutmaningar. I dagsläget erbjuder Högskolan i Skövde ett flertal utbildningsprogram i folkhälsovetenskap; det tvååriga Hälsocoachprogrammet, det treåriga kandidatprogrammet Folkhälsovetenskapligt program samt magisterprogrammet Folkhälsovetenskap: Smittskydd och vårdhygien. Det senare programmet är unikt i sitt slag, både i Sverige och Norden. Samtliga utbildningsprogram ges på distans med enstaka campusträffar. Artikeln belyser därför även utmaningar och möjligheter med denna undervisningsform och ger praktiska råd hur man kan åstadkomma god genomströmning i distansundervisning.
13.	Krettek, Alexandra, 1968, et al. (author) Nordic School of Public Health NHV and its legacy in global health 2015 In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 43, s. 36-45 Journal article (peer-reviewed)abstract This article describes the legacy of the Nordic School of Public Health NHV (NHV) in global health. We delineate how this field developed at NHV and describe selected research and research training endeavours with examples from Vietnam and Nepal as well as long-term teaching collaborations such as BRIMHEALTH (Baltic RIM Partnership for Public HEALTH) in the Baltic countries and Arkhangelsk International School of Public Health in Russia.
14.	Oli, Natalia, et al. (author) Changes in children’s diet and physical activity as perceived by their mothers : Impact of a health promotion intervention for mothers in a sub-urban area of Nepal 2018 In: Journal of Kathmandu Medical College. - Kathmandu : Kathmandu Medical College (KMC). - 2091-1785 .- 2091-1793. ; 7:4, s. 140-146 Journal article (peer-reviewed)abstract Background:Unhealthy diet and physical inactivity contribute to the growing burden of cardiovascular diseases in Nepal. Lifestyle is formed in childhood and in the Nepalese context influenced mainly by mothers, it is to date unknown how influential mothers are.Objectives:To assess changes in children’s diet and physical activity as perceived by their mothers after a health promotion intervention.Methodology:The Heart-Health Associated Research, Dissemination and Intervention in the Community is a community trial conducted in the Jhaukhel-Duwakot Health Demographic Surveillance site, in Bhaktapur district of Nepal. We conducted a health promotion intervention on diet and physical activity targeted at mothers with children aged one to nine years old in August-November 2016. Duwakot was randomized as the intervention site and Jhaukhel as the control. We conducted a follow-up study after three months to determine the outcome of the intervention. Nine trained enumerators conducted door-to-door visits to all households with eligible mothers. We calculated mean, frequency and percent changes for children’s behavior.Results:As responded by mothers, children in Duwakot consumed more healthy snacks after the intervention compared to Jhaukhel. Children in Duwakot increased consumption of water and milk. Children’s consumption of packet juices and soft drinks was decreased by 30% and 4% respectively. There was 21% increment in the duration of outdoor playing among the children at Duwakot during follow-up.Conclusion:The Heart-Health Associated Research, Dissemination and Intervention in the Community that focused on mothers showed indirect positive impact on their young children’s diet and physical activity behavior. In future, the longterm effects of such intervention should be assessed.
15.	Oli, Natalia, et al. (author) Diet and physical activity for children's health: a qualitative study of Nepalese mothers' perceptions 2015 In: Bmj Open. - : BMJ. - 2044-6055. ; 5:9 Journal article (peer-reviewed)abstract Objectives: Non-communicable diseases account for 50% of all deaths in Nepal and 25% result from cardiovascular diseases. Previous studies in Nepal indicate a high burden of behavioural cardiovascular risk factors, suggesting a low level of knowledge, attitude and practice/behaviour regarding cardiovascular health. The behavioural foundation for a healthy lifestyle begins in early childhood, when mothers play a key role in their children's lives. This qualitative study, conducted in a Nepalese peri-urban community, aimed to explore mothers' perception of their children's diet and physical activity. Design: We notated, tape-recorded and transcribed all data collected from six focus group discussions, and used qualitative content analysis for evaluation and interpretation. Setting: The study was conducted in the Jhaukhel-Duwakot Health Demographic Surveillance Site in the Bhaktapur district of Nepal. Participants: Local health workers helped recruit 61 women with children aged 5-10 years. We distributed participants among six different groups according to educational status. Results: Although participants understood the importance of healthy food, they misunderstood its composition, perceiving it as unappetising and appropriate only for sick people. Furthermore, participants did not prioritise their children's physical activities. Moreover, mothers believed they had limited control over their children's dietary habits and physical activity. Finally, they opined that health educational programmes would help mothers and recommended various intervention strategies to increase knowledge regarding a healthy lifestyle. Conclusions: Our data reveal that mothers of young children in a peri-urban community of Nepal lack adequate and accurate understanding about the impact of a healthy diet and physical activity. Therefore, to prevent future cardiovascular disease and other non-communicable diseases among children, Nepal needs health education programmes to improve mothers' cardiovascular health knowledge, attitude and behaviour.
16.	Oli, Natalia, et al. (author) Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial 2019 In: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 12:1 Journal article (peer-reviewed)abstract Background: Nepal, like many low- and middle-income countries, exhibits rising burden of cardiovascular diseases. Misconceptions, poor behavior, and a high prevalence of risk factors contribute to this development. Health promotion efforts along with primary prevention strategies, including risk factor reduction in both adults and children, are therefore critical. Objectives: This study assessed the effectiveness of a health promotion intervention on mothers? knowledge, attitude and practice (KAP) and their children?s behavior regarding diet and physical activity. Methods: The Heart-health Associated Research, Dissemination and Intervention in the Community (HARDIC), a community-based trial, used peer education to target mothers with 1?9-year-old children in the peri-urban Jhaukhel?Duwakot Health Demographic Surveillance Site, Nepal, during August?November 2016. In the intervention area, 47 peer mothers were trained to conduct four education classes for about 10 fellow mothers (N = 391). After 3 months, all eligible mothers in the intervention and control areas were interviewed and the results were compared with the KAP of all eligible mothers at baseline. Results: Post-intervention, mothers? KAP median scores had improved regarding heart-healthy diet and physical activity. More mothers had ?good? KAP (>75% of maximum possible scores), and mothers with ?good? knowledge increased from 50% to 81%. Corresponding control values increased only from 58% to 63%. Mothers? attitude and practice improved. Additionally, mothers in the intervention area reported improvement in their children?s diet and physical activity behavior. Moreover, Difference in Differences analysis showed that the HARDIC intervention significantly increased mothers? KAP scores and children?s behavior scores in the intervention area compared to the control area. Conclusions: Our intervention improves KAP scores regarding diet and physical activity and shows potential for expansion via community health workers, volunteers, and/or local women. Moreover, HARDIC can contribute to Nepal?s Package of Essential Noncommunicable Diseases Initiative, which currently lacks a specific package for health promotion.
17.	Oli, Natalia, et al. (author) Knowledge, attitude and practice on diet and physical activity among mothers with young children in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal 2018 In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 13:7 Journal article (peer-reviewed)abstract The prevalence of cardiovascular diseases is increasing in low and middle-income countries; Nepal's population shows a high prevalence of behavioral risk factors. Our cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), located near the capital Kathmandu, explored knowledge, attitude, and practice (KAP) of mothers with young children regarding diet and physical activity and mothers' perception of their children's attitude and behavior toward the same issues. The purpose of our study was to assess needs of the mothers concerning cardiovascular health in general and more specifically regarding diet and physical activity, and to establish a baseline for future intervention in the community by comparing two villages of JD-HDSS. In August-November 2014, nine trained enumerators interviewed all mothers of children aged 1-7 years (N = 962). We scored responses on dietary and physical activity KAP, then categorized the scores based on the percentage obtained out of the maximum possible scores into "poor," "fair," and "good." More highly educated mothers scored higher for KAP (all p<0.001); the children's behavior score reflected their mother's education level (p = 0.007). Most respondents were unfamiliar with the concept of healthy and unhealthy food. Overall, 57% of respondents in JD-HDSS had "good" knowledge, 44.6% had "good" attitude, and most (90%) had "poor" practice. We observed no significant differences between the villages regarding mothers' knowledge and attitude or children's behavior. Practice score of mothers in Jhaukhel was higher than those in Duwakot regarding diet and physical activity (p<0.001). Mothers' perceived barriers for improving lifestyle were high cost of healthy food, taste preference of other family members, and lack of knowledge regarding healthy food. Barriers for physical activity were lack of leisure time, absence of parks and playgrounds, busy caring for children and old people, feeling lazy, and embarrassed to be physically active in front of others. Our findings suggest that a health education intervention promoting a healthy lifestyle for mothers and children might improve KAP and also improve cardiovascular health. To address mothers' gap between knowledge and practice, a future intervention should consider perceived barriers.
18.	Povlsen, Lene, et al. (author) Adolescents' knowledge and opinions about smoking : a qualitative study from the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal 2018 In: International Journal of Adolescent Medicine and Health. - : Walter de Gruyter. - 0334-0139 .- 2191-0278. ; 30:1 Journal article (peer-reviewed)abstract BACKGROUND: The use of tobacco products among adolescents in Southeast Asia represents a major public health burden. Two out of ten adolescents attending school are tobacco users and several factors influence them to initiate tobacco use. Most studies related to tobacco use are quantitative, whereas qualitative studies exploring adolescents' smoking behavior and their views, knowledge and experiences are scarce.OBJECTIVE: To gain a deep understanding of Nepalese adolescents' knowledge and opinions about smoking and reasons for smoking initiation.SUBJECTS: Adolescents from four secondary schools in the Bhaktapur district, Nepal.METHODS: Eight focus-group discussions were conducted with 71 adolescents aged 13-16 years and from grades 8-10. Data were analyzed using manifest qualitative content analysis.RESULTS: The participants knew that smoking represents health risks as well as socio-economic risks, but few described the addictive nature of tobacco and health risks related to passive smoking. Most participants related smoking initiation to the smoking behavior of peers and family members, but easy accessibility to cigarettes, ineffective rules and regulations, and exposure to passive smoking also created environments for smoking. Some expressed confidence to resist peer pressure and refuse to start smoking, but also expressed the need for prevention strategies in schools and for governmental initiatives, such as more strict implementation of tobacco control and regulations to prevent and reduce smoking.CONCLUSION: Curbing the tobacco epidemic in Nepal requires healthy public policies and multifaceted interventions to address the knowledge gap on health consequences associated with smoking among adolescents, teachers and parents/adults.
19.	Shrestha, Binjwala, et al. (author) Uterine prolapse and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal 2015 In: Global Health Action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 8, s. 1-9 Journal article (peer-reviewed)abstract Background: Uterine prolapse (UP) is a reproductive health problem and public health issue in low-income countries including Nepal. Objective: We aimed to identify the contributing factors and stages of UP and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site of Bhaktapur, Nepal. Design: Our three-phase study used descriptive cross-sectional analysis to assess quality of life and stages of UP and case-control analysis to identify contributing factors. First, a household survey explored the prevalence of self-reported UP (Phase 1). Second, we used a standardized tool in a 5-day screening camp to determine quality of life among UP-affected women (Phase 2). Finally, a 1-month community survey traced self-reported cases from Phase 1 (Phase 3). To validate UP diagnoses, we reviewed participants' clinical records, and we used screening camp records to trace women without UP. Results: Among 48 affected women in Phase 1, 32 had Stage II UP and 16 had either Stage I or Stage III UP. Compared with Stage I women (4.62%), almost all women with Stage III UP reported reduced quality of life. Decreased quality of life correlated significantly with Stages I-III. Self-reported UP prevalence (8.7%) included all treated and non-treated cases. In Phase 3, 277 of 402 respondents reported being affected by UP and 125 were unaffected. The odds of having UP were threefold higher among illiterate women compared with literate women (OR = 3.02, 95% CI 1.76 5.17), 50% lower among women from nuclear families compared with extended families (OR = 0.56, 95% CI 0.35-0.90) and lower among women with 1-2 parity compared to >5 parity (OR = 0.33, 95% CI 0.14-0.75). Conclusions: The stages of UP correlated with quality of life resulting from varied perceptions regarding physical health, emotional stress, and social limitation. Parity, education, age, and family type associated with UP. Our results suggest the importance of developing policies and programs that are focused on early health care for UP. Through family planning and health education programs targeting women, as well as women empowerment programs for prevention of UP, it will be possible to restore quality of life related to UP.
20.	Usynina, A. A., et al. (author) Maternal Risk Factors for Preterm Birth in Murmansk County, Russia: A Registry-Based Study 2016 In: Paediatric and Perinatal Epidemiology. - : Wiley. - 0269-5022 .- 1365-3016. ; 30:5, s. 462-472 Journal article (peer-reviewed)abstract Background: Globally, about 11% of all liveborn infants are preterm. To date, data on prevalence and risk factors of preterm birth (PTB) in Russia are limited. The aims of this study were to estimate the prevalence of PTB in Murmansk County, Northwestern Russia and to investigate associations between PTB and selected maternal factors using the Murmansk County Birth Registry. Methods: We conducted a registry-based study of 52 806 births (2006–2011). In total, 51 156 births were included in the prevalence analysis, of which 3546 were PTBs. Odds ratios with 95% confidence intervals of moderate-to-late PTB, very PTB and extremely PTB for a range of maternal characteristics were estimated using multinomial logistic regression, adjusting for potential confounders. Results: The overall prevalence of PTB in Murmansk County was 6.9%. Unmarried status, prior PTBs, spontaneous and induced abortions were strongly associated with PTB at any gestational age. Maternal low educational level increased the risk of extremely and moderate-to-late PTB. Young (<18 years) or older (≥35 years) mothers, graduates of vocational schools, underweight, overweight/obese mothers, and smokers were at higher risk of moderate-to-late PTB. Secondary education, alcohol abuse, diabetes mellitus, or gestational diabetes were strongly associated with moderate-to-late and very PTB. Conclusions: The observed prevalence of PTB (6.9%) in Murmansk County, Russia was comparable with data on live PTB from European countries. Adverse prior pregnancy outcomes, maternal low educational level, unmarried status, alcohol abuse, and diabetes mellitus or gestational diabetes were the most common risk factors for PTB. © 2016 John Wiley & Sons Ltd
21.	Usynina, A. A., et al. (author) Risk factors for perinatal mortality in Murmansk County, Russia: a registry-based study 2017 In: Global Health Action. - : Informa UK Limited. - 1654-9880 .- 1654-9716. ; 10:1 Journal article (peer-reviewed)abstract Background: Factors contributing to perinatalmortality (PM) in Northwest Russia remain unclear. This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry. Objective: This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry. Methods: The study population consisted of all live-and stillbirths registered in the Murmansk County Birth Registry during 2006-2011 (n = 52,806). We excluded multiple births, births prior to 22 and after 45 completed weeks of gestation, infants with congenital malformations, and births with missing information regarding gestational age (a total of n = 3,666) and/or the studied characteristics (n = 2,356). Possible associations between maternal socio-demographic and lifestyle characteristics, maternal pre-pregnancy characteristics, pregnancy characteristics, and PM were studied by multivariable logistic regression. Crude and adjusted odds ratios with 95% confidence intervals were calculated. Results: Of the 49,140 births eligible for prevalence analysis, 338 were identified as perinatal deaths (6.9 per 1,000 births). After adjustment for other factors, maternal low education level, prior preterm delivery, spontaneous or induced abortions, antepartum hemorrhage, antenatally detected or suspected fetal growth retardation, and alcohol abuse during pregnancy all significantly increased the risk of PM. We observed a higher risk of PM in unmarried women, as well as overweight or obese mothers. Maternal underweight reduced the risk of PM. Conclusions: Our results suggest that both social and medical factors are important correlates of perinatal mortality in Northwest Russia.
22.	Usynina, Anna A., et al. (author) Social correlates of term small for gestational age babies in a Russian Arctic setting 2016 In: International Journal of Circumpolar Health. - : CoAction Publishing. - 1239-9736 .- 2242-3982. ; 75 Journal article (peer-reviewed)abstract BACKGROUND: Small for gestational age (SGA) births have been associated with both short- and long-term adverse health outcomes. Although social risk factors for SGA births have been studied earlier, such data are limited from Northern Russia.OBJECTIVE: We assessed maternal social risk factors for term SGA births based on data from the population-based Murmansk County Birth Registry (MCBR).DESIGN: Data on term live-born singleton infants born between 2006 and 2011 in Murmansk County were obtained from the MCBR. We applied the 10th percentile for only birth weight (SGAW) or for both birth weight and birth length (SGAWL). Binary logistic regression was used to estimate the effect of independent variables on SGA males and females with adjustment for known risk factors and potential confounders. Both crude and adjusted odds ratios with 95% confidence intervals for the studied risk factors were calculated.RESULTS: The proportions of term SGAW and SGAWL births were 9.7 and 4.1%, respectively. After adjustment for potential confounders, the risk of term SGA births among less educated, unemployed, unmarried, smoking and underweight women was higher compared with women from the reference groups. Evidence of alcohol abuse was also associated with birth of SGAWL and SGAW boys. Maternal overweight and obesity decreased the risk of SGA.CONCLUSIONS: Maternal low education, unemployment, unmarried status, smoking, evidence of alcohol abuse and underweight increased the risk of term SGA births in a Russian Arctic setting. This emphasizes the importance of both social and lifestyle factors for pregnancy outcomes. Public health efforts to reduce smoking, alcohol consumption and underweight of pregnant women may therefore promote a decrease in the prevalence of SGA births.
23.	Vaidya, Abhinav, et al. (author) High prevalence of prehypertension in mothers of young children in peri-urban Nepal 2016 In: Journal of Kathmandu Medical College. - : Kathmandu Medical College (KMC). - 2091-1785 .- 2091-1793. ; 5:2, s. 52-60 Journal article (peer-reviewed)abstract Background: Prehypertension is clinically defined as a level of blood pressure between normal and hypertension, i.e. elevated systolic blood pressure between 120-139 or diastolic blood pressure between 80-89 mm Hg. Prehypertension remains neglected as a public health problem, and has not been explored in mothers with small children in Nepal.Objectives: We aimed to study prehypertension and its related factors including obesity-related parameters among mothers with children aged 1-7 years in Duwakot and Jhaukhel communities of Bhaktapur district, Nepal.Methods: We prepared a sampling frame of all the eligible mothers, and interviewed 962 mothers. The trained enumerators also measured their blood pressure, body weight, height, waist and hip circumferences. We analysed data with SPSS version 22. We received ethical approval from the Nepal Health Research Council to conduct the study, and obtained informed verbal consent from the participating mothers.Results: About one-third (31.8%) of the mothers had prehypertension. It was more common among Newars and those aged 30-34 years. Multivariate analysis did not reveal significant association with sociodemographic variables except for education. We found positive correlations between blood pressure and obesity parameters. Overweight and obese participants were 2.24 (95% confidence interval: 1.06-4.73) and 4.65 (95% confidence interval: 1.92-11.23) times, respectively, more likely to have prehypertension than underweight mothers.Conclusions: Our study demonstrated a high prevalence of prehypertension, coupled with high obesity parameters, among young mothers of peri-urban Nepal. Primordial preventive efforts at community level are needed not only for the mothers themselves, but for heart-health of their offspring as well.
24.	Vaidya, Abhinav, et al. (author) Preference of Food-items and Physical Activity of Peri-urban Children in Bhaktapur 2017 In: Journal of Nepal Health Research Council. - : Nepal Health Research Council. - 1727-5482 .- 1999-6217. ; 15:2, s. 150-158 Journal article (peer-reviewed)abstract BACKGROUND: Though cardiovascular diseases are mostly seen in adulthood, the foundation of diet and physical activity is largely formed during childhood. The study aimed to explore children's preference for diet and physical activity in a peri-urban area of Nepal because this is an important dimension to explore in the life-course approach to combat non-communicable diseases.METHODS: We conducted a cross-sectional study to enquire young peri-urban children of Duwakot and Jhaukhel villages of Bhaktapur district, Nepal on their preferences for diet and physical activity. All eligible households with children in the age range 5-10 years as enlisted from the Jhaukhel-Duwakot Health Demographic Surveillance Site database were selected for the study. Twelve enumerators visited the selected households and facilitated the eligible children to fill in the questionnaire. We used a child-friendly photo-assisted questionnaire with face-scales that easily enabled the children to select a particular preference for each of the food item and physical activity. During analysis, food items were categorized into 'green', 'yellow' and 'red' on the basis of their nutritive values. Physical activity was categorized based on severity of the activity.RESULTS: Four hundred and thirty seven children filled up the questionnaires. Overall, median preference scores for 'red' food were higher than for healthier 'green' food (4.16 vs. 4.03), particularly, if mothers were self-employed. Likewise, the children preferred low over moderate-to-severe physical activity (4.16 vs. 3.50), and preference was affected by parents' occupation and income.CONCLUSIONS: The study objectively revealed that most of the children preferred unhealthier food-items and low physical activities. It shall be useful to consider these findings while planning health promotional activities targeted at them.
25.	Vaidya, Abhinav, et al. (author) The heart-health associated research, dissemination and intervention in the community (HARDIC) trial for nepalese mothers regarding diet and physical activity : A process evaluation 2017 In: Kathmandu University Medical Journal. - : Kathmandu University. - 1812-2027 .- 1812-2078. ; 15:58, s. 107-116 Journal article (peer-reviewed)abstract Background Mothers with young children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance site of Bhaktapur district have misconceptions and poor behavioural practice regarding diet and physical activity. We developed the Heart-health Associated Research, Dissemination and Intervention in the Community trial - a health promotion intervention for mothers. Objective The objective of this study was to evaluate the intervention’s feasibility, acceptability, potential for transferability and scaling up, and to determine its immediate outcome. Method Duwakot and Jhaukhel were randomly selected as the intervention and control communities, respectively. We trained 47 peer mothers from Duwakot, each of whom gave classes with 10 fellow mothers of their neighbourhood. The process evaluation was carried out on a continuous basis at different points of the intervention held from August to November 2016. Result In round one, the participation and completion rates were both > 90% for peer mothers; and 85% and 70%, respectively, for the fellow mothers. However, the participation rates fell in the round two of the intervention. On the whole, the mothers expressed satisfaction and acceptance of the course content and training modality. Immediate evaluation of the intervention showed improvement of knowledge, attitude and practice of diet and physical activity among both groups of mothers. Conclusion The successful implementation of the intervention targeting diet and physical activity clearly demonstrates the feasibility of health promotional activities in the Nepalese community for improvement of cardiovascular health. © 2017, Kathmandu University. All rights reserved.

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