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  • 1. Abdullahi, A.
    et al.
    Kalid, Mohamed
    Dalarna University, School of Health and Welfare, Care Sciences. Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Kipchumba, E.
    Sulaiman, M.
    Supporting Micro-enterprise in Humanitarian Programming: Impact Evaluation of Business Grants versus Unconditional Cash Transfer2023In: Journal of African Economies, ISSN 0963-8024, E-ISSN 1464-3723, Vol. 32, no 4, p. 415-437Article in journal (Refereed)
    Abstract [en]

    Humanitarian programming in fragile economies often use unconditional cash transfers (UCTs) to offset food insecurity. However, there is an increasing focus on using cash transfers to boost household incomes beyond the short-term through micro-enterprise start-up and growth. This paper conducts a randomised control trial to measure the impact of three different sizes of business grants against UCT in Somalia. We find that giving the same amount of money as a lump sum business grant results in higher likelihood of business ownership and income compared with UCT in the short run (3-4 months after the transfers). However, the impacts are larger and persist 3 years later only for those who received larger amount of grants. The results indicate our 'medium'-sized grant being more cost-effective. © 2022 The Author(s).

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  • 2. Abshir, Juweria N L
    et al.
    Osman, Fatumo
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Somali National University, Mogadishu, Somalia; Uppsala University, Uppsala.
    Dahir, Gallad
    Somali National University, Mogadishu, Somalia.
    Dahlberg, Anton
    Uppsala University, Uppsala.
    Parental burnout among Somali mothers: Associations with mental health, perceived social support, and sociodemographic factors2023In: PLOS Global Public Health, E-ISSN 2767-3375, Vol. 3, no 10, article id e0002501Article in journal (Refereed)
    Abstract [en]

    Parenthood can be defined by the contradiction that it is one of the most satisfying yet stressful experiences in life. Many parents experience stress during parenthood, and some to the extent that they display symptoms of parental burnout. Nevertheless, research on parental burnout is scant and many studies have only examined the condition in Western settings. The aim of this study was to examine parental burnout among Somali mothers in Mogadishu, Somalia, and its association with certain psychological, psychosocial, and sociodemographic factors. In this cross-sectional study, questionnaire data were collected through the measurements Parental Burnout Assessment and Patient Health Questionnaire 9, as well as through social and demographic questions. A total of 882 Somali mothers in Mogadishu participated. The analysis methods used were univariate, bivariate, and multiple linear regression analysis. The results revealed that the mean parental burnout score was low in the sample. Additionally, a significant association was found between higher levels of parental burnout and higher levels of depression, perceived lack of social support, being unmarried, having a low monthly household income, and when the youngest child was of school-age.

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  • 3.
    Abzhandadze, Tamar
    et al.
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Westerlind, Emma
    rg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Palstam, Annie
    Dalarna University, School of Health and Welfare, Medical Science. Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Sunnerhagen, Katharina S
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Persson, Hanna C
    Sahlgrenska Academy, University of Gothenburg, Gothenburg; Sahlgrenska University Hospital, Gothenburg.
    Sick leave one year after COVID-19 infection: a nationwide cohort study during the first wave in Sweden2024In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 572Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate the patterns of sick leave, as well as factors associated with sick leave due to COVID-19 during one year after the COVID-19 diagnosis, and sex-related aspects on sick leave. This nationwide study involved 11,902 individuals who received sickness benefits for COVID-19 during the first wave of the pandemic. Data from three Swedish registries were analyzed for sick leave that commenced between March 1 and August 31, 2020, with a follow-up period of 12 months. Sick leave due to COVID-19 was counted as the number of days with sickness benefits and required to include at least one registered COVID-19 diagnosis. The median duration of sick leave was 35 days, and 347 (2.9%) individuals continued their sick leave during the entire follow-up period. Furthermore, 1 year later, the cumulative incidence of sick leave was slightly higher in males (3.5%) compared to females (2.7%). Older age, being single with no children, diagnosed with the virus, medium income level, history of sick leave, and need for inpatient care were significantly associated with a higher duration of sick leave due to COVID-19, both in the total population and when stratified by sex. These results indicated that three out of 100 (3%) patients were still on sick leave 1 year after their COVID-19 diagnosis. Aspects regarding the importance of sick leave duration differed between males and females and comprised sociodemographic characteristics and need for inpatient care. The results indicated the complexity of sick leave due to COVID-19.

  • 4. Agahi, Neda
    et al.
    Dahlberg, Lena
    Dalarna University, School of Education, Health and Social Studies, Social Work. Aging Research Center.
    Carin, Lennartsson
    Social integration and alcohol consumption among older people: A four-year follow-up of a Swedish national sample2019In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 196, p. 40-45Article in journal (Refereed)
    Abstract [en]

    Background: Today’s older people drink more alcohol than earlier cohorts of older people. Social integration has been identified as an important factor for older people’s drinking, but the association is complex. This study investigates both high and low levels of social integration and their associations with longitudinal patterns of alcohol consumption among older women and men.

    Methods: Longitudinal nationally representative data of older Swedish women and men aged over 65 – the Swedish Level of Living Survey (LNU) and Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) – from 2010/2011 and 2014 (n = 1048). Associations between social contacts and social activities at baseline and longitudinal patterns of drinking frequency were examined with multinomial logistic regression analyses. Results: Men reported drinking alcohol more often than women, but the most common drinking frequency among both women and men was to drink monthly or less. Drinking habits were generally stable over time. People with high levels of social activity at baseline were more likely to have a stable daily or weekly drinking frequency or increased drinking frequency over the four-year follow-up period, particularly women. People with low levels of social contacts and/or social activities were less likely to have a stable daily or weekly drinking frequency, compared to people in the low and stable drinking frequency group.

    Conclusions: Alcohol consumption is embedded in a social context, older people drink in social situations and social integration predicts continued drinking patterns.

  • 5.
    Aminoff, Stephanie
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Hellander, Solveig
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Förlossningsupplevelsen under covid-19 pandemin: En integrativ litteraturstudie ur den födandes perspektiv2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Covid-19 pandemic have had a major impact on the healthcare system, both globally and nationally. A variety of guidelines and policies from hospitals and governments affected the maternity care. Because of guidelines and policies women have been limited in their options regarding their childbirth, and the opportunity to bring a partner, doula or support person has been uncertain. Aim: The aim of this study was to, from the birthing persons perspective, investigate how the covid-19 pandemic affected their birth experience. Method: Integrative literature review. A systematic search was conducted in the databases PubMed and Cinahl. Inclusion- and exclusion criteria were chosen, quality was assessed, and data was extracted from relevant studies. In the data analysis a qualitative content analysis with a deductive approach was used. Findings: A total of 16 articles were included. Guidelines and policies aiming to protect women led to feelings of loss of autonomy, and disappointment regarding the birth plans and wishes. Women gave birth alone, some women without pain relief, some have been separated from their newborn, and some did not received information or options regarding their birth. Conclusion and clinical implications: Based on the recommendations regarding intrapartum care for a positive birth experience, restrictions during the pandemic have restricted the woman's right to a positive birth experience. Therefore, when guidelines arise during a pandemic, it is important to consider the evidence that already exists to promote a good birth experience.

  • 6.
    Amran, Mohammad Yosuf
    Dalarna University, School of Health and Welfare.
    Health in Crisis: An Integrative Review of Sexual and Reproductive Health in Humanitarian Settings2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Sexual and Reproductive Health (SRH) is a cornerstone of overall health, particularly in fragile humanitarian contexts. Despite being recognized as a fundamental human right, access to quality SRH services is often significantly restricted in crisis situations. This limitation can lead to damaging health outcomes for women, children, and marginalized groups. Given this reality, there is an urgent need for an enriched understanding of SRH in area simpacted by conflicts, disasters, and population displacements. With global trends such as increasing forced migration and escalating crises, a thorough re evaluation of the challenges and potential solutions associated with SRH in these contexts is crucial.

    Aim: The aim of the integrative review is to describe the current status of sexual and reproductive health (SRH) services and interventions in humanitarian settings and explore key challenges in sexual and reproductive health services in these settings.

    Methodology: This integrative literature review analyzed and synthesized 22 research papers through inductive methodology by Elo and Kyngäs (2008).

    Results: This in-depth review of studies from a wide range of humanitarian environments worldwide, has unveiled critical insights into the hurdles surrounding Sexual and Reproductive Health (SRH) services. Firstly, barriers to accessibility and awareness prevent individuals from acquiring vital SRH knowledge and services, and this prevention is often intensified by sociocultural stigmas. Educational and language obstacles further amplify these challenges, particularly for migrants. This review also underscores the severe impact of gender-based violence (GBV) and early or forced marriages on SRH outcomes.

    Conclusions: This analysis reveals key obstacles that obstruct the provision of SRH services in humanitarian settings. Acknowledging these issues enables decision-makers to plan effectivestrategies and interventions to address the SRH needs in these settings. Exploration of each barrier and seeking holistic solutions to overcome these challenges is suggested.

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  • 7.
    Andersson, Eva
    et al.
    Gymnastik- och idrottshögskolan, GIH, Laboratoriet för tillämpad idrottsvetenskap (LTIV).
    Oddsson, Kristjan
    Gymnastik- och idrottshögskolan, GIH, Laboratoriet för tillämpad idrottsvetenskap (LTIV).
    Nilsson, Johnny
    Gymnastik- och idrottshögskolan, GIH, Laboratoriet för tillämpad idrottsvetenskap (LTIV).
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Björn Ekbloms och Mats Börjessons forskningsgrupp.
    Wahlgren, Lina
    Gymnastik- och idrottshögskolan, GIH, FoU-gruppen för rörelse, hälsa och miljö.
    Kjellman, Bengt
    Jonsson, Bo
    Taube, Jill
    Improved Physical Capacity in a Project with Guided Physical Activity for Persons with Depression or Anxiety.2010Conference paper (Refereed)
    Abstract [en]

    Background: Higher physical capacity is correlated with increased health. Knowledge in this area regarding psychiatric diseases is sparse. 

    Purpose: The aim was to study aerobic and several strength capacities in a physical activity project for persons with depression or anxiety.

    Methods: Eighty-four persons (56 women and 28 men) with depression or anxiety were recruited from psychiatric out-patient clinics in Stockholm. Their mean age and BMI was 46 (21-80) years and 26 (17-41) kg/m2, respectively. 50% were sick-listed. 50% had BMI>25. Aerobic and strength tests were chosen by each subgroup´s project leaders. Directed physical activity was given, in groups 10-15, 1 hour twice/week during 8-12 weeks.

    Results: Significant changes (p<0.05, of all n=84) between pre- and post tests were seen in submaximal cycle test (11% enhanced values, n=56) and distance of 6 minutes walk test (16%, n=15) as well as in strength tests for the back for the back (i.e. time in static horizontal belly-back, 40%, n=44), abdominal and hip flexors (i.e. number of hip flexion sit-ups, 45%, n=38), leg (i.e. standing with 90O in hips and knees, 48%, n=56) and arm with shoulder muscles (i.e. number of raising weights alternately with the arms, 46%, n=32). Hand grip tests, BMI or blood pressure values did not change significantly.

    Conclusions: Directed 8-12 weeks physical activity programs can improve physical fitness in individuals with depression or anxiety.

  • 8. Andersson, Peter
    et al.
    Tistad, Malin
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge.
    Eriksson, Åsa
    Enebrink, Pia
    Sturidsson, Knut
    Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care – Study protocol for a multicenter cluster randomized trial2022In: Contemporary Clinical Trials Communications, E-ISSN 2451-8654, Vol. 27, p. 100907-100907, article id 100907Article in journal (Refereed)
    Abstract [en]

    Introduction: Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants’ illness management skills and recovery. Objective: To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual. Method: This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory. Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Registration No. 2020–02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132). 

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  • 9. Appelgren Engström, Heléne
    et al.
    Borneskog, Catrin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Northumbria University, Newcastle upon Tyne, UK.
    Loeb, Carina
    Häggström-Nordin, Elisabet
    Almqvist, Anna-Lena
    Associations between heteronormative information, parental support and stress among same-sex mothers in Sweden-A web survey2022In: Nursing Open, E-ISSN 2054-1058, Vol. 9, no 6, p. 2826-2835Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to investigate same-sex mothers' self-assessed experiences of forming a family, and the association between heteronormative information, parental support and parenting stress.

    DESIGN: A quantitative, cross-sectional study.

    METHODS: In a web survey conducted in Sweden in 2019, same-sex mothers (N = 146) with a child aged 1-3 years answered questions about their experiences of forming a family through assisted reproduction and questions about parenting stress. Descriptive statistics describes the process of forming a family. Pearson's correlation analyses and independent sample t tests were used to test hypotheses about heteronormative information, parental support and parenting stress.

    RESULTS: Same-sex mothers experienced going through assisted reproduction treatment as stressful, and parental groups as not being supportive. Heteronormative information correlated with both lower perceived parental support and higher perceived parenting stress. Non-birth mothers experienced less acknowledgement and support than birthmothers.

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  • 10.
    Arkkukangas, Marina
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, Västerås; Research and Development in Sörmland, Region Sörmland, Eskilstuna.
    Strömqvist Bååthe, Karin
    Dalarna University, School of Health and Welfare, Medical Science.
    Ekholm, Anna
    Research and Development in Sörmland, Region Sörmland, Eskilstuna.
    Tonkonogi, Michail
    Dalarna University, School of Health and Welfare, Medical Science.
    Short Multicomponent Group Exercise Intervention Promotes Long-Term Physical Activity Habits among Community-Dwelling Older Adults during COVID-19 Restrictions: A Cohort Study2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 22, article id 15140Article in journal (Refereed)
    Abstract [en]

    This study investigated whether strength, balance, body mass index, falls self-efficacy, activity levels, self-rated health, and participation in a multicomponent exercise intervention could predict physical activity levels after 5 months of self-quarantine due to the COVID-19 pandemic. This study included baseline data of 200 community-dwelling older adults (79% women, 21% men) with a mean age of 72 years who participated in a randomized controlled trial investigating a multicomponent exercise program, with 7-month follow-up survey data of their physical activity levels. The results showed significant associations with the activity levels at the 7-month follow-up. The activity levels (odds ratio (OR): 2.83, 95% CI: 1.20-6.71), the self-rated health score (2.80, 1.42-5.53), and being allocated to a specific multicomponent group-based exercise program (2.04, 1.04-4.00) showed a significant association with the activity habits at the 7-month follow-up. As this study suggests, besides the physical activity levels and the self-rated health score, participation in a high challenge multicomponent exercise program was significantly associated with physical activity levels at the 7-month follow-up. This study indicates that a relatively short multicomponent group exercise program (6-9 weeks) can motivate individuals to sustain their own training and activity levels even several months after the program has been paused or terminated. Identifying older adults' physical activity levels and self-rated health scores and prescribing multicomponent group-based exercise programs to promote sustained physical activity habits may be a successful alternative to provide for older adults in the future.

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  • 11. Baldanzi, Gabriel
    et al.
    Sayols-Baixeras, Sergi
    Ekblom-Bak, Elin
    Ekblom, Örjan
    Dekkers, Koen F
    Hammar, Ulf
    Nguyen, Diem
    Ahmad, Shafqat
    Ericson, Ulrika
    Arvidsson, Daniel
    Börjesson, Mats
    Johanson, Peter J
    Smith, J Gustav
    Bergström, Göran
    Lind, Lars
    Engström, Gunnar
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institutet, Huddinge.
    Kennedy, Beatrice
    Orho-Melander, Marju
    Fall, Tove
    Accelerometer-based physical activity is associated with the gut microbiota in 8416 individuals in SCAPIS.2024In: EBioMedicine, E-ISSN 2352-3964, Vol. 100, article id 104989Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous population-based studies investigating the relationship between physical activity and the gut microbiota have relied on self-reported activity, prone to reporting bias. Here, we investigated the associations of accelerometer-based sedentary (SED), moderate-intensity (MPA), and vigorous-intensity (VPA) physical activity with the gut microbiota using cross-sectional data from the Swedish CArdioPulmonary bioImage Study.

    METHODS: In 8416 participants aged 50-65, time in SED, MPA, and VPA were estimated with hip-worn accelerometer. Gut microbiota was profiled using shotgun metagenomics of faecal samples. We applied multivariable regression models, adjusting for sociodemographic, lifestyle, and technical covariates, and accounted for multiple testing.

    FINDINGS: Overall, associations between time in SED and microbiota species abundance were in opposite direction to those for MPA or VPA. For example, MPA was associated with lower, while SED with higher abundance of Escherichia coli. MPA and VPA were associated with higher abundance of the butyrate-producers Faecalibacterium prausnitzii and Roseburia spp. We observed discrepancies between specific VPA and MPA associations, such as a positive association between MPA and Prevotella copri, while no association was detected for VPA. Additionally, SED, MPA and VPA were associated with the functional potential of the microbiome. For instance, MPA was associated with higher capacity for acetate synthesis and SED with lower carbohydrate degradation capacity.

    INTERPRETATION: Our findings suggest that sedentary and physical activity are associated with a similar set of gut microbiota species but in opposite directions. Furthermore, the intensity of physical activity may have specific effects on certain gut microbiota species.

    FUNDING: European Research Council, Swedish Heart-Lung Foundation, Swedish Research Council, Knut and Alice Wallenberg Foundation.

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  • 12.
    Banda, Hazel Kwangu Chilima
    et al.
    Dalarna University, School of Health and Welfare.
    Elagbash, Ahmed
    Dalarna University, School of Health and Welfare.
    Sustaining change in maternal and child health: Perspectives from public health officials in Gambia, Kenya, Ethiopia, Malawi, Somalia, and Uganda2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: WHO guidelines' clarity on evidence-based quality midwifery practice emphasizes that knowledge should be translated into practice with adherence to recommended quality of midwifery care. The MIDWIZE Capacity Building Training Program was established to build the capacity of public health officials by ensuring that midwifery and maternal health care is consistent with international guidelines. The Capacity Building Training Program ensures that public health officials are trained in the field of reproductive, maternal, newborn, child, and adolescent health by following a MIDWIZE care model which adheres to the WHO guidelines' clarity on evidence-based quality midwifery practice. However, there is a gap in knowledge on what facilitates and sustains change and what inhibits change when quality improvement interventions are made in maternal and child health.

    Aim: To examine what brings change, what inhibits change, and what sustains change in Maternal and Child Health from the views of public health officials in five East African Countries.

    Methodology: Qualitative content analysis with a deductive research approach.

    Ethical Considerations: No ethical approval was needed to conduct this study.

    Result: The authors identified the government as being the central mandatory authority to facilitate and sustain change. The results emphasized the importance of evidence-based practice and using a multi-sectoral approach to facilitate change. An inhibitor to change was found to be an inadequate skilled workforce.

    Conclusion: The strategies mentioned by the participants in what facilitates and sustains change have been backed up by previous research and they are key to attaining positive outcomes in maternal and child health. 

  • 13.
    Banda, Hazel Kwangu Chilima
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Elagbash, Ahmed
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Sustaining change in maternal and child health: Perspectives from public health officials in Gambia,Kenya, Ethiopia, Malawi, Somalia, and Uganda: A qualitative study with participants in a Capacity BuildingTraining Program2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: WHO guidelines' clarity on evidence-based quality midwifery practice emphasizes that knowledge should be translated into practice with adherence to recommended quality of midwifery care. The MIDWIZE Capacity Building Training Program was established to build the capacity of public health officials by ensuring that midwifery and maternal health care is consistent with international guidelines. The Capacity Building Training Program ensures that public health officials are trained in the field of reproductive, maternal, newborn, child, and adolescent health by following a MIDWIZE care model which adheres to the WHO guidelines' clarity on evidence-based quality midwifery practice. However, there is a gap in knowledge on what facilitates and sustains change and what inhibits change when quality improvement interventions are made in maternal and child health. Aim: To examine what brings change, what inhibits change, and what sustains change in Maternal and Child Health from the views of public health officials in five East African Countries. Methodology: Qualitative content analysis with a deductive research approach. Ethical Considerations: No ethical approval was needed to conduct this study. Result: The authors identified the government as being the central mandatory authority to facilitate and sustain change. The results emphasized the importance of evidence-based practice and using a multi-sectoral approach to facilitate change. An inhibitor to change was found to be an inadequate skilled workforce. Conclusion: The strategies mentioned by the participants in what facilitates and sustains change have been backed up by previous research and they are key to attaining positive outcomes in maternal and child health.

  • 14. Baxter, Rebecca
    et al.
    Jemberie, Wossenseged Birhane
    Li, Xia
    Naseer, Mahwish
    Dalarna University, School of Health and Welfare, Social Work.
    Pauelsen, Mascha
    Shebehe, Jacques
    Viklund, Emilia
    Xia, Xin
    Elena Zulka, Linn
    Badache, Andreea
    COVID-19: Opportunities for interdisciplinary research to improve care for older people in Sweden2021In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, no 1, p. 29-32Article in journal (Refereed)
    Abstract [en]

    The emergence of COVID-19 has changed the world as we know it, arguably none more so than for older people. In Sweden, the majority of COVID-19-related fatalities have been among people aged ⩾70 years, many of whom were receiving health and social care services. The pandemic has illuminated aspects within the care continuum requiring evaluative research, such as decision-making processes, the structure and organisation of care, and interventions within the complex public-health system. This short communication highlights several key areas for future interdisciplinary and multi-sectorial collaboration to improve health and social care services in Sweden. It also underlines that a valid, reliable and experiential evidence base is the sine qua non for evaluative research and effective public-health systems.

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  • 15. Bengtsson Tops, Anita
    et al.
    Ehliasson, Kent
    Statens institutionsstyrelse.
    Ericsson, Ulf
    Det vardagliga livet på LSS-boende för personer med psykisk funktionsnedsättning: ett brukar- och professionsperspektiv2015Report (Other academic)
  • 16.
    Bergström, Anna
    et al.
    Uppsala University, Uppsala; University College London, London, UK.
    Hoa, Dinh Phuong
    Vietnam National Children's Hospital, Hanoi, Vietnam; Hanoi University of Public Health, Hanoi, Vietnam.
    Nga, Nguyen Thu
    Vietnam National Children's Hospital, Hanoi, Vietnam.
    Hoa, Trieu
    Provincial Health Bureau, Cao Bang, Vietnam.
    Tu, Tran Thanh
    National Children's Hospital, Hanoi, Vietnam.
    Lien, Pham Thi Lan
    National Children's Hospital, Hanoi, Vietnam.
    Trang, Tran
    National Children's Hospital, Hanoi, Vietnam.
    Wallin, Lars
    Dalarna University, School of Health and Welfare, Caring Science/Nursing.
    Persson, Lars-Åke
    London School of Hygiene & Tropical Medicine, London, UK.
    Eriksson, Leif
    Uppsala University, Uppsala; .
    A facilitated social innovation: stakeholder groups using Plan-Do-Study-Act cycles for perinatal health across levels of the health system in Cao Bang province, Vietnam2023In: Implementation Science Communications, E-ISSN 2662-2211, Vol. 4, article id 24Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Universal coverage of evidence-based interventions for perinatal health, often part of evidence-based guidelines, could prevent most perinatal deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to the implementation of evidence-based guidelines, but successful use of social innovations relies on the engagement of communities and health system actors. This proof-of-concept study aimed to assess whether an earlier successful social innovation for improved neonatal survival that employed regular facilitated Plan-Do-Study-Act meetings on the commune level was feasible and acceptable when implemented on multiple levels of the health system (52 health units) and resulted in actions with plausibly favourable effects on perinatal health and survival in Cao Bang province, northern Vietnam.

    METHODS: The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided the implementation and evaluation of the Perinatal Knowledge-Into-Practice (PeriKIP) project. Data collection included facilitators' diaries, health workers' knowledge on perinatal care, structured observations of antenatal care, focus group discussions with facilitators, their mentors and representatives of different actors of the initiated stakeholder groups and an individual interview with the Reproductive Health Centre director. Clinical experts assessed the relevance of the identified problems and actions taken based on facilitators' diaries. Descriptive statistics included proportions, means, and t-tests for the knowledge assessment and observations. Qualitative data were analysed by content analysis.

    RESULTS: The social innovation resulted in the identification of about 500 relevant problems. Also, 75% of planned actions to overcome prioritised problems were undertaken, results presented and a plan for new actions to achieve the group's goals to enhance perinatal health. The facilitators had significant roles, ensuring that the stakeholder groups were established based on principles of mutual respect. Overall, the knowledge of perinatal health and performance of antenatal care improved over the intervention period.

    CONCLUSIONS: The establishment of facilitated local stakeholder groups can remedy the need for tailored interventions and grassroots involvement in perinatal health and provide a scalable structure for focused efforts to reduce preventable deaths and promote health and well-being.

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  • 17.
    Bizjak, Isabella
    et al.
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Envall, Niklas
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Karolinska Institutet, Stockholm.
    Emtell Iwarsson, Karin
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Kopp Kallner, Helena
    Karolinska Institutet, Stockholm; Danderyd Hospital, Stockholm.
    Gemzell-Danielsson, Kristina
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Contraceptive uptake and compliance after structured contraceptive counseling - secondary outcomes of the LOWE trial2024In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 103, no 5, p. 873-883Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Highly effective long-acting reversible contraceptive (LARC) methods reduce unintended pregnancy rates; however, these methods are underutilized. The LOWE trial intervention provided structured contraceptive counseling resulting in increased uptake of LARC. This longitudinal follow up of the LOWE study assessed the long-term impact of the intervention by investigating the contraceptive use at 12 months with a focus on continued use of LARC.

    MATERIAL AND METHODS: In the cluster randomized LOWE trial, abortion, youth, and maternal health clinics were randomized to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of an educational video on contraceptive methods, key questions asked by the health care provider, a tiered effectiveness chart and a box of contraceptive models. Women ≥ age 18, who were sexually active or planned to be in the upcoming 6 months, could participate in the study. We assessed self-reported contraceptive use at three, six and 12 months. Contraceptive choice and switches were analyzed with descriptive statistics. Contraceptive use at 12 months and continued use of LARC were analyzed using mixed logistic regressions, with clinic included as a random effect. Analysis with imputed values were performed for missing data to test the robustness of results.

    RESULTS: Overall, at 12 months, women in the intervention group were more likely to be using a LARC method (aOR 1.90, 95% CI: 1.31-2.76) and less likely to be using a short-acting reversible contraceptive (SARC) method (aOR 0.66, 95% CI: 0.46-0.93) compared to the control group. Women counseled at abortion (aOR 2.97, 95% CI: 1.36-6.75) and youth clinics (aOR 1.81, 95% CI: 1.08-3.03) were more likely to be using a LARC method, while no significant difference was seen in maternal health clinics (aOR 1.84, 95% CI: 0.96-3.66). Among women initiating LARC, continuation rates at 12 months did not differ between study groups (63.9% vs. 63.7%). The most common reasons for contraceptive discontinuation were wish for pregnancy, followed by irregular bleeding, and mood changes.

    CONCLUSIONS: The LOWE trial intervention resulted in increased LARC use also at 12 months. Strategies on how to sustain LARC use needs to be further investigated.

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  • 18. Bjurling-Sjöberg, Petronella
    et al.
    Göras, Camilla
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Department of Anesthesia and Intensive Care Unit, Falun Hospital, Region Dalarna, Falun.
    Lohela-Karlsson, Malin
    Nordgren, Lena
    Källberg, Ann-Sofie
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Department of Emergency Medicine, Falun Hospital, Region Dalarna, Falun.
    Castegren, Markus
    Condén Mellgren, Emelie
    Holmberg, Mats
    Ekstedt, Mirjam
    Resilient performance in healthcare during the COVID-19 pandemic (ResCOV): study protocol for a multilevel grounded theory study on adaptations, working conditions, ethics and patient safety.2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 12, article id e051928Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Since early 2020, the COVID-19 pandemic has challenged societies and revealed the built-in fragility and dependencies in complex adaptive systems, such as healthcare. The pandemic has placed healthcare providers and systems under unprecedented amounts of strain with potential consequences that have not yet been fully elucidated. This multilevel project aims to explore resilient performance with the purpose of improving the understanding of how healthcare has adapted during the pandemic's rampage, the processes involved and the consequences on working conditions, ethics and patient safety.

    METHODS: An emerging explorative multilevel design based on grounded theory methodology is applied. Open and theoretical sampling is performed. Empirical data are gathered over time from written narratives and qualitative interviews with staff with different positions in healthcare organisations in two Swedish regions. The participants' first-person stories are complemented with data from the healthcare organisations' internal documents and national and international official documents.

    ANALYSIS: Experiences and expressions of resilient performance at different system levels and times, existing influencing risk and success factors at the microlevels, mesolevels and macrolevels and inter-relationships and consequences in different healthcare contexts, are explored using constant comparative analysis. Finally, the data are complemented with the current literature to develop a substantive theory of resilient performance during the pandemic.

    ETHICS AND DISSEMINATION: This project is ethically approved and recognises the ongoing strain on the healthcare system when gathering data. The ongoing pandemic provides unique possibilities to study system-wide adaptive capacity across different system levels and times, which can create an important basis for designing interventions focusing on preparedness to manage current and future challenges in healthcare. Feedback is provided to the settings to enable pressing improvements. The findings will also be disseminated through scientific journals and conferences.

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  • 19.
    Blomgren, Johanna
    et al.
    Karolinska Institutet, Stockholm.
    Gabrielsson, Sara
    Lund University Centre for Sustainability Studies, Lund.
    Erlandsson, Kerstin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Karolinska Institutet, Stockholm.
    Wagoro, Miriam C A
    University of Nairobi, Nairobi, Kenya.
    Namutebi, Mariam
    Makerere University College of Health Sciences, Kampala, Uganda.
    Chimala, Eveles
    Kamuzu University of Health Sciences, Blantyre, Malawi.
    Lindgren, Helena
    Karolinska Institutet, Stockholm; Sophiahemmet University, Stockholm.
    Maternal health leaders' perceptions of barriers to midwife-led care in Ethiopia, Kenya, Malawi, Somalia, and Uganda.2023In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 124, article id 103734Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify and examine barriers to midwife-led care in Eastern Africa and how these barriers can be reduced DESIGN: A qualitative inductive study with online focus group discussions and semi-structured interviews using content analysis SETTING: The study examines midwife-led care in Ethiopia, Malawi, Kenya, Somalia, and Uganda -five African countries with an unmet need for midwives and a need to improve maternal and neonatal health outcomes.

    PARTICIPANTS: Twenty-five participants with a health care profession background and current position as a maternal and child health leader from one of the five study countries.

    FINDINGS: The findings demonstrate barriers to midwife-led care connected to organisational structures, traditional hierarchies, gender disparities, and inadequate leadership. Societal and gendered norms, organisational traditions, and differences in power and authority between professions are some factors explaining why the barriers persist. A focus on intra- and multisectoral collaborations, the inclusion of midwife leaders, and providing midwives with role models to leverage their empowerment are examples of how to reduce the barriers.

    KEY CONCLUSIONS: This study provides new knowledge on midwife-led care from the perspectives of health leaders in five African countries. Transforming outdated structures to ensure midwives are empowered to deliver midwife-led care at all healthcare system levels is crucial to moving forward.

    IMPLICATIONS FOR PRACTISE: This knowledge is important as enhancing the midwife-led care provision is associated with substantially improved maternal and neonatal health outcomes, higher satisfaction of care, and enhanced utilisation of health system resources. Nevertheless, the model of care is not adequately integrated into the five countries' health systems. Future studies are warranted to further explore how reducing barriers to midwife-led care can be adapted at a broader level.

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  • 20.
    Bohman, Tony
    et al.
    Dalarna University, School of Health and Welfare, Medical Science. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Holm, Lena W
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lekander, Mats
    Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Hallqvist, Johan
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Skillgate, Eva
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden.
    Influence of work ability and smoking on the prognosis of long-duration activity-limiting neck/back pain: a cohort study of a Swedish working population2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e054512Article in journal (Refereed)
    Abstract [en]

    Objectives Long-duration activity-limiting neck/back pain is common, but the knowledge of what work and lifestyle factors that influence the prognosis is sparse. The objective was therefore to evaluate if two factors, good self-perceived work ability and no daily smoking, are associated with a favourable prognosis of long-duration activity-limiting neck/back pain in a working population, and if these exposures have a synergistic prognostic effect.

    Design A prospective cohort study based on three subsamples from the Stockholm Public Health Cohort.

    Settings A working population in Stockholm County, Sweden.

    Participants Individuals, 18–61 years old, reporting long-duration activity-limiting neck/back pain the previous 6 months at baseline in 2010 (n=5177).

    Measures The exposures were: self-perceived work ability (categorised into good, moderate and poor) and daily smoking (no/yes). The outcome in 2014 was ‘absence of long-duration activity-limiting neck/back pain’ the previous 6 months representing a favourable prognosis of reported problems at baseline in 2010. Risk ratios (RRs) and risk differences (RDs) with 95% CI was estimated by general linear regressions, and the synergistic effect was estimated by the synergy index (SI) with 95% CI.

    Results Participants with moderate or good work ability, respectively, had an adjusted RR for a favourable prognosis of 1.37 (95% CI 1.11 to 1.69), and 1.80 (1.49 to 2.17) in comparison with participants with poor work ability. The corresponding adjusted RD were 0.07 (0.02 to 0.11) and 0.17 (0.12 to 0.22). Participants not smoking on daily basis had an adjusted RR of 1.21 (1.02 to 1.42), and an adjusted RD of 0.05 (0.01 to 0.10) for a favourable outcome compared with daily smokers. The adjusted SI was 0.92 (0.60 to 1.43).

    Conclusion For participants with long-duration activity-limiting neck/back pain, moderate or good self-perceived work ability and not being a daily smoker were associated with a favourable prognosis but having both exposures seemed to have no synergistic prognostic effect.

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  • 21. Borg, Johan
    Assistive technology - A facilitator of human freedoms for people with disabilities?2011Conference paper (Other academic)
  • 22.
    Borg, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Commentary on selection of assistive technology in a context with limited resources2019In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 14, no 8, p. 753-754Article in journal (Refereed)
  • 23.
    Borg, Johan
    Lund universitet.
    The Participation Pyramid: a response to "Reconsideration ICF scheme" by Heerkens et al. 20172018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 1, p. 123-124Article in journal (Other academic)
  • 24.
    Borg, Johan
    et al.
    Lunds universitet.
    Ekman, Björn Olof
    Östergren, Per-Olof
    Is centre-based provision of hearing aids better than community-based provision?: A cluster-randomized trial among adolescents in Bangladesh2018In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 13, no 6, p. 497-503Article in journal (Refereed)
    Abstract [en]

    Purpose: In response to the need for hearing aids in low-income countries, an approach to provide hearing aids through trained community workers was developed. This study compares the effectiveness of the community-based approach with that of a centre-based approach. Methods: One hundred and forty adolescents (56% girls; 12-18 years; mean: 15 years) from eleven sub-districts participated in a cluster-randomized trial comparing a community-based service (n = 75) with a centre-based service (n = 65) in Bangladesh. The International Outcome Inventory for Hearing Aids (IOI-HA) was administered to the participants six weeks after fitting of a hearing aid, and its scores were analyzed by Mann-Whitney U-tests and an ordinal regression model. Results: The community-based approach performed as well as the centre-based approach on five out of seven outcome measures. The latter approach performed statistically significantly better on Residual participation restrictions (p = .007) and Impact on others (p = .012), but the effect sizes were small. Controlling for sex, age, hearing loss, place of living and proxy responses did not change the results. Conclusions: The community-based approach is a viable and effective option for hearing aid delivery in low-resourced settings. The approach needs to be adapted to particular contexts, and possible down-sides may need to be counteracted by special interventions.

  • 25.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Khasnabis, ChapalWorld Health Organization.Zhang, WeiWorld Health Organization.
    Global report on assistive technology2022Collection (editor) (Refereed)
  • 26.
    Borg, Johan
    et al.
    Lunds universitet.
    Larsson, Stig
    Assistive devices for people affected by leprosy: Underutilised facilitators of functioning?2009In: Leprosy Review, ISSN 0305-7518, E-ISSN 2162-8807, Vol. 80, no 1, p. 13-21Article in journal (Refereed)
    Abstract [en]

    Objectives People affected by leprosy and their families face social and economic problems. The focus of interventions is often on prevention of disabilities and socioeconomic rehabilitation. The objective of this study was to explore to what extent the potential of assistive devices to facilitate activities and participation of people affected by leprosy has been utilised. Design Published literature was reviewed and the findings analysed. Results Considerable attention has been given to the protecting role of assistive devices. The focus of assistive devices facilitating functioning has been on mobility aspects of self-care and domestic life. Conclusions The findings indicate that the potential of assistive devices to facilitate activities and participation in life areas such as work and employment is still waiting to be utilised on a broad scale.

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  • 27.
    Borg, Johan
    et al.
    Lunds universitet.
    Larsson, Stig
    Ostergren, Per-Olof
    The right to assistive technology: for whom, for what, and by whom?2011In: Disability & Society, ISSN 0968-7599, E-ISSN 1360-0508, Vol. 26, no 2, p. 151-167Article in journal (Refereed)
    Abstract [en]

    Despite its facilitating role in creating opportunities for people with disabilities to exercise human rights, access to assistive technology is limited in many countries. It is therefore promising that the Convention on Rights of Persons with Disabilities (CRPD) addresses this area. The purpose of this study was to analyse the assistive technology content of the CRPD from a basic human rights perspective in order to clarify its limitations and opportunities for formulation of policies and implementation strategies. Data were collected through a content analysis of the CRPD. It is concluded that a non-discriminatory interpretation of the provisions entitles all people with disabilities to a right to demand available and affordable assistive technology. Ensuring this right is a national as well as an international responsibility.

  • 28.
    Borg, Johan
    et al.
    Lunds universitet.
    Larsson, Stig
    Ostergren, Per-Olof
    Eide, Arne H.
    The Friction Model - a dynamic model of functioning, disability and contextual factors and its conceptual and practical applicability2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 21, p. 1790-1797Article in journal (Refereed)
    Abstract [en]

    Purpose. To develop a model of the dynamics of functioning, disability and contextual factors which harmonises with the International Classification of Functioning, Disability and Health (ICF). Method. Model parts based on ICF were identified and a model drawing from engineering concepts was developed. The conceptual and practical applicability of the model was discussed. Results. The so called Friction Model was created, which incorporates the ICF entities capacity, performance, environmental factors, health condition, body functions and structures, and personal factors. Friction describes the interaction between a person and his or her environment. The coefficient of friction is defined as the ratio between capacity and performance. Conclusion. Carrying conceptual strengths and limitations, the Friction Model appears to offer opportunities for practical applications, including ICF-based alternatives to health-economic analyses. Harmonising with the ICF model and terminology, the model uses friction to describe the interaction between a person and the environment. The coefficient of friction can be used as a simple measure of how facilitating an environment is. The applicability is not limited to functioning of people with impairments.

  • 29.
    Borg, Johan
    et al.
    Lunds universitet.
    Larsson, Stig
    Ostergren, Per-Olof
    Rahman, A. S. M. Atiqur
    Bari, Nazmul
    Khan, A. H. M. Noman
    Assistive technology use and human rights enjoyment: a cross-sectional study in Bangladesh2012In: BMC International Health and Human Rights, E-ISSN 1472-698X, Vol. 12, article id 18Article in journal (Refereed)
    Abstract [en]

    Background: About half a billion people with disabilities in developing countries have limited access to assistive technology. The Convention on the Rights of persons with Disabilities requires governments to take measures to ensure provision of such technologies. To guide implementation of these measures there is a need for understanding health outcomes from a human rights perspective. The objective of this study was therefore to explore the relation between assistive technology use and enjoyment of human rights in a low-income country. Methods: Data was collected in eight districts of Bangladesh through interviews of people with hearing impairments using and not using hearings aids, and people with ambulatory impairments using and not using manual wheelchairs (N = 583). Using logistic regression, self-reported outcomes on standard of living, health, education, work, receiving information and movement were analyzed. Results: The adjusted likelihood of reporting greater enjoyment of human rights was significantly higher among people using hearing aids compared to non-users for all outcomes except working status. Compared to non-users, users of wheelchairs reported a significantly higher adjusted likelihood of good ambulatory performance and a significantly lower adjusted likelihood of reporting a positive working status. Further analyses indicated that physical accessibility to working places and duration of wheelchair use had a statistically significant impact on the likelihood of reporting positive work outcomes. Conclusions: The findings support the notion that assistive technology use increases the likelihood of human rights enjoyment, particularly hearing aid use. Physical accessibility should always be addressed in wheelchair provision.

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  • 30.
    Borg, Johan
    et al.
    Lunds universitet.
    Larsson, Stig
    Östergren, Per-Olof
    Rahman, A. S. M. Atiqur
    Bari, Nazmul
    Khan, A. H. M. Noman
    User involvement in service delivery predicts outcomes of assistive technology use: A cross-sectional study in Bangladesh2012In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 12, article id 330Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge about the relation between user involvement in the provision of assistive technology and outcomes of assistive technology use is a prerequisite for the development of efficient service delivery strategies. However, current knowledge is limited, particularly from low-income countries where affordability is an issue. The objective was therefore to explore the relation between outcomes of assistive technology use and user involvement in the service delivery process in Bangladesh. Methods: Using structured interviews, data from 136 users of hearing aids and 149 users of manual wheelchairs were collected. Outcomes were measured using the International Outcome Inventory for Hearing Aids (IOI-HA), which was adapted for wheelchair users. Predictors of user involvement included preference, measurement and training. Results: Users reported outcomes comparable to those found in other high- and low-income countries. User involvement increased the likelihood for reporting better outcomes except for measurement among hearing aid users. Conclusions: The findings support the provision of assistive technology as a strategy to improve the participation of people with disabilities in society. They also support current policies and guidelines for user-involvement in the service delivery process. Simplified strategies for provision of hearing aids may be explored.

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  • 31.
    Borg, Johan
    et al.
    Lunds universitet.
    Lindstroem, Anna
    Larsson, Stig
    Assistive technology in developing countries: national and international responsibilities to implement the Convention on the Rights of Persons with Disabilities2009In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 374, no 9704, p. 1863-1865Article in journal (Refereed)
  • 32.
    Borg, Johan
    et al.
    Lunds universitet.
    Lindstrom, Anna
    Larsson, Stig
    Assistive technology in developing countries: a review from the perspective of the Convention on the Rights of Persons with Disabilities2011In: Prosthetics and Orthotics International, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 35, no 1, p. 20-29Article in journal (Refereed)
    Abstract [en]

    Background: The ‘Convention on the Rights of Persons with Disabilities’ (CRPD) requires governments to meet the assistive technology needs of citizens. However, the access to assistive technology in developing countries is severely limited, which is aggravated by a lack of related services. Objectives: To summarize current knowledge on assistive technology for low- and lower-middle-income countries published in 1995 or later, and to provide recommendations that facilitate implementation of the CRPD. Study design: Literature review. Methods: Literature was searched in web-based databases and reference lists. Studies carried out in low- and lower-middle-income countries, or addressing assistive technology for such countries, were included. Results: The 52 included articles are dominated by product oriented research on leg prostheses and manual wheelchairs. Less has been published on hearing aids and virtually nothing on the broad range of other types of assistive technology. Conclusions: To support effective implementation of the CRPD in these countries, there is a need for actions and research related particularly to policies, service delivery, outcomes and international cooperation, but also to product development and production.

  • 33.
    Borg, Johan
    et al.
    Lunds universitet.
    Ostergren, Per-Olof
    Users’ perspectives on the provision of assistive technologies in Bangladesh: awareness, providers, costs and barriers2015In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 10, no 4, p. 301-308Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this work was to contribute to a better understanding of challenges and solutions to equitable provision of assistive technologies in resource limited environments by (i) describing sources of awareness, types of providers and costs of assistive technologies; (ii) describing common reasons for not possessing assistive technologies; and (iii) comparing these sources, providers, costs and reasons among younger and older men and women living in urban and rural settings. Methods: Descriptive and analytic statistics were used to analyze crosssectional data from a total sample of 581 hearing aid users, wheelchair users, individuals with hearing impairments not using hearing aids and individuals with ambulatory impairments not using wheelchairs living in eight districts of Bangladesh. Results: Major sources of awareness, types of providers and costs paid varied between users of different types of assistive technology. Lack of affordability was the main reason for not possessing assistive technology. Outcome differences were found between younger and older groups, men and women, and literate and illiterate respondents, while no differences related to place of living were identified. Conclusions: Age, gender, type of impairment and socioeconomic status need to be considered when planning and implementing equitable provision of assistive technologies.

  • 34.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Winberg, Mikael
    Department of Science and Mathematics Education, Umeå University, 90187 Umeå, Sweden.
    Eide, Arne H
    Department of Health Research, SINTEF Digital, 0373 Oslo, Norway.
    Calvo, Irene
    Assistive Technology Access Team, Health Product Policy and Standards Department, World Health Organization, 1211 Geneva, Switzerland.
    Khasnabis, Chapal
    Assistive Technology Access Team, Health Product Policy and Standards Department, World Health Organization, 1211 Geneva, Switzerland.
    Zhang, Wei
    Assistive Technology Access Team, Health Product Policy and Standards Department, World Health Organization, 1211 Geneva, Switzerland.
    On the Relation between Assistive Technology System Elements and Access to Assistive Products Based on 20 Country Surveys2023In: Healthcare, E-ISSN 2227-9032, Vol. 11, no 9, article id 1313Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to explore the relationship between assistive technology system elements and access to assistive products. Data on assistive technology system elements and self-reported survey data on access to assistive products from 20 countries were analyzed using multivariate statistical methods, including orthogonal partial least squares analyses. Access to assistive products was primarily associated with the geographic coverage of assistive technology services in a country, followed by system elements related to policy and personnel. To achieve universal access to assistive technology, geographic coverage of assistive technology services is an instrumental system element. However, it requires the implementation of appropriate policies along with sufficient funding, recruitment of adequately trained personnel, and availability of assistive products in need.

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  • 35.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Zhang, Wei
    World Health Organization, Geneva, Switzerland.
    Assistive Technology Needs, Use and Experiences among Adults in Sweden Based on a Representative Survey2022In: ICCHP-AAATE 2022 Open Access Compendium: Assistive Technology, Accessibility and (e)Inclusion / [ed] Petz, Andrea; Hoogerwerf, Evert-Jan; Mavrou, Katerina, Linz: Association ICCHP , 2022, p. 101-107Conference paper (Refereed)
    Abstract [en]

    The objective of the study was to estimate the prevalence of needs for and use of assistive products, and experiences of assistive technology among adults under COVID-19 pandemic circumstances in Sweden. Mainly during June 2021, a nationally representative telephone survey was conducted to collect data through an adapted version of the WHO rapid Assistive Technology Assessment (rATA) questionnaire. Including spectacles, the prevalence of needing at least one assistive product was 68.9% and the prevalence of using at least one assistive product was 68.1%. Excluding spectacles, these prevalence rates were 17.1% and 15.8%, respectively. The access rate was 89.7% including spectacles and 83.2% excluding spectacles. The impact of the pandemic on assistive technology provision appeared to be relatively small.

  • 36.
    Borg, Johan
    et al.
    Dalarna University, School of Health and Welfare, Medical Science.
    Zhang, Wei
    Smith, Emma M.
    Holloway, Cathy
    Introduction to the companion papers to the global report on assistive technology2021In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614, Vol. 33, no sup1, p. 1-2Article in journal (Refereed)
  • 37.
    Borneskog, Catrin
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Northumbria University, Newcastle Upon Tyne, UK.
    Häggström-Nordin, Elisabet
    Stenhammar, Christina
    Tydén, Tanja
    Iliadis, Stavros I
    Changes in sexual behavior among high-school students over a 40-year period.2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 13963Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate sexual behavior, contraceptive use, risk factors as well as sources of sex information among first-year high-school students in Sweden. Secondly, to assess differences between genders and study programs as well as changes over a 40-year period. A repeated cross-sectional survey was conducted in two cities. A questionnaire comprising 77 items was used. The study population consisted of 415 students (63.4% females). The median age of sexual intercourse was 15 years. In total, 37% had had sexual intercourse, compared to 56.3% in 2009 and 45% in 1999 (p < 0.001), and the proportion of students who had their first sexual intercourse was not influenced by gender. More students in vocational programs (46.3%), compared to theoretical (33.3%), had experience of at least one sexual intercourse (p = 0.019). The same extend of contraception use at first and latest intercourse was reported, compared to previous studies. Forty-nine percent were mostly informed about sex from the internet, while in previous years, magazines, family and youth clinics were the main information sources. Comparing over time, students were in general less sexually experienced and less engaged in non-penetrative sex and physical intimacy. These findings call for a new approach, when designing sex and relationship education and health-care counseling in adolescents.

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  • 38.
    Brun Sundblad, Gunilla
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Mechbach, Jane
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Lundvall, Suzanne
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Nilsson, Johnny
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Orka hela vägen: Upplevd hälsa, idrotts- och träningsbakgrund bland studenter på en fysiskt inriktad yrkesutbildning.  Lärarstudenter GIH 2008 delrapport 1: 20092010Report (Other academic)
    Abstract [sv]

    Sammanfattning

    Ett sammanfattande porträtt av den nyantagna lärarstudenten vid GIH med utgångspunkt från enkätsvaren ger vid handen en bild av en person, som är ca 21 år gammal, född i Sverige och uppvuxen i en medelstor stad i Mellansverige. Studenten trivdes mycket bra i skolan och var som elev något över medel med MVG i idrott och hälsa.

    Valet av yrkesutbildning grundade sig på ett stort intresse för idrott, samt en önskan att få jobba med barn och ungdom. Studievalet hade för många påverkats av en tidigare idrotts-lärare, kompisar och familj. En bra lärare i idrott och hälsa är enligt studenten positiv, engagerad, rättvis, bestämd och kunnig.

    Lärarstudenten ser sig behärska bollspel väl. Störst kunskap och färdighet uppges i fot-boll och alpin skidåkning. Minst kunskap och färdighet skattades i softboll, baseboll, bergsklättring, långfärdsskridskoåkning och i konsten att kunna valla skidor. Många ser sig ha god kunskap om sambandet mellan hälsa, livsstil och miljö, men mindre god om hur en idrottsaktivitet har betydelse för kulturarvet, samband mellan miljö och männi-skans hälsa i ett historiskt och nutidsperspektiv samt i ergonomi.

    På sin fritid går lärarstudenten ofta på idrottsevenemang, café, tittar på TV och video eller umgås med vänner och familj. Lärarstudenten går sällan på bio och nästan aldrig på tea-ter, museum eller vernissager. "Vad är vernissage?" undrar en student.

    Hälsan, både fysiskt och psykiskt, skattas som tillfredsställande och man känner ofta hopp, glädje och meningsfullhet. Emellertid finner man sig även ofta stressad på grund av tidsbrist och alla krav. Många kvinnliga studenter (41%) rapporterade ryggont och många, både kvinnor och män, beskrev att de har besvär från en skadad fotled eller knä. De flesta lärarstudenterna är regelbundet fysiskt aktiva och de finner att mängden motion delvis är tillfredsställande.

    Förväntningarna är höga på utbildningen både att den är mångsidig och kommer att ge ökad kunskap inom olika områden. Under studietiden förväntar man sig att utvecklas och förbättra sin egen fysiska status och hälsa. En student uttrycker det med orden: "Mitt nya liv startar idag". Den sammanfattande bilden av lärarstudenten på GIH liknar den som tidigare har redovisats av Meckbach och Wedman i en liknande studie från maj 2005. Deras studie genomfördes på studenter efter ett års studier på GIH (Meckbach & Wed-man, 2007).

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  • 39.
    Busnardo, Solène Marie
    et al.
    Dalarna University, School of Health and Welfare.
    Giannakopoulou, Aikaterini
    Dalarna University, School of Health and Welfare.
    Alqarqani, Alhusayn Abdulhamid Hilal
    Dalarna University, School of Health and Welfare.
    Global policies on maternal mental health: A Scoping Review with a Policy Mapping2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Mental health (MH) has until recently been a neglected subject which is gradually being recognized from the governments worldwide. Although women are increasingly seeking for emotional support during the pregnancy period and the first year after birth, the main attention and studies remain focused on the medical aspects of those periods. leaving the various health policies and intervention plans addressing perinatal MH, insufficient and/or incomplete.

    Aim: This Scoping Review aims to present a worldwide Policy Mapping of the latest maternal mental health (MMH) policies from government agencies and major non-governmental organizations (NGOs), and a more in-depth view of recurrent influential factors across a few of the policies that acknowledge the MH of various vulnerable groups of women.

    Methodology: A Policy Mapping and a Scoping Review were chosen as the appropriate designs to present the percentage of countries that show awareness of MMH issues globally. A deductive Content Analysis identified recurrent categories in seven selected interrelated policies and provided a qualitative description of the findings.

    Results: The results of the quantitative research identified 103 countries that raise awareness on MMH in their latest policies, and 89 of them were from governmental sources. The study revealed 139 countries that had either no reachable data or did not address the issue in their policies. The Content Analysis of the seven selected policies identified a main category entitled ‘Influential socio-economic factors’ and two generic categories ‘Socio-cultural behaviors’ and ‘Socio-education inequalities’ with subcategories which highlight the family and individualism as both a strength and a burden for MMH. A holistic view of individuals in their specific context and the importance of speaking a common language is essential for appropriate mental healthcare. In low socio-economic groups more stigma and less identification of mental health issues is described.

    Conclusions: This study provides a global overview of the current awareness on MMH and supports world policy makers in strengthening the plans proposed on MMH issues. It sheds light on the need for contextualization and reflects the common needs and challenges for vulnerable groups of women.

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  • 40.
    Byrskog, Ulrika
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Uppsala universitet; Centre for Clinical Research, Falun.
    Olsson, Pia
    Uppsala universitet.
    Essén, Birgitta
    Uppsala universitet.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Being a bridge: Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence.

    Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis.

    Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women.

    Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

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  • 41.
    Byrskog, Ulrika
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Centrum för klinisk forskning, Dalarna, Institutionen för kvinnors och barns hälsa, Uppsala Universitet. .
    Olsson, Pia
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Essén, Birgitta
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Perceptions and experiences of war, violence, migration and reproductive health among Somali refugee women in Sweden2013In: 19th Nordic Midwifery Congress - Nordic and Global Challenges: Book of abstracts, 2013, p. 75-Conference paper (Refereed)
    Abstract [en]

    Perceptions and experiences of war, violence and migration and related sexual and reproductive health among Somali refugee women in Sweden.

    Background and objectives: Sweden has during the latest six years experienced a twofold increase of Somali born refugees. Elevated levels of pregnancy related morbidity and perinatal complications are seen among Somali born refugee women.  Research has shown links between a mother´s prenatal stress and anxiety and the health of the child the first year. Furthermore, violence towards a mother-to-be has negative health effects and increases the neonatal mortality The specific aim in the current study was to explore perceptions and experiences of war, violence and migration among Somali refugee women in Sweden. This in order to find strategies in caring for birth giving Somali refugee women, with possible experiences of violence, which would benefit the woman and society at large.

    Material and methods: Qualitative individual audio-recorded interviews were conducted with Somali born refugee women in fertile ages. Interviews were held in three steps: 1) personal narratives by newly arrived Somali born women, 2) perceptions and views out of a depersonalized case and 3) reflections upon emerging themes by female key persons of Somali origin. Thematic analysis according to Clarke and Braun was applied.

    Preliminary results: The analysis resulted in two main themes: Lives controlled by the presence of violence and Sacrificing for the sake of a future. Access to education, livelihood opportunities and health facilities has been strictly limited by the long-lasting civil war. Escalated violations of sexual and reproductive health and rights were a common triggering factor for finalizing escape. Lives have been extensively marked by family separations. Patience created by war and a pragmatic orientation in life have made survival possible.

    Conclusions: To be presented at the congress

    Implications for practice: The results will provide increased evidence based knowledge useful to midwives when caring and supporting birth giving refugee women.

     

     

     

  • 42.
    Byrskog, Ulrika
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Centrum för klinisk forskning, Dalarna, Institutionen för kvinnors och barns hälsa, Uppsala Universitet. .
    Olsson, Pia
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Essén, Birgitta
    Institutionen för kvinnors och barns hälsa, Uppsala Universitet .
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Violence, sexual and reproductive health and rights in Somalia: Qualitative interviews with Somali born women in Sweden2013Conference paper (Other academic)
    Abstract [en]

    Background: Political violence is a push factors for migration and social determinants of health among migrants. The Somali migration to Sweden has increased threefold during the latest six years, now comprising refugees with more than 20 years of war experiences. Adverse childbearing health and outcomes are reported among Somali born refugees in high income countries. Health is influenced by earlier life experiences and a link between adverse sexual and reproductive health, violence and mental distress is described in research. Therefore, the aim was to explore experiences and perceptions on war, violence and sexual and reproductive health before migration among Somali born women in Sweden.

     

    Method: Qualitative semi-structured individual interviews with Somali born refugee women living in Sweden were conducted, based on personal narratives and a hypothetical case. Thematic analysis was applied.

    Results: Escalating violence and power based restrictions permeated gradually all aspect of life and limited both access to and quality of reproductive health services in pre-migration Somalia. Formal societal support for women exposed to violence was absent. This reinforced shame and stigma connected to war related and community based sexual violence and the silence surrounding sexual and intimate partner violence. Women expressed survival strategies in the context of war based on social networks, pragmatism, strength and faith.

    Conclusions: Lack of formal structures on community levels has together with collective violence negatively impacted the whole spectra of women’s lives which have undermined the sexual and reproductive and health and rights. Several factors reinforce non-disclosure of violence exposure and can thus hamper health care seeking for violence related illness in the receiving country. Survival strategies shaped by war contain resources for resilience and enhancement of mental, sexual and reproductive health in receiving country.

    Keywords: Somalia, war, violence, refugee, sexual and reproductive health and rights, qualitative method, thematic analysis

     

  • 43.
    Byrskog, Ulrika
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Small, Rhonda
    Schytt, Erica
    Community-based bilingual doulas for migrant women in labour and birth: findings from a Swedish register-based cohort study2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 721Article in journal (Refereed)
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  • 44. Collaborators, GBD 2021 Nervous System Disorders
    et al.
    Steinmetz, Jaimie D
    Seeher, Katrin Maria
    Schiess, Nicoline
    Nichols, Emma
    Cao, Bochen
    Servili, Chiara
    Cavallera, Vanessa
    Ärnlöv, Johan
    Dalarna University, School of Health and Welfare, Medical Science.
    Dua, Tarun
    Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.2024In: Lancet Neurology, ISSN 1474-4422, E-ISSN 1474-4465, Vol. 23, no 4, p. 344-381Article in journal (Refereed)
    Abstract [en]

    Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed.Bill & Melinda Gates Foundation.

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  • 45.
    Dahir, Gallad
    et al.
    Somali National University, Mogadishu, Somalia.
    Kulane, Asli
    Karolinska Institutet.
    Omar, Bakar
    Somali National University, Mogadishu, Somalia.
    Osman, Fatumo
    Dalarna University, School of Health and Welfare, Caring Science/Nursing. Somali National University, Mogadishu, Somalia.
    We have almost accepted child spacing. Let's wait on family planning and limiting children': Focus group discussions among young people with tertiary education in Somalia2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 35, article id 100828Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Somalia has high rates of maternal mortality, fertility and pregnancy among young women. Factors contributing to this situation are a lack of knowledge regarding sexual and reproductive health, early marriages, cultural norms and the unmet need for or use of contraceptives. This study aimed to explore the perceptions of family planning among young men and women with tertiary education in Mogadishu.

    METHODS: A purposeful and convenience strategy using snowballing was used to recruit participants. Four focus group discussions were held online with 26 young women and men aged 19-25 years old. All participants were studying at five different universities in Mogadishu, and only one participant was married. The data were analysed using thematic analysis.

    FINDINGS: The findings showed that participants objected to the concept of family planning but supported the concept of child spacing. They highlighted that people of their generation with tertiary education practise child spacing to combine careers with family life. Although all the participants knew of the benefits of child spacing, they had different opinions on whether modern contraceptive methods were an option for them. They were more comfortable with traditional contraceptive methods and believed that the quality of the modern contraceptive medicine available in the country was unreliable.

    CONCLUSION: Our findings suggest that it is crucial not only to include young people in family planning awareness initiatives and implementation but also to give them a voice to advocate family planning and start dialogues within their own communities.

  • 46.
    Dahlberg, Lena
    et al.
    Dalarna University, School of Health and Welfare, Social Work. Aging Research Center, Karolinska Institutet and Stockholm University.
    McKee, Kevin
    Dalarna University, School of Health and Welfare, Social Work.
    Lennartsson, Carin
    Rehnberg, Johan
    A social exclusion perspective on loneliness in older adults in the Nordic countries2022In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 19, no 2, p. 175-188Article in journal (Refereed)
    Abstract [en]

    Several factors associated with loneliness are also considered indicators of social exclusion. While loneliness has been proposed as an outcome of social exclusion, there is limited empirical evidence of a link. This study examines the associations between social exclusion indicators and loneliness in older adults (60+ years) in four Nordic countries. Data from four waves of the European Social Survey were pooled, providing a total of 7755 respondents (Denmark n = 1647; Finland n = 2501, Norway n = 1540; Sweden n = 2067). Measures of loneliness, demographic characteristics, health, and eight indicators of social exclusion were selected from the survey for analysis. Country-specific and total sample hierarchical logistic regression models of loneliness were developed. Significant model improvement occurred for all models after social exclusion indicators were added to models containing only demographic and health variables. Country models explained between 15.1 (Finland) and 21.5% (Sweden) of the variance in loneliness. Lower frequency of social contacts and living alone compared to in a two-person household was associated with a higher probability of loneliness in all countries, while other indicators were associated with loneliness in specific countries: lower neighbourhood safety (Sweden and Denmark); income concern (Sweden and Finland); and no emotional support (Denmark, Finland, and Sweden). A robust relationship was apparent between indicators of social exclusion and loneliness with the direction of associations being highly consistent across countries, even if their strength and statistical significance varied. Social exclusion has considerable potential for understanding and addressing risk factors for loneliness.

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  • 47.
    de Alwis, Manudul Pahansen
    et al.
    KTH Royal Inst Technol, Sch Engn Sci, Dept Engn Mech, Stockholm, Sweden..
    Lo Martire, Riccardo
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Äng, Björn
    Dalarna University, School of Health and Welfare, Medical Science. Karolinska Institute, Huddinge; Uppsala University, Center for Clinical Research Dalarna, Falun.
    Garme, Karl
    KTH Royal Inst Technol, Sch Engn Sci, Dept Engn Mech, Stockholm, Sweden..
    Exposure aboard high-performance Marine craft increases musculoskeletal pain and lowers contemporary work capacity of the occupants2021In: Journal of Engineering for the Maritime Environment (Part M), ISSN 1475-0902, E-ISSN 2041-3084, Vol. 235, no 3, p. 750-762, article id 1475090220981466Article in journal (Refereed)
    Abstract [en]

    High-Performance Marine Craft (HPMC) occupants are currently being investigated for various psychophysical impairments degrading work performance postulating that these deteriorations are related to their occupational exposures. However, scientific evidence for this is lacking and the association of exposure conditions aboard HPMC with adverse health and performance effects is unknown. Therefore, the study estimates the prevalence of musculoskeletal pain (MSP) among HPMC occupants and the association of their work exposure with MSP and performance degradation. It also presents a criterion for evaluating the self-reported exposure severity aboard three different types of mono-hull HPMC; displacement, semi-displacement and planing, on a par with the available standard criteria for objectively measurable exposures. Furthermore, another criterion is proposed to assess the performance-degradation of HPMC occupants based on self-reported fatigue symptoms and MSP. Swedish Coast Guard HPMC occupants were surveyed for MSP, fatigue symptoms as well as for work-related and individual risk indicators using a validated web-based questionnaire. Prevalence of MSP and performance-degradation during the past 12 months were assessed and presented as a percentage of the sample. Associations of exposure conditions aboard HPMC with MSP and performance-capacity were systematically evaluated using multiple logistic regression models and expressed as odds ratio (OR). Prevalence of MSP was 72% among which lower back pain was the most prevalent (46%) followed by neck pain (29%) and shoulder pain (23%) while 29% with degraded performance. Exposure to severe conditions aboard semi-displacement craft was associated with lower back (OR = 2.3) and shoulder (OR = 2.6) pain while severe conditions aboard planing craft with neck pain (OR = 2.3) and performance-degradation (OR = 2.6). MSP is common among Swedish coast guards. Severe exposure conditions aboard HPMC are significantly associated with both MSP and performance-degradation. The spine and shoulders are the most susceptible to work-related MSP among HPMC occupants which should be targeted in work-related preventive and corrective measures.

  • 48. Desmond, Deirdre
    et al.
    Layton, Natasha
    Bentley, Jacob
    Boot, Fleur Heleen
    Borg, Johan
    Lunds universitet.
    Dhungana, Bishnu Maya
    Gallagher, Pamela
    Gitlow, Lynn
    Gowran, Rosemary Joan
    Groce, Nora
    Mavrou, Katerina
    Mackeogh, Trish
    McDonald, Rachael
    Pettersson, Cecilia
    Scherer, Marcia J.
    Assistive technology and people: a position paper from the first global research, innovation and education on assistive technology (GREAT) summit2018In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 13, no 5, p. 437-444Article in journal (Refereed)
    Abstract [en]

    Assistive technology (AT) is a powerful enabler of participation. The World Health Organization’s Global Collaboration on Assistive Technology (GATE) programme is actively working towards access to assistive technology for all. Developed through collaborative work as a part of the Global Research, Innovation and Education on Assistive Technology (GREAT) Summit, this position paper provides a “state of the science” view of AT users, conceptualized as “People” within the set of GATE strategic “P” s. People are at the core of policy, products, personnel and provision. AT is an interface between the person and the life they would like to lead. People’s preferences, perspectives and goals are fundamental to defining and determining the success of AT. Maximizing the impact of AT in enabling participation requires an individualized and holistic understanding of the value and meaning of AT for the individual, taking a universal model perspective, focusing on the person, in context, and then considering the condition and/or the technology. This paper aims to situate and emphasize people at the centre of AT systems: we highlight personal meanings and perspectives on AT use and consider the role of advocacy, empowerment and co-design in developing and driving AT processes.

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  • 49.
    Di Lauro, Emma
    et al.
    Dalarna University, School of Health and Welfare.
    Berglund, Moa
    Dalarna University, School of Health and Welfare.
    Kavengi, Sophia
    Dalarna University, School of Health and Welfare.
    Provision of sexual and reproductive health care services in Ukraine: A scoping review based on the “Minimum Initial Service Package” framework2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    In 2014 Russia invaded Crimea, a conflict that escalated in 2022. The ongoing conflict in Ukraine is said to have negative effects on health outcomes most especially sexual reproductive health. Therefore it becomes crucial to investigate what is/ and what has been missing in sexual reproductive health (SRH) services in Ukraine since the start of the conflict.

    This thesis investigates implementation of SRH services by using the Minimum Initial Service Package (MISP) framework. The framework consists of a series of Sexual and Reproductive Health (SRH) activities that have to be implemented to assure SRH services at the onset of an emergency.

    Through the scoping review method, this study aims to discover what is and has been missing in the SRH health services and try to answer research questions regarding what SRHR “gaps” exist and what SRH services are “available”.

    One of the main findings of the study shows that emergencies present a huge need for SRH services. The war in Ukraine has disrupted all systems, which has created gaps in services and supplies provision- including creating barriers limiting delivery of SRH services in the framework of MISP. 

  • 50.
    Djiemo, Catherine
    Dalarna University, School of Teacher Education.
    The practice of Breast Ironing in Cameroon: A qualitative interview study with women, healthcare professionals and community stakeholders2023Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: There is little awareness on the practice of breast ironing, its cultural roots, why it exists and what could be the impact of this practice on young girls’ physical and psycholigical health. In addition, it is important to understand more of how the practice is related to the process of natural puberty, what could be the relationship between breast ironing, selfimagination, and the right to a proper education in sexual and reproductive health.

    Aim: To explore experiences and perceptions of the breast ironing practice in Cameroon, from the perspectives of women, healthcare professionals and community stakeholders.

    Method: A descriptive qualitative design was used. Data was collected through qualitative structured interviews with young women, mothers, health care staff and stakeholders in community, analysed by qualitative content analysis.

    Results: The results of this study indicate the significance of women’s breast development in relation to sexuality, but it also brings to light the dangers that young girls go through with breast developments. A divide between the older and younger generation of women about breastironing was shown, with the older generation considering breast ironing practice as a preventive measure to ensure right to education, prevent child marriage and unwanted pregnancy while the young generation emphasized the violation of their human rights. Physical and psychological health consequences on the survivors and broken family relations were displayed.

    Conclusions: The practice of breast ironing is complex, contributing to individual suffering andb roken family relations and it is evident that there is a need for a concrete legislation that can be effective in protecting the right of girls within cultures and traditions that practice breastironing. Legislation should include access to sex education for young girls, boys and as well as mothers and fathers.

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