Annual Report 2012 - Institutionen för folkhälsa och klinisk medicin

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Annual Report 2012
Umeå International School of Public Health
Epidemiology and Global Health
Printed by Print & Media, Umeå, Sweden 2013
Prologue
2012 was another active and successful year for Epidemiology and Global Health both
with regard to research and education. To give a more detailed background, this
annual report summarizes our unit’s first 30 years. The report reflects both the
gradual building of Epidemiology and Global Health, the successive development of
our international collaborations and the journey from masters and graduate
programs to internationally renowned public health research.
Like in previous years, we are very proud to present a number of new researchers
who have completed their doctorate in 2012. The summaries of their dissertations
illustrate a true global public health perspective of our unit with a wide range of
research topics, broad geographic coverage and a large empirical base
We are also proud to announce that our Master of Public Health programme has
received the highest evaluation by the Swedish National Agency for Higher
Education. Moreover, our programme continues to attract international students in
spite of the introduction of tuition fees in 2011. With the generous donation from the
Swedish EP Foundation in 2012, our unit can further improve its ability to recruit
students by offering more scholarships to applicants from non-EU countries over the
coming 5 years.
Epidemiology and Global Health remains one of Umeå University's strong research
environments. The unit is also one of the University's most international
environments and is engaged, despite a quite limited number of employees, in
competitive research collaboration with colleagues in both Asia, Australia, Africa,
Europe, North America and South America!
Thanks to excellent efforts by teachers, administrators and students it has been
possible for Epidemiology and Global Health, year after year, to remain as an
attractive and creative academic environment. However, Epidemiology and Global
Health is highly dependent on good partnerships. The positive climate of cooperation
within the Department of Public Health and Clinical Medicine is extremely valuable,
as well as our extensive partnerships with Västerbotten County Council.
By this annual report we thank our staff, our partners within Umeå University and all
other partners, both national and international, for their efforts during the year 2012.
Lars Weinehall
Head of unit
Yulia Blomstedt
Deputy head of unit
Contents
PAGE
Introduction................................................................................................... 1
PhD events during 2012 ..................................................................................................................... 1
Scholarships ..................................................................................................................................... 16
Thirty years’ work in a nutshell ................................................................................... 17
Institutional setting ........................................................................................................22
Organisation .........................................................................................................................22
Staff development ................................................................................................................22
Budget ..................................................................................................................................23
Progress ................................................................................................................................24
Staff ..................................................................................................................................... 30
Research activities ..........................................................................................................36
Working together globally to meet health challenges .......................................................... 37
Training at Umeå International School of Public Health ......................................39
Master of Public Health Programme ...................................................................................39
Single subject courses .......................................................................................................... 41
Highest marks for public health in Umeå ............................................................................ 41
Research training .................................................................................................................42
Educating Medical students .................................................................................................43
Biomedical programme ........................................................................................................43
Publications ..................................................................................................................... 48
Original articles 2012 .......................................................................................................... 48
Other publications 2012 ...................................................................................................... 56
Doctoral theses 1987-2012 ................................................................................................... 57
Licentiate theses 1994-2012 ................................................................................................. 61
Public health report series 2012...........................................................................................62
MFS-reports 2012 ............................................................................................................... 64
Epidemiology and Global Health – Annual Report 2012
PhD events during 2012
Fredrik Norström
Hailemariam Lemma Reda
1
Pham Thai Son
Ngyuen Ngoc Quang
2
Anna Myléus
Ana Lorena Ruano
3
Cynthia Anticona Huaynate
Anna Rosén
4
Felix Kisanga
5
Fredrik Norström
The burden of celiac disease and the value of
having it diagnosed
Thesis defended 11 May, 2012
Supervisors: Anneli Ivarsson, Lars Lindholm, Olof Sandström, Curt
Löfgren, Hans Stenlund
Opponent: Docent Pekka Collin, Tampere University Hospital,
Tampere, Finland
Background: Celiac disease is a chronic disease characterized by intolerance to gluten. It is
considered a public health problem affecting about 1% of Western populations, but, with most cases
still undiagnosed. A glutenfree diet is the only effective treatment for the disease.
Objectives: To investigate the burden of celiac disease and the value of having it diagnosed.
Additionally, the implications for a potential future celiac disease mass screening are discussed.
Methods: A questionnaire was sent during 2009 to 1,560 randomly selected adult members of the
Swedish Society for Coeliacs, in equal-sized age- and sex strata, and 1,031 (66%) responded. Members
were asked about symptoms, health-related quality of life as measured by EQ-5D, and health care
consumption during the year prior to diagnosis and during the past year. They were also asked about
the delay in having their celiac disease diagnosed and the appearance of other immune-mediated
diseases. A school-based celiac disease screening of 12-year-olds was performed during 2005-2006.
After blood sampling the 7,567 participating children and their parents received a questionnaire
including the EQ-5D instrument in order to measure the child’s health-related quality of life.
Comparisons were made between children with screening-detected celiac disease, those with
previously diagnosed disease and those without the disease. Parents were asked about their
willingness to pay for a celiac disease screening of their child, which was compared with the actual cost
of a screening.
Results: Adult celiac disease patients had a poorer health-related quality of life than the general
population, and a high prevalence of symptoms before celiac disease diagnosis. The mean delay from
symptoms to diagnosis was 9.7 years. After initiated treatment with a gluten-free diet, health-related
quality of life was improved to the level of the general population, and symptom relief and reduction in
health care consumption were also reported. For children, health-related quality of life was similar
across groups. The average cost per child for a screening was 47 EUR. Parents’ mean willingness to pay
for a screening was 79 EUR, median 10 EUR.
Conclusion: The delay in celiac disease diagnosis is long, and treatment with a gluten-free diet
substantially improved health for clinically detected cases. For screening-detected celiac disease the
health benefits are still uncertain. A mass screening might nevertheless be justified to avoid the burden
of living with undiagnosed disease, and parents’ willingness to pay indicates that performing it in
childhood might be economically motivated. However, as both the cost-effectiveness of a screening
and the short- and long term health benefits for screening-detected cases have not yet been sufficiently
investigated, it is too early to make a recommendation for a celiac disease mass screening.
6
Hailemariam Lemma Reda
Improving efficiency, access to and quality of the
rural Health Extension Programme in Tigray,
Ethiopia: the case of malaria diagnosis and
treatment
Thesis defended 15 May, 2012
Supervisors: Miguel San Sebastian, Curt Löfgren
Opponent: Ass prof Wakgari Deressa, School of Public Health, Addis
Ababa University, Addis Ababa, Ethiopia
Introduction: Ensuring universal access to primary health care (PHC) is a key component of the
Ethiopian nationalhealth policy. The policy also emphasises promoting and enhancing national selfreliance in health development bymobilizing and efficiently utilizing resources including community
participation. To this end, the government introducedthe accelerated expansion of the PHC strategy
through a comprehensive health extension programme (HEP). HEP is afamily and community-based
health care delivery system institutionalised at health post level which combines carefullyselected high
impact promotive, preventive and basic curative interventions. All HEP interventions are promotive
and preventive except the malaria intervention which, in addition, incorporates a curative service. In
the country, malaria is a leading disease. Unlike most Sub-Saharan African countries where P.
falciparum accounts for almost all malaria infections, in Ethiopia both P. falciparum and P. vivax are
co-dominant. Considering this peculiar epidemiological nature, the national guideline recommends
alternative diagnosis and treatment strategies.
Rationale: The lack of adequate resources and the efficiency with which available resources are being
utilised are the main challenges in any health care setting. Therefore, if the HEP which consumes
consideral amount of resource desires to reach its intended goal, monitoring and improving its
efficiency is of great public heath importance. HEP has been successful in improving access to PHC
including the malaria diagnosis and treatment service. Though this is a crucial measure, its quality
ought to be considered. For the malaria curative service, studying the cost-effectiveness of the
available strategy and patients’ adherence to the treatment regimen can be considered as proxy
measures of quality for which local evidence is lacking. However, none of the existing studies in this
field of research has addressed the Ethiopian malaria epidemiological context and its diagnosis and
treatment guideline. In Tigray, for more than two decades, access to malaria early diagnosis and
prompt treatment was facilitated by volunteer community healthworkers (CHWs). However, with the
introduction of artemether-lumefantrine (AL) the service was compromised mainly for reasons of cost,
safety and logistic. Therefore, it was important to explore the feasibility and the impact of community
deployment of AL with rapid diagnostic tests (RDTs).
The aim: to explore the overall performance of HEP and particularly the access to and quality of
malaria early diagnosis and prompt treatment in the Tigray region of Ethiopia.
Methods: Different study designs and populations were used for each of the four specific objectives.
Data envelop analysis (DEA) was applied to assess the HEP efficiency. For this, register data for the
output variables and primary data for the input and the environmental factors were collected. A health
provider perspective cost-effectiveness analysis was used to determine which among the currently
available diagnostic and treatment strategies is best for the country. Effectiveness data were generated
from a stratified cross-sectional survey and secondary data were used to calculate the cost. For
measuring adherence to the six-dose AL regimen, an assessment questionnaire and pill count was
employed at patients´ home. To determine whether deploying AL with RDT at community level was
feasible and effective, a number of designs were used: longitudinal follow-up, cross-sectional surveys,
cost analysis, verbal autopsyquestionnaires and focal group discussions.
Main findings: More than three-quarters of the health posts were found to be technically inefficient
with an average score of 42%, which implies potentially they could improve their efficiency by 58%.
Scale of operation was not a cause of inefficiency. None of the considered environmental factors was
7
associated with efficiency. The Parascreen-based strategy (multispecies RDT-BS) was found to be the
most cost-effective strategy, which allowed treating correctly an additional 65% of patients with less
cost than the paracheck-BS. Presumptive-BS was highly dominated. Among P.falciparum positive
patients to whom AL was prescribed, more than a quarter did not finish their treatment. The main
reasons for interrupting the dose were ‘too many tablets’ and ‘felt better before finishing the dose’. The
ownership of aradio, the belief that malaria cannot be treated traditionally and a delay of more than
one day in seeking treatment after the onset of fever were significantly associated with being adherent.
Deploying AL with RDT at community level was demonstrated to be effective and feasible. In the
intervention district, almost 60% of suspected cases were managed by CHWs. Malaria transmission
was lower at least threefold and malaria mortality risk by around 40% compared to the control district.
The use of RDTs reduced cost and possibly the risk of drug resistance development.
Conclusion: Though improving access to health care is important, it should be considered a means,
not an end. Themore accessible a system is the more people could utilise it to improve their health.
Thus, ensuring the access obtainedthrough HEP is maintained, its quality is improved and efficiently
utilised to its optimal productivity level is a necessarytask. The DEA study revealed a high level of
inefficiency where majority of the health posts needed improvement.This thesis also found parascreenBS to be the most cost-effective strategy and that there is no epidemiological andeconomical
contextual justification to keep both, the presumptive-BS and the RDT-BS specific only to
P.falciparum.The high poor adherence levels raises great concern as it leads to recurrent malaria
attacks of the patient, speed upthe development and spread of drug resistance strains and reduces the
effect of the drug on the transmission. Therefore,providing effective drug alone is not sufficient;
assessing and monitoring adherence to the treatment is by faressential. Deployment of AL with RDT
through a community-based service has shown an enormous impact in termsof cost, transmission,
morbidity and mortality. However, it is worth noting that this results came from an area wherea
community-based service has been involved in the PHC system for more than three decades.
8
Pham Thai Son
Hypertension in Vietnam. From communitybased studies to a national targeted programme
Thesis defended 1 June, 2012
Supervisors: Peter Byass, Nguyen Lan Viet, Stig Wall, Lars
Weinehall, Ruth Bonita
Opponent: Vice-rektor Alexandra Krettek, Nordic School for Public
Health, Göteborg
Background: In the context of transitional Vietnam, hypertension has been shown to be one of the
ten leading causes of morbidity and mortality in hospitals. However, population-based data on
hypertension are to a large extent lacking. This thesis aims to characterise the current epidemiology of
hypertension in the adult Vietnamese population and provide preliminary evidence for developing
effective community-based hypertension management programmes nationwide.
Methods: The study was conducted during 2002-2010. It includes two national surveys of the adult
population aged 25 years and older, randomly selected in eight provinces in different regions of
Vietnam, as well as a community-based programme on hypertension management in two communes
of Bavi district. The survey on hypertension and associated risk factors, which included 9,832 adults,
applied the WHO STEP-wise approach. The survey on hypertension-related knowledge and health
seeking behaviour included 31,720 adults, using a structured questionnaire. For the community-based
study, three-year follow-up data on 860 hypertensives was used to assess the effectiveness of the
hypertension control model.
Main findings: Hypertension prevalence was high (overall 25.1%, 28.3% in men and 23.1% in
women). The proportions of hypertensives aware, treated and controlled were unacceptably low
(48.4%, 29.6% and 10.7% respectively). Most Vietnamese adults (82.4%) had good knowledge about
high blood pressure. People received their information on hypertension from mass media
(newspapers, radio, and especially television). Most people would choose a commune health station
(75%) if seeking health care for hypertension. The programme on hypertension control was able to run
independently at the commune health station. Severity of hypertension and effectiveness of treatment
were the main factors influencing people’s adherence to the programme. The hypertension control
programme successfully reduced blood pressure (systolic blood pressure: -2.2 mmHg in men and -7.8
mmHg in women; diastolic blood pressure: -4.3 mmHg in men and -6.8 mmHg in women), the
estimated CVD 10-year risk (-2.5% in women), and increased the proportions of treatment (22% in
men and 13.6% in women) and control (11% in men and 17.3% in women) among hypertensive people.
Suggestions for hypertension control: (1) Address the general population by developing
community interventions, particularly salt reduction; (2) Provide interventions to individuals at high
risk of a CVD event, including multi-drug treatment within patient-centred primary health care. (3)
Set up a hypertension care network based in the existing health care system; (4) Improve and
strengthen capacity and skills of medical staff in cardiac care, particularly staff at primary care level.
9
Ngyuen Ngoc Quang
Understanding and managing cardiovascular
disease risk factors in Vietnam. Integrating
clinical and public health perspectives
Thesis defended 1 June, 2012
Supervisors: Peter Byass, Nguyen Lan Viet, Stig Wall, Ruth Bonita,
Lars Weinehall
Opponent: Professor Göran Bondjers, Göteborg University
Background: Vietnam, like other low-income countries, is facing an epidemic burden of
cardiovascular disease risk factors (CVDRFs). The magnitude and directions of CVDRF progression
are matters of uncertainty.
Objectives: To describe the epidemiological progression of CVDRFs and the preventive effects of
community lifestyle interventions, with reference to the differences in progression of CVDRF patterns
between men and women.
Methods: The study was conducted during 2001-2009 in nationally representative samples and in a
local setting of rural areas of Ba-Vi district, Ha-Tay province. Both epidemiological and interventional
approaches were applied: (i) a population-based cross-sectional survey of 2,130 people aged ≥25 years
in Thai-Binh and Hanoi; (ii) an individual participant-level meta analysis of 23,563 people aged 24-74
years from multiple similar surveys in 9 provinces around Vietnam; (iii) a 17-month cohort study of
497 patients in a hypertension management programme; (iv) a quasi-experimental trial on community
lifestyle promotion integrated with a hypertension management programme, evaluated by surveys of
4,645 people in both intervention and reference communes before and after a 3-year intervention.
Main findings: (i) in the general adult population ≥25 years, CVDRFs were common, often clustered
within individuals, and increased with age; (ii) the Vietnamese population is facing a growing epidemic
of CVDRFs, which are generally not well managed; (iii) it is possible to launch a community
intervention in low-resource settings within the scope of a commune-based patient-targeted
programme on hypertension management; (iv) community health intervention with comprehensive
healthy lifestyle promotion improves blood pressure and some behavioural CVDRFs.
Conclusion: Alarming increases in CVDRFs in the general population need comprehensive multilevel prevention strategies, which combine both individual high-risk and population health
approaches. The commune-based hypertension-centred management programmes integrated with
community health promotion are the initial but essential steps towards comprehensive and effective
management of CVDRFs and should be part of an integrated and co-ordinated national program on
the prevention and control of chronic diseases in low-resource settings like Vietnam.
10
Anna Myléus
Towards explaining the Swedish epidemic of
celiac disease - an epidemiological approach
Thesis defended 21 September, 2012
Supervisors: Anneli Ivarsson, Hans Stenlund, Stig Wall
Opponent: Stefano Guandalini, Department of Pediatrics, The
University of Chicago Medicine, Chicago, US
Background: Celiac disease occurs worldwide in approximately 1% of the population, whereof the
majority of cases are undiagnosed. Sweden experienced an epidemic (1984-1996) of clinically detected
celiac disease in children below 2 years of age, partly attributed to changes in infant feeding. Whether
the epidemic constituted a change in disease occurrence and/or a shift in the proportion of diagnosed
cases remains unknown. Moreover, the cause of the epidemic is not fully understood.
Objective: To increase the knowledge regarding the occurrence of celiac disease in Sweden, with
focus on the epidemic period and thereafter, as well as the etiology of celiac disease in general, by
investigating the Swedish epidemic and its potential causes.
Methods: We performed a two-phased cross-sectional multicenter screening study investigating the
total prevalence, including both clinically- and screening-detected cases, of celiac disease in 2 birth
cohorts of 12-year-olds (n=13 279): 1 of the epidemic period (1993) and 1 of the post-epidemic period
(1997). The screening strategy entailed serological markers analyses, with subsequent small intestinal
biopsy when values were positive. Diagnosis was ascertained in clinical cases detected prior to
screening. Infant feeding practices in the cohorts were ascertained via questionnaires. An ecological
approach combined with an incident case-referent study (475 cases, 950 referents) performed during
the epidemic were used for investigating environmental- and lifestyle factors other than infant feeding.
Exposure information was obtained via register data, a questionnaire, and child health clinic records.
All studies utilized the National Swedish Childhood Celiac Disease Register.
Results: The total prevalences of celiac disease were 2.9% and 2.2% for the 1993 and 1997 cohorts,
respectively, with 2/3 cases unrecognized prior to screening. Children born in 1997 had a significantly
lower celiac disease prevalence compared to those born in 1993 (prevalence ratio, 0.75; 95%
confidence interval [CI], 0.60-0.93). The cohorts differed in infant feeding; more specifically in the
proportion of infants introduced to dietary gluten in small amounts during ongoing breastfeeding. Of
the environmental and lifestyle factors investigated, no additional changes over time coincided with
the epidemic. Early vaccinations within the Swedish program were not risk factors for celiac disease.
Early infections (≥3 parental-reported episodes) were associated with increased risk for celiac disease
(adjusted odds ratio [OR] 1.5; 95% CI, 1.1-2.0), a risk that increased synergistically if, in addition to
having ≥3 infectious episodes, the child was introduced to gluten in large amounts, compared to small
or medium amounts, after breastfeeding was discontinued (OR 5.6; 95% CI, 3.1-10). Early infections
probably made a minor contribution to the Swedish epidemic through the synergistic effect with
gluten, which changed concurrently. In total, approximately 48% of the epidemic could be explained
by infant feeding and early infections.
Conclusion: Celiac disease is both unexpectedly prevalent and mainly undiagnosed in Swedish
children. Although the cause of the epidemic is still not fully understood, the significant difference in
prevalence between the 2 cohorts indicates that the epidemic constituted a change in disease
occurrence, and importantly, corroborates that celiac disease can be avoided in some children, at least
up to 12 years of age. Our findings suggest that infant feeding and early infections, but not early
vaccinations, have a causal role in the celiac disease etiology and that the infant feeding practice –
gradually introducing gluten-containing foods from 4 months of age, preferably during ongoing
breastfeeding – is favorable.
11
Ana Lorena Ruano
The role of social participation in municipal-level
health systems: the case of Palencia, Guatemala
Thesis defended 19 October, 2012
Supervisors: Miguel San Sebastian, Anna-Karin Hurtig, Kjerstin
Dahlblom
Opponent: Associate professor Francoise Barten, Radboud
University Nijmegen, The Netherlands
Background: Social participation has been recognized as an important public health policy since the
declaration of Alma-Ata presented it as one of the pillars of primary health care in 1978. Since then,
there have been many adaptations to the original policy recommendations, but participation in health
is still seen as a means to make the health system more responsive to local health needs, and as a way
to bring the health sector and the community closer together.
Aim: To explore the role that social participation has in a municipal-level health system in Guatemala
in order to inform future policies and programs.
Methods: The fieldwork for this study was carried out over eight months and three field visits
between early January of 2009 and late March of 2010. During this time, 38 indepth interviews with
provincial and district-level health authorities, municipal authorities, community representatives and
community health workers were conducted. Using an overall applied ethnographic approach, the main
means of data collection were participant observation, in-depth interviews, group discussions and
informal conversations. The data was analyzed in two different rounds. In the first one we used
documentary analysis, role-ordered matrices and thematic analysis (see papers I-IV) and in the second
round, thematic analysis was utilized.
Results: We found four themes that frame what the role of social participation in the municipality of
Palencia is. The first theme presents the historical, political and social context that has contributed to
shaping the participation policies and practices in Guatemala as a whole. The second theme takes a
deeper look at these policies and how they have been received in the municipality of Palencia. The
third theme presents data regarding the three situated practices of participation, each occurring at a
different level: municipal, community and the individual level. Finally, the last theme presents
reflections on what it means to participate to the people that were involved in this study.
Conclusion: In the process of social participation there are two different and complementary kinds of
power that depend on the amount and the kind of resources available at each level of the participation
structure. Stakeholders that have higher levels of power to formulate policies will have better access to
financial, human and material resources while stakeholders that have higher levels of power to
implement policies will have resources like community legitimacy, knowledge of local culture, values
and mores, as well as a deep understanding of local social processes. The coordination of financial,
human and material resources is just as important as the legitimacy that comes from having
community leaders involved in more steps of the process. True collaboration can only be obtained
through the promotion and creation of meaningful partnerships between institutional stakeholders
and community leaders and other stakeholders that are working at the community level. For this to
happen, more structured support for the participation process in the form of clear policies, funding
and capacity building is needed.
12
Cynthia Anticona Huaynate
Lead exosposure in indigenous children of the
Peruvian Amazon: Seeking the hidden source,
venturing into participatory research
Thesis defended 30 November, 2012
Supervisors: Miguel San Sebastian, Ingvar Bergdahl
Opponent: Assistant professor Mary Jean Brown, Department of
Society, Human Development and Health, Harvard School of Public
Health, Boston, USA
Introduction. In 2006, a Peruvian environmental agency reported the presence of elevated blood
lead levels (BLLs) in indigenous communities of the Corrientes river basin. This is a territory in the
Peruvian Amazon where oil activity has been associated with serious environmental effects, with
impact on an ongoing social conflict. This PhD project aimed to determine the lead sources, risk
factors and pathways in children of these communities and to suggest control and prevention
strategies. Given the arguments attributing the lead source to the oil activity pollution, the second
objective was to clarify any potential connection between the two. This project was conducted by a
collaborative research partnership with the regional health authorities and the community-based
organization. The third objective was to characterize the challenges, facilitating factors and the lessons
learned from the research process.
Methods. Two epidemiological studies were conducted. Study I (2009) was carried out in three
communities and study II (2010) in six communities with different levels of exposure to oil activity.
The participants were children 0–17 years old. Data collection included: determination of BLLs,
hemoglobin levels and anthropometric indicators, a risk factor questionnaire, an environmental
assessment and a risk map. Data analysis included univariate, bivariate and multivariate logistic
regression. Data for the third objective came from field notes, documents, interviews and a process of
collective reflection.
Results. Study I (n= 221) found no significant difference in the geometric mean(GM) BLLs between
the communities exposed and not exposed to oil activity. Older age and being a boy were found as risk
factors for BLLs ≥ 10 μg/dL. In study II (n= 346), age stratified logistic regression models indicated
that children 0–3 years whose mothers had BLLs ≥ 10 μg/dL, children 0–6 years who played with
pieces of lead and children 7–17 years who fished 3 times or more per week or chewed pieces of lead to
manufacture fishing sinkers had a significant increased risk of having BLLs ≥ 10 μg/dL. Children who
lived in communities near oil battery facilities also had a significant increased risk of having BLLs ≥ 10
μg/dL. In both studies, environmental samples showed lead concentrations below reference levels. The
challenges and facilitating factors identified focused on five interrelated themes: i) mutual trust, ii)
multiple agendas, iii) equal participation, iv) competing research paradigms and v) complex and
unexpected findings.
Conclusions. Metal lead appeared to be the main source of exposure. Playing with pieces of lead and
chewing pieces of lead to construct fishing sinkers appeared to be pathways of exposure for children
aged 0–6 years and 7–17 years, respectively. Mothers’ BLLs > 10 μg/dL was a risk factor for BLLs > 10
μg/dL in children aged 0–3 years. Living in a community with high exposure to oil activity was a risk
factor for BLLs > 10 μg/dL. The identified connection with oil activity was the proximity of
communities to oil battery facilities and thus greater access to lead from cables and other industrial
waste. Despite the numerous challenges, participatory research appears to be the most appropriate
approach for this type of context. The study findings led us to recommend:i) a comprehensive
community-based lead control and prevention plan,ii) the introduction of substitute non-harmful
material(s) for fishing sinkers and iii) secure containment of the oil company’s waste deposits.
13
Anna Rosén
Mass screening for celiac disease in 12-year-olds.
Finding them and then what?
Thesis defended 6 December, 2012
Supervisors: Anneli Ivarsson, Hans Stenlund, Maria Emmelin, Olof
Sandström
Opponent: Docent Claes Hallert, Institutionen för samhälls och
välfärdsstudier, hälsouniversitetet i Linköping
Background Mass screening for celiac disease (CD) as a public health intervention is controversial.
Before implementation, a suitable screening strategy should be outlined, and the acceptability of the
screening scrutinized. Also, the benefits of early detection and possible negative consequences should
be explored and compared. The overall aim of this thesis was to evaluate different strategies for finding
12-year-olds with undiagnosed CD in the general population, and to explore the experiences of those
receiving the diagnosis in a mass screening.
Methods A school-based CD screening of 12-year-olds was conducted in five study sites across
Sweden. Out of 10041 children who were invited, 7208 had a blood sample analyzed for CD-marker
tissue transglutaminase of isotype IgA (tTG-IgA) and 7161 for total serum IgA (s-IgA). If the s-IgA
value was low, tTG-IgG was also measured. Additional analysis of endomysial antibodies (EMA) was
performed if borderline values of tTG were found. In total, 192 had elevated CD-markers, 184
underwent a small intestinal biopsy and 153 eventually had CD diagnosed. Before receiving knowledge
about their CD status, children and their parents filled in questionnaires regarding symptoms and CDassociated conditions. Questionnaires were returned by 7054 children (98%) and 6294 parents
(88%). Later, all adolescents who had been diagnosed with CD more than one year ago (n=145), and
their parents, were invited to a mixed-method follow-up study in which they shared their experiences
in questionnaires, written narratives and focus group discussions. In total, we have information on 117
(81%) of these adolescents, either from the adolescents themselves (n=101) and/or from their parent/s
(n=125). Data were analyzed using a combination of descriptive and analytical quantitative and
qualitative methodologies.
Results We found that information on symptoms and CD-associated conditions were poor predictors
for finding undiagnosed CD in the study population. Questionnaire-based case-finding by asking for
CD-associated symptoms and conditions would have identified 52 cases (38% of all cases) at a cost of
blood-sampling 2282 children (37% of the study population). The tTG-IgA test had an excellent
diagnostic accuracy with the area under the receiver operating characteristic curve of 0.988. If using
the recommended cut-off for tTG-IgA (>5 U/mL) 151 had fulfilled biopsy criteria and 134 CD cases had
been identified. The strategy of lowering the cut-off to tTG-IgA>4 U/mL, and adding the EMA analysis
in those with tTG-IgA between 2-4 U/mL, identified another 17 cases (a 12% increase) at the cost of
performing 32 additional biopsies. Measuring total s-IgA in 7161 children discovered only two
additional cases at the cost of performing 5 additional biopsies. The positive predictive value of our
screening strategy was 80%.
Results from the follow-up study of the screening-detected CD cases illustrated that 54% reported
health improvement after initiated treatment, but also that these health benefits had to be balanced
against social sacrifices. We also found that although the screening-detected diagnosis was met with
surprise and anxiety, the adolescents and their parents were grateful for being made aware of the
diagnosis. A majority of parents (92%) welcomed a future screening, but both adolescents and parents
suggested that it should be conducted earlier in life.
Conclusion Obtaining information on symptoms and CD-associated conditions was not a useful step
in finding undiagnosed CD cases in a general population. The serological marker tTG-IgA, however,
had excellent diagnostic accuracy also when lowering the cut-off. The diagnosis had varying impact on
adolescents’ quality of life, and their perceived change in health had to be balanced against the social
sacrifices resulting from the diagnosis. Overall, CD mass screening seemed acceptable to most of those
who were diagnosed and their parents.
14
Felix Kisanga
Child sexual abuse in urban Tanzania:
Possibilities and barriers for prevention
Thesis defended 14 December, 2012
Supervisors: Lennarth Nyström, Maria Emmelin, Nora Hogan
Opponent: Docent Frank Lindblad, Department of Neuroscience,
Child and Adolescent Psychiatry, Uppsala University
Background: Child sexual abuse is a global public health and human rights concern. Despite being a
crime in most countries, and with well-known physical and mental health consequences, the majority
of sexual offences are not reported. Child sexual abuse is a maltreatment form characterized by contact
or non-contact acts perpetrated by adults or older children toward younger children who have little
power to resist. This thesis aims to understand the social context of child sexual abuse, and the
perceived roles of parents, community, and key professionals in handling such incidents in urban
Tanzania.
Methods: A combination of qualitative and quantitative research designs were applied to four substudies performed in Temeke district, Dar es Salaam. Qualititative content analysis was conducted on
23 in-depth interviews to describe the perceptions of key professionals and their experiences of
handling cases of child sexual abuse, in addition, eight in-depth interviews with parents to capture
their experiences of legal reporting of child sexual abuse incidents. Grounded theory was used to
analyse 13 focus group discussions held with male and female community members to explore norm
systems and community awareness related to child sexual abuse. Findings from these exploratory substudies paved the way for a school survey among 1359 students from 23 randomly selected secondary
schools. Using descriptive statistics and multivariate regression analyses, prevalence, risk factors, and
health consequences of child sexual abuse were estimated.
Results: Lack of working tools and financial support were perceived as major problems among the
key professionals. Corruption at community and institutional levels was seen as jeopardizing justice.
Community passivity and lack of knowledge about laws regulating sexual offences were identified as
additional challenges for conducting fair investigations. The community perspective illustrated that
children’s rights were challenged by lack of agency. Community awareness about child sexual abuse
was clear but there was also a lack of trust in that the healthcare and legal systems were capable of
handling such cases. Myths and cultural beliefs justified abuse. Disclosure of abuse was threatened by
fear of stigma and discrimination. Parental interviews identified four types of sexual abuse incidents.
The type most strongly associated with a determination to seek justice was one with an innocent child.
The youth who was forced into sex elicited feelings of parental betrayal. The consenting, curious youth
created uncertainty in how to proceed, while the transactional sex youth evoked feelings of parental
powerlessness. Shame and stigma, but also fear of perpetrator retaliation and breach of confidentiality,
were seen as challenges for disclosure. The school survey showed that 28% (boys=30%, girls=26%) of
the students were exposed to child sexual abuse, with boys more often affected than girls. Twenty-six
per cent of boys and 19% of girls reported being forced to look at pornography. Forced sexual
intercourse was experienced by 9.8% of boys and 8.7% of girls. Abuse increased with age and
diminished self-rated health. Perpetrators were most often neighbours, teachers and peers. In
contrast, survivor confidants were most often teachers, family members and friends. Most survivors
did not want any action taken for the abuse. Proportions of students who perceived having fair/poor
health increased with severity of abuse comparing the none-abused (7.0% and 6.3% of boys and girls
respectively) with the ever abused (26% and 41% of boys and girls respectively) and those reporting
penetrative sex (35% and 53% of boys and girls respectively). Likewise, suicidal ideation and attempts
increased with severity of abuse when compared with those not abused.
Conclusions and recommendations: Sexual abuse of children poses a devastating social, and
public health challenge. In Tanzania neither the community nor the health or legal institutions are
adequately prepared to handle these cases. Educating the community, economically empowering
women and strengthening the medico-legal system are needed to increase the opportunity for human,
legal and fair investigations and reactions. A national child protection system is needed to address the
complexities of abuse at different levels and to safeguard the rights of children in Tanzania.
15
Scholarships 2012/2013
The 2012-2013 Centre Party Global Health scholarships for MPH students at UISPH
SameerPadnis
India
The 2012 Centre Party Global Health Research scholarships for PHD students at UISPH
Vu Duy Kien
Vietnam
Hendrew Gekawaku
Lusey
Congo
Osama Ahmed Hassan
Ahmed
Sudan
Paola Mosquera
Mendez
Colombia
Vijendra Ingole
India
Tej Ram Jat
India
Ameneh Setareh
Forouzan
Iran
Maquins Sewe
Kenya
Thaddaeus Egondi
Kenya
16
Thirty years’ work in a nutshell
Epidemiology (from epidemic and Greek –
logi´a ’-learning’, -’science’, from lo´gos
’word’), scientific discipline addressing the
prevalence, aetiology and outcome of diseases. Source: Swedish Nationalencyklopedin (national encyclopaedia).
originally established in mid-1986 as the
‘Department of Epidemiology and Health
Care Research’ (Epidemiologi och hälsooch sjukvårdsforskning, ‘Epidemiologen’)
led by Professor Stig Wall. Dr. Wall
recruited other
researchers
representing a
range
of
disciplines
to
the
new
Department. As
a
result,
a
number
of
epidemiologic
studies, which
went
on
to
stimulate great
interest,
were
initiated and conducted by the Department.
One was a study of mortality and cancer
incidence among workers from the
Rönnskär smeltery in Northern Sweden.
Another was the Norsjö community
intervention project, which was unique at
that time for involving an entire
municipality in a public health intervention
to minimise the risk of cardiovascular
disease.
This classical interpretation of epidemiology
formed the basis for the department’s work.
This in turn led to the development of tools
for public health initiatives, the prevailing
focus of which is on how health trends may
be influenced in a positive direction and
how inequalities in health may be reduced.
Some 160 years ago, Dr. John Snow was
concerned about the rapidly growing cholera epidemic in London. He suspected that
the water supply might be the culprit
behind the rampant infection rate. After he
removed the handles on a water pump in
the area that had the highest infection rate,
the numbers of sick and dying declined dramatically. Dr. Snow is consequently recognized as the father of epidemiology.
Ill health frequently occurs as a result of our
individual choices. Known risk factors
include smoking, alcohol consumption and
poor diet. From a broader perspective, there
are many other causes of ill health that the
individual alone is unable to influence.
These include air pollution, occupational
hazards, social and economic inequality, a
shortage of health care resources, war, natural disasters and certain genetic predispositions.
International cooperation
From its inception, what is now the department of Epidemiology and Global Health
has conducted collaborative research projects in low and middle-income countries.
This was largely due to the fact that several
members of the staff had previously worked
in such countries. This collaborative activity
has taken on increasing significance and is
today one of the department’s hallmarks.
Ill health is costly for every society. In addition to the fact that it limits human potential for contributing to the common good,
medical care carries an enormous financial
burden. For this reason alone, interest in
improved public health is predictably on the
rise across the globe.
The Department’s beginnings
Public health efforts in Sweden and abroad
were initiated within the field of medicine
and were university-driven – not least by
Umeå University. What is now the
Epidemiology and Global Health Unit was
17
Education and research
The department’s first annual report describes a wide array of collaborative projects
in Ethiopia, Somalia, Tanzania, Zimbabwe,
Botswana and Pakistan. Initially, these projects focused on creating a foundation for
continued research by surveying these
populations, since reliable demographic
data are essential for any scientific research
project to be conducted.
After being in
operation for
only
three
months, the
Department
offered
its
first
weeklong course in
epidemiology,
which
was
held
in
Vietnam. The course, which dealt with
research methodology, was the starting
point for extensive training activities in both
Sweden and the collaborating countries.
The courses gave students from the
cooperating countries an introduction to
epidemiology as a discipline, and laid the
foundation for the strong international
attendance that followed. Plans for a
master’s degree program were also drawn
up in the Department’s first year.
In 1986, the Butajira project was initiated in
Ethiopia, and was the first to evolve into a
so-called field laboratory. In that same year,
the Kagera project in Tanzania began to
survey the HIV infection rate in response to
HIV/AIDS being discovered just a few years
earlier. The initial results were alarming,
with certain areas of the population found
to have infection rates as high as 25 percent.
The first students were accepted into the
master’s programme in 1991. The more the
Department extended its activities, the
more students it attracted from the
cooperating countries. In the academic year
2010/2011, there were 98 students
representing 27 countries.
In the autumn of 2011, parliament's decision to charge non-European students
tuition fees came into effect. This was a very
hard blow to the Unit because its activities
over the years had been founded on a
system of international student/researcher
exchanges.
The Kagera project has continued in accordance with the Norsjö project’s paradigm,
where the objective is to reduce the spread
of infection by practical interventions. This
approach has achieved positive results over
the years. In the 1980s, the Department also
began to increase its cooperation with
Somalia, Zimbabwe, Botswana and Zaire. It
also began to lay plans for cooperation with
Vietnam and Nicaragua.
The effect of this radical change in policy is
illustrated by the fact that the number of
newly registered students dropped from 43
in the autumn of 2010 to only 18 in the
autumn of 2011. In autumn 2012, 25
students started their studies, of which only
nine were from low and middle-income
countries. Generous scholarship funds will
hopefully restore the number of international students to previous levels.
Research alliances with the above-mentioned countries continued and were extended during the 1990s. In addition, new
partnerships with Indonesia, Pakistan and
Bangladesh were initiated. Regrettably, the
cooperation with Somalia had to be suspended due to the effects of the civil war
there. The results of the research in Somalia
carried a message that was as clear as it was
distressing – that infant mortality was
increasing in line with the disintegration of
the national political system and economy.
It is a strongly held opinion throughout the
department that parliament should reconsider its decision regarding the tuition fees.
A reversal of this decision would have a
positive impact on research aimed at
18
improving public health in low and middleincome countries.
terms of both vocation and culture, have
produced a creative and dynamic research
environment. Their studies and research at
Umeå have made an appreciable contribution to improving public health in many
countries.
In 2007, the original masters-equivalent
“magister” programme was converted into a
two-year master’s programme. Beginning in
2011, students were offered both a one-year
and a two-year programme in which the
first year led to the original Swedish
magister examination and the second year
resulted in the new international-style
master's degree. This degree programme
has received very high ratings from the
students. It has also been rated very positively by the Swedish Higher Education
Authority (formerly the Swedish National
Agency for Higher Education), which
evaluates and accredits Swedish universities
and university colleges. As of the summer of
2012, this body had accorded the Unit’s
master's degree in public health science its
highest rating of ”very high quality”. This
was the only Swedish master’s programme
within this discipline to receive the highest
rating. The one-year master’s-equivalent
programme received the ”high quality”
rating.
The Västerbotten research cluster
The research program at Epidemiology and
Global Health is in a state of continuous
development, which is exemplified by the
evolution of its name. It was originally
known as Epidemiologi och hälso- och
sjukvårdsforskning
(Department
of
Epidemiology and Health Care Research),
then Epidemiologi och folkhälsa (Department of Epidemiology and Public Health)
and now Epidemiology and Global Health
Unit.
As a result of the Rönnskär study of smeltery workers, researchers began to investigate the possible connection between
fertility and emissions in the work environment. A major study of youths in Umeå,
launched in 1988, addressed factors that
would
predispose
individuals
to
cardiovascular disease later in adulthood.
Research projects in Västerbotten County,
which were based on the Norsjö community
intervention, have increased steadily in
number. These are a testimony to the
Department's close and extensive cooperation with the Västerbotten County Council.
Through continuous interaction between
research and practice, this alliance has produced unique interventions, the ultimate
aim of which is for the inhabitants of
Västerbotten County to enjoy the highest
standard of health in the world by 2020.
By the end of academic year 2012, no fewer
than 87 students had sat for the doctoral
examination at the Unit. Almost half of
them are from low and middle-income
countries. The road from an idea to a final
doctoral thesis is long, and it is therefore
not surprising that the number of doctoral
students has increased over time. From the
outset up to the new millennium, 17
doctoral degrees were awarded. During the
2000s, the number increased by 46, and
within the last three years no fewer than 24
doctoral students defended their thesis.
This makes the department of Epidemiology
and Global Health one of the most researchintensive units at Umeå University.
The
experience
gained from the
Västerbotten
Intervention
Programme, VIP,
including
an
invitation
to
a
health check to all
citizens at ages 40, 50 and 60has, generated
international interest. In several places in
the world, intervention programmes are
carried out in order to improve the state of
health of limited population groups.
The widely differing backgrounds of the
undergraduate and doctoral students, in
19
WHO Centre of Excellence
Epidemiology and Global Health provides
major support for these programmes. VIP
constitutes a basis for the Unit’s second
research theme.
Since the new millennium,
research at Epidemiology
and Global Health has
gained
even
greater
momentum. In 2003, the
Unit was appointed as a
WHO collaborating centre
in
“Epidemiological
Surveillance and Public
Health Training”, which is a much-valued
accolade. This appointment was largely the
culmination of the myriad cooperative
projects undertaken across the globe and
the training of so many doctoral researchers
from low and middle-income countries.
A study to address the growing number of
children with gluten intolerance was
launched in the early 1990s. At the end of
2012 this research had resulted in three
doctoral theses, with five doctoral
researchers continuing the project both
nationally and internationally.
Unemployment and health
There have been many other promising
research projects over the years. One such
project is aimed at investigating the effects
of
unemployment
on
health.
Not
surprisingly, the central conclusion was that
unemployment is detrimental to health.
Another finding was that old age pensioners
and disability pensioners fare better than
individuals who are forced into retirement
before their time. Researchers in this field
have also started examining the health
impacts of changes in the labour market.
Unlike in the past, employment has become
increasingly short term, which causes
unease in the work force and ultimately has
an adverse effect on health.
Based on a model originally set up in
Butajira, a network of field labs was gradually extended across the globe. In the early
2000s, these labs were brought under an
umbrella organisation called Indepth (The
International Network for the Demographic Evaluation of Populations and
Their Health). There are now 31 such networks in 17 countries, a system that enables
researchers to conduct cross country
comparisons of health conditions.
Equality and health economics
Current research in this area seeks to
investigate prevailing social inequalities in
health and how these may be addressed. A
range of methods, based on a multidisciplinary approach, are applied in analysing
social, cultural and gender-specific disparities in health.
No research imperialism
Research in the partner countries has at all
times been conducted in congruence with
their specific goals and has never been
subjugated to the needs of Epidemiology
and Global Health. The head of unit, Dr.
Stig Wall, insisted on this policy, as a matter
of pride and absolute adherence, throughout his tenure. This policy has resulted in a
substantial proportion of the research in
these countries being devoted to child and
maternal health. Another research initiative
was begun in response to the high prevalence of wife-battering in Nicaragua, which
was so common that it constituted a serious
public health concern. The resulting
research program led to the enactment of a
law in Nicaragua that made domestic
violence a punishable offence. This research
programme has now been taken up globally.
Great interest has been taken in this
research, which addresses the effect of both
public and individual interventions. Health
economics – the means by which available
resources may be deployed in achieving
excellence in health and health care – has
evolved into a prominent research area.
Five research themes
An important milestone was reached in
2007 with the generous, and long-term,
grant awarded by the FAS – Swedish
Council for Working Life and Social
Research. It was this grant that enabled the
20
establishment of the Umeå Centre for
Global Health Research.
Funding – a constant struggle
The vision for the centre was for two
research areas to be given priority. The first
of these was focused on how to promote
public health in practice based on theoretical and methodological models. The second
was devoted to
the study of
how different
systems of care
respond to new
health threats.
From these, five
themes
were
defined
for
prioritising
research efforts.
For Epidemiology and Global Health,
raising sufficient research funds is a constant struggle. Much of the unit’s activity is
financed by external sources, and a great
deal of effort is devoted to drawing up grant
applications. These efforts have so far have
been successful. The multiyear grant from
FAS is one example. Another is a grant
given by the Swedish Centre Party, which
for 10 years, starting in 2007, provides SEK
1 million per annum for scholarships for
students from low and middle-income
countries. Another grant for the same purpose was given by the Erling Persson
foundation in late 2012, again worth SEK 10
million.
* How knowledge of different disease
patterns may be transferred between
affluent and poor nations and also between
poor nations.
The increase in the size of the unit’s budget
over time provides an indication of the
increase in its activities. In the first few
years, the budget totalled around SEK 6
million. By 2012 this had increased to SEK
67 million.
* How interventions to improve health may
be designed in different societies.
Another indication of the growing scope of
the unit’s activities comes from the number
of publications. The first year saw the
publication of just over 20 articles. For
some years after that, the number
decreased, which was a result of changes in
the Department’s structure. From then on,
the number has increased substantially and
is now at around 90 per year, with a peak in
2009 of 100 publications.
* How primary health care may be
strengthened for different groups in
different parts of the world.
* How gender-specific differences in health
may be reduced.
* How climate change affects health.
Communication
The future holds great promise. New
phenomena and issues that merit investigation crop up all the time, and our findings
have the potential to lead to improvements
in public health globally. Research within
the five themes under which the Unit now
organizes its extensive activities will certainly be further developed.
For research to have a positive effect on
public health globally, its results must be
presented both within and outside
academia. It is essential that research
results be accessible to decision-makers and
the general public. Epidemiology and
Global Health has devised a method for disseminating information that is wholly
unique:
Global
Health
Action.
Responsibility for this project rests with the
former Head of the Unit, Stig Wall. Through
Global Health Action, research results are
posted directly to the globalhealthaction.net
site, where they are available free of charge
to anyone in the world.
Umeå, August 2013
21
Institutional setting
Organisation
Figure 1. Organisational chart of division within department and faculty
Our division is one of six subunits within
the Department of Public Health and Clinical Medicine. Subsequently all formal decisions concerning the Division are taken by
the prefect. The advisory board of supervisors serves to address policy and research
training issues in our division, and more
specifically to assess candidates for PhD
training. Staff affairs are handled by the
management of the division.
for handling computer issues for employees
as well as students and a group with special
responsibility for the distribution of office
space among employees. Most issues within
the Division are also discussed in a biweekly staff meeting.
Staff development
At present 71 research and administrative
posts are attached to our division, not including international doctoral students. Of
these 68% are women. Of the 10 professors,
three are female. Of the 59 PhD students 33
are women and 26 are men. The female/male ratio with women in majority)
differs within groups, with a minority of
women among professors and teachers/researchers whereas it is quite the con-
Some of our faculty are full time employees,
others attached on a part time basis. Most of
the latter group are former PhD students
continuing their research and contributing
as teachers and supervisors.
The informal structure in our division is
represented by different groups with specific objectives. There is a group responsible
22
Budget
trary among administrators where most
employees are women.
The total budget (Table 1) for the year 2012
amounted to SEK 57.7 million, 70% of
which consisted of external research grants
or grants for bilateral development research
projects.
In all, 59 doctoral students are registered
(2012) within our research programme or
receive major tutorial with us. They represent a mix of physicians, nurses, sociologists, economists, social workers, dentists,
environmentalists, physiotherapists and
nutritionists. The post-doc personnel represent many disciplines such as environmental, paediatric, reproductive, nutritional and
oral health but also medical sociology, statistics and health economics.
Teaching support from the university has
been granted for our Public Health programme. Nine PhD students and one MPH
student were 2012 awarded scholarships
from the Swedish Centre Party donation.
Figure 2. Development of total budget 1987-2012.
23
Table 1. Revenues and costs during 2012.
Revenues (1000 SEK)
Government grants
External contracts
External grants
Other revenues
Undergraduate and
Master's Studies
4 431
1 345
24
474
Research and Commissioned
Doctoral Studies
research
8 190
0
0
9 002
30 239
0
3 882
88
Total
12 621
10 347
30 263
4 444
Total
6 274
42 311
9 090
57 675
Costs (1000 SEK)
Staff
Premises
Other operative expences
Depreciation
Overheads
4 204
80
874
16
137
20 990
381
14 753
124
3 794
2 461
0
1 261
14
0
27 655
461
16 888
154
3 931
Total
5 311
40 042
3 736
49 089
Table 2. Financial Resources in 2012 broken down by different funding agencies
Financier
Incomings (million SEK)
Vetenskapsrådet
FAS
EU
SIDA
Karolinska Institutet
Vårdalstiftelsen
Umeå Kommun
Västerbottens läns landsting
SMI
Folkhälsoinstitutet
Celiakiförbundet
Övriga Nordiska organisationer
8,9
8,5
3,5
3,3
1,8
1,1
0,7
0,7
0,6
0,6
0,3
0,3
Total
30.2
24
Progress
ods, result in a measurable outcome such as
a published paper.
There are no objective measures to assess
the progress of an activity. However, an
ultimate and measurable outcome criterion
is the number of publications (Figure 3).
The ups and downs of the curve are a proxy
for and a result of the process where research ideas, their gestational period, project planning, data collection and analysis
ultimately, after fairly long induction peri-
As part of the budget model adopted by the
Medical Faculty since 1996, three parameters are used to assess each of its departments: number of publications; number of
doctoral theses; and number of external
grants awarded. Each department is given a
budget, based partly on this assessment
system.
Figure 3. International publications in peer reviewed journals from our unit 1986-2012.
Figure 4. Research students at the division 1986-2012.
25
Figure 4 shows the number of research students over time, one of the parameters for
the budget model assessment system. During 2012, 59 PhD students were associated
with our department, 9 of which were regis-
tered during the yearFigure 5 shows the
number of doctoral dissertations over the 25
years that we have existed as an independent research environment.
Figure 5. Doctoral dissertations 1987-2012.
26
Special events during 2012
Unit days in Medlefors
27
Unit day at Folkets hus
28
Christmas lunch
29
Staff
30
Lars Weinehall. MD, Professor in epidemiology & family medicine and head of the unit. Research on cardiovascular disease (CVD) prevention, on the role of Primary Health Care in
community intervention programs, on health
system and health promotion policy research.
Also attached to the Research and Developmental Unit of the County Council.
Demographic Surveillance System in South Africa and heads the INDEPTH Network Migration
and Urbanisation Working Group.
Kjerstin Dahlblom. MPH, PhD. Chair of the
Programme council for the International Master
Programme in Public Health (PRPH). Administrator of scholarships for Minor Field Studies
(MFS). Teaches qualitative methodology and
coordinates the thesis course in the MPH programme. Thesis project was on sibling caretakers in León, Nicaragua. Research fields of interest: children’s rights, children’s participation in
research, qualitative methods.
Karin
Johansson.
Administrative
coordinator. Responsible for departmental and
staff administration. Faculty officer for the Master of Public Health programme.
Sabina Bergstén. MSc. Programme Administrator of the Public Health Programme, Umeå
International School of Public Health. Student
support and scholarship issues. International
contact person as well as gender equality representative for the Department of Public Health
and Clinical Medicine.
Lucia D’Ambruoso. PhD. Post-doctoral research fellow. Research interests: maternal
health in developing countries, care in obstetric
emergencies, critical incident audit, verbal autopsy/social autopsy, community participation,
the social determinants of health, social theory,
qualitative methods, interdisciplinarity and research ethics. Involved in research in South Africa developing verbal autopsy for routine application.
Lena Björklund Olofsson. BSc. Study Counsellor. Research interests in young people's wellbeing. Involved in the project “Unga I Umeå”,
evaluating child and adolescent health. Mapping
academic Global Health Centres working with
chronic diseases.
Kerstin Edin. RN midwife, MPH PhD, research associate. Main research interest on the
topic of intimate partner violence with special
focus on gender, sexuality and on the period of
pregnancy. Also attached to the Umeå Centre for
Gender Studies.
Yulia Blomstedt. MPH, PhD. Deputy Principal Investigator for INTREC – an EU financed
collaboration between partner universities and
organizations in Africa, Asia, USA and Europe,
designed to build capacity for research on social
determinants of health in low- and middleincome countries. Leader for Theme II “Lifecourse perspective on health interventions”
within Umeå Centre for Global Health Research.
Also involved in the collaborative programme
“Ageing and Living Conditions” at Umeå University. Research on health interventions, selfreported health, health care management.
Berit Edvardsson. MD, General Practitioner.
Doctoral studies on patients with symptoms
related to indoor environmental factors. Teaching in medical ethics. Also attached to Department of Family Medicine.
Kristina Edvardsson. Registered nurse, Master in Nursing. Doctoral studies on children´s
health within the Västerbotten County Council
Salut programme.
Andreas Ekholm. Economic coordinator.
Responsible for economic planning, budgeting
and accounting.
Peter Byass. Professor of Global Health and
Director of the Umeå Centre for Global Health
Research. Works extensively on health in Southern countries, particularly on issues of measuring health and disease. This involves close collaboration with the Indepth Network, where he
chairs the Scientific Advisory Committee, and
many of its population surveillance site members. Much of his research is concerned with
verbal autopsy and cause of death methods. He
is Deputy Editor of Global Health Action and
also holds honorary Professorships at the University of Aberdeen, Scotland and Witwatersrand University, South Africa.
Malin Eriksson. Social worker, MA in social
work, PhD in Public Health. Teaches social theory and qualitative methodology in the Master of
Public Health programme. Conducts research on
social capital and its implications for health
promotion.
Eva Eurenius. PhD, project assistant within
the Salut Child-Health Intervention Programme
in Västerbotten County. Studies within the Salut
Programme focus on the pregnant woman’s and
her partner’s health, lifestyle and lifesituation
with follow-ups of the infants’, adolescents’, and
parents’ ditto after childbirth.
Mark Collinson. PhD, Guest researcher. Leads
the field operations of the Agincourt Health and
31
Edward Fottrell. BSc MPH PhD. Post-doc
research fellow. Research interests in demographic and health surveillance in developing
countries, with a particular focus on methodological issues in measuring mortality and deriving causes of death through verbal autopsy,
global health transitions, and the issues of
health measurement particular to maternal and
neonatal health. Involved in teaching and supervision in the Epidemiology profile on the MPH
programme.
Anna-Karin Hurtig. MD, PhD, DTM&H, MSc.
Professor in public health. Director of research
studies and coordinator of the Swedish Research
School for Global Health. Theme leader for
"Strengthening primary health care- the roles of
rights, ethics and economic analyses" within
Umeå Center for Global Health Research. Main
areas of interest: international health systems
and policy research, infectious disease policy,
primary health care in low income countries.
Elisabet Höög. MA in work- and organizational psychology. Doctoral studies on Implementation challenges in health and social care organizations.
Isabel Goicolea. MD, MSc, PhD. Post-doc
research fellow. Research interests in sexual and
reproductive rights, gender, and adolescents´
health. Involved in research on masculinities
and young people´s sexual and reproductive
health and rights in Latin America.
Anneli Ivarsson. MD, PhD in Paediatrics,
Associate Professor in Epidemiology and Public
Health Sciences. Deputy Director of the Centre
for Global Health Research, and Editorial Board
Member of Global Health Action. Principal investigator of the Umeå SIMSAM Node focusing
on multidisciplinary register-based research
connecting childhood with life-long health and
welfare. Extensive research on coeliac disease,
and increasingly involved in child health issues
in Sweden and internationally. Attached to the
Research and Developmental Unit of the Västerbotten County Council.
Lena Granlund. MD, General Practitioner.
PhD-studies on vitamin D deficiency and health
in northern Sweden, an epidemiological study of
Immigrant and native Swedish populations at
latitude 63-69˚N. The study is including the
project VIDI (Vitamin D deficiency in Immigrants), an epidemiological study of vitamin D
deficiency in immigrants born in the Middle
East or Africa but living in Umeå. Also affiliated
to the Department of Family Medicine.
Jing Helmersson. PhD in Atomic Physics and
Laser Spectroscopy & M.S. in Public Health.
Research scientist at”Climate change and global
health" at Umeå Centre for Global Health Research. Her current research project is Mathematical Modeling of Dengue, a vector-borne
infectious disease. Dr. Helmersson was formerly
a professor in Physics from California State University Long Beach, USA.
Urban Janlert. MD, Professor of Public
Health, specialist in Social Medicine. Research
in social epidemiology (unemployment, social
deprivation). Also attached to the Research and
Developmental Unit of the County Council.
Helene Johansson. Physiotherapist. Doctoral
studies on "A more health promoting health care
service from the perspective of health professionals".
Alison Hernandez. MPH. PhD student. Doctoral studies on Health Service Delivery in Rural
Guatemala: Analysis of Strategies to Support the
Performance of Auxiliary Nurses.
Kathleen Kahn. PhD, MPH, MBBCh. Guest
Researcher. Collaborative work in child and
adolescent health, community-based cause of
death assessment, and adult health and aging
through INDEPTH multi-site work. Active in
forging research and training links with Wits
University, South Africa. Also based in the
MRC/Wits Rural Public Health and Health
Transitions Research Unit (Agincourt), School of
Public Health, University of the Wit-watersrand,
South Africa.
Yien Ling Hii. MPH. PhD study of the impact
of climate variability on dengue with focus on
climate-based dengue early warning system.
Anna Holmström. Since April 2011 Anna
Holmström is 50% coordinator of the Umeå
SIMSAM network, and 50% coordinator of the
national SIMSAM network. SIMSAM is short
for: ”Swedish Initiative for research on Microdata in the Social And Medical Sciences” and the
network in Umeå is focusing on multidisciplinary register-based research connecting childhood with life-long health and welfare
(www.simsam.org.umu.se). Link to the national
SIMSAM network: http://simsam.nu/. Anna
holds a PhD in molecular biology, and after a
post-doc period in Heidelberg she has acquired
broad experiences within project management.
Therese Kardakis. Doctoral student withing
the Vinnvård project. Research on implementation of national guidelines.
John Kinsman. Associate Professor in Global
Health, and Deputy Director of the Umeå Centre
for Global Health Research. Also serves as Associate Editor for BMC Public Health, and is a
member of the INDEPTH network’s Working
Group on Social Determinants of Health. Current research: the EU-funded ‘INTREC’ project,
32
on social determinants of health; development
of a healthy lifestyle intervention for adolescent
girls in rural South Africa; and developing mixed
methods research on the impact of climate
change and health. Extensive previous research
experience on behavioural HIV prevention, ART
adherence, AIDS policy, and HIV testing and
counselling in Africa.
Anna Myléus Medical doctor. Studies on the
Swedish epidemic of celiac disease in children.
Fredinah Namatovu. Masters in Health and
Society, Doctoral studies on exploring the environmental exposures to childhood celiac disease: A focus on the role of medical and socioeconomic factors in Sweden.
Nawi Ng. MD, MPH, PhD. Associate Professor/Senior lecturer in Epidemiology and Global
Health. Investigator in the WHO/INDEPTH
Study on Adult Health and Ageing (SAGE), and
the epidemiology of chronic diseases and their
risk factors in low and middle-income countries
within the INDEPTH Network. Participate in the
interdisciplinary research Västerbotten Intervention Program, a community-based intervention program to reduce cardiovascular disease in
Västerbotten County in Sweden since 90s.
Member of Centre for Global Health Research
steering group, theme leader in the “Epidemiological Transition” research at the centre and
managing editor of Global Health Action openaccess journal.
Tord Kjellström. Senior Guest Professor of
global health, specialist in environmental and
occupational epidemiology. Research on the
health impact of climate factors and climate
change on working people and the consequences
for the epidemiological transition and health
equity.
Barbro Larsson. Working with course administration in the medical and biomedicine programme. Reviewer for the unit in the Personnel
Administrative Self-Service at Umeå University.
Also involved in Minor Field Studies.
Lars Lindholm. Professor in Health economics. Studies on equity in health economic evaluation and the use of epidemiological data in the
distribution of health care resources.
Maria Nilsson. PhD. Research areas: tobacco
prevention and policy, climate change and
health. Also attached to the Unit of research,
education, development and public health at
Västerbotten County Council.
Marie Lindkvist. PhD in Statistics, Senior
Lecturer in statistics, Statistical consultant.
Kristina Lindvall. Dietitian, master in Food
and Nutrition, doctoral student. Involved in a
research project studying attitudes, norms, behaviours, strate-gies and eating habits important
for weight maintenance.
Faustine Nkulu Kalengayi. MD, MPH. Doctoral student attached to the center for global
health research. Research studies on the challenges and opportunities for HIV/AIDS/TB care
and prevention among immigrants from countries in sub-Saharan Africa.
Veronika Lodwika. Course administrator for
the courses in “Research Methodology with biostatistics” and ”Climate Change and Health”.
Also administrates the Master thesis seminars
and stipends for doctoral students.
Margareta Norberg. MD, PhD. Research on
risk markers for CVD and type 2 diabetes, both
metabolic and life style risk markers. Also involeved in the project "Ageing and Living Conditions", Centre for Population studies, Umeå
University. Medical coordinator of Västerbotten
Intervention Programme.
Wolfgang Lohr. Health Data Manager, involved in the DengueTools project.
Rebekah Lucas. Post
doctoral fellow.
Curt Löfgren. Senior lecturer in Economics.
Study director of the Master of Public Health
Programme. Doctoral studies in health economics, particularly issues on how to protect the
poor in third world countries from catastrophic
health expenditure.
Annika Nordström. PhD. Senior lecturer in
public health. Studies on hazardous alcohol use
related to health, social factors and gender. Attached to the Unit of research, education, development and public health at Västerbotten County Council.
Göran Lönnberg. Statistician, research assistant. Involved in the projects: “Västerbotten
Intervention Program” (VIP), “Sweden Stroke
Prevention Study” (SSPS), “Ageing and Living
Conditions” (ALC).
Katrina Nordyke. R.N., MPH, PhD student.
Doctoral studies on: “Mass screening for celiac
disease. A public health intervention from the
perspectives of the participants and society.”
Lena Mustonen. Administrator within the
EU-supported projects DengueTools and
INTREC. Responsible for the division's web
sites, the publication database (DIVA), staff
catalogue, and the research database.
Fredrik Norström. PhD in Epidemiology and
Public Health. PhLic in Mathematical Statistics.
Statistical consultant and lecturer in Biostatistics. Course responsible for “Epidemiologi och
biostatistik” which is part of the biomedicine
33
programme. Currently post-doctor at Epidemiology and Public Health. Post-doctoral research
is related to use and development of epidemiologic methods within the field of public health
with an emphasis on labour market and illhealth. Research interests also includes celiac
disease and health economics.
Joacim Rocklöv. PhD in environmental
health, trained in mathematics and statistics.
Enrolled in several projects focusing on the
health effects related to weather and climate. He
has been appointed theme leader for the climate
change and global health theme within the
Umeå Centre of Global Health Research. Also
active in teaching in biostatistics and epidemiology.
Lennarth Nyström. Associate professor in
epidemiology, Senior lecturer in biostatistics.
Research is focused on the evaluation of the
efficacy and effectiveness of mammography
screening in Sweden and cost-effectiveness of
treatment of hypertension in Västerbotten. Other research includes epidemiological studies of
asthma, diabetes, epilepsy and multiple sclerosis. Also involved in studies of reproductive
health (including HIV) in Zimbabwe and Tanzania and environmental tobacco smoking in Indonesia.
Anna Rosén. MD, Resident physician in Clinical genetics, PhD-student in Epidemiology and
Global Health. Studies on mass screening for
celiac disease utilizing a combination of qualitative, epidemiological and genetic research methods. Also attached to the department of Medical
and Clinical genetics. Lecturer in Qualitative
research methodology, Clinical genetics and
Genetic epidemiology.
Klas-Göran Sahlén. R.N, PhD. Studies in the
area of aging, prevention and health economics.
Lecturer in two subjects; health economics, and
qualitative methods.
Monica Nyström. Organizational behavior
and management in health service organizations, with a special interest in leadership, organizational development, quality improvement
and organizational innovation and learning processes. Currently leading five research projects
(VINNVÅRD, VINNOVA, SFO-V) focusing on
building organizational structures and processes
that enhances sustainable learning, innovation,
development and improvement in complex organizational systems. Also leading the project
Strategies for improving the care of older people
Works part time with her main employment at
Medical Management Centre at Karolinska Institutet.
Mariano Salazar. Md, Msc, Ph.D. Dr. Salazar
has conducted research on sexual and reproductive health, intimate partner violence and masculinity in the Nicaragua setting. Currently, he is
a member of the Umeå Centre for Global Health
Research Theme IV, a research group that focuses on gender, social inequality and health.
Dr. Salazar is also a researcher at the Centre for
Demography and Health Research (CIDS) at the
Nicaraguan National Autonomous University,
León.
Miguel San Sebastian. MD, PhD. Associate
professor, Senior lecturer in public health. Research areas: Environmental epidemiology, indigenous health (Amazon region), primary
health care and health impacts of globalisation
processes.
Raman Preet. Scientific Project Manager at
UCGHR responsible for coordination of two
European Union funded projects, DengueTools
and INTREC. A global health researcher who
holds two master degrees in public health and
dental public health with bachelor’s in dentistry.
Research interests are in the field of health policy; oral health as part of general health; and
gender & global health.
Ailiana Santosa. PhD student. Physician by
training and MPH-graduate. Working in the
Umeå Centre for Global Health Research on
epidemiological transition in Sweden and lowand middle income countries.
Karl-Erik Renhorn. Provides information,
advice and support in relation to external funding to the researchers at Umeå Centre for Global
Health Research. Together with administrative
resources at the centre, part of a team that supports the production of research applications to
major funders like the European Commission,
National Institutes of Health in the United
States, major private grant sources, and national
research funding agencies. Also assists researchers in the management of research projects.
Another important part of my work is “research
intelligence”, finding advance information and
contacts relating to research funding.
Rainer Sauerborn. MD,PhD. Guest Professor
of Climate Change and Global Health. Is Director of department, Institute of Public Health,
University of Heidelberg, Germany.
Julia Schröders. MPH. Research assistant
within the “Evidence for Policy and Implementation project” (EPI-4) which focuses on the reduction of inequities in the achievement of
health-related MDGs in China, India, Indonesia
and Vietnam. Project assistant in the “EPI-4+:
New health challenges in Indonesia” project
focusing on chronic non-communicable diseases
34
(NCDs). Editorial assistant for the Global Health
Action journal.
Stig Wall. Senior Professor of epidemiology
and health care research. Chief Editor, Global
Health Action. Epidemiologist with a social science background. Research on epidemiology and
international health, environmental and social
epidemiology, prevention and medical technology assessment.
Barbara Schumann. MPH, PhD. Epidemiologist with a background in psychology and public
health. She is deputy leader of the theme “Climate change and health” within the Umeå Centre for Global Health Research. Research interests: Climate change and health in Sweden and
other countries; analysis of longterm records of
climate, mortality and morbidity.
Susanne Walther. Working with budget and
departmental administration. Also involved in
the project on celiac disease.
Berndt Stenberg. Professor, occupational
dermatologist. Research on skin symptoms related to indoor environmental factors in office
work, nickel allergy and on psoriasis. Also attached to the Unit of Dermatology.
Masoud Vaezghasemi. MPH, Master in food
Hans Stenlund. Senior professor in biostatistics. Statistical consultant in several epidemiological and medical research projects. Giving
courses in biostatistics on various levels.
Johannah Wegerdt. Johannah Wegerdt is
Project Manager for two European Union funded projects. Her duties include supporting the
coordinators with the day-to-day management
of the projects and ensures communication
within the consortia.
and nutrition, PhD student. Doctoral studies on:
The emergence of dual burden of malnutrition
in Indonesia: The role of gender and social capital.
Hans Stenlund. Post-doc in the DengueTools
project. PhD in organic chemistry, trained in
Chemometrics which is an interdisciplinary research field including statistics, mathematics,
chemistry and computer science applied within
sciences like biochemistry and medicine. Is experienced working with the whole chain from
setting up statistical experimental designs to
analysis of large sets of multivariate data. Also
active in teaching and consulting.
Anna Westerlund. Project assistant.
Annelies Wilder-Smith. Guest professor.
Principal investigator within the EU-supported
project ”Innovative tools and strategies for surveillance and control of dengue”, StopDengue.
Birgitta Åström. Administrative coordinator
for the Swedish Research School for Global
Health. Administrator for postgraduate education and PhD-scholarships. Involved in the collaborative work with Indonesia. Representative
for the working environment at the department.
Linda Sundberg. Doctoral student.
Ann Sörlin. PhD, Physiotherapist, master in
sports medicine. Studies on gender equality and
health.
Ann Öhman. Professor in public health with
special reference to gender and health. Theme
manager of the research theme Gender and
Global Health within Umeå Centre for Global
Health Research. Research manager for the project SHY; Stress and Health among Youth, for
the project Gender equality in Swedish working
life and for the project Men, Health and Masculinities in a Latin-American context. Theme
manager for the theme Gender and Violence
within the research programme Challenging
Gender at Umeå University. She is also director
of Umeå Centre for Gender Studies.
Stephen Tollman. (MA MPH MMed PhD),
Guest Professor, directs the Medical Research
Council/Wits University Rural Public Health
and Health Transitions Research Unit (Agincourt) in rural northeast South Africa. In the
context of a rapidly transitioning society, his
research is on burden of chronic diseases,
strengthening of chronic primary health care
systems, and population dynamics. Founding
Board chair of the INDEPTH Network (20022006). Leads Network efforts in Adult Health
and Aging.
35
Research activities
Our research activities are characterised by
group work across disciplines, cultures and
geography. Epidemiological reasoning and
methodologies are central to disease surveillance, in the search for risk factors as
well as in the planning and evaluation of
intervention programmes. Studies can be
thought about under the three main
problem areas – aetiological, social and
evaluative research –, even though many
projects cover more than one area.
addressed. The recognition of the key role of
community participation for public health
promotion is a lesson learnt from
developing country experiences. Social epidemiology is also concerned with the social
consequences of disease and prevention.
Both quantitative and qualitative data and
methods are used in analyses of social,
cultural and gender differences in health.
The unfair distribution of health and its
prerequisites across different social
strata is a central concern for social epidemiology.
Aetiological studies
often start from a specific disease or a suspected exposure. They focus on the relation
of disease occurrence to social conditions
and exposures and to environmental and
lifestyle related agents. In Sweden, population-based registries of mortality and
diseases enable analysis of changing
patterns of mortality by geographical and
social groups and also enable the surveillance of various risk environments. Such
health information systems are badly
needed in developing countries. They may
serve as guidelines for primary health care
activities and could also enable the assessment of disease trends and predict disease
outbreaks. Umeå Centre for Global Health
Research is actively involved in the process
of supporting collaborating partners within
the INDEPTH network to utilize INDEPTH
surveillance data in cross site analysis.
Evaluative research
is a basis for health planning and management.
Epidemiological
methods
are
essential in evaluations of preventive
measures, such as community interventions
and individual preventions within the
health sector, as well as when assessing
medical technologies and practices. Evaluations of health care measures aim to learn
more about the efficacy, cost and ethics of
the specific measures, adjusting health programmes accordingly and improving the
implementation of public health interventions and implementation of improved
methods in health care. Particularly in
poorer countries where resources are
limited, planning for health must be based
on knowledge at the population level,
including information regarding the nonusers of health services. Applications
relating to mother and child health, nutrition, infectious diseases, and the evaluation
of primary health care are particularly relevant.
A proper understanding of the aetiology of
diseases and the natural history of disease
processes – and of health – is essential for
designing preventive programmes in public
health. National and international studies
reflect a wide range of research interests.
Several of the studies specifically address
the methodological problems of exposure
assessment.
Crossing boundaries
Most of our projects are part of international or national collaborations and cross
not only the boundaries of aetiological,
social and evaluative research, but also
other boundaries. Our research is usually
multi-disciplinary and originates within
different occupational areas, research paradigms, cultures and contexts. Accordingly, it
is not easy to give a systematic overview.
Social epidemiology
is concerned with the social patterning of
health and disease. It aims to characterise,
quantify and analyse social stratification of
health and health care, focusing on the maldistribution and social inequity in health. In
Sweden, distributional policy issues within
the health care sector are increasingly being
36
Thinking in previous decades tended to
group epidemiological issues as local (to a
particular institution) or international
(meaning a setting quite different from the
institution). Gradually this polarised way of
thinking has become more integrated,
leading to the relatively new paradigm of
“global health” which is taken to be geographically inclusive.
“Sweden and Scandinavia are just as much
part of the globe as anywhere else!”, he says,
“and we are interested in the health of
people everywhere, from Arctic reindeer
herders to African subsistence farmers –
and affluent city-dwellers”.
The new challenges of climate change for
human health form part of the Centre’s
research agenda. As accredited participants
within the United Nations Framework Convention
on
Climate
Change
(www.unfccc.int), Umeå researchers are
engaging with policy makers on the health
consequences of possible changes in
climate.
This global conceptualisation of epidemiological research, in which a range of
diseases, social factors and health services
interact with a variety of populations, is
reflected in our new institutional title “Epidemiology and Global Health”. Västerbotten
County, Sweden as a country, to say nothing
of our long-standing partner countries such
as Ethiopia and Vietnam, are all part of our
global purview.
At the same time, the Centre works closely
with international agencies such as the
World Health Organization (www.who.int),
contributing scientific expertise in specialised fields such as cause-of-death determination and the global burden of pregnancyrelated mortality.
Working together globally
to meet health challenges
“Being supported as a FAS Centre is very
important for our work,” explains Peter
Byass. “It provides resources which we can
use in a catalytic way to generate project
funding from external sources such as the
European Union.” The Centre’s productivity
in terms of published papers is also
increasing substantially year-on-year.
Health – of individuals, communities and
nations – is a global matter. So says
Professor Peter Byass, Director of the FAS
Centre for Global Health Research at Umeå
University. Health also can’t be separated
from history, geography, gender, politics
and economics, making it a truly multidisciplinary domain.
Making research findings available to other
researchers and policy makers globally is
also a challenge which the Umeå Centre is
addressing. “Many institutions around the
world simply cannot afford subscriptions to
access research results that are not made
freely available,” points out Peter Byass. For
that reason, in 2008 the Centre launched an
ambitious
new
open-access
journal,
Global Health Action
(www.globalhealthaction.net), which has
now successfully published a wide range of
work and is listed in all the major science
research indexes. Chief Editor Stig Wall
says “Anyone, anywhere can freely access
what we publish, via the internet – this is a
huge advance for global health”.
The FAS Centre established in Umeå in
2007 is based at the Unit for Epidemiology
and Global Health, which grew up around a
number of international research projects
and collaborations dating from the 1980s,
under the leadership of Professor Stig Wall.
The world continues to be a fundamentally
unequal place – including inequalities in the
ways that people’s health is recorded. Thus
we know much less about the health of
poorer people. Long-standing research
collaborations at Umeå have involved
developing extensive field databases to fill
some of these knowledge gaps, often in
collaboration with the INDEPTH Network
(www.indepth-network.org). The Unit’s
well-established international Master of
Public Health and PhD programmes
continue to build considerable professional
capacity for this around the world.
The FAS Umeå Centre for Global Health
Research has an exciting future ahead,
bringing rigorous research methods to bear
on fundamental issues for human life and
health around the world.
Asked “What is Global Health?”, Peter
Byass takes a very inclusive viewpoint.
37
More details of the Centre’s work can be
found at www.globalhealthresearch.net, and
specific
enquiries
directed
to
[email protected].
actions and interventions to strengthen
primary health care in poor and rich
countries, through projects stemming from
integrated rights-based approaches and
economic analyses. Our research is mainly
operational
using
multidisciplinary
methods and underpinned by the values
and principles expressed in primary health
care (Fig 1) focusing on the functions of
health systems as articulated by WHO. The
research group is interdisciplinary and
includes doctoral students based in India,
Iran,
Cambodia,
Colombia,
Peru,
Guatemala, Ethiopia, Zambia, Tanzania,
South Africa, Germany and Sweden. During
2011 three of our PhD students, from
Tanzania, Cameroon and Vietnam, successfully defended their work.
Theme I: Epidemiological Transitions
Contact: Anna-Karin Hurtig
[email protected]
Research in theme I intends to challenge the
current understanding of epidemiological
transitions. Through projects focusing on
the development and application of innovative methodologies and the measurement,
prediction and evaluation of population
health changes, this theme seeks to enrich
the capacity for an empirical evidence base
for epidemiological transitions theories.
Theme IV – Gender and Health
Health conditions in the world are strongly
gendered and it is vital to include both
women and men in global health research.
Gender is therefore one of the most
important analytical categories (or variables) in research about human beings and
their social conditions. The overall aim of
on-going and planned research is to
generate new knowledge on gender and
health and to support health development.
The theme uses empirical data from a
variety of sources. One of our basic aims is
to develop research designs that combine
qualitative and quantitative approaches.
Contact: Nawi Ng
[email protected]
Theme II: Life-course perspective on health interventions
Research in this theme focuses on the
design, implementation and evaluation of
health interventions that target different
stages of the life course, from the unborn
child to old age, taking into account social
contexts and gender aspects, in both
advantaged and disadvantaged communities.
Contact: Ann Öhman
[email protected]
Theme V: Climate change and
health
The overall aim of the research conducted
within the theme V is to strengthen the
knowledge of how climate change will affect
the health of populations in the world, and
build capacity, competence and knowledge
to mitigate and adapt to climate induced
risks.
Contact: Yulia Blomstedt
[email protected]
Theme III: Strengthening
primary health care: the roles
of rights, ethics and economic
analyses
Contact: Joacim Rocklöv
[email protected] and
Barbara Schumann
The research in this theme is designed to
inform key decision-makers involved in
[email protected]
38
Training at Umeå International School of Public
Health
Public health program students and staff
An integral component of the development of
the international collaborations has been the
International Public Health training, starting
from ad hoc training courses and workshops that
formed a springboard for the research projects.
What started as short courses in epidemiological
methods has grown into full master programmes
in public health taught in English and with
major recruitment from abroad, mainly from low
and middle income countries. Since 2001, these
activities have had the status of an international
school within the university. With their strong
research orientation, the programmes have
retained their role as channels into research
training.
remained basically the same until 2007,
although it was of course continuously revised
content wise.
In the 1990’s the programme recruited an
increasing number of students from low- and
middle income countries. Many of these
students came from our international research
collaborations. This group of students has come
to strongly dominate our student body.
In 2007 there was a large change of the
programme. As a result of the Bologna process,
but also due to student demand and a wish from
the staff to be able to go deeper into different
areas, the program was changed into a two-year
programme focussing on epidemiology, health
systems and social conditions and health.
Master Programmes in Public
Health
A decision on tuition fees taken by the Swedish
Parliament led to a drop of incoming students in
the fall of 2011 since non-European students
now have to pay tuition fees. To meet this
situation we are therefore offering two
The first courses in public health in Umeå were
given in 1986. Five years later, in 1991, a master
programme in public health was started. This
was a one-year programme. Its structure
39
programmes – both a one- year and a two-year
programme. The one-year programme is equal
to the first year of the two-year programme.
Since the introduction of tuitions fees we have
been awarded funds from the Erling-Persson
Family Foundation making it possible for us to
offer scholarships covering the tuition fees for
students from outside EU. Other scholarships
from the Swedish Institute and the government
have also been introduced, opening up the
opportunities for these students to attend our
programs. This year we have 12 new one-year
students and 25 new two-year students while 12
students are in their second year, constituting a
pronounced mix of students from Sweden, EU
and countries across the globe. The composition
of students makes our programmes unique and is
perceived as one of the strengths by our
students.
The Master Programme in Public Health – the first year
Global Public Health, 10 credits
Biostatistics 1, 5 credits
Epidemiology, 10 credits
Qualitative Methodology 1, 5 credits
Health Systems, 5 credits
Health Economic Evaluation Methods, 5 credits
Social Pathways in Health and Health Promotion, 5 credits
Master thesis, 15 credits
(The first year equals the one-year programme)
The Master Programme in Public Health – the second
year
Evaluation in Public Health, 5 credits
Biostatistics 2, 5 credits
Advanced Methods in Epidemiology, 5 credits
Chronic Diseases Epidemiology or Advanced Topics in
Health Economic Evaluation Methods, 5 credits
Social and Gender Inequalities in Global Health, 5 credits
Qualitative Methodology 2, 5 credits
Social Epidemiology, 5 credits
Health Care Management, 5 credits
Public Health Informatics, 5 credits
Master thesis, 15 credits
In the new two-year programme we are still
offering all of the courses from the two-year
programme that started in 2007. They have,
however, been reduced in size from 7.5 ECTS
credits to 5 ECTS credits.
Master students during seminars May 2012
40
Sources of public health programme students 1991-2012
programmes in public health sciences at 15
universities.
Single subject courses
All courses within the master programme can
be taken as single subject courses by students
not wishing to take the whole programme.
Priority is given to those studying for the
degree, but a number of non-programme
students are always accepted as well. This is
especially true with regards to research
method oriented courses, such as Qualitative
Methodology,
Epidemiology
and
Biostatistics, and subject courses in e.g.
Health Economics and Health Systems, as we
see it as essential that these subjects are
accessible to research students in adjoining
disciplines.
Only one of the two-year master programmes
received the highest mark – the Umeå
programme. Our one-year programme was
deemed to be of high quality.
Here is an excerpt of the interview with
Professor Lars Weinehall, then head of the
Department of Epidemiology and Public
Health where he explains:
“We need the international element that our
students represent. The students' own
experiences strengthen the quality of
education and help create an interesting
learning environment. Education and
research are closely connected here. We
have a large centre for research on global
health which is one of the university's
strong research environments. We also have
a number of research collaborations with
universities in low-income countries.
Education and research cross-fertilize each
other and some of our master's students
continue on to doctoral students in our
research projects. It is particularly
encouraging that the Swedish National
Agency of Higher Education lauded our
students'
in-depth
knowledge
of
methodology, the ability to critically and
systematically integrate knowledge and the
Highest marks for public
health in Umeå
In 2012 the Swedish National Agency for
Higher Education evaluated all public health
programmes in the country. The evaluation
resulted in the agency giving one of the
following three marks to each programme:
lacking in quality, high quality or very high
quality. The evaluation included 23 degree
41
general orientation in the profile area of
global health.”
(Editor: David Meyers , Link to news:
http://www.umu.se/english/news/.cid193926 )
International Student Barometer (ISB). The
survey was responded by international
students from 193 universities throughout the
world during the autumn of 2012.
In addition, Umeå University has been
ranked first in Sweden and third in Europe
for student satisfaction according to the
Both these rankings act as incentives for us
to continue striving for offering education of
very high quality.
Research training
Research students at Epidemiology and Global Health
We offer degrees in four PhD subjects:
Global Health, Epidemiology and Public
Health, Public Health, Global Health and
Family Medicine and Epidemiology.
Our unit is responsible for a major part of the
basic research-training course of the Medical
Faculty, and we offer courses in both
quantitative and qualitative methods.
Presently (Dec 31st, 2012 59 research
students are registered at the department, 26
men and 33 women (Table 5). 43 PhD
students have been recruited within
international research collaborations, while
25 are Swedish based research students. In
the period 1987 – 2012, 87 PhD theses and
eight licentiate theses were defended at the
department. Several of the research students
at the department are also affiliated with
another department, e.g. a clinical department, or to a university in another country.
Corresponding representation of two or more
departments is often found among the advisors to the research students.
Activities during doctoral days 2012
42
leadership training facilitated by Dr Kevin
Grigsby from Association of American
Medical Colleges, Washington, USA and
Jonas Nordquist, Karolinska Institutet.
Swedish Research School for
Global Health
In 2008 Umeå University and Karolinska
Institutet launched the Swedish Research
School for Global Health with financial
support from the Swedish Research Council.
The two institutions have different strengths
within the area of global health research and
the Research school takes advantage of the
different capacities and complementary
competences. The main aim is to develop and
strengthen the capacity for research training
in global health, through multi-disciplinary
collaboration in education, research and
training. The specific aims of the research
school are to provide courses and seminars in
global health on a doctoral level, to secure a
base of new generations of researchers in
global health and to provide a creative
environment for students and teachers.
Meeting at Långholmen, Stockholm, November 2012
During 2012 the School commissioned a
report of the first years´ achievements. The
report can be found at www.sweglobe.net.
Educating the medical
students
The Research School offers a broad variety
of doctoral courses comprising topics in
global health, advanced method courses,
professional development and thematic
workshops with networking opportunities.
Students of the Research School can attend
the programme’s courses at the cooperative
institutions and can apply for funding of
external national and international courses,
workshops and conferences. The possibility
to have support for internationalisation has
been much appreciated by students who have
had the possibility to visit other research
institutions and international agencies,
participate in specialised courses and
disseminate their findings at international
and regional conferences.
Since 2002 the division has been responsible
for teaching the medical students in
community medicine and since 2005 also in
global health; a new course that was
introduced in 2005 as a response to the
request of the students. The lectures in
community health have recently been moved
from semester 10 to semester 5, as a
consequence of the new U2007 curriculum
for the medical students. The separate week
in global health has also, due to the same
reason, been moved from semester 9 to
semester 5. The teaching in community
medicine has been carried through together
with the division of occupational medicine
and the department of law (lectures in
medical law). An important resource for the
case work in global health has been the
master students in public health, who have
been serving as resource persons for the
different countries that were used as
examples in the cases.
Currently 55 students have been admitted to
the School and by end of 2012 19 students
had successfully defended their theses.
Biomedical programme
During the first semester of the ‘Biomedical
programme’ (180 credits), our unit is
responsible for a 7-credit course in
Epidemiology and biostatistics. In the
autumn
2012
course,
37
students
participated.
Meeting at Långholmen, Stockholm, November 2012
The annual meeting 2012 took place in
Långholmen, Stockholm 19-21 of November.
Two days of the meeting was dedicated to a
43
Table 4. Seminars at the department during 2012
February
Fredrik Norström - Pre-dissertation
The burden of celiac disease and the value of having it diagnosed
Kristina Edvardsson - Midterm seminar
Health promotion in pregnancy and early parenthood. The challenge of innovation, implementation and
change
March
Endy Paryanto Prawirohartono - Lic dissertation
Prenatal zinc and vitamin A supplementation. A study on the impact of prenatal micronutrient
supplementation in rural Indonesia
April
Thaddaeus Egondi - PhD plan presentation
Modeling exposure to urban outdoor air pollution and associated mortality in Nairobi, Kenya
Kanyiva Muindi - PhD plan presentation
Indoor air pollution and adverse pregnancy outcomes in Kenya
May
Yien Ling Hii - Midterm seminar
Climate Change and Dengue Fever: Climate index as an early warning for dengue prevention and control
Anne Neumann - Midterm seminar
Prevention of Type 2 Diabetes Mellitus. Modeling the cost-effectiveness of diabetes prevention
Fredrik Norström - Dissertation
The burden of celiac disease and the value of having it diagnosed
Hailemariam Lemma Reda - Dissertation
Improving efficiency, access to and quality of the rural Health Extension Programme in Tigray, Ethiopia: the
case of malaria diagnosis and treatment
Elisabet Höög
Strategies for managing change
Ana Lorena Ruano - Pre-dissertation
The role of social participation in municipal-level health systems: the case of Palencia, Guatemala
Anand Krishan - Midterm seminar
Gender inequity in child survival – Travails of a girl child in rural north India
June
Anna Myléus - Pre-dissertation
Exploring the Swedish epidemic of celiac disease in children – towards preventing celiac disease
Son Thai Pham - Dissertation
Hypertension in Vietnam – From community-based studies to a national targeted programme
Quang Ngoc Nguyen - Dissertation
Understanding and Managing Cardiovascular Disease Risk Factors in Vietnam
Osama Ahmed Hassan Ahmed – PhD plan presentation
Epidemiology and impact of Rift Valley fever outbreaks in Sudan using a one health approach
Midterm seminar – Jennifer Crowe
Exposure to extreme heat in sugarcane harvesters in the face of climate change
September
Masoud Vaezghasemi - PhD plan presentation
Inter- and Intra-household inequities and dual burden of malnutrition in Indonesia
Nitin Gangane - PhD plan presentation
Breast cancer in rural Wardha district, India
Cynthia Anticona - PhD pre-defense
Lead exposure among children of the Peruvian Amazon
Anna Myléus – Dissertation
Towards Explaining the Swedish Epidemic of Celiac Disease – an epidemiological approach
Anna Rosén – PhD pre-defense
Mass screening for celiac disease in 12-year-olds. Finding them and then what?
October
Siddhivinayak Hirve – Midterm seminar
Integrating Aging research in demographic surveillance areas - the Indian experience
Juan Antonio Cordoba - PhD plan presentation
Economic crises and health inequalities in Spain
Tej Ram Jat - Midterm seminar
Maternal health in Madhya Pradesh state of India
44
Anna Lorena Ruano – Dissertation
The role of social participation in municipal-level health systems: the case of Palencia, Guatemala
Vu Duy Kien – PhD plan presentation
Inequalities in chronic non-communicable diseases in urban Vietnam: Patterns, risk factors and health system
responsiveness
Hideyuki Kobayashi – PhD plan presentation
How can nursing develop old age capability?
November
Fatwa Sari Tetra Dewi – PhD pre-defense
Working with community: exploring community empowerment to support Non-communicable diseases
control in a middle-income country
Simon Lloyd (London School of Hygiene and Tropical Medicine)
Climate change and undernutrition
Paola Mosquera Mendez – Midterm seminar
Learning from the experiences of comprehensive primary health care: the case of Bogota, Colombia
Therese Kardakis – Midterm seminar
Strengthening health promotion in health care - the organisational change challenge
Sewe Marquin – PhD plan presentation
Developing and evaluating an M-health weather based malaria early warning system to reduce under five
mortality in KEMRI/CDC HDSS,Kenya
Elisabet Höög – Midterm seminar
Implementation challenges in health and social care organizations: See(k)ing obstacles - Finding opportunities
Cynthia Anticona Huaynate– Dissertation
Lead exposure in indigenous children of the Peruvian Amazon. Seeking the hidden source, venturing in
participatory research.
December
Anna Rosén - Dissertation
Mass screening for celiac disease in 12-year-olds. Finding them and then what?
Setareh Forouzan – Midterm seminar
The Mental Health Care System Responsiveness in Iran
Fredinah Namatovu – Midterm seminar
Exploring the multifactorial etiology of childhood celiac disease using combined Swedish national registers
Felix Kisanga – Dissertation
Child sexual abuse in urban Tanzania – Possibilities and barriers for prevention
45
Table 5. Doctoral students registered at the division 2012.
Name
Professional
background
Thesis subject
Osama Ahmed
Veterinary
Epidemiology and impact of Rift Valley fever outbreaks in Sudan using a one health approach
Cynthia Anticona
The case of heavy metals exposure in the indigenous communities of the Corrientes River Basin, Peru
Monika Appel
Dentist
(Diss. Nov. 2012)
Sociologist
Jennifer Crowe
MPH
Exposure to extreme heat in sugarcane harvesters in the face of climate change
Kristina Edvardsson
Nurse
Child health promotion and surveillance. The challenge of innovation, implementation and change
Thaddaeus Egondi
MSc in biostat
Assessing exposure to urban outdoor air pollution and associated mortality in Nairobi, Kenya
Setareh Forouzan
MD
The mental health care system responsiveness in Iran
Maria Furberg
MD
Climate change related aspects of health in northern Sweden
Hendrew Gekawaky
Nurse
Masculinity and HIV prevention in Dr Congo
Tesfay Gebrehiwet
MPH
Improving the utilization of maternal health care in health extension program context in Tigray region, Ethiopia
Yegomawork Gossaye
Nurse
Women’s health, domestic violence and its association to adverse mental health and child survival in Ethiopia
Lena Granlund
MD
D-vitaminbrist i Norra Sverige. En epidemiologisk studie av svenska och immigrerande populationer på latitud 63-7 grader Nord
Mats Granvik
Health planner
Befolkningen och hälso- och sjukvården – om psykosociala problem, prevention, somatisering och medikalisering
Lemma Hailemariam R.
Early diagnosis and prompt treatment of malaria. Implications of a new malaria control policy in Ethiopia
Elli Nur Hayati
BSc Biology
(Diss. May 2012)
Psychologist
Christina Hedlund
MD
Epidemiology and Surveillance of Climate sensitive Infectious Diseases in the Circumpolar area
Alison Hernandez
Nurse
Health service delivery in rural Guatemala: Supporting the performance of auxiliary nurses
Yien Ling Hii
Nurse
Climate index as an early warning for dengue prevention and control
Siddhivinayak Hirve
MPH
Integrating aging research in demographic surveillance are as- The Vadu HDSS experience in rural district of western India
Kerstin Hultén
Nutritionist
Breast cancer and dietary habits – an epidemiologic study of protective factors
Elisabet Höög
MA occup. psychology
Implementation challenges in health and social care organizations: Seeking obstacles, finding opportunities
Vijendra Ingole
MSc
A study of weather effects, susceptibilities and potential impacts of climate change on mortality in Vadu HDSS, India
Shabbir Ismail Abbas
MD, Community Health
Epidemiology of HIV/AIDS and high risk sexual behaviours among populations of Central Ethiopia
Junia Joffer
MPH
Self-rated health in adolescence – Experiences of and predictors for good health
Faustine Kalengayi
MD
Therese Kardakis
MPH
A world on the move: Challenges and opportunities for HIV/AIDS/TB Prevention and care for immigrants
from countries in sub-Sahara Africa
Strengthening health promotion in health care – the organizational change challenge
Alireza Khatami
MD
Vu Duy Kien
MPH
Felix Kisanga
The socio-cultural context of child sexual abuse (CSA) in Tanzania: possibilities and barriers for community prevention
Anand Krishnan
MD
(Diss. Dec. 2012)
MD
Utami Puji Lestari
Nurse
Risk factor of type 2 diabetes and their trends in Purworejo district, Indonesia
Creative competition or hampering hierarchy-a study concerning the academic working environment focusing on the doctoral student
Domestic violence in urban and rural Indonesia: Women´s experiences and men´s roles for prevention
Development and validation of a disease-specific instrument for evaluation of quality of life in adult Iranian patients with acute old world
cutaneous leishmaniasis
Inequalities in chronic non-communicable diseases in urban Vietnam: Patterns, social determinants and health system responses
Gender inequity in child survival: Travails of a girl child in rural North India
Kristina Lindvall
Dietician
Those who are able to be stable – Primary weight maintenance as a public health strategy for obesity prevention
Emil Löfroth
Economist
Vem ska få behandling? Ekonomiska, etiska och epidemiologiska aspekter på fördelningen av resurser för att förebygga hjärt-kärlsjukdom.
Paul Mee
MSc Epidemiology
Analysis of the effectiveness of a community health clinic via analysis of population level measures of mortality and morbidity
Paola Mosquera Mondez
MA soc policy
Learning from the experiences of comprehensive primary health care: Case Bogotá, Colombia
Kanyiva Muindi
Indoor air pollution and adverse pregnancy outcomes in Kenya
Fredinah Namatovu
MSc in Epidemiology and
biostatistics
Medical intern
(Diss. Sept. 2012)
MA health and society
Anne Neumann
Master of Med Sc
Prevention of Type 2 Diabetes Mellitus: modeling the cost-effectiveness of diabetes prevention
Per Nordin
Statistician
Kontaktgrad och vårdkonsumtion, en alternativ ansats för att belysa behov av sjukvård
Katrina Nordyke
Nurse
Mass screening for celiac disease. A public health intervention from the perspectives of participants and society
Fredrik Norström
Is mass screening for celiac disease a wise use of recourses?
Hassen Nuru
Statistician
(Diss. May 2012)
MD
Firdy Permana
MD
Environmental tobacco smoke exposure (ETS): children’s respiratory effects and the strategy to reduce domestic exposure
Endy Paryanto Prawirohartono
MD
(Lic. March 2012)
MSc health policy
Growth and health of children under tow years of age in Purworejo district, Central Java, Indonesia
MD
(Diss. June 2012)
MA social work
Women & hypertension in rural area of Vietnam. Perceptions, risk factors, burden and solutions
Exploring the complexity of screening detected celiac disease
Ailiana Santosa
MD
(Diss. Dec. 2012)
Sociology
(Diss. Oct. 2012)
MD, MpH
Melissa Scribani
MPH
Linda Sundberg
Psychologist
Pham Thai Son
Fatwa Sari Tetra Dewi
MD
(Diss. June 2012)
MD
Concequences of obesity and determinants of weight maintenance: a study of adult populations in rural New York State and Västerbotten
County, moving towards an intervention to stem the tide of the obesity epidemic
Development and implementation of national clinical guidelines in Swedish healthcare. The challenge to transform new knowledge to clinical
practice
Management of hypertension at community level in rural Vietnam – an intervention study
Nguyen Thi Bic Thuan
Economist
The burden of health care expenditure on households in a rural district of Vietnam
Masoud Vaezghasemi
The emergence of dual burden of malnutrition in Indonesia: The role of gender and social capital.
Maj Lis Voss
MSc Publ health and
epidemiology
Economist
Ryan Wagner
MSc
The economics of epilepsy: Modelling cost-effective interventions for the treatment of epilepsy in sub-Saharan Africa
Joseph Zulu
MSc in Social and cultural
anthropology
Integrating community health workers (CHWs into the health system and NIV/AIDS interventions in Zambia
Anna Myleus
Tej Ram Jat
Nguyen Ngoc Quang
Eva Randell
Anna Rosén
Ana Lorena Ruano Salguero
The Swedish Epidemic of Celiac Disease in Children. Aetiology and clinical expression explored by epidemiological research methods
Exploring the multifactorial etiology of childhood celiac disease combining national registers.
Health care financing reform in Addis Ababa public sector: Does it have any implication on health resources availability
Maternal health and emergency obstetric care in Madhya Pradesh state of India: A case study of Khargoue district
Tonårspojkars hälsa och självbild
The role of social participation in promoting democratic governance in local health systems: a case study in Guatemala
Towards a better understanding of epidemiological transition, based on Sweden´s experience
Tobacco control activities in southern area of Java
Assessing pre-adolescent well-being in low income and high income countries
Epidemiology and Global Health– Annual Report 2012
educational intervention. Clinical Chemistry
and Laboratory Medicine. 2013;51(2):303-310.
PUBLICATIONS
Brink M, Hansson M, Mathsson L, Jakobsson P,
Holmdahl R, Hallmans G, et al. Multiplex
analyses of antibodies against citrullinated
peptides in individuals prior to development of
rheumatoid
arthritis.
Arthritis
and
Rheumatism. 2013;65(4):899-910.
Original articles 2012Adam-Poupart A, Labreche F, Smargiassi A,
Duguay P, Busque M, Gagne C, et al. Climate
Change and Occupational Health and Safety in a
Temperate Climate: Potential Impacts and
Research Priorities in Quebec, Canada.
Industrial Health. 2013;51(1):68-78.
Byass P, Chandramohan D, Clark S J,
D'Ambruoso L, Fottrell E, Graham W J, et al.
Strengthening standardised interpretation of
verbal autopsy data: the new InterVA-4 tool.
Global health action. 2012;5:1-8.
Anticona C, Bergdahl I A, San Sebastian M.
Lead exposure among children from native
communities of the Peruvian Amazon basin.
Revista panamericana de salud pùblica.
2012;31(4):296-302.
Byass P, Friberg P, Blomstedt Y, Wall S.
Beyond 2015: time to reposition Scandinavia in
global health?. Global health action. 2013;6:1-3.
Anticona C, Bergdahl I, San Sebastian M.
Sources and risk factors for lead exposure in
indigenous children of the Peruvian Amazon,
disentangling connections with oil activity.
International journal of occupational and
environmental health. 2012;18(4):268-277.
Byass P. Is global health really global?.
International Conference on Global Public
Health, Colombo, Sri Lanka, in December 2012.
Byass P. The UN needs joined-up thinking on
vital registration. The Lancet. 2012;380(9854):
1643-1643.
Anticona C, Coe A, Bergdahl I, San Sebastian
M. Easier said than done: applying the
Ecohealth principles to a study of heavy metals
exposure among indigenous communities of the
Peruvian. BMC Public Health. 2013;13(437)
Chikovore J, Nyström L, Lindmark G, Ahlberg
B M. "How Can I Gain Skills if I Don't Practice?''
The Dynamics of Prohibitive Silence against PreMarital Pregnancy and Sex in Zimbabwe. PLoS
ONE. 2013;8(1):e53058-.
Backé E, Seidler A, Latza U, Rossnagel K,
Schumann B. The role of psychosocial stress at
work for the development of cardiovascular
diseases: a systematic review. International
Archives of Occupational and Environmental
Health. 2012;85(1):67-79.
Clark S J, Kahn K, Houle B, Arteche A,
Collinson M A, Tollman S M, et al. Young
Children's Probability of Dying Before and After
Their Mother's Death: A Rural South African
Population-Based Surveillance Study. PLoS
Medicine. 2013;10(3):e1001409-.
Barnett A G, Hajat S, Gasparrini A, Rocklöv J.
Cold and heat waves in the United States.
Environmental Research. 2012;112:218-224.
Coe A, Goicolea I, Hurtig A, San Sebastian
M. Understanding how young people do
activism: Youth strategies on sexual health in
Ecuador and Peru. Youth & society.
2012;(October 31)
Bertram M Y, Steyn K, Wentzel-Viljoen E,
Tollman S, Hofman K J. Reducing the sodium
content of high-salt foods: Effect on
cardiovascular disease in South Africa. SAMJ
South
African
Medical
Journal.
2012;102(9):743-745.
Coe A, Goicolea I, Öhman A. How gender
hierarchies matter in youth activism: Young
people's mobilizing around sexual health in
Ecuador and Peru. Journal of Youth Studies.
2012;(December 14)
Blomstedt Y, Souares A, Niamba L, Sie A,
Weinehall L, Sauerborn R. Measuring selfreported health in low-income countries:
piloting three instruments in semi-rural Burkina
Faso. Global health action. 2012;5:8488-.
Dambach P, Machault V, Lacaux J, Vignolles C,
Sie A, Sauerborn R. Utilization of combined
remote
sensing
techniques
to
detect
environmental variables influencing malaria
vector densities in rural West Africa.
International Journal of Health Geographics.
2012;11:8-.
Bölenius K, Brulin C, Grankvist K, Lindkvist
M, Söderberg J. A content validated
questionnaire for assessment of self reported
venous blood sampling practices. BMC Research
Notes. 2012;5:39-.
Bölenius K, Söderberg J, Hultdin J, Lindkvist
M, Brulin C, Grankvist K. Minor improvement
of venous blood specimen collection practices in
primary health care after a large-scale
D'Ambruoso L. Global health post-2015: the
case for universal health equity. Global health
action. 2013;6:1-8.
48
D'Ambruoso L. Relating the construction and
maintenance of maternal ill-health in rural
Indonesia. Global health action. 2012;5:17989-.
Gebrehiwot T, Goicolea I, Edin K, Sebastian
M S. Making pragmatic choices: women's
experiences of delivery care in Northern
Ethiopia. BMC Pregnancy and Childbirth.
2012;12(1):113-.
Diboulo E, Sie A, Rocklöv J, Niamba L, Ye M,
Bagagnan C, et al. Weather and mortality: a 10
year retrospective analysis of the Nouna Health
and Demographic Surveillance System, Burkina
Faso. Global health action. 2012;5:19078-.
Goicolea I, Coe A, Hurtig A, San Sebastian
M. Mechanisms for achieving adolescentfriendly services: a realist evaluation approach.
Global health action. 2012;5:18748-.
Edvardsson D, Petersson L, Sjogren K,
Lindkvist M, Sandman P. Everyday activities
for people with dementia in residential aged
care: associations with person-centredness and
quality of life. International journal of older
people nursing. 2013;
Goicolea I, Öhman A, Salazar Torres M,
Morras I, Edin K. Condemning violence
without rejecting sexism?: Exploring how young
men understand intimate partner violence in
Ecuador. Global health action. 2012;5:1-12.
Edvardsson K, Ivarsson A, Garvare R,
Eurenius E, Lindkvist M, Mogren I, et al.
Improving child health promotion practices in
multiple sectors: outcomes of the Swedish Salut
Programme. BMC Public Health. 2012;12(1):
920-.
Goicolea I, Salazar Torres M, Edin K,
Öhman A. When sex is hardly about mutual
pleasure: Dominant and resistant discourses on
sexuality and its consequences for young
people's sexual health. International Journal of
Sexual Health. 2012;24(4):303-317.
Egondi T, Kyobutungi C, Kovats S, Muindi K,
Ettarh R, Rocklöv J. Time-series analysis of
weather and mortality patterns in Nairobi's
informal settlements. Global health action.
2012;5:23-32.
Goicolea I, Vives-Cases C, San Sebastian M,
Marchal B, Kegels G, Hurtig A. How do
primary health care teams learn to integrate
intimate partner violence (IPV) management? A
realist evaluation protocol. Implementation
Science. 2013;8:36-.
Ekblom K, Marklund S L, Palmqvist R, Van
Guelpen B, Hallmans G, Weinehall L, et al.
Iron Biomarkers in Plasma, HFE Genotypes,
and the Risk for Colorectal Cancer in a
Prospective Setting. Diseases of the Colon &
Rectum. 2012;55(3):337-344.
Gomez-Olive F X, Thorogood M, Clark B, Kahn
K, Tollman S. Self-reported health and health
care use in an ageing population in the
Agincourt sub-district of rural South Africa.
Eliassen A H, Hendrickson S J, Brinton L A,
Buring J E, Campos H, Dai Q, et al. Circulating
Carotenoids and Risk of Breast Cancer: Pooled
Analysis of Eight Prospective Studies. Journal of
the National Cancer Institute. 2012;104(24):
1905-1916.
Gustafsson P E, Janlert U, Theorell T,
Westerlund H, Hammarström A. Do peer
relations in adolescence influence health in
adulthood?: Peer problems in the school setting
and the metabolic syndrome in middle-age.
PLoS ONE. 2012;7(6):e39385-.
Eriksson M. Socialt kapital och hälsa förklaringsmodeller och implikationer för
hälsofrämjande interventioner. Socialmedicinsk
Tidskrift. 2012;89(4-5):332-346.
Gustafsson P E, Janlert U, Theorell T,
Westerlund H, Hammarström A. Social and
material adversity from adolescence to
adulthood and allostatic load in middle-aged
women and men: results from the Northern
Swedish cohort. Annals of Behavioral Medicine.
2012;43(1):117-128.
Fors R, Stenberg B, Stenlund H, Persson M.
Nickel allergy in relation to piercing and
orthodontic appliances-a population study.
Contact Dermatitis. 2012;
Gustafsson P E, Janlert U, Virtanen P,
Hammarström A. The association between longterm accumulation of temporary employment,
the cortisol awakening response and circadian
cortisol levels.
Psychoneuroendocrinology.
2012;37(6):789-800.
Fottrell E, Tollman S, Byass P, GoloobaMutebi F, Kahn K. The epidemiology of
'bewitchment' as a lay-reported cause of death in
rural South Africa. Journal of Epidemiology
and Community Health. 2012;66(8):704-709.
Hammarström A, Janlert U. Cohort Profile:
The Northern Swedish Cohort. International
Journal of Epidemiology. 2012;41(6):1545-1552.
Franklin K A, Sahlin C, Stenlund H, Lindberg
E. Sleep apnoea is a common occurrence in
females.
European
Respiratory
Society
Journals; European Respiratory Journal.
2013;41(3):610-615.
Hayati E N, Eriksson M, Hakimi M, Högberg
U, Emmelin M. "Elastic band strategy": women's
lived experience of coping with domestic
49
violence in rural Indonesia. Global health
action. 2013;6:1-12.
insurance in rural Burkina Faso. BMC Health
Services Research. 2012;12:363-.
Hellquist B N, Jonsson H, Nyström L. Unclear
methods in estimate of screening effect in
women ages 40-49 years Author Reply. Cancer.
2012;118(4):1170-1171.
Hounton S, De Bernis L, Hussein J, Graham W
J, Danel I, Byass P, et al. Towards elimination
of maternal deaths: maternal deaths surveillance
and response. Reproductive health. 2013;10:1-.
Hellquist Numan B, Duffy S W, Nyström L,
Jonsson H. Overdiagnosis in the populationbased service screening programme with
mammography for women aged 40 to 49 years
in Sweden. Journal of Medical Screening.
2012;19(1):14-19.
Huda M M, Hirve S, Siddiqui N A, Malaviya P,
Banjara M R, Das P, et al. Active case detection
in national visceral leishmaniasis elimination
programs in Bangladesh, India, and Nepal:
feasibility, performance and costs. BMC Public
Health. 2012;12:1001-.
Hernández A, Hurtig A, Dahlblom K, San
Sebastián
M.
Translating
community
connectedness to practice: a qualitative study of
midlevel health workers in rural Guatemala.
ISRN Nursing. 2012;2012:648769-.
Hutajulu S H, Ng N, Jati B R, Fachiroh J,
Herdini C, Hariwiyanto B, et al. Seroreactivity
against Epstein-Barr virus (EBV) among firstdegree relatives of sporadic EBV-associated
nasopharyngeal carcinoma in Indonesia.
Journal of Medical Virology. 2012;84(5):768776.
Hernestål-Boman J, Norberg M, Jansson J,
Eliasson M, Eriksson J W, Lindahl B, et al. Signs
of dysregulated fibrinolysis precede the
development of type 2 diabetes mellitus in a
population-based
study.
Cardiovascular
Diabetology. 2012;11:152-.
Ingole V, Juvekar S, Muralidharan V,
Sambhudas S, Rocklöv J. The short-term
association of temperature and rainfall with
mortality in Vadu Health and Demographic
Surveillance System: a population level time
series analysis. Global health action. 2012;5:4452.
Hii Y L, Rocklöv J, Wall S, Ng L C, Tang C S,
Ng N. Optimal lead time for dengue forecast.
PLoS Neglected Tropical Diseases. 2012;6(10):
e1848-.
Ivarsson A, Myléus A, Norström F, van der
Pals M, Rosén A, Högberg L, et al. Prevalence
of childhood celiac disease and changes in infant
feeding. Pediatrics. 2013;131(3):e687-e694.
Hii Y L, Zhu H, Ng N, Ng L C, Rocklöv J.
Forecast of dengue incidence using temperature
and rainfall. PLoS Neglected Tropical Diseases.
2012;6(11):e1908-.
Jakobson Mo S, Larsson A, Johansson L,
Stenlund H, Forsgren L, Riklund K. Crosscamera comparison of ROI-based semiquantitative 123I-IBZM SPECT data in healthy
volunteers using an anthropomorphic phantom
for calibration. Acta Radiologica. 2013;
Hirve S, Juvekar S, Sambhudas S, Lele P,
Blomstedt Y, Wall S, et al. Does self-rated
health predict death in adults aged 50 years and
above in India?: Evidence from a rural
population under health and demographic
surveillance.
International
Journal
of
Epidemiology. 2012;41(6):1719-1727.
Johansson L, Stenlund H, Bylund P, Eriksson
A. ER visits predict premature death among
teenagers. Accident Analysis and Prevention.
2012;48(S1):397-400.
Hoi L V, Tien N T, Tien N V, Dung D V, Chuc N
T, Sahlen K, et al. Willingness to use and pay
for options of care for community dwelling older
people in rural Vietnam. BMC Health Services
Research. 2012;12:36-.
Kahn K, Collinson M A, Gomez-Olive F X,
Mokoena O, Twine R, Mee P, et al. Profile:
Agincourt Health and Socio-demographic
Surveillance System. International Journal of
Epidemiology. 2012;41(4):988-1001.
Holmner Å, Rocklöv J, Ng N, Nilsson M.
Climate change and eHealth: a promising
strategy for health sector mitigation and
adaptation. Global health action. 2012;5:1-9.
Karim K R, Emmelin M, Resurreccion B P,
Wamala S. Water development projects and
marital violence: experiences from rural
Bangladesh.
Health
Care
for
Women
International. 2012;33(3):200-216.
Hondula D M, Rocklöv J, Sankoh O A. Past,
present, and future climate at select INDEPTH
member Health and Demographic Surveillance
Systems in Africa and Asia. Global health action.
2012;5:74-86.
Karlsson B, Lindkvist M, Lindkvist M,
Karlsson M, Lundström R, Håkansson S, et al.
Sound and vibration: effects on infants' heart
rate and heart rate variability during neonatal
transport. Acta Paediatrica. 2012;101(2):148154.
Hounton S, Byass P, Kouyate B. Assessing
effectiveness of a community based health
50
Kautto E, Ivarsson A, Norström F, Högberg
L, Carlsson A, Hörnell A. Nutrient intake in
adolescent girls and boys diagnosed with coeliac
disease at an early age is mostly comparable to
their non-coeliac contemporaries. Journal of
human nutrition and dietetics (Print). 2013;
Lilja M, Rolandsson O, Norberg M, Söderberg
S. The iImpact of Leptin and Adiponectin on
incident type 2 Diabetes is modified by sex and
insulin resistance. Metabolic Syndrome and
Related Disorders. 2012;10(2):143-151.
Linder J, Libelius R, Nordh E, Holmberg B,
Stenlund H, Forsgren L. Anal sphincter
electromyography in patients with newly
diagnosed idiopathic parkinsonism. Acta
Neurologica Scandinavica. 2012;126(4):248255.
Kidanto H L, Wangwe P, Kilewo C D, Nyström
L, Lindmark G. Improved quality of
management of eclampsia patients through
criteria based audit at Muhimbili National
Hospital, Dar es Salaam, Tanzania: Bridging the
quality gap. BMC Pregnancy and Childbirth.
2012;12:134-.
Linder J, Wenngren B, Stenlund H, Forsgren
L. Impaired oculomotor function in a
community-based patient population with newly
diagnosed idiopathic parkinsonism. Journal of
Neurology. 2012;259(6):1206-1214.
Kinsman J. "A time of fear": local, national,
and international responses to a large Ebola
outbreak in Uganda. Globalization and health.
2012;8(1):15-.
Lundberg V, Lindh V, Eriksson C, Petersen S,
Eurenius E. Health-related quality of life in
girls and boys with juvenile idiopathic arthritis:
self- and parental reports in a cross-sectional
study. Pediatric Rheumatology. 2012;10:33-.
Kjellström T, Lemke B, Otto M. Mapping
Occupational Heat Exposure and Effects in
South-East Asia: Ongoing Time Trends 19802011 and Future Estimates to 2050. Industrial
Health. 2013;51(1):56-67.
Kjellström T, McMichael A J. Climate change
threats to population health and well-being: the
imperative of protective solutions that will last.
Lundqvist L, Stenlund H, Laurell G, Nylander
K. The importance of stromal inflammation in
squamous cell carcinoma of the tongue. Journal
of Oral Pathology & Medicine. 2012;41(5):379383.
Kjellström T, Sawada S, Bernard T E, Parsons
K, Rintamäki H, Holmér I. Climate change and
occupational heat problems. Industrial Health.
2013;51(1):1-2.
Madhavan S, Schatz E, Clark S, Collinson M.
Child mobility, maternal status, and household
composition in rural South Africa. Demography.
2012;49(2):699-718.
Kowal P, Chatterji S, Naidoo N, Biritwum R, Fan
W, Lopez Ridaura R, et al. Data resource profile:
the World Health Organization Study on global
AGEing and adult health (SAGE). International
Manithip C, Edin K, Sihavong A, Wahlström R,
Wessel H. Poor quality of antenatal care
services-Is lack of competence and support the
reason? An observational and interview study in
rural areas of Lao PDR. Midwifery.
2012;29(3):195-202.
Krishnan A, Dwivedi P, Gupta V, Byass P,
Pandav C S, Ng N. Socioeconomic development
and girl child survival in rural North India:
solution or problem?. Journal of Epidemiology
Månsdotter A, Lundberg M, Lindholm L. How
does gender equality progress link to alcohol
care and death?: A registry study of the Swedish
parental cohort of 1988/1989. Journal of Public
Health Policy. 2012;33(1):105-118.
Krishnan A, Ng N, Kapoor S K, Pandav C S,
Byass P. Temporal trends and gender
differentials in causes of childhood deaths at
Ballabgarh, India: need for revisiting child
survival strategies. BMC Public Health.
2012;12:555-.
Massad E, Amaku M, Bezerra Coutinho F A,
Kittayapong P, Wilder-Smith A. Theoretical
impact of insecticide-impregnated school
uniforms on dengue incidence in Thai children.
Kyaddondo D, Wanyenze R K, Kinsman J,
Hardon A. Home-based HIV counseling and
testing: client experiences and perceptions in
Eastern
Uganda.
BMC
Public
Health.
2012;12(1):966-.
Massad E, Rocklöv J, Wilder-Smith A.
Dengue infections in non-immune travellers to
Thailand.
Epidemiology
and
Infection.
2013;141(2):412-417.
Millde-Luthander C, Högberg U, Nyström M
E, Pettersson H, Wiklund I, Grunewald C. The
impact of a computer assisted learning
programme on the ability to interpret
cardiotochography. A before and after study.
Lemke B, Kjellström T. Calculating workplace
WBGT from meteorological data: a tool for
climate change assessment. Industrial Health.
2012;50(4):267-278.
51
Sexual & Reproductive HealthCare. 2012;3(1):
37-41.
Nguyen N Q, Pham T S, Do L D, Nguyen V L,
Wall S, Weinehall L, et al. Cardiovascular
disease risk factor patterns and their
implications for intervention strategies in
Vietnam. International journal of hypertension.
2012;(560397)
Mosquera P A, Hernandez J, Vega R, Martinez J,
Labonte R, Sanders D, et al. Primary health care
contribution to improve health outcomes in
Bogota-Colombia: a longitudinal ecological
analysis. BMC Family Practice. 2012;13:84-.
Nguyen N Q, Pham T S, Nguyen L, Weinehall
L, Bonita R, Byass P, et al. Time trends in
blood pressure, body mass index and smoking in
the Vietnamese population: a meta-analysis
from multiple cross-sectional surveys. PLoS
ONE. 2012;7(8):e42825-.
Mosquera P A, Hernandez J, Vega R, Martinez J,
Labonte R, Sanders D, et al. The impact of
primary healthcare in reducing inequalities in
child health outcomes, Bogota - Colombia: an
ecological analysis. International Journal for
Equity in Health. 2012;11:66-.
Nguyen N Q, Pham T S, Nguyen V L, Wall S,
Weinehall L, Bonita R, et al. Effectiveness of
community-based
comprehensive
healthy
lifestyle promotion on cardiovascular disease
risk factors in a rural Vietnamese population: a
quasi-experimental study. BMC Cardiovascular
Disorders. 2012;12(article nr 56)
Musenge E, Chirwa T F, Kahn K, Vounatsou P.
Bayesian analysis of zero inflated spatiotemporal
HIV/TB child mortality data through the INLA
and SPDE approaches: applied to data observed
between 1992 and 2010 in rural North East
South Africa. International Journal of Applied
Earth Observation and Geoinformation.
2013;22:86-98.
Nilsson A, Lindkvist M, Rasmussen B,
Edvardsson D. Staff attitudes towards older
patients with cognitive impairment: need for
improvements in acute care. Journal of Nursing
Management. 2012;20(5):640-647.
Musenge E, Vounatsou P, Collinson M,
Tollman S, Kahn K. The contribution of
spatial analysis to understanding HIV/TB
mortality in children: a structural equation
modelling approach. Global health action.
2013;6:38-48.
Nilsson M, Evengård B, Sauerborn R, Byass
P. Connecting the global climate change and
public health agendas. PLoS Medicine.
2012;9(6):e1001227-.
Myléus A, Hernell O, Gothefors L,
Hammarström M, Persson L, Stenlund H, et
al. Early infections are associated with increased
risk for celiac disease: an incident case-referent
study. BMC Pediatrics. 2012;12(1):194-.
Nkulu Kalengayi F K, Hurtig A, Ahlm C,
Ahlberg B M. "It is a challenge to do it the right
way": an interpretive description of caregivers'
experiences in caring for migrant patients in
Northern Sweden. BMC Health Services
Research. 2012;12:433-.
Myleus A, Stenlund H, Hernell O, Gothefors
L, Hammarström M, Persson L, et al. Early
vaccinations are not risk factors for Celiac
Disease. Pediatrics. 2012;130(1):E63-E70.
Nkulu Kalengayi F K, Hurtig A, Ahlm C,
Krantz I. Fear of deportation may limit legal
immigrants' access to HIV/AIDS-related care:
a survey of Swedish language school students in
Northern Sweden. Journal of Immigrant and
Minority Health. 2012;14(1):39-47.
Ng N, Carlberg B, Weinehall L, Norberg M.
Trends of blood pressure levels and
management in Västerbotten County, Sweden,
during 1990-2010. Global health action.
2012;5:1-12.
Norberg M, Danielsson M. Overweight,
cardiovascular diseases and diabetes: Health in
Sweden. Scandinavian Journal of Public
Health. 2012;40(9 Suppl):135-63.
Ng N, Hakimi M, Santosa A, Byass P, Wilopo
S A, Wall S. Is Self-Rated Health an
Independent Index for Mortality among Older
People in Indonesia? PLoS ONE. 2012;7(4):
e35308-.
Nordyke K, Norström F, Lindholm L,
Stenlund H, Rosén A, Ivarsson A. Healthrelated quality of life in adolescents with
screening-detected celiac disease, before and
one year after diagnosis and initiation of glutenfree diet, a prospective nested case-referent
study. BMC public health. 2013;13(142)
Ng N, Johnson O, Lindahl B, Norberg M. A
reversal of decreasing trends in population
cholesterol levels in Västerbotten County,
Sweden. Global health action. 2012;5:10367-.
Ngugi A K, Bottomley C, Kleinschmidt I, Wagner
R G, Kakooza-Mwesige A, Ae-Ngibise K, et al.
Prevalence of active convulsive epilepsy in subSaharan Africa and associated risk factors:
cross-sectional and case-control studies. Lancet
Neurology. 2013;12(3):253-263.
Norström F, Sandström O, Lindholm L,
Ivarsson A. A gluten-free diet effectively
reduces symptoms and health care consumption
in a Swedish celiac disease population. BMC
Gastroenterology. 2012;12(1):125-.
52
Nygren K, Bergström E, Janlert U, Nygren L.
Adolescent Self-Reported Health in Relation to
School Factors: A Multilevel Analysis. Journal of
School Nursing. 2013;
Their Relationships With Infant Body
Composition. Diabetes Care. 2013;36(2):267269.
Ramroth H, Lorenz E, Rankin J C, Fottrell E,
Ye M, Neuhann F, et al. Cause of death
distribution with InterVA and physician coding
in a rural area of Burkina Faso. Tropical
medicine & international health. 2012;17(7):
904-913.
Nygren K, Bergström E, Janlert U, Nygren L.
Parents matter: but relations to parents do not
explain gender differences in self-reported
health in adolescents. Scandinavian Journal of
Caring Sciences. 2012;26(4):643-653.
Nygren K, Janlert U, Nygren L. What happens
with local survey findings?: A study of how
adolescent school surveys are disseminated and
utilized in Swedish schools. Scandinavian
Journal of Educational Research. 2012;
Revill J, Candia Carnevali M D, Forsberg Å,
Holmström A, Rath J, Khan Shinwari Z, et al.
Lessons learned from implementing education
on dual-use in Austria, Italy, Pakistan and
Sweden. Medicine, Conflict and Survival.
2012;28(1):31-44.
Nyholm M, Lissner L, Hörnell A, Johansson I,
Hallmans G, Weinehall L, et al. Exploring
dietary patterns, obesity and sources of bias: the
Västerbotten Intervention Programme (VIP).
Public Health Nutrition. 2013;16(4):631-638.
Rocklöv J, Barnett A G, Woodward A. On the
estimation of heat-intensity and heat-duration
effects in time series models of temperaturerelated mortality in Stockholm, Sweden.
Environmental health. 2012;11:23-.
Nyström M E, Terris D D, Sparring V, Tolf S,
Brown C R. Perceived organizational problems
in health care: a pilot test of the structured
problem and success inventory. Quality
Management in Health Care. 2012;21(2):93103.
Rocklöv J, Ebi K L. High Dose Extrapolation in
Climate Change Projections of Heat-Related
Mortality. Journal of Agricultural Biological
and Environmental Statistics. 2012;17(3):461475.
Nyström M E, Westerlund A, Höög E, MilldeLuthander C, Högberg U, Grunewald C.
Healthcare system intervention for prevention of
birth injuries - process evaluation of selfassessment, peer review, feedback and
agreement for change. BMC Health Services
Research. 2012;12(article number 274)
Rocklöv J, Sauerborn R, Sankoh O. Weather
conditions and population level mortality in
resource-poor settings - understanding the past
before projecting the future. Global health
action. 2012;5:2-5.
Rolandsson O, Norberg M, Nyström L,
Söderberg S, Svensson M, Lindahl B, et al. How
to diagnose and classify diabetes in primary
health care: Lessons learned from the Diabetes
Register in Northern Sweden (DiabNorth).
Scandinavian Journal of Primary Health Care.
2012;30(2):81-87.
Obando Medina C, Jegannathan B, Dahlblom
K, Kullgren G. Suicidal expressions among
young people in Nicaragua and Cambodia: a
cross-cultural
study.
BMC
Psychiatry.
2012;12:28-.
Ohlsson L, Israelsson A, Öberg Å, Palmqvist R,
Stenlund H, Hammarström M, et al. Lymph
node CEA and MUC2 mRNA as useful predictors
of outcome in colorectal cancer. International
Journal of Cancer. 2012;130(8):1833-1843.
Romanos J, Rosén A, Kumar V, Trynka G,
Franke L, Szperl A, et al. Improving coeliac
disease risk prediction by testing non-HLA
variants additional to HLA variants. Gut. 2013;
Rönnlund M, Carlstedt B, Blomstedt Y,
Nilsson L, Weinehall L. Secular trends in
cognitive test performance: Swedish conscript
data 1970-1993. Intelligence. 2013;41(1):19-24.
Petersen Z, Nilsson M, Steyn K, Emmelin M.
Identifying with a process of change: A
qualitative assessment of the components
included in a smoking cessation intervention at
antenatal clinics in South Africa. Midwifery.
2012;
Ruano A L, Hernández A, Dahlblom K,
Hurtig A, San Sebastián M. ‘It’s the sense of
responsibility that keeps you going’: stories and
experiences of participation from rural
community health workers in Guatemala.
Archives of Public Health. 2012;70:18-.
Pham S T, Nguyen Q N, Viet N, Khai P, Wall S,
Weinehall L, et al. Prevalence, awareness,
treatment and control of hypertension in
Vietnam: results from a national survey. Journal
of Human Hypertension. 2012;26:268-280.
Sahlen K, Johansson H, Nyström L,
Lindholm L. Health coaching to promote
healthier lifestyle among older people at
moderate risk for cardiovascular diseases,
diabetes and depression: a study protocol for a
Pomeroy J, Renström F, Gradmark A, Mogren I,
Persson M, Bluck L, et al. Maternal Physical
Activity and Insulin Action in Pregnancy and
53
randomized controlled trial in Sweden. BMC
public health. 2013;13:199-.
Changing
Climate.
2013;51(1):123-127.
Sahlen K, Löfgren C, Brodin H, Dahlgren L,
Lindholm L. Measuring the value of older
people's production: a diary study. BMC Health
Services Research. 2012;12:4-.
Sjögren K, Lindkvist M, Sandman P, Zingmark
K, Edvardsson D. Person-centredness and its
association with resident well-being in dementia
care units. Journal of Advanced Nursing. 2013;
Salazar M, Högberg U, Valladares E, Öhman
A. The supportive process for ending intimate
partner violence after pregnancy: the experience
of nicaraguan women. Violence against Women.
2012;18(11):1257-1278.
Sjögren K, Lindkvist M, Sandman P, Zingmark
K, Edvardsson D. Psychometric evaluation of the
Swedish version of the Person-Centered Care
Assessment
Tool
(P-CAT.
International
psychogeriatrics. 2012;24(3):406-415.
Salazar M, Högberg U, Valladares E, Persson
L. Intimate partner violence and early child
growth: a community-based cohort study in
Nicaragua. BMC Pediatrics. 2012;12:82-.
Sjöström M, Stenlund H, Johansson S,
Umefjord G, Samuelsson E. Stress urinary
incontinence and quality of life: A reliability
study of a condition-specific instrument in paper
and web-based versions. Neurourology and
Urodynamics. 2012;31(8):1242-1246.
Salazar M, Valladares E, Högberg U. Questions
about intimate partner violence should be part
of contraceptive counselling: findings from a
community-based
longitudinal
study
in
Nicaragua. Journal of family planning and
reproductive health care. 2012;38(4):221-228.
Industrial
Health.
Sörlin A, Öhman A, Ng N, Lindholm L. Can
the impact of gender equality on health be
measured? a cross-sectional study comparing
measures based on register data with individual
survey-based data. BMC Public Health.
2012;12(1):795-.
Salzer J, Hallmans G, Nyström M, Stenlund H,
Wadell G, Sundström P. Vitamin D as a
protective factor in multiple sclerosis.
Neurology. 2012;79(21):2140-2145.
Sparring V, Nyström L, Östman J, Wahlström
R, Burström K, Jonsson P. Changing healthcare
utilization patterns in diabetes mellitus: casecontrol studies 1 year and 8 years after
diagnosis. Diabetic Medicine. 2012;29(6):784791.
Wadell G, Sundström P. Vitamin A and systemic
inflammation as protective factors in multiple
sclerosis. Multiple Sclerosis. 2013;
Stordalen G A, Rocklöv J, Nilsson M, Byass
P. Only an integrated approach across
academia, enterprise, governments, and global
agencies can tackle the public health impact of
climate change. Global health action. 2013;6:16.
Wadell G, Sundström P. Smoking as a risk factor
for multiple sclerosis. Multiple Sclerosis. 2012;
Sandzén B, Haapamäki M M, Nilsson E,
Stenlund H C, Öman M. Treatment of
Common Bile Duct Stones in Sweden 19892006: An Observational Nationwide Study of a
Paradigm Shift. World Journal of Surgery.
2012;36(9):2146-2153.
Szajewska H, Chmielewska A, Pieścik-Lech M,
Ivarsson A, Kolacek S, Koletzko S, et al.
Systematic review: early infant feeding and the
prevention of coeliac disease. Alimentary
Pharmacology and Therapeutics. 2012;36(7):
607-618.
Sandzén B, Haapamäki M M, Nilsson E,
Stenlund H, Öman M. Surgery for acute
gallbladder disease in Sweden 1989-2006: A
register study. Scandinavian Journal of
Gastroenterology. 2013;48(4):480-486.
Taha H, Al-Qutob R, Nyström L, Wahlström R,
Berggren V. "Voices of fear and safety".
Women's ambivalence towards breast cancer
and breast health: a qualitative study from
Jordan. BMC Women's Health. 2012;12:21-.
Sankoh O, Byass P. The INDEPTH Network:
filling vital gaps in global epidemiology.
International
Journal
of
Epidemiology.
2012;41(3):579-588.
Tawatsupa B, Lim L L-Y, Kjellström T,
Seubsman S, Sleigh A. Association between
occupational heat stress and kidney disease
among 37 816 workers in the Thai Cohort Study
(TCS). Japan Epidemiological Association;
Schumann B, Edvinsson S, Evengård B,
Rocklöv J. The influence of seasonal climate
variability on mortality in pre-industrial
Sweden. Global health action. 2013;6:1-9.
Tawatsupa B, Yiengprugsawan V, Kjellström
T, Berecki-Gisolf J, Seubsman S, Sleigh A.
Association
between
Heat
Stress
and
Occupational Injury among Thai Workers:
Sheffield P E, Herrera J G, Lemke B,
Kjellström T, Romero L E. Current and Future
Heat Stress in Nicaraguan Work Places under a
54
Findings of the Thai Cohort Study. Industrial
Health. 2013;51(1):34-46.
evaluation of an integrated child health delivery
platform. Global health action. 2013;6:1-9.
Tawatsupa B, Yiengprugsawan V, Kjellström
T, Seubsman S, Sleigh A. Heat stress, health and
well-being: findings from a large national cohort
of Thai adults. BMJ Open. 2012;2(6)
Verguet S, Jassat W, Hedberg C, Tollman S,
Jamison D T, Hofman K J. Measles control in
Sub-Saharan Africa: South Africa as a case
study. Vaccine. 2012;30(9):1594-1600.
Thanh N X, Lindholm L. Has Vietnam Health
care funds for the poor policy favored the elderly
poor?.
BMC
health
services
research.
2012;12:333-.
Virtanen P, Janlert U, Hammarström A.
Health status and health behaviour as predictors
of the occurrence of unemployment and
prolonged unemployment. Public Health.
2013;127(1):46-52.
Thoa N T, Thanh N X, Chuc N T, Lindholm L.
The impact of economic growth on health care
utilization: a longitudinal study in rural
Vietnam. International journal for equity in
health. 2013;12:19-.
Virtanen P, Janlert U, Hammarström A.
Suboptimal health as a predictor of nonpermanent employment in middle age: a 12-year
follow-up study of the Northern Swedish Cohort.
International Archives of Occupational and
Environmental Health. 2013;86(2):139-145.
Thomsen S, Biao X, Kusnanto H, Mavalankar D,
Malqvist M, Ng N, et al. The world we want:
focus on the most disadvantaged. Global health
action. 2013;6:20919-.
Wagman J A, Namatovu F, Nalugoda F,
Kiwanuka D, Nakigozi G, Gray R, et al. A public
health approach to intimate partner violence
prevention in Uganda: The SHARE project.
Violence against Women. 2012;18(12):13901412.
Thomsen S, Ng N, Biao X, Bondjers G,
Kusnanto H, Liem N T, et al. Bringing evidence
to policy to achieve health-related MDGs for all:
justification and design of the EPI-4 project in
China, India, Indonesia, and Vietnam. Global
health action. 2013;6:1-10.
Waller G, Thalén P, Janlert U, Hamberg K,
Forssén A. A cross-sectional and semantic
investigation of self-rated health in the northern
Sweden MONICA-study. BMC Medical Research
Methodology. 2012;12:154-.
Torres V M, Goicolea I, Edin K, Öhman A.
'Expanding your mind': the process of
constructing gender-equitable masculinities in
young Nicaraguan men participating in
reproductive health or gender training
programs. Global health action. 2012;5
Weinehall L. Foreword. Global health action.
2013;6:1-1.
Weinehall L. Västerbottens satsning på
storskalig hjärt–kärlprevention. Stockholm;
Läkartidningen. 2012;109(36):1552-4.
Tsegay Y, Gebrehiwot T, Goicolea I, Edin K,
Lemma H, Sebastian M S. Determinants of
antenatal and delivery care utilization in Tigray
region, Ethiopia: a cross-sectional study.
International journal for equity in health.
2013;12:30-.
Wennberg M, Strömberg U, Bergdahl I A,
Jansson J, Kauhanen J, Norberg M, et al.
Myocardial infarction in relation to mercury and
fatty acids from fish: a risk-benefit analysis
based on pooled Finnish and Swedish data in
men. American Journal of Clinical Nutrition.
2012;96(4):706-713.
Vaezghasemi M, Lindkvist M, Ivarsson A,
Eurenius E. Overweight and lifestyle among
13-15 year olds: A cross-sectional study in
northern Sweden. Scandinavian Journal of
Public Health. 2012;40(3):221-228.
Wennberg M, Stromberg U, Bergdahl I, Jansson
J, Kauhanen J, Norberg M, et al. Myocardial
infarction in relation to mercury and fatty acids
from fish. 48th Congress of the EuropeanSocieties-of-Toxicology (EUROTOX), JUN 1720, 2012, Stockholm, SWEDEN. Toxicology
Letters. 2012;211:S125-S125.
Valham F, Sahlin C, Stenlund H, Franklin K A.
Ambient temperature and obstructive sleep
apnea: effects on sleep, sleep apnea and
morning alertness. Sleep. 2012;35(4):513-517.
Van Minh H, Ng N, Byass P, Wall S. Patterns
of subjective quality of life among older adults in
rural Vietnam and Indonesia. Geriatrics &
Gerontology International. 2012;12:397-404.
Wennberg M, Tornevi A, Johansson I, Hörnell
A, Norberg M, Bergdahl I A. Diet and lifestyle
factors associated with fish consumption in men
and women: a study of whether gender
differences can result in gender-specific
confounding. Nutrition Journal. 2012;11:101-.
Verguet S, Jassat W, Bertram M Y, Tollman S
M, Murray C J, Jamison D T, et al.
Supplementary immunization activities (SIAs)
in South Africa: comprehensive economic
Westerlund H, Gustafsson P E, Theorell T,
Janlert U, Hammarström A. Social Adversity in
55
Adolescence
Increases
the
Physiological
Vulnerability to Job Strain in Adulthood: A
Prospective Population-Based Study. PLoS ONE.
2012;7(4):e35967-.
hospital admissions in Europe in a changing
climate:
a
health
impact
assessment.
group.bmj.open;
BMJ
Open.
2013;3(1):
e001842-.
Westerlund H, Gustafsson P E, Theorell T,
Janlert U, Hammarström A. Parental academic
involvement
in
adolescence,
academic
achievement over the life course and allostatic
load in middle age: a prospective populationbased cohort study. Journal of Epidemiology
Åstrom C, Rocklöv J, Hales S, Beguin A, Louis
V, Sauerborn R. Potential Distribution of
Dengue Fever Under Scenarios of Climate
Change and Economic Development. EcoHealth.
2012;9(4):448-454.
Ärlestig L, Mullazehi M, Kokkonen H, Rocklöv
J, Rönnelid J, Rantapää Dahlqvist S. Antibodies
against cyclic citrullinated peptides of IgG, IgA
and IgM isotype and rheumatoid factor of IgM
and IgA isotype are increased in unaffected
members of multicase rheumatoid arthritis
families from northern Sweden. BMJ Publishing
Group; Annals of the Rheumatic Diseases.
2012;71(6):825-829.
Wiklund M, Malmgren-Olsson E, Öhman A,
Bergström E, Fjellman Wiklund A. Subjective
health complaints in older adolescents are
related to perceived stress, anxiety and gender: a
cross-sectional school study in Northern
Sweden. BMC Public Health. 2012;12(993)
Wiklund P, Nordström A, Jansson J,
Weinehall L, Nordström P. Low bone mineral
density is associated with increased risk for
myocardial infarction in men and women.
Osteoporosis International. 2012;23(3):963970.
Other publications 2012
Anticona Huaynate C. Lead exposure in
indigenous children of the Peruvian Amazon:
seeking the hidden source,venturing into
participatory research. [Thesis]. Umeå: Umeå
university; 2012. Umeå University medical
dissertations, 1529.
Wilder-Smith A, Byass P, Olanratmanee P,
Maskhao P, Sringernyuang L, Logan J G, et al.
The impact of insecticide-treated school
uniforms on dengue infections in school-aged
children: study protocol for a randomised
controlled trial in Thailand. BioMed Central;
Trials. 2012;13:212-.
Dewi F S. Working with community: exploring
community empowerment to support noncommunicable disease prevention in a middleincom country. [Thesis]. Umeå: Umeå
universitet; 2013. Umeå University medical
Wilder-Smith A, Renhorn K, Tissera H, Abu
Bakar S, Alphey L, Kittayapong P, et al.
DengueTools: innovative tools and strategies for
the surveillance and control of dengue. Global
health action. 2012;5:17273-.
Edvardsson K. Health promotion in
pregnancy and early parenthood: the challenge
of innovation, implementation and change
within the Salut Programme. [Thesis]. Umeå:
Umeå Universitet; 2013. Umeå University
medical dissertations, 1570.
Williams J, Ibisomi L, Sartorius B, Kahn K,
Collinson M, Tollman S, et al. Convergence
in fertility of South Africans and Mozambicans
in rural South Africa, 1993-2009. Global health
action. 2013;6:20-26.
Hii Y L, Ng N, Ng L C, Zhu H, Rocklöv J.
Dengue risk index as an early warning. 2013.
Wilson A R, Nyström L, Paci E, Gilbert F,
Mann R. Current issues in breast cancer
screening. 8th European Breast Cancer
Conference (EBCC), MAR 21-24, 2012, Vienna,
AUSTRIA. European Journal of Cancer.
2012;48:S8-S10.
Hii Y L. Climate and dengue fever: early
warning based on temperature and rainfall.
[Thesis]. Umeå: Umeå University; 2013. Umeå
University medical dissertations, 1554.
Kisanga F. Child sexual abuse in urban
Tanzania: possibilities and barriers for
prevention. [Thesis]. Umeå: Umeå universitet;
2012. Umeå University medical dissertations,
1534.
Zaba B, Calvert C, Marston M, Isingo R,
Nakiyingi-Miiro J, Lutalo T, et al. Effect of HIV
infection on pregnancy-related mortality in subSaharan Africa: secondary analyses of pooled
community-based data from the network for
Analysing
Longitudinal
Population-based
HIV/AIDS data on Africa (ALPHA). The Lancet.
2013;381(9879):1763-71.
Kjellström T, McMichael T, Smith K, Singh S.
Environmental health. In: Global Health, 3rd
edition. Boston: Jones and Bartlett Publishers;
2012. p. 481-537.
Åström C, Orru H, Rocklöv J, Strandberg G,
Ebi K L, Forsberg B. Heat-related respiratory
Lemma H. Improving efficiency, access to and
quality of the rural health extension programme
56
in Tigray, Ethiopia: the case of malaria diagnosis
and treatment. [Thesis]. Umeå: Umeå
Wimelius E M, Isaksson J, Eriksson M,
Hanberger A, Ghazinour M. Ensamkommande
flyktingbarn och ungdomar: förutsättningar för
mottagandet och kunskapsläget. Umeå: Umeå
Universitet; 2012. UCER - Arbetsrapporter.
Myléus A. Towards explaining the Swedish
epidemic of celiac disease: an epidemiological
approach. [Thesis]. Umeå: Umeå Universitet;
1506.
Doctoral Theses 19871.
Nguyen Q N. Understanding and managing
cardiovascular disease risk factors in Vietnam:
integrating
clinical
and
public
health
perspectives. [Thesis]. Umeå: Umeå universitet;
1498.
Rosén M. Epidemiology in planning for
health: with special reference to regional
epidemiology and the use of health
registers. 1987. Umeå University Medical
Dissertation New Series No 188.
2. Sandström A. Epidemiology at a smeltery:
Changing patterns concerning occurrence,
work environment, smoking and risk
perceptions over six decades. 1992. Umeå
University Medical Dissertation New Series
No 353.
Nilsson L M, Evengård B. Food and water
security indicators in an arctic health context:
a report by the AHHEG/SDWG, and the
AMAP/HHAG during the Swedish chairmanship
of the Arctic Council 2011-2013. Umeå; 2013.
Publications from Arctic Research Centre, 1.
3. Shamebo D. Epidemiology for public
health research and action in a developing
society: the Butajira Rural Health Project in
Ethiopia [Eds Wall S, Freij L, Muhe L,
Sandström A]. 1992. Umeå University
Medical Dissertation New Series No 360.
Nkulu Kalengayi F. A world on the move:
challenges and opportunities for hiv/aids
and tuberculosis care and prevention among
vulnerable migrant populations in Sweden.
[Thesis]. Umeå: Umeå Universitet; 2013. Umeå
4. Brännström I. Community participation
and social patterning in cardiovascular
disease intervention. 1993. Umeå University
Medical Dissertation New Series No 383.
Norström F. The burden of celiac disease and
the value of having it diagnosed. [Thesis]. Umeå:
Umeå Universitet; 2012. Umeå University
medical dissertations, 1489.
5. Muhe L. Child health and acute respiratory
infections in Ethiopia: Epidemiology for prevention and control. 1994. Umeå University
Medical Dissertations New Series No 420.
Nyström M, Garvare R, Ivarsson A,
Eurenius E, Höög E, Edvardsson K, et al.
På väg mot uthållighet i innovationer och
organisatoriskt
lärande
inom
vården:
Slutrapport från Vinnvårdsprojekt A 2007034.
2013.
6. Killewo J. Epidemiology towards the
control of HIV infection in Tanzania with
special reference to the Kagera region. 1994.
Umeå University Medical Dissertations New
Series No 421.
Prawirohartono E. Prenatal zinc and vitamin
A supplementation: a study on the impact of
prenatal micronutrient supplementation in rural
Indonesia. [Thesis]. Umeå: Umeå University;
2012.
7.
Stenberg B. Office illness: The worker, the
work and the workplace. 1994. Umeå
University Medical Dissertations New Series
No 399.
Rosén A. Mass screening for celiac disease in
12-year-olds: Finding them and then what?.
[Thesis]. Umeå: Umeå universitet; 2012. Umeå
8. Bergström E. Cardiovascular risk indicators in adolescents: the Umeå Youth
study. 1995. Umeå University Medical
Dissertations New Series No 448.
Ruano A L. The role of social participation in
municipal-level health systems: the case of
Palencia, Guatemala. [Thesis]. Umeå: Umeå
9. Lindholm L. Health economic evaluation
of community-based cardiovascular disease
prevention: Some theoretical aspects and
empirical results. 1996. Umeå University
Son P T. Hypertension in Vietnam: from
community-based studies to a national targeted
programme. [Thesis]. Umeå: Umeå universitet;
1499.
10. Wulff M. Reproductive hazards in an
industrial setting: An epidemiological
assessment. 1996. Umeå University Medical
57
11. Barnekow
Bergkvist
M.
Physical
capacity, physical activity and health: A
population
based
fitness
study
of
adolescents with an 18 year follow-up. 1997.
Series No 494.
23. Edlund C. Långtidssjukskrivna och deras
medaktörer: en studie om sjukskrivning och
rehabilitering. 2001. Umeå University
24. Kwesigabo G. Trends in HIV infection in
the Kagera region of Tanzania. 2001. Umeå
No 710.
12. Forsberg B. Urban air quality and
indicators of respiratory problems. 1997.
Series No 522.
25. Öhman A. Profession on the move.
Changing
conditions
and
gendered
development in physiotherapy. 2001. Umeå
No 730.
13. Weinehall L. Partnership for health: On
the role of primary health care in a
community intervention programme. 1997.
Series No 531.
26. Ivarsson A. On the multifactorial etiology
of celiac disease. An epidemiological
approach to the Swedish epidemic. 2001.
Series No 739.
14. Ibrahim MM. Child health in Somalia: An
epidemiological
assessment
in
rural
communities during a pre-war period. 1998.
Series No 557.
27. Grönblom-Lundström L. Rehabilitation
in light of different theories of health.
Outcome for patients with low-back
complaints - a theoretical discussion. 2001.
Series No 760.
15. Peña R. Infant mortality in transitional
Nicaragua. 1999. Umeå University Medical
16. Mogren I. Reproductive factors' impact on
the health of mother and offspring - An
epidemiological study. 1999. Umeå University Medical Dissertations New Series No
633.
28. Nurdiati D. Nutrition and reproductive
health in Central Java, Indonesia. An
epidemiological approach. 2001. Umeå University Medical Dissertations New Series No
757.
17. Zelaya E. Adolescent pregnancies in
Nicaragua. The importance of education.
1999.
Umeå
University
Medical
29. Hyder SM Z. Anemia and iron deficiency
in women. Impact of iron supple-mentation
during pregnancy in rural Bangladesh.
2002.
Umeå
University
Medical
18. Ellsberg MC. Candies in hell: Research
and action on domestic violence against
women in Nicaragua. 2000. Umeå
No 670.
30. Utarini A. Evaluation of the user-provider
interface in malaria control programme: The
case of Jepara district, Central Java
province, Indonesia. 2002. Umeå University
19. Johansson E. Emerging perspectives on
tuberculosis and gender in Vietnam. 2000.
Series No 675.
31. Ringbäck Weitoft G. Lone parenting,
socioeconomic conditions and severe illhealth. Longitudinal register-based studies.
2003.
Umeå
University
Medical
20. Nyström L. Assessment of population
screening: the case of mammography. 2000.
Series No 678.
32. Chicovore J. Gender power dynamics in
sexual and reproductive health. A qualitative
study in Chiredzi District, Zimbabwe. 2004.
Series No 876.
21. Berhane Y. Women’s health and
reproductive outcome in rural Ethiopia.
2000.
Umeå
University
Medical
33. Sri Hartini Th N. Food habits, dietary
intake and nutritional status during
economic crisis among pregnant women in
Central Java Indonesia. 2004. Umeå University Medical Dissertations New Series No
885.
22. Andersson T. Survival of mothers and
their offspring in 19th century Sweden and
contemporary rural Ethiopia. 2000. Umeå
No 684.
58
34. Emmelin M. Self-rated health in public
health evaluation. 2004. Umeå University
South Africa. 2006. Umeå University
35. Lind T. Iron and zinc in infancy: Results
from experimental trials in Sweden and
Indonesia. 2004. Umeå University Medical
48. Norberg M. Identifying risk of type 2
diabetes: epidemiologic perspectives from
biomarkers to lifestyle. 2007. Umeå
No 1077.
36. Hang HM. Epidemiology of unintentional
injuries in rural Vietnam. 2004. Umeå University Medical Dissertations New Series No
914.
49. Hagberg L. Cost-effectiveness of the
promotion of physical activity in health care.
2007.
Umeå
University
Medical
37. Hassler S. The health conditions in the
Sami population of Sweden 1961-2002.
2005.
Umeå
University
Medical
50. Jerdén L. Health-promoting health
services: Personal health documents and
empowerment.2007.
Umeå
University
38. Valladares Cardoza E. Partner violence
during pregnancy. Psychosocial factors and
child outcomes in Nicaragua. 2005Umeå
No 976.
51. Tesfaye F. Epidemiology of cardiovascular
disease risk factors in Ethiopia: The ruralurban gradient. 2008. Umeå University
52. Fantahun M. Mortality and survival from
childhood to old age in rural Ethiopia. 2008.
Series No 1153.
39. Nguyen TX. The injury poverty trap in
rural Vietnam: Causes, consequences and
possible solutions. 2005. Umeå University
53. Fottrell E F. Dying to count: Mortality
surveillance methods in resource-poor settings. 2008. Umeå University Medical
40. Oscarson N. Health economic evaluation
methods for decision-making in preventive
dentistry. 2006. Umeå University Medical
54. Dahlblom K. Home alone. Sibling
caretakers in Léon, Nicaragua. 2008. Umeå
No. 1210.
41. Månsdotter A. Health, economics and
feminism. On judging fairness and reform.
2006. University Medical Dissertations New
Series No 1013.
55. Tollman S. Closing the gap: Applying
health and socio-demographic surveillance
to complex health transitions in South and
sub-Saharan Africa. 2008. Umeå University
Medical Dissertations New Series No. 1226.
42. Ng N. Chronic disease risk factors in a
transitional country. The case of rural
Indonesia. 2006. Umeå University Medical
43. Minh HV. Epidemiology of cardiovascular
disease in rural Vietnam. 2006. Umeå
No 1018.
56. Sorensen J. Social marketing for injury
prevention: Changing risk perceptions and
safety-related behaviours among New York
farmers. 2009. Umeå University Medical
Dissertations New Series No. 1238.
44. Edin K. Perspectives on intimate partner
violence, focusing on the period of
pregnancy. 2006. Umeå University Medical
57. Emmelin A. Counted – and then? Trends
in child mortality within an Ethiopian
demographic surveillance site. 2009. Umeå
No. 1256.
45. Dao Lan Huong. Mortality in transitional
Vietnam. 2006. Umeå University Medical
58. Nilsson
M.
Promoting
health
in
adolescents – preventing the use of tobacco.
2009.
Umeå
University
Medical
46. Nafziger A. A population perspective on
obesity prevention: lessons learned from
Sweden and the U.S. 2006. Umeå University
59. Collinson MA. Striving against adversity.
The dynamics of migration, health and
poverty in rural South Africa. 2009. Umeå
No. 1251.
47. Kahn K. Dying to make a fresh start:
mortality and health transition in a new
59
60. Sahlén K-G. An ounce of prevention is
worth a pound of cure. Preventive home
visits among seniors. 2009. Umeå
No. 1278.
71. Petersen Z. Smoking cessation during
pregnancy. A person-centred approach
among disadvantaged women in South
Africa. 2011. Umeå University Medical
61. Kasenga F. Making it happen. Prevention
of mother to child transmission of HIV in
rural Malawi. 2009. Umeå University
72. Maluka
S.
Strengthening
fairness,
transparency and accountability in health
care priority setting at district level in
Tanzania. Opportunities, challenges and the
way forward. 2011. Umeå University Medical
62. Goicolea I. Adolescent pregnancies in the
amazon basin of Ecuador – a rights and
gender approach to girls’ sexual and
reproductive health. 2009. Umeå University
73. Salazar M. Intimate partner violence in
Nicaragua. Studies on ending abuse, child
growth, and contraception. 2011. Umeå
No. 1411.
63. Kidanto HL. Improving quality of
perinatal care through clinical audit. A study
from a tertiary hospital in Dar es Salaam,
Tanzania. 2009. Umeå University Medical
74. Njozing B. Bridging the gap. Implementing
tuberculosis and HIV/AIDS collaborative
activities in the Northwest Region of
Cameroon. 2011. Umeå University Medical
Dissertations New Series No. 1431
64. Nzefa Dapi L. Socioeconomic and sex
differences in adolescents’ dietary intake,
anthropometry and physical activity in
Cameroon, Africa. 2010. Umeå University
75. Sörlin A. Health and the elusive gender
equality. Can the impact of gender equality
on health be measured? 2011. Umeå
No. 1420.
65. Eriksson M. Social capital, health and
community action - implications for health
promotion. 2010. Umeå University Medical
76. Hoi L V. Health for community dwelling
older people: Trends, inequalities, needs
and care in rural Vietnam. 2011. Umeå
No. 1437.
66. Waldau S. Creating organisational capacity
for priority setting in health care. Using a
bottom-up approach to implement a topdown policy decision. 2010. Umeå
No. 1368.
77. Frumence G. The role of social capital in
HIV prevention: Experiences from the
Kagera Region of Tanzania. 2011. Umeå
No. 1453.
67. Wiklund M. Close to the edge. Discursive,
gendered and embodied stress in modern
youth. 2010. Umeå University Medical
78. Laisser R. Prevention of intimate partner
violence – Community and healthcare
workers’ perceptions in urban Tanzania.
2011.
Umeå
University
Medical
68. Johansson H. En mer hälsofrämjande
hälso- och sjukvård. En studie med
utgångspunkt från vårdens professioner.
2010.
Umeå
University
Medical
79. Norström F. The burden of celiac disease
and the value of having it diagnosed. 2012.
Series No. 1489.
69. Probandari A. Revisiting the choice. To
involve hospitals in the partnership for
tuberculosis control in Indonesia. 2010.
Series No. 1383.
80. Reda H. Improving efficiency, access to
and quality of the rural Health Extension
Programme in Tigray, Ethiopia: the case of
malaria diagnosis and treatment. 2012.
Series No. 1497.
70. Lundqvist G. Tobaksvanor i medelåldern.
Riskfaktormönster, rökstoppsattityder och
erfarenheter av att sluta röka. 2011. Umeå
No. 1344.
81. Son P T. Hypertension in Vietnam. From
community-based studies to a national
targeted programme. 2012. Umeå University
60
82. Quang N N. Understanding and managing
cardiovascular disease risk factors in
Vietnam. Integrating clinical and public
health perspectives. 2012. Umeå University
Licentiate Theses 1994Abdulaziz Sharif Aden. Studies for health
planning in rural Somalia:Community perceptions and epidemiological data. Licentiate
thesis. Umeå University 1994.
83. Myléus A. Towards explaining the Swedish
epidemic of celiac
disease
– an
epidemiological approach. 2012. Umeå
No. 1506.
Maymuna Muhiddin Omar. Women's health
in rural Somalia. Licentiate thesis. Umeå
University 1994.
Dinh Phoung Hoa. Social patterning of child
health in Vietnam. Licentiate thesis. Umeå
University 1996.
84. Ruano A L. The role of social participation
in municipal-level health systems: the case
of Palencia, Guatemala. 2012. Umeå
No. 1517.
Hoang Thi Hoa. Family planning and reproductive pattern in rural Vietnam. A study during
a period of rapid socio-economic transition.
Licentiate thesis. Umeå University 1996.
85. Anticona Huaynate C. Lead exposure in
indigenous children of the Peruvian
Amazon: Seeking the hidden source,
venturing into participatory research. 2012.
Series No. 1529.
Ngo Van Toan. Utilisation of reproductive
health services in two rural areas in Vietnam.
Licentiate thesis. Umeå University 1996.
Elmer Zelaya. Teenage sexuality and reproduction in Nicaragua: Gender and social differences. Licentiate thesis. Umeå University
1996.
86. Rosén A. Mass screening for celiac disease
in 12-year-olds - Finding them and then
what? 2012. Umeå University Medical
Mary Ellsberg. Candies in hell: Domestic
violence against women in Nicaragua. Licentiate
thesis. Umeå University 1997.
87. Kisanga F. Child sexual abuse in urban
Tanzania – Possibilities and barriers for
prevention. 2012. Umeå University Medical
Anna Fjelddahl. Evaluation of caries prevention.a four year longitudinal study in Swedish
adolescents. Licentiate thesis. Umeå University
2001.
88. Dewi FST. Working with community.
Exploring community empowerment to
support
non-communicable
disease
prevention in a middle income country.
2013.
Umeå
University
Medical
Kerstin Hultén. Diet and breast cancer.an
epidemiological study on plasma biomarkers of
dietary intake. Licentiate thesis. Umeå
University 2001.
89. Nkulu Kalengayi F. A world on the move.
Challenges
and
opportunities
for
HIV/AIDS/TB care and prevention among
vulnerable migrant populations in Sweden.
2013.
Umeå
University
Medical
Th. Ninuk Sri Hartini. Dietary intake and
nutritional status during economic crisis: the
case of pregnant women in Central Java
Indonesia. Licentiate thesis. Umeå University
2002.
90. Hii Y L. Climate and dengue fever: early
warning based on temperature and rainfall.
2013.
Umeå
University
Medical
Jeremiah
Chikovore.
Gender
power
dynamics in women´s reproductive health: A
study of male perspectives in women´s
reproductive health with special emphasis on
abortion. Licentiate thesis. Umeå University
2002.
91. Edvardsson K. Health promotion in
pregnancy and early parenthood: the
challenge of innovation, implementation
and change within the Salut Programme.
2013.
Umeå
University
Medical
Nils Oscarson. Costs and cost-effectiveness of
different caries-preventive measures in youth
dental care in Sweden. Licentiate thesis. Umeå
University 2003.
Endy P. Prawirohartono. Prenatal zinc and
vitamin A supplementation. A study on the impact of prenatal micronutrient supplementation
61
2012:8
Dina
Vemming
Oksen.
An
epidemiological overview on oral outbreaks of
Chagas disease in South America. Master thesis
in public health. Umeå International School of
Public Health, Epidemiology Global Health,
Department of Public Health and Clinical
Medicine, Umeå University, 2012.
in rural Indonesia. Licentiate thesis. Umeå
University 2012.
Master of Public Health Thesis
(Public Health Report series) 2012
2012:1 Md. Muradul Islam. Married men’s
views on gender rights and sexuality in a
northwest Bangladesh village. Master thesis in
public health. Umeå International School of
2012:9 Bong Ngeasham Collins. Assessing
the outcome of tuberculosis treatment in the
Cameroon Baptist convention health board
tuberculosis treatment centers. Master thesis in
2012:2 Sundip Gurung. Silent sufferers. Street
children, drugs, and sexual abuse in
Kathmandu, Nepal. Master thesis in public
health. Umeå International School of Public
Health,
Epidemiology
Global
Health,
2012:10
Helene
Johansson.
Vårdval
Stockholm, Husläkarverksamheten och det
hälsofrämjande arbetet. En studie med
utgångspunkt från vårdens professioner.
2012:11 Khemachitra Saneewong na
ayuttaya. The cost-effectiveness of five statin
therapies for outpatients with diabetes at a
Thailand hospital. Master thesis in public
Health,
Epidemiology
Global
Health,
2012:3 Parshin Yousefi. Overweight/obesity
and lifestyle. Characteristics among Iranian preschool children. Master thesis in public health.
Umeå International School of Public Health,
Epidemiology Global Health, Department of
Public Health and Clinical Medicine, Umeå
University, 2012.
2012:12 Tasmia Islam. Partial least square
regression analysis to investigate climatic
dengue risk factors: A global study. Master
thesis in public health. Umeå International
School of Public Health, Epidemiology Global
Health, Department of Public Health and
Clinical Medicine, Umeå University, 2012.
2012:4 Nguyen Van Hiep. Sexual risk
behaviors among male sex workers in Ho Chi
Minh City, Vietnam- Implications for HIV
prevention. Master thesis in public health. Umeå
International School of Public Health,
University, 2012.
2012:5 Shufen Cao. The home-based elderly
care system analysis: An illustration from
Hangzhou, China. Master thesis in public health.
University, 2012.
2012:13
Kayvan
Bozorgmehr.
Trade
liberalisation and tuberculosis: A longitudinal
multi-level analysis on tuberculosis incidence in
22 high burden countries between 1990 & 2010.
Master thesis in public health. Umeå
University, 2012.
2012:6 Mona Mohamed Ali. Food-and sun
habits with a specific focus on vitamin D among
pregnant Somali women living in Sweden. A
study protocol. Master thesis in public health.
University, 2012.
2012:14 Lena Grundberg. Experiences of the
implementation process of Health Promoting
School within the Salut Programme in Lycksele
municipality. Master thesis in public health.
University, 2012.
2012:7 Zafarullah Khan Qamar. Depression
among stroke patients and relation with
demographic and stroke characteristics. Master
2012:15 Jing Helmersson. Mathematical
modeling of Dengue-temperature effect on
vectorial capacity. Master thesis in public health.
62
University, 2012.
University, 2012.
2012:16 Gilbonce Betson. Self-reported
occupational health problems and factors
affecting compliance to occupational health and
safety requirements among barbers and
hairdressers in Ilala municipality, Dar es
Salaam, Tanzania. Master thesis in public
Health,
Epidemiology
Global
Health,
2012:23 Navina Gerlach. The uptake of social
determinants in maternal health programme
implementation in rural Ethiopia: Discerning
the importance of gender implications. Master
2012:17
Asonganyi
Edwin
Nyagwui.
Assessing the risk of motorcycle injuries among
secondary school students in the Tiko
municipality. Master thesis in public health.
University, 2012.
2012:24 Nazmun Nahar. Assessment of
professionals view on managing mental health
problems as a result of exposure to natural
disaster (cyclone) in Bangladesh. Master thesis
2012:18 Birgitta Rönnlund. Which factors in
Västerbotten´s health system may cause the low
prescription rate of medication against alcohol
dependence in primary health care? Master
2012:25 S.M Abul Bashar. Determinants of
the use of skilled birth attendants at delivery by
pregnant women in Bangladesh. Master thesis in
2012:26 Huyen Le Thu. Exploring medical
representative’s strategies to influence doctors
prescribing decisions in Vietnam. Master thesis
2012:19 Laith N. Hussain. Verbal autopsy:
Family given cause of death vs. InterVA
diagnoses, to investigate lay-perceptions of
causes of mortality in Agincourt area, South
Africa. Master thesis in public health. Umeå
University, 2012.
2012:27 Michael Okai Atakora. Assessment
of workers knowledge and views of occupational
health hazards on gold mining in Obuasi
municipality, Ghana. Master thesis in public
Health,
Epidemiology
Global
Health,
2012:20 Muhammad Ali Leghari. A pilot
study on oral health knowledge of parents
related to dental caries of their children Karachi, Pakistan. Master thesis in public
Health,
Epidemiology
Global
Health,
2012:28 Daniel Adane. Effectiveness of
PMTCT programs in Sub-Saharan Africa, a
meta-analysis. Master thesis in public health.
University, 2012.
2012:21
Karthikeyan
Kandasamy.
Perception of physiotherapy profession by
physiotherapists in Tamilnadu, India. Master
2012:29 Leila Yavari. Antibiotic resistance in
salmonella enterica and the role of animal and
animal food control. A literature review of
Europe and USA. Master thesis in public health.
University, 2012.
2012:22 Muhammad Awais Arif. The
association between cigarette smoking and
consumption of daily fruits and vegetables with
human papillomavirus infection among women
in United States. Master thesis in public health.
63
2012:30 Biping Song. Occupational heat stress
and health impact assessment at a shoe factory
in China. Master thesis in public health. Umeå
University, 2012.
Epidemiology, Global Health, Department of
University, 2012.
2012:38 Aneth Hellmold. Neighbourhood
Safety.Risk factors of perceived neighborhood
safety among elderly in South Africa. Umeå
University, 2012.
2012:31 Moses Arinaitwe. Initiative and
innovation: A narrative account of rural hospital
workers in Eastern Uganda. Master thesis in
Public Health, Epidemiology, Global Health,
2012:39 Emauwa Isonguyo. Assessment of
potential health risks from exposure of male
slaughter house workers to smoke from tyre fire
in Nigeria: a study protocol. Umeå International
School of Public Health, Epidemiology, Global
2012:32 Bernard Che Longo. Patterns and
motives of alcohol consumption among students
in Buea, Cameroon; A study protocol. Master
School of Public Health, Epidemiology, Global
2012:40 Oraegbu Anthony.C. Conflict
Management In Health Care Organizations. A
protocol for a study in Umoru Shehu
ultramodern hospital Maiduguri, Northeast
Nigeria. Umeå International School of Public
Health,
Epidemiology,
Global
Health,
2012:33. Yinqing Hu. The Gender differences
in health care accessibility among older people
in China. Master thesis in public health. Umeå
University, 2012.
2012:41 Ana Karina Pastrana Polo.
Childhood overweight and obesity in Colombia:
effects of a nutrition transition process.
Literature review. Umeå International School of
Public Health, Epidemiology, Global Health,
2012:34. Samuel Nambile Cumber. Children
taking up family responsibilities in Bamenda
Cameroon: Determinents and consequences.
Master thesis in public health. Umeå
University, 2012.
MFS-reports 2012
2012:35. Negin Yekkalam. Patterns and risk
factors of social exclusion among older people in
India. Master thesis in public health. Umeå
University, 2012.
No 68, 2012 Johannes Zachrison and
Matilda Persson. Nurses experiences of their
possibility to support patients’ self-care regarding diabetes mellitus.
No 69, 2012 Adnan Sukkarwalla. To determine knowledge levels, attitude and behavior
towards oral hygiene of pregnant women in
Pakistan. A cross-sectional study using quantitative research methods.
2012:36. Muhammad Tayyab Minhas.
Prevalence of type 2 Diabetes Mellitus among
HCV infected patients; A Literature Review.
University, 2012.
No 70, 2012 Caroline Linder and Malena
Rolandson. Vietnam, an economical “tiger” of
Asia. Has growth and impact on paediatric
health?
2012:37 Jijia Zhu. The Risk Factors of
Depression among older people in China. Umeå
64

Annual Report 2012 - Institutionen för folkhälsa och klinisk medicin

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