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Co-creation methods for public health research — characteristics, benefits, and challenges : a Health CASCADE scoping review
No full textBackground: Co-creation engages diverse stakeholders, including marginalized populations, in collaborative problem-solving to enhance engagement and develop contextually appropriate solutions. It is increasingly recognized as a way to democratize research and improve the impact of interventions, services, and policies. However, the lack of synthesized evidence on co-creation methods limits methodological rigor and the establishment of best practices. This review aimed to identify co-creation methods in academic literature and analyze their characteristics, target groups, and associated benefits and challenges. Methods: This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The search was conducted in the Health CASCADE database v1.5 (including CINAHL, PubMed, and 17 additional databases via ProQuest) from January 1970 to March 2022. Data was aggregated and summarized, with qualitative data analyzed using Braun and Clarke's six-phase thematic analysis approach. Results: The review included 266 articles, identifying 248 distinct co-creation methods published between 1998 and 2022. Most methods were rooted in participatory paradigms (147 methods), with 49 methods derived from co-approaches like co-creation, co-design, and co-production, and 11 from community-based health promotion and action research. Methods were applied across 40 target populations, including children, adults, and marginalized groups. Many methods (62.3%) were delivered face-to-face, with 40 articles incorporating digital tools. Thematic analysis revealed nine benefits, such as enhanced creativity, empowerment, and improved communication, and six challenges, including resource constraints and systemic and structural barriers. Conclusion: This review emphasizes the importance of robust documentation and analysis of co-creation methods to inform their application in public health. Findings support the development of collaborative co-creation processes that are responsive to the needs of diverse populations, thereby enhancing the overall effectiveness and cultural sensitivity of the outcomes. This review highlights the potential of co-creation methods to promote equity and inclusion while emphasizing the importance of evaluating and selecting methods tailored to specific objectives, offering a critical resource for planning, conducting, and evaluating co-creation projects
Early career progression in young adults with coeliac disease : a register‐based retrospective cohort study
No full textAim: To investigate early career progression and national insurance use in young adults with paediatric coeliac disease. Methods: We performed a register study of a population born in Sweden between 1976 and 1992. Coeliac disease was diagnosed before 15 years of age. The comparison population was matched 4:1 by sex, region of residence at birth and birth year/month. We analysed education, employment, income, job position and national insurance use (sickness benefits, parental leave benefits and social welfare provision) at 25 and 30 years of age. Results: We identified 1812 individuals with coeliac disease (6888 comparison population) at 25 years of age and 263 individuals (984 comparison population) at 30 years of age. No statistically significant differences were seen in education, employment, income, job position, use of parental leave benefits or social welfare provision. More individuals with coeliac disease used sickness benefits at age 25 years (OR 1.34 [95% CI 1.12–1.59]). Conclusion: In this register study, we showed that coeliac disease diagnosed in childhood does not cause disadvantages on career progression on a population level. However, findings suggest that coeliac disease increases the risk for sickness benefit use.Funding: The Center for Clinical Research Region Dalarna, Anna Cederberg foundation, Faculty of Medicine Umeå University, National Research Schoolin General Practice, Region Västerbotten and the Swedish Celiac Disease Association supported with funding of the project. Research reported in this publication was supported by the National Institute of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health under Award NumberK23DK119584. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes ofHealth. This study was supported by the ISSCD M-in-M programme. The ISSCD M-in-M programme has been made possible by an unrestricted grant fromTakeda Pharmaceuticals. The Umeå SIMSAM Lab data infrastructure used in this study was developed with support from the Swedish Research Council, the Riksbanken Jubileumsfond and by strategic funds from Umeå University. The work was done independent of the funding source.</p
Policy critique: The conflation of shaken baby syndrome and abusive head trauma : a measure with several negative effects
No full textThe amalgamizing of shaken baby syndrome (SBS) with the much broader and heterogeneous abusive head trauma (AHT) diagnosis is problematized. We suggest that the reason why American Academy of Pediatrics (AAP) took this step in 2009 was a response to another theory being presented and discussed from 2001 and onwards. This theory had completely different legal consequences as it suggested that the medical findings on which the SBS diagnosis were based, i.e. “the triad” (subdural hemorrhages/SDH, retinal hemorrhages/RH, and encephalopathy) were non-traumatic. If such an explanation was accepted, this would reveal not only that serious legal abuses had occurred in the past and that the pediatricians should be held responsible for this, but also that it would in the future be more difficult to protect the child by claiming abuse in cases of unclear diagnosis. We present also other steps, taken by other pediatric organizations, having similar effects upon the current SBS controversy. We suggest that these value-based considerations were the underlying reasons why SBS was integrated in the AHT concept, and why competing theories and evidence-based criticism is ignored, allowing to always interpret triad findings as the result of abuse. If the ethical principle to protect the child is more important to AAP than the scientific ambition to develop evidence-based diagnostic procedures, we encourage AAP to be honest and admit this prioritization. Or at least to admit that in this ethical dilemma, AAP finds that the least bad choice is First of all, protect the child! despite the price is that many infants and its siblings may be separated on wrong grounds from their family, and that caregivers might be falsely accused and convicted of child abuse
An acoustic model of speech dysprosody in patients with Parkinson's disease
No full textPurpose: This study aimed to determine the acoustic properties most indicative of dysprosody severity in patients with Parkinson's disease using an automated acoustic assessment procedure. Method: A total of 108 read speech recordings of 68 speakers with PD (45 male, 23 female, aged 65.0 ± 9.8 years) were made with active levodopa treatment. A total of 40 of the patients were additionally recorded without levodopa treatment to increase the range of dysprosody severity in the sample. Four human clinical experts independently assessed the patients' recordings in terms of dysprosody severity. Separately, a speech processing pipeline extracted the acoustic properties of prosodic relevance from automatically identified portions of speech used as utterance proxies. Five machine learning models were trained on 75% of speech portions and the perceptual evaluations of the speaker's dysprosody severity in a 10-fold cross-validation procedure. They were evaluated regarding their ability to predict the perceptual assessments of recordings excluded during training. The models' performances were assessed by their ability to accurately predict clinical experts' dysprosody severity assessments. Results: The acoustic predictors of importance spanned several acoustic domains of prosodic relevance, with the variability in fo change between intonational turning points and the average first Mel-frequency cepstral coefficient at these points being the two top predictors. While predominant in the literature, variability in utterance-wide fo was found to be only the fifth strongest predictor. Conclusion: Human expert raters' assessments of dysprosody can be approximated by the automated procedure, affording application in clinical settings where an experienced expert is unavailable. Variability in pitch does not adequately describe the level of dysprosody due to Parkinson's disease
The reliability of replications : a study in computational reproductions
No full textThis study investigates researcher variability in computational reproduction, an activity for which it is least expected. Eighty-five independent teams attempted numerical replication of results from an original study of policy preferences and immigration. Reproduction teams were randomly grouped into a 'transparent group' receiving original study and code or 'opaque group' receiving only a method and results description and no code. The transparent group mostly verified original results (95.7% same sign and p-value cutoff), while the opaque group had less success (89.3%). Second-decimal place exact numerical reproductions were less common (76.9 and 48.1%). Qualitative investigation of the workflows revealed many causes of error, including mistakes and procedural variations. When curating mistakes, we still find that only the transparent group was reliably successful. Our findings imply a need for transparency, but also more. Institutional checks and less subjective difficulty for researchers 'doing reproduction' would help, implying a need for better training. We also urge increased awareness of complexity in the research process and in 'push button' replications
Att vara ung och leva med rörelsenedsättning : att ge röst åt behoven och utmaningarna för barn, ungdomar och deras vårdgivare i nordöstra Tanzania
No full textBackground: In Tanzania, 13% of families have a member with a disability, presenting unique challenges for entire household. Despite its complexity, disability is often overlooked in development and research agendas. However, disability has gained significant attention over the past decade, particularly with its integration in the 2030 sustainable development goals that were adopted by all United Nations member states in 2015. These goals are intended to promote inclusion and equal opportunities for all, including young people with disabilities. Nevertheless, young people with physical disabilities face considerable barriers to participation in society, driven by negative norms, discrimination, and stigma. This population remains underrepresented in research, and there is a significant gap in public health knowledge, particularly in resource-poor settings. This thesis aims to describe and explore the needs and challenges associated with being young and having a physical disability, drawing on the perspectives of children, adolescents, and young adults with disabilities – along with their families and carers – in northeastern Tanzania. Methods: The research was conducted in the Kilimanjaro region of northeastern Tanzania, using both qualitative and quantitative methods. A quantitative survey was completed by the primary carers (aged 18 years or older) of 212 children and adolescents with physical disabilities, aged between 2 and 18 years. The data collected during the survey were analysed in Studies I and III. The SurveyCTO software was used to collect data electronically via a questionnaire. The questionnaire was developed based on the International Classification of Functioning, Disability, and Health (ICF) framework. Statistical analysis (Studies I and III) was performed using IBM SPSS version 28. For the qualitative aspect of the research, Study II employed constructivist grounded theory, while Study IV analysed the experiences of adolescents and young adults regarding inclusion using reflexive thematic analysis. Results: Children and adolescents with physical disabilities have significant difficulties with walking, self-care, and participating in social activities, household chores, and schooling. Furthermore, they were reported needing assistive devices, therapeutic exercises, and nutritional support. Regarding essential services, most families lived near health facilities that did not provide rehabilitation services. Additionally, a quarter of the children and adolescents with physical disabilities had never received any rehabilitation service. More than two thirds did not have health insurance. The carers faced psychological challenges, with over half of the 212 carers surveyed reporting poor psychological wellbeing, and 42% and 38% describing symptoms of anxiety and depression, respectively. Support from extended family members was linked to better psychological wellbeing and a lower likelihood of experiencing anxiety and depression. Support systems, particularly via social networks, were crucial in helping families meet basic needs and ensure the safety of vtheir children. The adolescents and young adults, however, reported feeling marginalised, facing significant barriers to full societal integration, and experiencing an uncertain future with little hope. Conclusion: This thesis found significant activity limitations among children and adolescents with physical disabilities in areas such as walking, self-care, communication, and participation in social activities, household chores, and schooling. Access to essential services, particularly healthcare, is inadequate, or in many cases impossible to access. Adolescents and young adults face both present and future barriers to full inclusion in society, and families are constantly adapting to meet the challenging needs of their children, with carers experiencing a considerable psychological burden. To address these challenges, it is crucial for the Ministry of Health to strengthen rehabilitation services within primary healthcare settings. Health-insurance reforms are also necessary to ensure the societal inclusion of young people with disabilities. Public-awareness campaigns that highlight the potential of people with disabilities and promote inclusion are crucial for supporting social networks and challenging negative societal norms.
Impact of static myoblast loading on protein secretion linked to tenocyte migration
No full textExercise has been shown to promote wound healing, including tendon repair. Myokines released from the exercised muscles are believed to play a significant role in this process. In our previous study, we used an in vitro coculture and loading model to demonstrate that 2% static loading of myoblasts increased the migration and proliferation of cocultured tenocytes─two crucial aspects of wound healing. IGF-1, released from myoblasts in response to 2% static loading, was identified as a contributor to the increased proliferation. However, the factors responsible for the enhanced migration remained unknown. In the current study, we subjected myoblasts in single culture conditions to 2, 5, and 10% static loading and performed proteomic analysis of the cell supernatants. Gene Ontology (GO) analysis revealed that 2% static loading induced the secretion of NBL1, C5, and EFEMP1, which is associated with cell migration and motility. Further investigation by adding exogenous recombinant proteins to human tenocytes showed that NBL1 increased tenocyte migration but not proliferation. This effect was not observed with treatments using C5 and EFEMP1
The role of women’s empowerment in fertility preferences and outcomes : analysis of the 2017 Indonesia demographic and health survey
No full textBackground: With a population of 275 million, Indonesia is the world’s fourth most populous country and has made considerable efforts to reduce its Total Fertility Rate from 5.6 in 1971 to a target of 2.1 by 2024. Women’s empowerment has been identified as a critical factor influencing fertility dynamics, gender equality, reproductive autonomy, and broader socioeconomic development. This study examines the association between four dimensions of women’s empowerment and three fertility-related outcomes among married women aged 22 years and older in Indonesia. Methods: We used cross-sectional data from 34,017 married women participating in the 2017 Indonesia Demographic and Health Survey (IDHS). An outcome-wide analytical approach was adopted to explore three outcomes: total number of children ever born, ideal number of children, and fertility preference alignment, i.e. whether actual fertility matched stated preferences. Four empowerment domains were assessed: household decision-making, attitudes toward wife beating, attitudes toward refusing sex, and labour force participation. Stepwise multivariate Poisson regression modelling was applied, adjusting for key demographic and socioeconomic covariates. Results: Our study found that the association between each type of women’s empowerment and fertility-related outcomes varied, reinforcing the notion that empowerment does not uniformly affect reproductive behaviour. Among the four empowerment indicators, rejecting all justifications for wife beating emerged as the most consistent and significant predictor across all fertility outcomes. It was association with fewer children ever born (β = 0.03), a lower ideal number of children (β = 0.04), and a higher likelihood of meeting fertility preferences (PR = 1.02). Attitudes toward refusing sex were also significantly associated with fewer children (β = 0.02) and lower fertility ideals (β = 0.07). However, participation in decision-making and labour force participation showed mixed or non-significant associations, indicating that different empowerment dimensions may influence reproductive behaviour in diverse ways. Conclusions: Women’s empowerment - particularly in the domains of gender-based violence and sexual autonomy - is closely linked to fertility preferences and behaviours. The findings underscore that empowerment is a multidimensional construct, with varying influences across its domains. Strengthening women’s autonomy and addressing gender-based violence are essential steps toward enhancing reproductive rights and achieving Sustainable Development Goal 5 in Indonesia. Gender-sensitive data systems and interventions tailored to different aspects of empowerment are urgently needed
A common terminology to unify research and conservation of coralline algae and the habitats they create
No full textLinguistic uncertainty is a prime source of uncertainty pervading ecology and conservation. Coralline algae are a widespread and diverse group of calcifying red macroalgae that underpin coastal ecosystem function and service provision. Recent increasing interest in coralline algae in the scientific literature has revealed a diverse but confusing terminology at organism to habitat scales. Coralline algal research and conservation are international and multidisciplinary, so there are geographic and disciplinary imbalances in research and conservation efforts. To reach consensus and reduce uncertainty, we propose a unified terminology. We review trends in cultural and scientific use of coralline algal terms and propose a system based on six morphologies: (1) attached, (2) free-living geniculate, (3) encrusting and free-living nongeniculate coralline algae, the latter either being (4) nucleated or (5) non-nucleated thalli or (6) fragments. We take inspiration from other coastal systems that have achieved consensus through umbrella terms, such as ‘coral’ and ‘kelp’, to accelerate global progress in coralline algal research and conservation. We characterise 14 coralline algae–dominated habitat global types, falling within seven functional groups, four biomes and four realms: (1) freshwater coralline streams; (2) coralline tide pools; (3) intertidal coralline rims and (4) turf; (5) coralline sea caves; (6) coral–algal reefs; (7) algal ridges; (8) coralligenous reefs; subtidal (9) carbonate crusts, (10) coralline barrens and (11) turf; and (12) articulith, (13) maerl and (14) rhodolith beds, which fall into the coralline algal bed functional group. We hope this unified terminology promotes data comparison, enables cross-boundary and cross-sector sharing of best practices, develops capacity for meta-analyses and improves conservation strategies
Low occupational physical activity is associated with incident type 2 diabetes in overweight and obese individuals : a population-based cohort study
No full textBackground: Leisure-time physical activity decreases the risk of type 2 diabetes. Whether occupational physical activity affects the risk of type 2 diabetes is still not fully understood. The primary aim of this study was to investigate the association between occupational physical activity and 10-year diabetes incidence in a general adult population in Northern Sweden. The secondary aim was to explore the moderating role of BMI on this association. Methods: This population-based, longitudinal cohort study included 16,282 diabetes-free individuals aged 28–52 years who participated in a cardiovascular intervention programme in Northern Sweden, and who reported the same occupational physical activity level at baseline and at 10-year follow-up. Incident type 2 diabetes was diagnosed based on oral glucose tolerance testing or a register-based diagnosis. Occupational physical activity was self-reported and categorized as: a) Low: ‘Sedentary or standing’ or ‘Light but partly physically active’, b) Moderate: ‘Light and physically active’, or c) High: Sometimes physically strenuous or ‘Physically strenuous most of the time’. Odds ratios (OR) and 95% confidence intervals (CI) for incident diabetes were calculated using multivariable logistic regression analysis, adjusting for age, sex, smoking, education level, family history of diabetes, country of birth, intake of fruits and vegetables, leisure-time physical activity, prediabetes and BMI. Potential interactions between BMI category and T2D were tested using interaction terms in the multivariable model. Results: Six hundred twenty-four individuals developed type 2 diabetes in the 10 years between the first visit and the follow-up. A significant moderation effect of BMI on occupational physical activity was found (p = 0.01). Having a low level of occupational physical activity, compared with a moderate level of occupational physical activity, was associated with an increased risk of incident type 2 diabetes in overweight and obese individuals (OR 1.46, 95% CI 1.09–1.96), but not in those with normal weight (OR 0.80, 95% CI 0.52–1.23). High level of occupational physical activity was not associated with type 2 diabetes (OR 1.12, 95% CI 0.82–1.54). Conclusions: Low occupational physical activity was associated with incident type 2 diabetes in overweight and obese individuals. Public-health efforts may benefit from encouraging less sitting and standing and more light physical activity during the workday