Publikationer från Umeå universitet
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Improving adherence to oral nutritional supplements in clinical practice : a practice pattern for a holistic person-centred approach
No full textAssociation between poor mental health in mothers and child stunting : a population-based cross-sectional study in Rwanda
No full textOBJECTIVE: Child undernutrition is linked to substantial national economic and health losses in low- and middle-income countries, including Rwanda. Although the causal and contextual factors contributing to chronic malnutrition in children in Rwanda have been explored, the role of the mothers' mental health has not been fully investigated. This study aims to determine the prevalence of major depressive disorders, generalised anxiety and suicide risk among mothers in Rwanda and to explore their association with child stunting. DESIGN: This study used a cross-sectional, population-based design. SETTING AND PARTICIPANTS: Participants included children aged 1-36 months (n=601) and their mothers (n=601) in Rwanda's Northern Province. Mothers' mental health was assessed using four modules from the Mini International Neuropsychiatric Interview, based on the Diagnostic and Statistical Manual of Mental Disorders. Child anthropometric measurements followed WHO guidelines. PRIMARY AND SECONDARY OUTCOMES: The primary outcome of the study was child stunting that was defined as a height-for-age Z (HAZ) score <-2 SD according to WHO growth standards. RESULTS: Among the 601 mothers assessed, generalised anxiety disorder had the highest prevalence (36.6%), followed by recurrent major depressive disorder (27.3%), current major depressive disorder (22.7%) and current suicide risk (18.2%). Among the children, 27.1% were stunted, with prevalence rising from 9.8% in infants (1-12 months) to 39.9% in toddlers (25-36 months). Current major depressive disorders in mothers were associated with child stunting (adjusted OR 1.67; 95% CI 1.06 to 2.61). Affected children had lower HAZ scores (-1.68 ± 1.36 vs -1.30 ± 1.09; p = 0.004), and excess relative risk (ERR) analysis confirmed depression as a significant risk factor (ERR: 1.56; p = 0.005). CONCLUSIONS: Mental health disorders in mothers, especially depression, showed a significant association with child stunting. Addressing mental health disorders in mothers is essential for improving child nutritional outcomes
Self-reported health status in the general population over 2 decades : variation in EQ-5D-3L in health survey for England
No full textBackground: Population reference data based on self-reported EQ-5D constitute a valuable resource in a broad range of settings. Within the UK, EQ-5D has been included in national population surveys for over 30 years, notably as part of the Health Survey for England, however, the extent to which such data varies over time remains largely unknown. Methods: Between 1996 and 2014, the Health Survey for England included the original 3-level version of EQ-5D (EQ-5D-3L) and provides data from more than 100,000 respondents; these data form the basis of the present study. Age-stratified rates of reporting any problem in EQ-5D dimensions were computed for men and women; these were standardised using 1996 as the index year. Logit regression was used to examine the influence of year respondent socio-demographic characteristics, and current health status on rates of reporting any problems in EQ-5D-3L. The data of self-rated health status recorded on a 0-100 scale (EQ VAS) was also analyzed. Results: More than 30% report a problem with Pain/Discomfort with around 20% reporting a problem with Anxiety/Depression, Mobility having a similar problem rate, about 18%. Some 5% of respondents report a problem with Self Care. After an initial fall from 1996, self-reported health remains relatively stable across 10 years, however between 2008 and 2012 rates of reporting any problem increased, particularly in the Anxiety/Depression dimension and amongst older women. Logit regression analysis demonstrates that most of the covariates had statistically significant coefficients, such as age, gender, education, economic activity, income, and long-standing illness/condition. Conclusions: The study demonstrates the stability of EQ-5D responses over time in HSE data from 1996 to 2014. However, there is evidence of periodic deterioration in health status notably in the years immediately after 2007. Further investigation of this effect could have implications for the interpretation and use of population data based on EQ-5D. The study demonstrates the importance in national surveys of the general population of regular collection of health status data using a standardised measure of health-related quality of life
Case-based clinical ethics support – a description and normative discussion of methodological issues from the Swedish perspective
No full textClinical Ethics Support (CES) includes various forms of systematic support to deal with ethical challenges in healthcare and case-based CES (C-CES) is used for CES in particular cases. The aim was to describe and normatively discuss organizational and methodological aspects of C-CES used in Swedish healthcare. A mixed-methods approach was used. A descriptive survey was answered regarding eight organizations on hospital, regional and national level, with large variations in the number of conducted C-CES activities. Data were compiled and frequencies calculated. Based on the survey results, normative questions were formulated. Six participants, with expertise of C-CES, participated in a normative group discussion. Field notes and transcribed data were analysed qualitatively. The top ranked goal of C-CES was "Supporting decision making". Mainly prospective cases were used and C-CES was carried out as un-planned and pre-planned sessions. The normative results showed the importance of avoiding making C-CES unattractive to clinicians, for instance by keeping the time frame. The professional backgrounds of C-CES leaders varied greatly and arguments were provided for the facilitating role and that C-CES leaders ought not facilitate where they have been clinically engaged. Identified challenges included variations in uptake of C-CES activities that do not mirror the ethical challenges of the context. The unfair uptake of C-CES can be compared with the uptake in Norway where there are legal requirements for CES. In this study patients and families were not reported to request or attend C-CES. Thus, further research and interventions are needed to ensure their representation in Swedish C-CES
Isolated lumbar extension exercise alone or in a multimodal program for low back pain and radiculopathy : a non-randomized controlled trial
No full textIsolated lumbar extension resistance exercise (ILEX) has been shown to effectively address chronic low back pain (LBP) and paraspinal deconditioning. However, its role within the widely recommended multimodal management approaches remains unclear. This study aimed to: (1) closely monitor the effects of ILEX throughout the course of a 16-weeks intervention, applied as a stand-alone approach in patients with nociceptive and/or neuropathic pain and (2) to compare this intervention with a multimodal treatment program including general exercise (GE) and manual therapy (MT). Fifty-eight LBP patients were enrolled in this single-center (Wuerzburg, Germany), prospective, non-randomized controlled trial. The ILEX-only group (Powerspine Back[PSB]: n = 29) completed 25 sessions of ILEX, whereas the integrative group (PSB+ : n = 29) also received GE (added to each session) and MT (5 to 7 sessions). Outcome measures were assessed at baseline, 3, 6, 9 and 16 weeks including lumbar multifidus cross-sectional area (CSA), muscle thickness (MT), echointensity (EI) (ultrasound-derived), isometric lumbar strength (isokinetic device) and validated questionnaires (Visual Analog Scale [VAS]; Oswestry Disability Index [ODI]; Short-Form 36). Between-subjects repeated measures ANOVA and correlation analyses were performed. Both groups (PSB: m = 16, f = 15, Ø40.26 (± 13.71) years, BMI 25.16 (± 4.07) kg/m2; PSB+ : m = 16, f = 13, Ø42.00 (± 12.69) years, BMI 25.20 (± 3.29) kg/m2) demonstrated comparable linear improvements in multifidus CSA (PSB: Δ0.59 [95% CI 0.36–0.82] cm2; PSB+ : Δ0.72 [95% CI 0.49–0.96] cm2, both p < 0.001; main effect (group): p = 0.52) along with similar strength gains (PSB: Δ96.79 [95% CI 57.64–135.93] Nm; PSB+ : Δ86.88 [95% CI 48.70–125.06] Nm; both p < 0.001; main effect (group): p = 0.91) over time. EI remained unchanged in both groups. No-between group differences were observed for self-reported measures, while all outcomes significantly improved (ODI: PSB: − 15.0 [95% CI − 19.3 to − 10.8], PSB+ : − 11.7 [95% CI − 16.0 to − 7.4]; VAS: PSB: − 29.30 [95% CI − 37.73 to − 20.86], PSB+ : − 29.34 [95% CI − 37.78 to − 20.91], both p < 0.001). Only PSB+ showed correlations between multifidus changes and clinical outcomes. Stand-alone and combined isolated lumbar extension resistance exercise interventions are effective in reversing muscle deconditioning and produce comparable clinical outcomes. The results inform clinical decision-making and support the development of targeted, resource-efficient rehabilitation strategies
Feasibility of ecological momentary assessment during cognitive behavioural therapy in athletes : a single-case study
No full textAthletes undergoing psychotherapy, such as cognitive behavioural therapy (CBT), is an understudied group. Therefore, the aim of this study was to examine the feasibility of combining a single-case design (SCD) with ecological momentary assessment (EMA) throughout a CBT intervention with athletes. We conducted an SCD with multiple-baselines with three athletes seeking treatment at a university sports psychology clinic. EMA was employed with six daily questionnaires measuring positive and negative affect, and momentary context and activity for 105 days. A feasibility questionnaire and semi-structured interviews were conducted post-intervention to investigate the overall experience of participation and specific features of the design. Feasibility was determined by descriptively investigating the assessment frequency, questionnaire length, compliance, potential response patterns, and perceived burden of the sampling protocol. The three participants completed an average of 455 questionnaires with response rates of 48%, 73%, and 77%, respectively. Compliance varied more over weeks than within week or day. The main reason for compliance was the quickness of completing the questionnaire. The number of daily questionnaires was perceived as more burdensome than the number of items in each questionnaire and the length of the study. The current study is the first to demonstrate the feasibility of combining SCD and EMA during CBT with athletes in a real-world clinical setting. This study contributes to evidence-based care for athletes' mental health by demonstrating a design that enables the analysis of individual processes throughout a CBT intervention. This approach can be adopted to further investigate the effectiveness and mechanisms of psychotherapeutic interventions
Gender-related differential item functioning in SweSAT verbal subtests : the role of extramural English activities in first and foreign language performance
No full textStandardized admission tests such as the Swedish Scholastic Aptitude Test (SweSAT) aim to ensure fairness in higher education selection by assessing verbal and quantitative skills. Previous research on the SweSAT indicates declining scores in the Swedish Reading subtest and improved scores in the English reading subtest. Gender differences are present, with males outperforming females on most SweSAT subtests–males often perform better on the multiple-choice format used in SweSAT, especially in English as a foreign language, while females typically perform better in school. Informal English exposure through Extramural English (EE) activities, such as digital gaming and reading, is associated with higher English proficiency, with males engaging more in gaming. However, EE impact on first-language proficiency alongside gender-related differences in test performance remains unclear. This study investigates how EE activities and item format contribute to gender-related performance differences in the SweSAT verbal subtests. A total of 5,230 SweSAT test-takers completed a questionnaire on their engagement in EE activities, focusing on reading and gaming. The SweSAT verbal items were examined using Mantel-Haenszel (MH) Differential Item Functioning (DIF) analyses to identify gender- and EE-related item biases. Results showed that gamers were more likely to be favored on English reading comprehension items, whereas non-gamers were favored on Swedish subtests. English items displayed DIF favoring frequent readers, whereas low-frequency readers were favored on some Swedish items. Male-favored DIF appeared mainly on English items, and females were favored on Swedish items. No consistent DIF patterns were linked to item format or word class across verbal items
"A dark in Swedish history" : A critical discourse analysis of Ulf Kristersson´s speeches to the nation.
No full textThis bachelor’s thesis aims to investigate two speeches to the nation held by the Swedish prime minister Ulf Kristersson. The first one was held in 2023, due to the gang related wave of violence that shook the country. Around 20 people were killed and around 30 injured in shootings and explosions. The next speech took place two years later, after the worst shooting in modern Swedish history. The shooting occurred at an adult education center in Örebro, where eleven people were killed – including the shooter, who shot himself. Through a critical discourse analysis (CDA) with a focus on rhetorical strategies, this study examines how Ulf Kristersson addresses his citizens during a national crisis, differences and patterns in the speeches, and what these might mean. The purpose is to compare how the prime minister portrays and describes Sweden in his speeches to the nation in 2023 and 2025, and to what extent party political positions appear in these speeches. The method as well as the theoretical framework is based on CDA and Norman Fairclough’s three-dimensional model, which helps us shed light on how Ulf Kristersson's speech to the nation reproduces or changes various interests and agendas in society. The thesis explores how political ideology is expressed or downplayed in times of crisis, revealing how party political positions are either emphasized or silenced. The analysis shows that Kristerssons portrayal of Sweden shifts between a nation under threat and a nation in mourning, and that this framing plays a key role in legitimizing both political direction and national identity
Cross-Country Skiing and Threshold Values : A Study of the Relationship Between Different Physiological Thresholds and Performance
No full textBakgrund Längdskidåkning är en uthållighetsidrott som ställer höga krav på utövarens aeroba och anaeroba kapacitet. I likhet med många andra idrotter präglas längdskidåkning av en kontinuerlig utveckling av träningsmetoder och prestationsanalyser. Ett vanligt tillvägagångssätt för att strukturera träningen är att utgå ifrån fysiologiska trösklar. De kan användas för att planera, övervaka och optimera prestationsutvecklingen. Elitidrottare investerar mycket tid och resurser i att förbättra dessa kapaciteter. Syftet med denna studie är att undersöka sambandet mellan olika fysiologiska tröskelvärden och faktisk prestationsförmåga, för att bidra till en mer effektiv och praktiskt tillämpbar träningsstyrning. Metod Totalt deltog fjorton studenter i studien, varav nio var män och fem kvinnor. Deltagarna var juniorlängdskidåkare tävlande på elitnivå som studerade vid samma skidgymnasium. Inklusionskriterierna för deltagande var att individerna skulle vara friska och skadefria vid testtillfället. Samtliga tester genomfördes inomhus på löpband. Trösklarna som togs fram var två fixerade trösklar på 2 respektive 4 mMol/L samt två individuella, anaerob laktattröskel och ventilatorisk tröskel. För att kvantifiera prestationsförmåga användes resultat från specifika tävlingar, där prestationsmåttet utgjordes av åkarens procentuella tid i förhållande till vinnartiden i både sprint- och distanslopp. Därefter gjordes statistisk analys och konstruktion av linjära regressionsmodeller för att undersöka samband mellan respektive tröskel och prestation. Resultat Ett signifikant samband identifierades mellan den ventilatoriska tröskeln och prestationsförmåga hos män på distanslopp (p = 0,03). Övriga sju analyser, inkluderande samtliga tröskelvärden för både män och kvinnor, visade inga statistiskt signifikanta samband (p > 0,05). Konklusion Studien visar att en signifikant korrelation mellan tröskelvärde och prestationsresultat endast återfinns vid den ventilatoriska tröskeln hos män i distanslopp. Övriga tröskelvärden uppvisade inga statistiskt signifikanta samband med prestation. Resultaten tyder på att enskilda fysiologiska tröskelvärden inte har någon tydlig koppling till tävlingsresultat. Background Cross-country skiing is an endurance sport that places high demands on the athlete's aerobic and anaerobic capacity. Like many other sports, cross-country skiing is characterized by a continuous development of training methods and performance analysis. A common approach to structuring the training is to start from physiological thresholds. They can be used to plan, monitor and optimize performance development. Elite athletes invest a lot of time and resources in improving these capabilities. The purpose of this study is to investigate the relationship between different physiological thresholds and actual performance, in order to contribute to a more effective and practically applicable exercise control. Method A total of fourteen students participated in the study, of which nine were men and five women. The participants were junior cross-country skiers competing at the elite level who studied at the same ski high school. The inclusion criteria for participation were that the individuals should be healthy and injury-free at the time of the test. All tests were carried out indoors on a treadmill. The thresholds that were developed were two fixed thresholds of 2 and 4 mMol/L respectively and two individual, anaerobic lactate threshold and ventilatory threshold. To quantify performance, results from specific competitions were used, where the performance measure consisted of the skier's percentage time in relation to the winning time in both sprint and distance races. Statistical analysis and construction of linear regression models were then performed to investigate the relationship between each threshold and performance. Result One significant correlation was identified; between the ventilatory threshold and performance for men in the sprint race (p = 0,03). The remaining seven results either showed no correlations (p > 0,05) for either men or women. Conclusion The study shows that a significant correlation between threshold and performance outcomes is only found at the ventilatory threshold in men in distance races. Other thresholds showed no statistically significant correlation with performance. The results indicate that individual physiological threshold values have no clear connection to competition performance.
Emergence and spread of Hyalomma ticks and Crimean-Congo haemorrhagic fever in Europe : a systematic review
No full textBackground: Crimean-Congo haemorrhagic fever (CCHF) is a severe, often fatal zoonotic disease caused by the CCHF virus (CCHFV). It is primarily transmitted by Hyalomma ticks, which serve as both reservoir and vector. While these ticks are endemic to Asia, Africa, and parts of Europe, recent detections in previously unaffected European regions raise concerns about the potential spread of the disease. Objectives: This study aims to systematically review the first detections of Hyalomma ticks, CCHFV, and CCHF disease in Europe. The goal is to support surveillance strategies and enhance preparedness for future outbreaks. Methods: A systematic literature search was conducted across six international databases, complemented by targeted searches. From 1315 articles retrieved (1235 from systematic and 80 from targeted searches), 92 were included based on relevance to the presence of Hyalomma ticks, CCHFV, and/or CCHF in Europe. Results: Hyalomma ticks are either endemic or have been detected at least once in 40 European countries. CCHFV and CCHF diseases have been reported in 24 and 22 countries, respectively. The distribution of Hyalomma ticks has expanded because of environmental and climatic changes, as well as increased movement of birds, livestock, and humans. CCHF has been present in Europe for decades, with early reports from Bulgaria, Russia, Ukraine, and Kosovo. More recent detections include Georgia, Spain, the UK, and Portugal. Conclusions: The ecological and climatic suitability for Hyalomma ticks is increasing across Europe, heightening the risk of CCHFV transmission. Integrated entomological surveillance and virological monitoring are essential for early detection and rapid response to potential outbreaks. Strengthening these efforts will be critical to containing the spread of CCHF and protecting public health