Publikationer från Umeå universitet
Not a member yet
55455 research outputs found
Sort by
Provision of contraception to adolescents in primary healthcare clinics in South Africa : Perspectives of healthcare practitioners
No full textIntroduction: The provision of contraception to adolescents is a fundamental public health strategy for preventing adolescent pregnancies and realising universal access to sexual and reproductive health. In the South African context, and as informed by national and provincial policy guidelines, this strategy is delivered at primary healthcare clinics. In this study, we sought to explore the barriers and enablers of providing contraception to adolescents in primary healthcare clinics from the perspectives of healthcare practitioners. Methods: We employed a qualitative research design. Using purposive sampling, we recruited senior managers and nurses involved in primary healthcare and sexual and reproductive health programmes in South Africa. We conducted semi-structured interviews with twenty-nine participants working in an urban or rural district. Subsequently, we transcribed the interviews, verifying for errors. Guided by Braun and Clarke’s model of thematic analysis, we grouped the data into four themes derived from the healthcare access frameworks. Each of the four themes has sub-themes describing both enablers and barriers to providing contraception to adolescents. Results: The study revealed that practitioners’ knowledge of policy guidelines enabled them to provide contraception to adolescents effectively. However, the differences between what is stated in policy documents and practical limitations could impede the extent to which services reach adolescents. Other barriers to providing contraception to adolescents included language differences between healthcare practitioners and users, time constraints, and lack of privacy during consultations. Participants noted that appropriate nurse training and ensuring an accepting environment for adolescents facilitated the provision of contraception to this age group. Conclusion: Our study offers valuable insights into the perspectives of primary healthcare practitioners about the barriers and enablers in providing contraception to adolescents. Our results indicate that policy development and future research should focus on strengthening the delivery of contraception services for adolescents
Exkludering inom den Särskilda Polistaktiken
No full textViolence associated with football matches has a long history, dating back to medieval England. Initially, supporters were seen as dangerous, requiring riot police and enclosures. However, since the turn of the millennium, a new method within the Swedish Police, translated to Special Police Tactics (SPT), has been introduced and which is based on the new theories of mass psychology which views the crowd as consisting of individuals with different social identities who can be influenced by circumstances and police actions. The police should facilitate and support the positive majority while selectively intervening against the violent minority through prosecution and stadium bans. The conflict-reducing principles, particularly differentiation, are central to distinguishing between disorderly individuals and legitimate participants, aiming to maintain order and safety at events. This approach reduces disturbances and makes football matches safer for all supporters.This thesis aims to examine police officers' experiences with the prosecution and exclusion of disorderly individuals at football-matches and analyse what impact these measures have on the public order situation at these events. The focus is on stadium bans and improvements in working methods. The research questions address police perceptions of prosecution and exclusion, their impact on public order, and potential improvements.Stadium bans are considered an effective tool for excluding problematic supporters but measuring the impact of prosecution and exclusion is challenging. Stadium bans are seen by the supporters as a harsher punishment than legal consequences and they also have a more long-term result.Improvements to make the exclusion of disorderly individuals even more effective include specific training for investigators, focusing on long-term results, joint exercises and closer collaboration between operational and investigative units
Intersectional inequities in colorectal cancer screening attendance in Sweden : using decision trees for intersectional matrix reduction
No full textColorectal cancer (CRC) represents a significant health burden worldwide, with existing inequities in incidence and mortality. In Sweden, CRC screening programmes have varied regionally since the mid-2000s, but the significance of organised screening for counteracting complex inequities in screening attendance has not been investigated. This study aimed to assess patterns of inequities in lifetime CRC screening attendance in the Swedish population aged 60-69 years by identifying intersectional strata at higher risk of never attending CRC screening. The research question is answered using decision trees to reduce the complexity of a full intersectional matrix into a reduced intersectional matrix for risk estimation. Participants were drawn from the cross-sectional 2019 European Health Interview Survey (N=9,757, response rate: 32.52%). The Conditional Inference Tree (CIT) (AUC= 0.7489, F-score=0.7912, depth= 4, significance level=0.05) identified region of residence (opportunistic vs organised screening), country of origin, gender, age and income as relevant variables in explaining lifetime CRC screening attendance in Sweden. Then, Poisson regression with robust standard errors estimated that EU-born women living in opportunistic screening regions belonging to the 2nd income quintile had the highest risk of never attending CRC screening (PR=8.54, p<0.001), followed by EU-born men living in opportunistic screening regions (PR=7.41, p<0.001) compared to the reference category (i.e. people aged 65-69 living in organised screening regions). In contrast, only age-related differences in attendance were found in regions with organised screening (i.e. people aged 60-64 living in regions with organised screening (PR=2.01, p<0.05)). The AUC of the reduced intersectional matrix model (0.7489) was higher than the full intersectional matrix model (0.6959) and slightly higher than the main effects model (0.7483), demonstrating intersectional effects of the reduced intersectional matrix compared with the main effects model and better discriminatory accuracy than the full intersectional matrix. In conclusion, regions with long-established organised CRC screening programmes display more limited socio-demographic inequities than regions with opportunistic CRC screening. This suggests that organised screening may be a crucial policy instrument to improve equity in CRC screening, which, in the long run, has the potential to prevent inequities in colorectal cancer mortality. Moreover, decision trees appear to be valuable statistical tools for efficient data-driven simplification of the analytical and empirical complexity that epidemiological intersectional analysis conventionally entails
Nelvy Cáceres. World Vision Bolivia and community health workers in Bolivia : a historical reflection
No full textDr. Nelvy Cáceres was a key figure in the development of the work with health promoters at World Vision Bolivia (WVB). Since joining in 1989, Nelvy has been involved in multiple stages of this effort, playing key roles in the training of health promoters, management of water and sanitation projects, and training in healthy and nutritional practices. Since 1983, WVB has been developing programmes and projects with a multidisciplinary approach and focused on the well-being and quality of life of the most vulnerable children, families and communities in rural, peri-urban and urban areas of Bolivia. WVB has fought against inequality and injustice with the aim of transforming the conditions of vulnerability of its inhabitants, together with local leaders, authorities and communities. The first decade of WVB's work was linked to the work of local evangelical churches, which served as administrators of community programmes that directly supported children. The second decade was characterised by transformative development in health, education, agro-ecology and community leadership, emergency preparedness and justice promotion, strengthening the resilience and capacity of communities and partners to respond to current and future challenges to child well-being, including disaster response. In this narrated interview, Nelvy takes a historical look at WVB's work with health promoters and reflects on their future and challenges as agents of change in the Bolivian context
What are the important risk factors for excessive daytime sleepiness in a population-based cohort?
No full textExcessive daytime sleepiness (EDS) is a common complaint in the general population and is associated with cardiovascular disease and increased mortality. We aimed to investigate whether sleep duration is related to excessive daytime sleepiness in the general population, both in itself and in combination with other factors. We performed a cross-sectional analysis in the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort (n = 27,976; 14,436 females; aged 50–64 years) to assess how sleep-related factors along with anthropometric, lifestyle, socioeconomic factors as well as somatic disease and psychological distress, were related with EDS assessed by the Epworth sleepiness scale (ESS). Analyses were performed using logistic regression modelling with EDS defined by an ESS score of ≥11 as the main outcome. Both short and long sleep duration were related to EDS with increasing ORs for decreasing sleep duration (7 h vs. reference (8 h): OR 1.2, 95% CI 1.02–1.3 to ≤4 h: 1.9; 1.4–2.5). In addition to sleep-related factors such as insomnia (1.3; 1.2–1.4), poor sleep quality (1.2; 1.04–1.4), snoring (1.5; 1.4–1.6), and nocturnal gastro-oesophageal reflux (1.5; 1.21–1.8), psychological distress showed a strong association with EDS. This included sadness/depression (1.2; 1.1–1.3), stress (some stress: 1.4; 1.1–1.7 to constant stress over 5 years: 1.7; 1.3–2.2), and self-rated "control in life" (lowest quartile: 1.7; 1.6–2.0). Daytime sleepiness is multifactorial and associated with both sleep duration and sleep quality. Strong associations were also established with factors related to psychological distress. Further research may investigate interventions targeting both sleep and psychological health to reduce daytime sleepiness at the societal level
Navigating legal discourses in quasi-markets : juridification and privatisation in Swedish local preschool governance
No full textThe education sector has been increasingly affected by legal discourse, new managerialism, litigation, burgeoning regulation and accountability involving inspections and audits, and rises in lawsuits. These processes have been described as juridification and have complex effects. In this paper we focus on juridification’s impact on preschool governance during times of increased privatisation in Sweden. We aim to unpack links between juridification and privatisation by analysing the multifaceted issues of how law, litigation and legal discourse become manifested and are navigated by various actors in local preschool quasi-market governance. The results show how intricate connections between juridification and privatisation tend to make public and private relations more legalistic, contract-based and competitive. Juridification and privatisation also increase conformity in terms of, for instance, pedagogical profiles, practices and organisational structures. In addition, these inter-related processes promote and largely benefit corporate group formation and expansion as legal knowledge and economic resources to navigate local preschool quasi-market governance become increasingly essential. This starkly contrasts with the core ostensible objectives of privatisation and marketisation reforms – to promote diversity, pluralism, and a wide range of preschool options for parents.Förskolan som markna
Ultra-fast, one-click radiotherapy treatment planning outside a treatment planning system
No full textWe present an automated radiation oncology treatment planning pipeline that operates between segmentation and plan review, minimizing manual interaction and reliance on traditional planning systems. Two AI models work in sequence: the first generates a dose distribution, and the second creates a deliverable DICOM-RT plan. Trained and validated on 276 plans, and tested on 151 datasets, the system produced clinically deliverable plans—complete with all VMAT parameters—in about 38 s. These plans met target coverage and most organ-at-risk constraints. This proof-of-concept demonstrates the feasibility of generating high-quality, deliverable DICOM plans within seconds
Mars Express investigations of the Martian ionosphere using ASPERA-3 and new MARSIS fixed frequency modes
No full textThe plasma package Analyzer of Space Plasma and Energetic Atoms (ASPERA-3) onboard Mars Express has observed ions and electrons accelerated by the Mars Advanced Radar for Subsurface and Ionosphere Sounding (MARSIS) radar when it operates in its active ionospheric sounding mode. To better study the processes involved, new operational modes for MARSIS have been developed. In the first, a fixed frequency mode, the transmitter does not sweep over a range of frequencies, as normal, but instead transmits pulses at a fixed frequency. This frequency has been chosen to be close to the fundamental frequency of the local ionosphere around the spacecraft, which in all cases is < 350 kHz. Also, an alternating mode has been introduced, where observations in the fixed frequency mode are interleaved with observations that sweep over frequencies in order to investigate how ions are accelerated. Here we describe the new operational modes and present the results of several tests performed in the years 2020, 2021, and 2023
Telomemore enables single-cell analysis of cell cycle and chromatin condensation
No full textSingle-cell RNA-seq methods can be used to delineate cell types and states at unprecedented resolution but do little to explain why certain genes are expressed. Single-cell ATAC-seq and multiome (ATAC + RNA) have emerged to give a complementary view of the cell state. It is however unclear what additional information can be extracted from ATAC-seq data besides transcription factor binding sites. Here, we show that ATAC-seq telomere-like reads counter-inituively cannot be used to infer telomere length, as they mostly originate from the subtelomere, but can be used as a biomarker for chromatin condensation. Using long-read sequencing, we further show that modern hyperactive Tn5 does not duplicate 9 bp of its target sequence, contrary to common belief. We provide a new tool, Telomemore, which can quantify nonaligning subtelomeric reads. By analyzing several public datasets and generating new multiome fibroblast and B-cell atlases, we show how this new readout can aid single-cell data interpretation. We show how drivers of condensation processes can be inferred, and how it complements common RNA-seq-based cell cycle inference, which fails for monocytes. Telomemore-based analysis of the condensation state is thus a valuable complement to the single-cell analysis toolbox
Lithium and the risk of severe COVID-19 infection : a retrospective population-based register study
No full textObjectives: Previous research has suggested antiviral properties for lithium, including potential effectiveness against COVID-19 in vitro. This study aimed to investigate the impact of lithium and other psychotropic drugs on the risks of mortality, hospitalization, and ICU admission due to COVID-19 among individuals with bipolar disorder. The primary objective was to assess whether lithium was beneficial in COVID-19-infection in a real-world population. Methods: Retrospective register study using data from multiple Swedish patient registers, including 39,063 individuals in Sweden with bipolar disorder and prescribed mood stabilizers. Outcomes included COVID-19-associated death, hospitalization, and ICU admission between 11 March 2020 and 10 March 2021. Multivariate logistic regression adjusted for age, sex, and somatic comorbidities was conducted. Results: Lithium were prescribed to 44.2 % of patients, either as mono- or combination therapy; other mood stabilizers were prescribed to 55.8 %. There were no significant associations between lithium and COVID-19-associated death, hospitalization, or ICU admission. Atypical antipsychotics were associated with increased odds ratios for COVID-19-associated death (OR 1.58 [95 % CI 1.01–2.47]), hospitalization (OR 1.80 [95 % CI 1.49–2.18]), and ICU admission (OR 2.25 [95 % CI 1.33–3.80]). Benzodiazepines were associated with a significant increase in COVID-19-associated death (OR 1.54 [95 % CI 1.01–2.35]) and hospitalization OR 1.26 [95 % CI 1.03–1.53]). In an ad hoc analysis, lithium monotherapy was, however, associated with reduced hospitalizations and ICU admissions. Conclusions: Our findings weaken the hypothesis that lithium reduces the risk of severe events associated with COVID-19 infection in bipolar disorder