Mid Sweden University

This study explored the community perception of maternal deaths influenced by natural disaster (flood), and the practice of maternal complications during natural disaster among the rural population in Bangladesh. It also explored the challenges faced by the community for providing healthcare and referring the pregnant women experiencing complications during flood disaster. Three focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted in the marginalized rural communities in the flood-prone Khaliajhuri sub-district, Netrakona district, Bangladesh. Flood is one of the major risk factors for influencing maternal death. Pregnant women seriously suffer from maternal complications, lack of antenatal checkup, and lack of doctors during flooding. During the time of delivery, it is difficult to find a skilled attendant, and referring the patient with delivery complications to the healthcare facility. Boats are the only mode of transport. The majority of maternal deaths occur on the boats during transfer from the community to the hospital. Rural people feel that the maternal deaths influenced by natural disaster are natural phenomena. Pre-preparation is needed to support pregnant women during disasters. There is unawareness of maternal health, related care, and complications during disasters among local health service providers and volunteers. 

Background: Community misperception on newborn care and poor treatment of sick newborn attributes to neonatal death and illness severity. Misperceptions and malpractices regarding neonatal care and neonatal complications are the leading causes of neonatal deaths in Bangladesh. The study was conducted to explore neonatal care’s perceptions and practices and manage complications among Bangladesh’s rural communities.

Methods: A qualitative study was conducted in Netrakona district of Bangladesh from April to June 2015. Three sub-districts (Upazilas) including Purbadhala, Durgapur and Atpara of Netrakona district were selected purposively. Five focus group discussions (FGDs) and twenty in-depth interviews (IDIs) were conducted in the rural community. Themes were identified through reading and re-reading the qualitative data and thematic analysis was performed.

Results: Community people were far behind, regarding the knowledge of neonatal complications. Most of them felt that the complications occurred due to lack of care by the parents. Some believed that mothers did not follow the religious customs after delivery, which affected the newborns. Many of them followed the practice of bathing the newborns and cutting their hair immediately after birth. The community still preferred to receive traditional treatment from their community, usually from Kabiraj (traditional healer), village doctor, or traditional birth attendant. Families also refrained from seeking treatment from the health facilities during neonatal complications. Instead, they preferred to wait until the traditional healers or village doctors recommended transferring the newborn.

Conclusions: Poor knowledge, beliefs and practices are the key barriers to ensure the quality of care for the newborns during complications. The communities still depend on traditional practices and the level of demand for facility care is low. Appropriate interventions focusing on these issues might improve the overall neonatal mortality in Bangladesh.

Water immersion methods, such as cold water immersion and contrast water therapy are popular recovery interventions after athletic training and competition. Nevertheless, post-exercise cold water immersion may actually inhibit hypertrophic signalling pathways and muscle adaptation to training (1). It is has been commonly assumed that the mechanism of impaired training adaptation is mediated by blunted inflammatory responses to muscle-damaging exercise, although this assumption has been questioned by recent data (2). A weakness of previous studies is omission of active recovery in water immersion interventions, which would arguably be utilised in addition to water immersion by athletic populations. The aim of this study was to compare the influence of three water immersion methods, performed after active recovery, on inflammatory responses to muscle-damaging exercise. Nine male participants (age 20-35 y) performed an intensive exercise protocol, consisting of maximal jumps and sprinting, on four occasions. After each trial, participants completed one of four recovery protocols in a randomised, crossover design (ACT, active recovery only, 10 min cycling; heart rate 120-140 b/min; CWI, active recovery followed by 10 min cold water immersion, 10°C; TWI, active recovery followed by 10 min temperate water immersion, 24°C and CWT, active recovery followed by contrast water therapy, 10 min alternating 10°C and 38°C in 1 min cycles). The study was conducted in accordance with the Declaration of Helsinki and approved by the local ethical review board. Venous blood samples were collected pre-exercise and 5 min, 60 min, 24 h, 48 h and 96 h post-exercise, then analysed for myocyte chemoattractant protein 1 (MCP-1) and creatine kinase (CK) using ELISA and high-sensitivity C-reactive protein (hs-CRP) using a chemiluminescence assay. Two-way repeated measures ANOVA was used to compare biomarker concentrations between groups over time. There were no differences in biomarker concentrations during exercise and recovery between groups across the six time points, however main effects of time were present for all three markers (MCP-1: F(2.32, 18.56) = 23.1, p < 0.0001; CK: F(2.059, 16.47) = 8.74, p = 0.002; hs-CRP: F(1.07, 8.57 = 13.8, p = 0.005). Tukey’s post-hoc analysis of simple time effects revealed increases in MCP-1 at post-5 min versus pre in all groups except CWT. In TWI and CWI, MCP-1 was still elevated above pre at 60 min post-exercise. hs-CRP peaked at 24 h post-exercise in all groups. CK was elevated at post-60 versus pre in all groups and at post-24 except in CWT. Our findings suggest that use of cold or thermoneutral water immersion in combination with active recovery may slightly prolong the immediate post-exercise elevation in MCP-1 but have minimal overall effect on markers of inflammation and muscle damage.

Purpose: The aim of this study was to compare the efficacy of three water immersion interventions performed after active recovery compared to active recovery only on the resolution of inflammation and markers of muscle damage post-exercise. Methods: Nine physically active men (n = 9; age 20‒35 years) performed an intensive loading protocol, including maximal jumps and sprinting on four occasions. After each trial, one of three recovery interventions (10 min duration) was used in a random order: cold-water immersion (CWI, 10 °C), thermoneutral water immersion (TWI, 24 °C), contrast water therapy (CWT, alternately 10 °C and 38 °C). All of these methods were performed after an active recovery (10 min bicycle ergometer), and were compared to active recovery only (ACT). 5 min, 1, 24, 48, and 96 h after exercise bouts, immune response and recovery were assessed through leukocyte subsets, monocyte chemoattractant protein-1, myoglobin and high-sensitivity C-reactive protein concentrations. Results: Significant changes in all blood markers occurred at post-loading (p < 0.05), but there were no significant differences observed in the recovery between methods. However, retrospective analysis revealed significant trial-order effects for myoglobin and neutrophils (p < 0.01). Only lymphocytes displayed satisfactory reliability in the exercise response, with intraclass correlation coefficient > 0.5. Conclusions: The recovery methods did not affect the resolution of inflammatory and immune responses after high-intensity sprinting and jumping exercise. It is notable that the biomarker responses were variable within individuals. Thus, the lack of differences between recovery methods may have been influenced by the reliability of exercise-induced biomarker responses. 

The aim of this study was to compare the effectiveness of 3 water immersion interventions performed after active recovery compared with active recovery only on physical and mental performance measures and physiological responses. The subjects were physically active men (age 20-35 years, mean ± SD 26 ± 3.7 years). All subjects performed a short-term exercise protocol, including maximal jumps and sprinting. Four different recovery methods (10 minutes) were used in random order: cold water immersion (CWI, 10° C), thermoneutral water immersion (TWI, 24° C), and contrast water therapy (CWT, alternately 10° C and 38° C). All these methods were performed after an active recovery (10-minute bicycle ergometer; heart rate [HR] 120-140 b·min, 60-73% from age-calculated maximum HR), and the fourth method was active recovery (ACT) only. Within 96 hours after exercise bouts, recovery was assessed through a 30-m maximal sprint test, maximal countermovement jump (CMJ), self-perceived muscle soreness and relaxation questionnaires, and blood lactate, creatine kinase, testosterone, cortisol, and catecholamine levels. The self-perceived feeling of relaxation after 60-minute recovery was better (p < 0.05) after CWI and CWT than ACT and TWI. Statistically significant differences were not observed between the recovery methods in any other marker. In the 30-m sprint test, however, slower running time was found in ACT (p < 0.001) and CWT (p = 0.005), and reduced CMJ results (p < 0.05) were found in ACT when the results were compared with baseline values. Based on these findings, it can be concluded that CWI and CWT improve the acute feeling of relaxation that can play a positive role in athletes' performance and well-being.

INTRODUCTION:Subjective sleep quality may decrease during menstruation, although the duration and composition of sleep remains relatively stable across the menstrual cycle (MC) (1). Recording heart rate variability (HRV) is a tool to monitor the autonomic nervous system and recovery of the body. Meta-analytical data has not revealed significant changes in HRV from the early follicular phase (menses) to the mid-follicular phase (2). However, reduced HRV-values were observed during menses compared to follicular phase in women with pain during menses (dysmenorrhea) (3). Only a few studies have examined effects of the MC on nocturnal HRV. The aim of this study was to investigate how menses and associated pain affects nocturnal HRV and subjective sleep quality.METHODS:Participants included 14 healthy, physically active women, who did not use hormonal contraception. During one MC, participants completed a diary of sleep, MC and related symptoms. HRV was registered every night (Bodyguard 2, Firstbeat Technologies Ltd., Finland). HRV-data (RMSSD and LF/HF-ratio) were analyzed for two nights after a blood sample and over a four-hour period beginning 30 min after bedtime. Only the menses (M) and mid-follicular phases (FP) are used in this study. Blood samples (estradiol, E2, and progesterone, P4) were collected during M (day 2-3 of the MC) and FP (day 7-10) to ensure normal hormonal function associated with the MC (4).RESULTS:E2 was higher (p=0.012) during FP (267±150 pmol/L) compared to M (143±88 pmol/L), but P4 remained stable (p=0.103). Mean heart rate (HRmean) was higher during M (54±8 beats/min) compared to FP (52±7 beats/min, p=0.022). However, HRV-variables did not differ between M and FP (RMSSD: 76.7±34.5 to 77.3±27.0 ms, p=0.872; LF/HF: 1.416±1.380 to 1.273±0.769, p=0.826). Subjectively-assessed sleep quality remained unchanged between M and FP (p=0.349). The change in RMSSD and HRmean between M and FP did not differ (RMSSD: p=0.728; HRmean: p=0.149) between participants with and without menstrual pains.CONCLUSION:Menses has no effect on nocturnal HRV and subjective sleep quality of physically active women, though the higher nocturnal HRmean during M may indicate decreased recovery during menses.

REFERENCES:1. Driver, H.S., Werth, E., et al. The Menstrual Cycle Effects on Sleep. Sleep Med Clin 2008, 3:1–11.2. Schmalenberger, K.M., Eisenlohr-Moul, T.M., et al. A Systematic Review and Meta-Analysis of Within-Person Changes in Cardiac Vagal Activity across the Menstrual Cycle: Implications for Female Health and Future Studies. J Clin Med 2019, 8:1946.3. Jayamala, A.K., Preethi, B.L., et al. Comparative Analysis of Heart Rate Variability During Different Phases of Menstrual Cycle in Eumenorrhea & Dysmenorrhea Subjects. Exp Clin Physiol Biochem 2017, 1.4. Elliot-Sale, K.J., Minahan, C.L., et al. Methodological Considerations for Studies in Sport and Exercise Science with Women as Participants: A Working Guide for Standards of Practice for Research on Women. Sports Med 2021, 51:843–861.

Dental caries has declined in high-income countries in the last 30 years but is on the rise in low-income countries, affecting both children and adults. Although oral health is an integral and vital part of general health, it is still a neglected global public health area despite oral diseases being the most common non-communicable diseases globally. Objectives: This study aimed to understand and describe oral health professionals' experiences and perspectives with oral health prevention in Somaliland. Methods: Qualitative study with semi-structured telephone interviews with oral health professionals (n = 9). Subjects were recruited through convenience, and snowball sampling process, and data were analysed using inductive thematic analysis. Results: Three main themes were identified: (1) insufficient awareness and traditional beliefs, (2) the government's limitations, and (3) strategies to improve oral health prevention. Limited oral health knowledge and low health literacy contributed to the high prevalence of dental caries. Additionally, the government's limitations constrain efforts to promote healthy living standards, aggravating the population's oral health and country’s substandard oral healthcare system. Preventative efforts targeting the most vulnerable in Somaliland and improving educational attainment in the country, with focus on mothers, were strategies raised to improve the populations’ oral health. Conclusion: With limited resources, investing and focusing on primary prevention is advisable. The available research on oral health was mainly based on data from high-income countries; thus, more research is required. National oral health surveys and baseline data are necessary to plan context- and cultural-appropriate oral health programs relevant for Somaliland.

Patient-vårdpersonalkontakt är en viktig faktor för en god och jämlik vård, men även för patienters trygghetskänsla i vården. Patienter som känner sig trygga kan ha högre motivation att uppsöka vård eller delta i regelbundna screeningar. I vissa situationer kan patienter komma med önskemål om vårdpersonalens kön – något som personalen lär vara förberedd på att bemöta på bästa möjliga sätt för att bevara patienters tillit. Syftet med studien är att beskriva vårdpersonalens erfarenheter av patienter som har önskemål om att vårdas av personal av ett visst kön. En mixad design metod användes som innehöll ett frågeformulär med flersvarsalternativ samt öppna frågor. Vårdpersonal med patientnära arbete rekryterades (n=90). Resultat beräknades på 87 deltagare, varav 49% (n=42) svarade att de har blivit ombedda att byta med en kollega av det andra könet, män signifikant högre än kvinnor (p=0,001). Vårdpersonalens attityd mot självupplevd patientpreferens var oftast positiva (38% n=16) medan om en kollega upplevde liknande situation var attityder oftast negativa (45%, n=30). Slutsats: Önskemål om vårdpersonalens kön förekommer inom svenska vården och de flesta av vårdpersonalen accepterar situationer utan problem. Det kan bidra till en mer jämlik hälso- och sjukvård.

Aim: To develop knowledge of nurses' perceptions of participation for patients treated with haemodialysis and their next of kin.

Design: A qualitative study with a hermeneutic approach.

Methods: The data were collected in 2015 through focus groups with 13 nurses in Central Norway.

Results: The nurses reported that patient participation ranging from non-involvement to shared decision-making was related to whether dialysis was initiated as acute or scheduled. The restrictions required in chronic haemodialysis limited participation. The next of kin were not involved. The nurses highlighted interventions on both the individual and system levels to strengthen participation.

Conclusion: Dialysis units should develop strategies for participation related to individual needs and design treatment in cooperation with patients and their families, ensuring involvement early in the clinical pathway. Further research is needed on issues related to next of kin, including their desired level of involvement.

Background: For individuals in need of dialysis, patient participation is important when determining care goals and in decision making regarding dialysis modality. Nephrologists hold a key role in delivering evidence-based healthcare that integrates patient preferences and values throughout the trajectory, and their experiences with patient participation are important for improving health care. The aim of this study was to explore nephrologists’ experiences with patient participation in different phases of the end-stage renal disease trajectory for working-age individuals who require dialysis. Methods: This explorative study comprised interviews with ten nephrologists from four different dialysis units in Central Norway. We analysed the interviews by applying an interpretive phenomenological approach. Results: Nephrologists had varied experiences with patient participation throughout the different phases of the treatment trajectory. During decision making on the dialysis modality, nephrologists emphasised patients’ choices in two approaches. In the first approach, they expected patients to choose the modality based on the provided information, which could be actively steered. In the second approach, they recognised the patients’ values and lifestyle preferences through shared decision-making. Within hospital haemodialysis, nephrologists considered patients’ self-care activities equivalent to patient participation, seeing self-care as a source of patient empowerment. They identified divergent patient–professional values and organisational structures as barriers to patient participation. Conclusion: Our study shows that nephrologists have different approaches to patient participation in different phases of the end-stage renal disease trajectory. Individual understanding as well as organisational structures are important factors to address to increase patient participation in end-stage renal disease care. Shared decision making, in which patient values are balanced against biomedical treatment targets, allows for mutual agreement between patients and healthcare professionals concerning medical plans and minimises the potential for patient–professional tensions. 

Aim and objective: To explore how working-age adults experience patient participation in hospital haemodialysis. Background: End-stage kidney disease is a progressive, chronic condition imposing patients with high treatment burdens and low health-related quality of life. Patients face multiple medical decisions related to living with kidney failure. Given their frequent interaction with health services, patient participation may be of special value. Design: Qualitative design with a narrative approach. Methods: In 2018, eleven patients aged 35–64 years undergoing hospital haemodialysis participated in individual interviews. All interviews were analysed using a narrative approach. Reporting followed the Consolidated criteria for Reporting Qualitative Research guidelines. Findings: The patients’ narratives of participation comprised three themes following their healthcare trajectory: Informed, but not involved in treatment choices; Duality of care and control; and Frail trust reflecting collaborative deficiencies. The patients received good information about dialysis, but were not involved in choice of treatment modality. Professional work, as well as the nature of treatment, contributed to restricted patient autonomy. Patients’ trust suffered from collaborative deficiency generating delays in their treatment trajectories, and patients extended their responsibility into the coordination of transitions as a way of coping with these issues. Conclusions: The study identified challenges related to patient involvement and interdisciplinary collaboration. Involving patients through dialogue and acknowledging their experiences, preferences and lifestyles may strengthen the mutual patient–professional understanding of treatment. Despite increased focus on seamless trajectories, patients face obstacles regarding interdisciplinary collaboration and coordination of health services. Relevance to clinical practice: The findings indicate a want of individually customised care for people requiring dialysis. Patients need to be involved in the choice of treatment modality as well as decisions related to the current treatment. Information must include potential consequences of the different treatment modalities. Health services need to strengthen collaboration in order to secure treatment continuity and patient involvement. 

Introduction: To date, no study has compared anaerobic capacity (AnC) estimates computed with the maximal accumulated oxygen deficit (MAOD) method and the gross energy cost (GEC) method applied to treadmill running exercise.

Purpose: Four different models for estimating anaerobic energy supply during treadmill running exercise were compared.

Methods: Fifteen endurance-trained recreational athletes performed, after a 10-min warm-up, five 4-min stages at ∼55–80% of peak oxygen uptake, and a 4-min time trial (TT). Two linear speed-metabolic rate (MR) regression models were used to estimate the instantaneous required MR during the TT (MRTT_req), either including (5+YLIN) or excluding (5-YLIN) a measured Y-intercept. Also, the average GEC (GECAVG) based on all five submaximal stages, or the GEC based on the last submaximal stage (GECLAST), were used as models to estimate the instantaneous MRTT_req. The AnC was computed as the difference between the MRTT_req and the aerobic MR integrated over time.

Results: The GEC remained constant at ∼4.39 ± 0.29 J⋅kg–1⋅m–1 across the five submaximal stages and the TT was performed at a speed of 4.7 ± 0.4 m⋅s–1. Compared with the 5-YLIN, GECAVG, and GECLAST models, the 5+YLIN model generated a MRTT_req that was ∼3.9% lower, with corresponding anaerobic capacities from the four models of 0.72 ± 0.20, 0.74 ± 0.16, 0.74 ± 0.15, and 0.54 ± 0.14 kJ⋅kg–1, respectively (F1.07,42 = 13.9, P = 0.002). The GEC values associated with the TT were 4.22 ± 0.27 and 4.37 ± 0.30 J⋅kg–1⋅m–1 for 5+YLIN and 5-YLIN, respectively (calculated from the regression equation), and 4.39 ± 0.28 and 4.38 ± 0.27 J⋅kg–1⋅m–1 for GECAVG and GECLAST, respectively (F1.08,42 = 14.6, P < 0.001). The absolute typical errors in AnC ranged between 0.03 and 0.16 kJ⋅kg–1 for the six pair-wise comparisons and the overall standard error of measurement (SEM) was 0.16 kJ⋅kg–1.

Conclusion: These findings demonstrate a generally high disagreement in estimated anaerobic capacities between models and show that the inclusion of a measured Y-intercept in the linear regression (i.e., 5+YLIN) is likely to underestimate the MRTT_req and the GEC associated with the TT, and hence the AnC during maximal 4-min treadmill running.

Purpose: This study aimed to compare performance and pacing strategies between elite male and female cross-country skiers during a sprint competition on snow using the skating technique.

Methods: Twenty male and 14 female skiers completed an individual time-trial prolog (TT) and three head-to-head races (quarter, semi, and final) on the same 1,572-m course, which was divided into flat, uphill and downhill sections. Section-specific speeds, choice of sub-technique (i.e., gear), cycle characteristics, heart rate and post-race blood lactate concentration were monitored. Power output was estimated for the different sections during the TT, while metabolic demand was estimated for two uphill camera sections and the final 50-m flat camera section.

Results: Average speed during the four races was ∼12.5% faster for males than females (P < 0.001), while speeds on the flat, uphill and downhill sections were ∼11, 18, and 9% faster for the males than females (all P< 0.001 for terrain, sex, and interaction). Differences in uphill TT speed between the sexes were associated with different sub-technique preferences, with males using a higher gear more frequently than females (P < 0.05). The estimated metabolic demand relative to maximal oxygen uptake (V&#x2D9;" role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; overflow-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V˙V˙O2max) was similar for both sexes during the two uphill camera sections (∼129% of V&#x2D9;" role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; overflow-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V˙V˙O2max) and for the final 50-m flat section (∼153% of V&#x2D9;" role="presentation" style="box-sizing: border-box; display: inline; line-height: normal; word-spacing: normal; overflow-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; outline: 0px !important;">V˙V˙O2max). Relative power output during the TT was 18% higher for males compared to females (P < 0.001) and was highly variable along the course for both sexes (coefficient of variation [CV] between sections 4–9 was 53%), while the same variation in heart rate was low (CV was ∼3%). The head-to-head races were ∼2.4% faster than the TT for both sexes and most race winners (61%) were positioned first already after 30 m of the race. No sex differences were observed during any of the races for heart rate or blood lactate concentration.

Conclusion: The average sex difference in sprint skiing performance was ∼12.5%, with varying differences for terrain-specific speeds. Moreover, females skied relatively slower uphill (at a lower gear) and thereby elicited more variation in their speed profiles compared to the males.

Purpose: This study aimed to compare physiological factors and cycle characteristics during cross-country (XC) roller-skiing at matched inclines and speeds using the double-poling (DP) and diagonal-stride (DS) sub-techniques in junior female and male XC skiers. Methods: Twenty-three well-trained junior XC skiers (11 women, 12 men; age 18.2 ± 1.2 yr.) completed two treadmill roller-skiing tests in a randomized order using either DP or DS. The exercise protocols were identical and included a 5 min warm-up, 4 × 5 min submaximal stages, and an incremental test to exhaustion, all performed at a 5° incline. Results: No significant three-way interactions were observed between sex, submaximal exercise intensity, and sub-technique. For the pooled sample, higher values were observed for DP versus DS during submaximal exercise for the mean oxygen uptake kinetics response time (33%), energy cost (18%), heart rate (HR) (9%), blood lactate concentration (5.1 versus 2.1 mmol·L−1), rating of perceived exertion (12%), and cycle rate (25%), while cycle length was lower (19%) (all P &lt; 0.001). During the time-to-exhaustion (TTE) test, peak oxygen uptake (V˙ O2peak), peak HR, and peak oxygen pulse were 8%, 2%, and 6% lower, respectively, for DP than DS, with a 29% shorter TTE during DP (pooled data, all P &lt; 0.001). Conclusion: In well-trained junior XC skiers, DP was found to exert a greater physiological load than DS during uphill XC roller-skiing at submaximal intensities. During the TTE test, both female and male athletes were able to ski for longer and reached markedly higher V˙ O2peak values when using DS compared to DP. 

Anaerobic capacity is an important performance-determining variable of sprint cross-country skiing. Nevertheless, to date, no study has directly compared the anaerobic capacity, determined using the maximal accumulated oxygen deficit (MAOD) method and gross efficiency (GE) method, while using different skiing sub-techniques.

Purpose: To compare the anaerobic capacity assessed using two different MAOD approaches (including and excluding a measured y-intercept) and the GE method during double poling (DP) and diagonal stride (DS) cross-country skiing.

Methods: After an initial familiarization trial, 16 well-trained male cross-country skiers performed, in each sub-technique on separate occasions, a submaximal protocol consisting of eight 4-min bouts at intensities between ~47–78% of V.V.O2peak followed by a 4-min roller-skiing time trial, with the order of sub-technique being randomized. Linear and polynomial speed-metabolic rate relationships were constructed for both sub-techniques, while using a measured y-intercept (8+YLIN and 8+YPOL) or not (8–YLIN and 8–YPOL), to determine the anaerobic capacity using the MAOD method. The average GE (GEAVG) of all eight submaximal exercise bouts or the GE of the last submaximal exercise bout (GELAST) were used to calculate the anaerobic capacity using the GE method. Repeated measures ANOVA were used to test differences in anaerobic capacity between methods/approaches.

Results: A significant interaction was found between computational method and skiing sub-technique (P < 0.001, η2 = 0.51) for the anaerobic capacity estimates. The different methodologies resulted in significantly different anaerobic capacity values in DP (P < 0.001, η2 = 0.74) and in DS (P = 0.016, η2 = 0.27). The 8-YPOL model resulted in the smallest standard error of the estimate (SEE, 0.24 W·kg−1) of the MAOD methods in DP, while the 8-YLIN resulted in a smaller SEE value than the 8+YLIN model (0.17 vs. 0.33 W·kg−1) in DS. The 8-YLIN and GELAST resulted in the closest agreement in anaerobic capacity values in DS (typical error 2.1 mL O2eq·kg−1).

Conclusions: It is discouraged to use the same method to estimate the anaerobic capacity in DP and DS sub-techniques. In DP, a polynomial MAOD method (8-YPOL) seems to be the preferred method, whereas the 8-YLIN, GEAVG, and GELAST can all be used for DS, but not interchangeable, with GELAST being the least time-consuming method.

Background Effective maintenance management of medical equipment is one of the major issues for quality of care, for providing cost-effective health services and for saving scarce resources. This study aimed to develop a comprehensive checklist for assessing the medical equipment maintenance management (MEMM) in the Iranian hospitals. Methods This is a multi-methods study. First, data related to factors which affect the assessment of MEMM were collected through a systematic review in PubMed, ProQuest, Scopus, Embase, and web of science without any time limitation until October 2015, updated in June 2017. Then, we investigated these factors affecting using document review and interviews with experts in the Iranian hospitals. In the end, the results of the first and second stages were combined using content analysis and the final checklist was developed in a two-round Delphi. Results Using a combination of factors extracted from the systematic and qualitative studies, the primary checklist was developed in the form of assessment checklists in seven dimensions. The final checklist includes 7 dimensions and 19 sub-categories: "resources = 3," "quality control = 3," "information bank = 4," "education = 1," "service = 3," "inspection and preventive maintenance = 2" and "design and implementation = 3." Conclusions Developing an assessment checklist for MEMM provide a comprehensive framework for the proper implementation of accurate assessment of medical equipment maintenance. This checklist can be used to improve the profitability of health facilities and the reliability of medical equipment. In addition, it is implicated in the decision-making in support of selection, purchase, repair and maintenance of medical equipment, especially for capital equipment managers and medical engineers in hospitals and also for the assessment of this process.

Aims: Worldwide, smokeless-tobacco use is a major risk factor for oral cancer. Evidence regarding the particular association between Swedish snus use and oral cancer is, however, less clear. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between snus use and oral cancer. Methods: A total of 418,369 male participants from nine cohort studies were followed up for oral cancer incidence through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. Results: During 9,201,647 person-years of observation, 628 men developed oral cancer. Compared to never-snus use, ever-snus use was not associated with oral cancer (adjusted HR 0.90, 95% CI: 0.74, 1.09). There were no clear trends in risk with duration or intensity of snus use, although lower intensity use (â©œ 4 cans/week) was associated with a reduced risk (HR 0.65, 95% CI: 0.45, 0.94). Snus use was not associated with oral cancer among never smokers (HR 0.87, 95% CI: 0.57, 1.32). Conclusions: Swedish snus use does not appear to be implicated in the development of oral cancer in men. 

Psykisk ohälsa ökar framför allt bland yngre kvinnor i dagens västerländska samhälle som karaktäriseras av konsumtion och materialism. Studier visar att ju mer en person bryr sig om yttre, materialistiska mål och värden desto lägre är dess personliga välbefinnande och personen rapporterar lägre lycka och livstillfredsställelse. Den här studiens syfte var att undersöka om det finns samband mellan shopping och låg livskvalitet bland kvinnor mellan 19 och 24 år. Data samlades in med en digital enkät med frågor relaterade till shoppingvanor, shoppingberoende och livskvalitet. Etthundraåtta kvinnor svarade. Det fanns ett positivt samband mellan shoppingberoende och självupplevd god livskvalitet. Kvinnor som bor i city/innerstad var mer shoppingberoende och upplevde högre livskvalitet medan kvinnor som bodde på landsbygden var shoppingberoende i mindre utsträckning och uppgav lägre grad av livskvalitet. När gränsen för shoppingberoende höjdes försvann sambandet mellan shoppingberoende och god livskvalitet vilket skulle kunna tolkas som att en tendens till eller en moderat grad av shoppingberoende har positivt samband med god livskvalitet men vid ett kraftigare shoppingberoende försvinner denna positiva effekt. 

Universitetsutbildningar som leder till arbete inom relationsbaserade yrken behöver förbereda studenterna för de etiska dilemman och möten med människor i svåra situationer som de i yrkeslivet kan ställas inför. Vi behöver därför fråga oss hur studenterna i undervisningen bäst kan ges förutsättningar för att utvecklas som kritiskt tänkande och socialt ansvarstagande individer. Vid flera svenska lärosäten används idag exempelvis skönlitteratur som pedagogiskt material i läkar- och socionomutbildningar för att ge träning i kritisk reflektion, perspektivtagande och empatisk förmåga. Några av de användningsområden som i detta sammanhang har lyfts fram är att fiktionen kan illustrera och applicera teorier, bidra till att se andras villkor samt utveckla personliga egenskaper och förmågor (Ottelid 2015). Fiktionens potential att gestalta livsfrågor ur olika perspektiv (se exempelvis Pettersson 2009; Brewer & Hogarth 2015) är ytterligare en aspekt av fiktionaliteten som bidrar till att skönlitterär läsning har en funktion att fylla i undervisningssammanhang. Den pedagogiska potentialen förstärks ytterligare av att denna träning i föreställningsförmåga utgör en viktig förutsättning för empati, ett inom relationsbaserade yrken betydelsefullt förhållningssätt (Bernhardsson, Nilsson & Palm 2015). Syftet med vår pågående pilotstudie är tudelat, med lärare och studenter på det rehabiliteringsvetenskapliga programmet vid Mittuniversitetet som målgrupp. För det första arbetar vi för att öka kompetensen hos lärarkollegiet om hur de kan arbeta med skönlitteratur som ett pedagogiskt redskap. För det andra utarbetar vi en modell för att använda skönlitterära texter i undervisningen som ett medel för att utveckla ovan beskrivna förmågor och därmed bidra till att studenterna upparbetar ett kritiskt helhetstänkande och en djupare social förståelse (Rosenblatt 1995). Genom att projektet fokuserar på både utveckling av kursinnehåll och undervisningsmetoder samt på utveckling av den pedagogiska diskussionen i lärarkollegiet menar vi att det bidrar till ett hållbart lärande. Genomförandet inleds med att lärarna gemensamt läser ett urval skönlitterära texter. Därefter följer en reflekterande diskussion ledd av projektledaren om hur lärarna upplevde den lästa boken och tänker sig att den didaktiskt ska användas i undervisningen. Diskussionsanteckningar utgör insamlad data. Efter läsningen av varje bok reflekterar varje lärare skriftligt över boken och dess pedagogiska potential, innan den eventuellt förs in som kurslitteratur. De erfarenheter som slutligen ges från den pedagogiska tillämpningen av skönlitteraturen samlas in i form av en öppen enkät till studenterna och som anteckningar från ansvarig lärare. 86 Då studien pågår finns ännu inga färdiga resultat, men avsikten är att sammanställa och analysera insamlat data för publicering i en högskolepedagogisk tidskrift.

Intimate partner sexual violence (IPSV) is a public health problem andprimarily affects women. Almost 30% of all women who have been in arelationship with a man, have experienced physical or sexual violence by theirpartner in their life. Even though sexual violence is being investigated inIndia, the determinants of sexual violence are thus far little investigated,specifically the determinants of IPSV. The purpose of the study was toexamine the demographic and socioeconomic determinants of IPSV againstwomen in India. The study was carried out using a quantitative method basedon secondary data from the National Family Health Survey 4 (NFHS-4). Thevariables used was age, residential area, education, religion, wealth index andemployment (current/all year/seasonal). Descriptive statistics, Chi-square testand a multivariate logistic regression analysis were used to analyze the data.The results indicated that younger women experienced more IPSV than olderwomen, and women in rural areas lived through more IPSV than women inurban areas. However, were women with urban residency were more likely tobe exposed to IPSV, which indicates that urban residency can be a risk factorfor sexual violence. A remarkable finding was that the prevalence of IPSVamong working women was higher (9%) than nonworking women (6%), butthat the adjusted ORs showed no correlation between working status andIPSV. Current study has added further evidence of IPSV in India, usingnationally representative samples. Younger women with lower educationshould be emphasized and seen as a risk group for IPSV. An in-depth studyregarding the partner’s characteristics in India is warranted and an importantstep to chart additional determinants for IPSV.

Aim and objectives: To translate the Clinical Trial Nursing Questionnaire (CTNQ) into Swedish and test it for face and content validity as well as internal consistency and reproducibility using test–retest procedures. Introduction/Background: In many countries, as in Sweden, a registered nurse can be involved in research by becoming a clinical research nurse. The clinical research nurse plays a pivotal role in clinical studies as a part of the research team. Scales have been developed and used with the objective to clarify the role of clinical research nurses: one of them is the CTNQ. Methods: A quantitative cross-sectional design with a test–retest procedure was applied to validate the translated questionnaire. By using a snowball sampling method, relevant participants were identified and 49 registered nurses working in the field of research as clinical research nurses answered the questionnaire on two occasions. An expert panel of three clinical research nurses evaluated the questionnaire for face and content validity. The STROBE checklist for observational research has been followed for presenting the research (see File S1). Results: Face and content validity was agreed upon in the expert panel group. Tests for internal consistency of the CTNQ was calculated and showed a high Cronbach's alpha for both the frequency and importance subscales. The test–retest correlation analysis (reproducibility) also revealed a high correlation coefficient for both subscales. Conclusion: The CTNQ-SWE is a valid and robust instrument in a Swedish version. The instrument can be of importance in assessing the role of clinical research nurses in Sweden in future studies. Relevance to clinical practice: Use of the CTNQ-SWE in future research can be of value for clarification and professional development of the clinical research nurse role in Sweden. The further use of the CTNQ in Sweden can be of value in understanding the process where licensed nurses make a transition into becoming a clinical research nurse, and to identify needs for customised education.

Background: The inadequate awareness of livestock breeders on brucellosis transmission, as well as their improper knowledge about preventing brucellosis is considered as one of the important barriers to animal vaccination against brucellosis. The present study aimed to design and validate a brucellosis prevention questionnaire focused on animal vaccination. The valid questionnaire was used to design, implement, and evaluate an interventional training program. Method: A brucellosis prevention questionnaire (BPQ) was developed in the exploratory psychometric study. In addition, face-to-face interviews were conducted to formulate its initial items, the results of which were merged with those obtained from literature review. Further, the face, content, and construct validity of the questionnaire were assessed by co-operating livestock breeders, veterinarians, and health educationists. The impact score (IS), and content validity ratio (CVR) and index (CVI) of the items were calculated, and the construct validity of the questionnaire was evaluated through factor analysis. Furthermore, the reliability of the results related to the questionnaire was measured by using Cronbach’s alpha, intra-class correlation coefficient (ICC), and composite reliability, as well as the standard error of measurement (SEM). Results: The questionnaire was finalized with 53 items and its validity was confirmed by CVI (0.90), CVR (0.74), and IS (4.30). Additionally, the items were loaded into three constructs of awareness, attitude, and practice. Further, the predictive power of awareness, attitude, and practice was determined as 43.43, 15.81, and 15.78%, respectively. Furthermore, the fitness of the proposed model among the constructs was confirmed by the root mean square error of approximation (RMSEA) < 0.08, as well as normed chi-square (× 2/ df) < 5.0, comparative fit index (CFI) ≥ 0.90, and Tucker- Lewis index (TLI) ≥ 0.9. Conclusion: The brucellosis prevention questionnaire represented acceptable psychometric properties. The factors influencing the preventive behavior of livestock breeders can be identified by applying the questionnaire, and co-operating veterinarians and educational planners. 

Background

This article reports the steps of an educational intervention, which is designed to change livestock breeders’ preventive behavior in terms of vaccinating their livestock against brucellosis. The study has been conducted in a rural area in a country with the second highest brucellosis prevalence in the world.

Methods

In a quasi-experimental study and applying PRECEDE-PROCEED model, 45 livestock breeders were trained through basket method, accompanied with constructive feedback from researchers and peers and a brief interactive lecture at the end. The livestock breeders’ awareness, attitude and practice level in the intervention group was compared with those of other 45 livestock breeders in a control group, 1 and 6 months after the intervention. According to the results of the Rose Bengal tests (RBTs), as a rapid and simple screening test, the presence or absence of Brucella antibodies in the animals’ serum was investigated.

Results

Immediately and 1 month after the intervention, the mean scores of knowledge, awareness and practice of livestock breeders in the intervention group were significantly higher. Six months after the intervention, the results of the RBTs were positive in more livestock in the intervention group compared to the animals in the control group. The positive result of RBT after educational intervention, in livestock whose test results were negative immediately before intervention, accompanying the results of observation indicating a good general condition of livestock was considered as a probable evidence of the success of the educational intervention.

Conclusion

The model-driven educational intervention could significantly increase livestock breeders’ awareness, attitude and practice regarding prevention of brucellosis and vaccination of their livestock against brucellosis; however, a period of non-continuous reinforcement and gradual reduction of the number of the reinforcements by health educator workers is recommended in order to increase the maintenance of the learnt behavior.

Trial registration

Conducting this study was registered at Iranian Registry of Clinical Trials (IRCT20180304038945N1). Registered 24 December 2018. The proposal was registered before enrollment of the first participant.

Background and Objective: Suicide is a leading cause of death and a critical public health problem among adolescents worldwide. However, adolescent suicidal behaviour is a neglected public health issue, especially in low- and middle-income countries, such as Bangladesh. There is evidence from developed countries showing that suicidal ideation (SI) among adolescents is related to social indicators as well as individual risk factors. Scarce evidence from studies inlow- and middle-income countries suggests that social factors may influence adolescent SI. In Bangladesh, only a few studies have focused on the social determinants of suicide, and the present study is the first to examine the prevalence and social determinants of suicidal ideation among adolescents in rural Bangladesh. Therefore, the present thesis assessed the effects of socioeconomic status (SES) on adolescent SI.

Methods: The present thesis is based on two studies, which used data from a cross-sectional survey conducted in 2013 among 2,476 adolescents aged 14-19 years selected randomly in arural community in Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district, an area surveyed within the Injury Prevention Program of the Centre for Injury Prevention and Research, Bangladesh (CIPRB). Study I estimated the prevalence of suicidal ideation among adolescents and investigated what factors were associated with suicidal ideation. Study II examined the relationship between parental socio-economic factors and suicidal thoughts among adolescents.

Results: Study I showed that life time prevalence of suicidal ideation was 5% among adolescents. The majority of adolescents with suicidal ideation were female (67, 5.3%), unmarried (106, 5.5%) and students (86, 6.2%). Suicidal ideation was significantly associated with age, education, occupation and living with parents or others. Respondents aged 18-19 years, had a Secondary school certificate (SSC) and Higher Secondary school certificate (HSC) or higher, were day labourers, living without parent had odds ratios of 2.31 (CI 1.46-3.65), 2.38(CI 1.51-3.77), 4.15 (CI 2.41-7.14), .28 (CI 0.13-0.60) and 1.80 (CI 1.07-3.03), respectively.

In study 2, results demonstrated that suicidal ideation was more common among adolescents with parents from the low-income group (5.5%). In addition, adolescent SI was found to be significantly associated with parental education, marital status and house ownership. Adolescents whose parents received an SSC or higher had an SI odds ratio of 2.10 (CI 1.21-3.64) and 1.92 (CI 1.15-3.23) for mothers and fathers respectively. Suicidal ideation among adolescents with single parents was higher with an odds ratio of 3.00 (CI 1.75-5.19) in comparison to adolescents who had both parents. Adolescents whose parents owned a house had an odds ratio of 0.14 (0.05, 0.35).

Conclusion: The thesis found that the prevalence of lifetime suicidal ideation among adolescents is moderately high in a rural community of Bangladesh. Furthermore, it was observed that personal characteristics such as parental marital status, education and homeownership were statistically significantly associated with suicidal ideation among adolescentseven after adjusting for potential confounders.

, Abstract: Background: The aim of this present study is to explore what makes orienteering meaningful and rewarding to former elite athletes’ years or even decades after ending their elite careers. Methods: Applying a qualitative approach with a case study design, data was collected through semi-structured interviews with 11 former elite orienteers from Norway and Sweden, and the data was subsequently analyzed with thematic analysis, resulting in two main themes: individually matched challenges and a social community. Results: The character, structure, and culture of orienteering both enabled and encouraged former elite athletes to make the transition into recreational sport. Even so, the characteristics of the sport related to both its structure (range of ages, level, and ambition) and organization (well-organized) as well as the participants’ backgrounds (well-educated) and intrinsic motivation (satisfaction, enjoyment, mastery) seemed to match a lifelong sport participation. Conclusions: These factors could indicate that orienteering is a sport that can facilitate a lifelong sport participation for athletes with such a background. 

Background and Objective: Gestational Diabetes Mellitus (GDM) is a prevalent and important disease during pregnancy and has detrimental effects on both the mother and the baby. The current study explored the perception and attitude of the community people about GDM and describes the challenges and gaps in knowledge, availability and accessibility of services for GDM screening and management at a rural community in Bangladesh. Methods: We performed a qualitative study including seven Focus Group Discussions (FGDs) and eight Key Informant Interviews (KIIs) from November 2017 to January 2018 at randomly selected areas of Tangail district. A highly trained team including two anthro-pologists conducted the qualitative studies (FGDs and KIIs) under the guidance of experienced researchers. Thematic analysis was performed. Results: GDM is not a known term for pregnant women, their husbands, mothers, and mothers-in-law. Most of the participants (78.7%) did not even hear the term. Some of them (25.5%) perceived that GDM will persist for whole life and transmit from husband to wife and mother to baby. Some people (21.3%) thought that GDM entirely depends on the wish of the God. Most of the participants (68.1%) perceived that symptoms of other types of diabetes and GDM are almost the same. Some participants (19.1%) thought that GDM patients need to intake some medicines that might affect the fetus. The majority of the respondents (83%) had no idea when a pregnant woman should test her diabetes during pregnancy. If GDM diagnosed, pregnant women decided to follow the advice of the doctors. The results from KII with health managers found that they lack in-depth knowledge of GDM. There is no structured guideline or protocol at their facilities for GDM management. Conclusion: The existing barriers at the communities for adequate detection and management of GDM are identified properly. The findings of this study will be helpful for the decision-makers in taking necessary actions to control the GDM. 

The entire project revolves around a lifestyle intervention that has been developed, implemented and evaluated. The intervention included adults with ADHD and comorbid mental illness. ADHD (Attention Deficiency Hyperactive Disorder) is a neuropsychiatric diagnosis/disability characterized by attention problems, impulsivity and hyperactivity and can affect education, working life, social relationships and form the basis for impaired lifestyle habits. Previous research shows shortened life expectancy in adults with ADHD, which related to deteriorating lifestyle habits. In the long run, the disability may be the basis for impaired living conditions and lifestyle habits and contribute to the individual's well-being and quality of life. In the field of health sciences, it is important to alleviate suffering, promote health and prevent ill health. Thus, the overall aim of this dissertation is to analyze living conditions among people with ADHD and mental illness, as well as to develop and evaluate a lifestyle intervention for this group.

The PhD project includes four sub-studies: Study I, a qualitative interview study (n = 20) of adults with ADHD and mental illness, aimed at describing experiences of everyday suffering in this group. The analysis showed experiences of both suffering and well-being in living with ADHD. The focus of the suffering was the experience of loneliness, both regarding relationships in life, relationships in health care, but also to ADHD diagnosis and mental illness. Well-being was experienced when diagnosed with ADHD but also in relation to supportive social relationships. Study II, a quantitative descriptive and comparative study, aimed to gain more knowledge about people withADHD and their health situation. One group of people with ADHD (n = 48)was compared to the normal population without ADHD (n = 42). The results showed poorer health outcomes regarding self-perceived general health and the group with ADHD was less weekly physical active but nevertheless had no decreased aerobic fitness compared to the normal population. Study III, aquantitative descriptive study (n = 25), aimed to examine the degree of acceptance of the intervention and its impact on lifestyle habits, health and well-being, MBI and physical fitness. The tests before and after completing intervention showed small positive effects regarding weekly physical activity, quality of life and general- and mental health. Study IV, a qualitative study(n = 15), with adults with ADHD and comorbid mental illness aimed to investigate the experience of participating in a nurse-led lifestyle intervention. The analysis, based on material from interviews, showed that the participants perceived the intervention as supportive, which is related to the interpersonal relationships that arose in the intervention. Through supportive kindship with the other participants in the intervention, lifestyle habits and health experience were improved.

The conclusion of the thesis is that the lifestyle intervention, based on interpersonal relationships and supported kindship, can be useful for making lifestyle changes in adults with ADHD and mental illness. Such support is important because adults with ADHD and mental illness experience a lack of and a desire for social support and has an increased risk of deteriorating health and unhealthy lifestyles. However, future adjustments to the content of the intervention must be made to improve the lifestyle intervention towards more sustainable lifestyle changes. Above all, the lifestyle intervention ought to be continuous. It is also of great importance for further research that insider perspective is used, that is, investigate the professionals' experiences regarding the intervention.

Living with attention deficit hyperactivity disorder (ADHD) and mental illness involves an increased risk of lifestyle-related diseases. Although there are several ways to provide support to adult persons with ADHD, there is a lack of non-medical strategies for this purpose. This study explore how adult persons with ADHD with mental illness experienced taking part in a nurse-led lifestyle intervention. Fifteen participants participated in a 52-week lifestyle intervention. The analysis revealed two main categories; Building trusting relationships and Health together. This nurse-led lifestyle intervention could be an alternative or complement to current approaches to promoting health in adults with ADHD.