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  • 1051.
    West, Daniel J.
    et al.
    Northumbria Univ, Sch Life Sci, Dept Sport & Exercise Sci, Newcastle Upon Tyne NE1 8ST, Tyne & Wear, England.
    Cook, Christian J.
    UK Sport, Res & Innovat, Bath, Avon, England.
    Beaven, C. Martyn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kilduff, Liam P.
    Swansea Univ, Coll Engn, Swansea, W Glam, Wales.
    THE INFLUENCE OF THE TIME OF DAY ON CORE TEMPERATURE AND LOWER BODY POWER OUTPUT IN ELITE RUGBY UNION SEVENS PLAYERS2014In: JOURNAL OF STRENGTH AND CONDITIONING RESEARCH, ISSN 1533-4287, Vol. 28, no 6, p. 1524-1528Article in journal (Refereed)
    Abstract [en]

    Core temperature typically displays a low circadian in the morning before peaking later in the day, and these changes occur within small physiological ranges. Body temperature plays an important role in physical performance, and some athletes may be required to train and compete in both the morning and evening. However, the influence of the circadian change in body temperature and its influence on physical performance in elite athletes are unclear. This study examined the effects of the time of day on core temperature and lower body power output in elite rugby union sevens players. Sixteen elite rugby union sevens players completed morning (in AM) countermovement jump and core temperature (T-core) measurement, which were then repeated later the same day (in PM). Countermovement jump was processed for peak power output (PPO). Data were analyzed using paired samples t-test and Pearson's product moment correlation and are presented in mean +/- SD. T-core significantly increased from AM to PM (AM, 36.92 +/- 0.23 vs. PM, 37.18 +/- 0.188 degrees C; P < 0.001) with PPO significantly increasing from AM to PM in all 16 players (AM, 5248 +/- 366 vs. PM, 5413 +/- 361 W; P < 0.001). The delta change in T-core (0.26 +/- 0.138 degrees C) and PPO (164 +/- 78 W) was significantly related (r = 0.781; P < 0.001). In conclusion, small circadian changes in core temperature can influence physical performance in elite athletes. Coaches should seek to use strategies, which may raise morning body temperature to offset the circadian low in the morning.

  • 1052.
    Westling, Nina
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Åström, Lisa
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Den psykosociala arbetsmiljön för första linjens chefer: - En kvalitativ studie av ett kommunalt bolag2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 1053.
    Widerström, Micael
    et al.
    Umeå University, Umeå, Sweden.
    Schonning, Caroline
    Public Health Agency of Sweden, Solna, Sweden.
    Lilja, Mikael
    Umeå University, Umeå, Sweden.
    Lebbad, Marianne
    Public Health Agency of Sweden, Solna, Sweden.
    Ljung, Thomas
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Allestam, Gorel
    Public Health Agency of Sweden, Solna, Sweden.
    Ferm, Martin
    Umeå University, Umeå, Sweden.
    Björkholm, Britta
    Public Health Agency of Sweden, Solna, Sweden.
    Hansen, Anette
    Public Health Agency of Sweden, Solna, Sweden.
    Hiltula, Jan I.
    Östersund Municipality, Östersund, Sweden.
    Långmark, Jonas
    Public Health Agency of Sweden, Solna, Sweden .
    Löfdahl, Margareta
    Public Health Agency of Sweden, Solna, Sweden .
    Omberg, Maria
    Jämtland County Council, Östersund, Sweden .
    Reutenwall, Christina
    Public Health Agency of Sweden, Solna, Sweden .
    Samuelsson, Eva
    Umeå University, Umeå, Sweden .
    Widgren, Katarina
    Public Health Agency of Sweden, Solna, Sweden .
    Wallensten, Anders
    Public Health Agency of Sweden, Solna, Sweden .
    Lindh, Johan
    Public Health Agency of Sweden, Solna, Sweden .
    Large Outbreak of Cryptosporidium hominis Infection Transmitted through the Public Water Supply, Sweden2014In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 20, no 4, p. 581-589Article in journal (Refereed)
    Abstract [en]

    In November 2010, approximate to 27,000 (approximate to 45%) inhabitants of Ostersund, Sweden, were affected by a waterborne outbreak of cryptosporidiosis. The outbreak was characterized by a rapid onset and high attack rate, especially among young and middle-aged persons. Young age, number of infected family members, amount of water consumed daily, and gluten intolerance were identified as risk factors for acquiring cryptosporidiosis. Also, chronic intestinal disease and young age were significantly associated with prolonged diarrhea. Identification of Ctyptosporidium hominis subtype lbA10G2 in human and environmental samples and consistently low numbers of oocysts in drinking water confirmed insufficient reduction of parasites by the municipal water treatment plant. The current outbreak shows that use of inadequate microbial barriers at water treatment plants can have serious consequences for public health. This risk can be minimized by optimizing control of raw water quality and employing multiple barriers that remove or inactivate all groups of pathogens.

  • 1054.
    Wietmarschen, Herman
    et al.
    Louis Bolk Institute, Bunnik, Netherlands.
    Tjaden, Bram
    Trainer, Aandachtigedokters, Zeist, Netherlands.
    van Vliet, Marja
    Louis Bolk Institute, Bunnik, The Netherlands.
    Battjes-Fries, Marieke
    Louis Bolk Institute, Bunnik, The Netherlands.
    Jong, Miek C.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Louis Bolk Institute, Bunnik, The Netherlands.
    Effects of mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians: a mixed-methods study2018In: BJGP Open, ISSN 2398-3795, Vol. 2, no 4, p. 11Article in journal (Refereed)
    Abstract [en]

    Background Primary care physicians are subjected to a high workload, which can lead to stress and a high incidence of burnout. A mindfulness training course was developed and implemented for primary care physicians to better cope with stress and improve job functioning.

    Aim To gain insight into the effects of the mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians.

    Design & setting A pragmatic mixed-methods pre–post design in which physicians received 8 weeks of mindfulness training.

    Method Participants completed validated questionnaires on perceived stress (Perceived Stress Scale [PSS]), self-compassion (Self-Compassion Scale [SCS]), and self-reflection (Groningen Reflection Ability Scale [GRAS]) before the training, directly after, and 6 months later. Semi-structured interviews were conducted with six participants after the training and a content analysis was performed to gain in depth understanding of experiences.

    Results A total of 54 physicians participated in the study. PSS was reduced (mean difference [MD] -4.5, P<0.001), SCS improved (MD = 0.5, P<0.001), and GRAS improved (MD = 3.3, P<0.001), directly after the 8-week training compared with before training. Six months later, PSS was still reduced (MD = -2.9, P = 0.025) and SCS improved (MD = 0.7, P<0.001). GRAS did not remain significant (MD = 2.5, P = 0.120). Qualitative analysis revealed four themes: being more aware of their own feelings and thoughts; being better able to accept situations; experiencing more peacefulness; and having more openness to the self and others.

    Conclusion Mindfulness training might be an effective approach for improving stress resilience, self-compassion, and self-reflection in primary care physicians.

  • 1055.
    Wiksten, Måns
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Effekten av koffeinintag på trötthet under maximala cykelsprinter hos juniorishockeyspelare2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 1056.
    Wikström, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Respiratoriska variablers förändringar under en skidskyttestudie i fält2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 1057.
    Willis, Sarah J
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hébert-Losier, Kim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Andersson, Erik
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ørtenblad, Niels
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    DOUBLE POLING MUSCLE ACTIVATION AND FATIGUE DURING A SIMULATED CLASSIC SPRINT CROSS-COUNTRY SKIING COMPETITION2013In: Proceedings for the 6th International Congress on Science and Skiing / [ed] Erich Mueller, Josef Kröll, Stefan Josef Lindinger, Jurgen Pfusterschmied, Thomas Stöggl, 2013, p. 16-16Conference paper (Refereed)
  • 1058.
    Wiltmann, Victor Wennemar
    et al.
    Natl Dev Ctr Thunder Bay, Canada; Univ Jyväskylä, Finland.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Pelttari, Pasi
    Univ Jyväskylä, Finland.
    Mikkola, Jussi
    KIHU Res Inst Olymp Sports, Finland.
    Hakkinen, Keijo
    Univ Jyväskylä, Finland.
    Ohtonen, Olli
    Univ Jyväskylä, Finland.
    Linnamo, Vesa
    Univ Jyväskylä, Finland.
    Biomechanical analysis of different starting strategies utilized during cross-country skiing starts2016In: European Journal of Sport Science, ISSN 1746-1391, E-ISSN 1536-7290, Vol. 16, no 8, p. 1111-1120Article in journal (Refereed)
    Abstract [en]

    The present study was designed to analyse and compare the kinetics and kinematics associated with three different starting strategies during classic cross-country ski racing. Inside a ski tunnel, 12 elite male skiers performed three sets of three 38m starts. Each set included one start using: double poling only (DP), diagonal stride only (DIA) and freely chosen (FREE) (i.e. where subjects used the strategy or combination of strategies they felt was fastest) in random order. The first 18m was performed on a series of force plates that measured horizontal and vertical forces followed by 20m of a standard snow track. Additionally, cycle characteristics and joint angles were measured. DIA and FREE were faster over 38m than DP (P<.01). Net horizontal impulse (taking into account both positive and negative impulses) 5-10m after the start was lower during DP than during DIA and FREE (both P<.05). All subjects skied faster when using only DIA for the entire 38m. Furthermore, the sum duration and frequency of propulsive contacts over the first 18m was less in DP than DIA and FREE (P<.01). In conclusion, differences between the starting strategies examined was especially pronounced during the initial cycles. Transition from DIA to DP during the start also slowed the skiers, but optimal timing for such a transition was not elucidated.

  • 1059.
    Winnersjö, Rocio
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, SE-17176 Sweden..
    Ponce de Leon, A
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, SE-17176 Sweden..
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute.
    Macassa, Gloria
    Department of Occupational and Public Health Sciences, University of Gävle.
    Violence and self-reported health. Does individual socioeconomic position matter?2012In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 4, no 2, p. 87-95Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Violence is a major public health problem. Both clinical and population based studies shows that violence against men and women has physical and psychological health consequences. However, elsewhere and in Sweden little is known of the effect of individual socioeconomic position (SEP) on the relation between violence and health outcomes. Objective: This study aimed to assess the effect of individual SEP on the relation between violence and three health outcomes (general health, pain and anxiety) among women in Stockholm County. METHODS: The study used data from the Stockholm Public Health Survey, a cross-sectional survey carried out in 2006 for the Stockholm County Council by Statistic Sweden. 34 704 respondents answered the survey, the response rate was sixty one percent. Analyses were carried out using descriptive statistics and logistic regression analysis in SPSS v.17.0. RESULTS: Individual SEP increased the odds of reporting poor health outcomes among victimized women in Stockholm County. Regarding self-reported health women in low-SEP who reported victimization in the past twelve months had odds of 2,36 (95% CI 1.48-3.77) for the age group 18-29 years and 3.78 (95% CI 2.53-5.64) for the age group 30-44 years compared with women in high-SEP and non-victim. For pain the odds was 2,41 (95% CI 1,56-3,73) for the age group 18-29 years and 2,98 (95% CI 1,99-4,46) for women aged 30-44 years. Regarding anxiety the age group 18-29 years had odds of 2,53 (95% CI 1,58-4,03) and for the age group 30-44 years had odds of 3,87 (95% CI 2,55-5,87). CONCLUSION: Results showed that individual SEP (measured by occupation) matters to the relationship between violence and health outcomes such as general self-reported health, pain and anxiety. Women in lower SEP who experienced victimization in the past twelve months had increased odds of reporting poorer self-rated health, pain and anxiety compared to those in higher SEP with no experience of victimization. However, further exploration of the relationship between poverty, individual SEP is needed using other Swedish population samples.

  • 1060.
    Wonkavaara, Camilla
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Påverkar mindfulnessinterventioner upplevelsen av krav och kontroll på arbetsplatsen2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
  • 1061.
    Wredenberg, Agnes
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Electromyographic activity in standing shooting position in biathlon at rest and after physical activity2015Independent thesis Advanced level (degree of Master (One Year)), 20 HE creditsStudent thesis
    Abstract [en]

    The purpose of the present study was to investigate the relationship between muscle activation and shooting performance in biathlon at rest and after pysical activity (PA). Seven female age 19 - 24 (21+-1 yrs) regularly competin on natinal/international level participated. The study was made indoor with sharp ammunition and contents of 20 shots at rest an 20 shots at rest and 20 shots after PA (arm-andlegcycle) 4X4 minuters of 85% of HRmax. EMG measured on right, m. Triceps Brachii, m. Deltoideus, m. Flexor Carpi Radialis, m. Extenstor Cari Radialis, left and right m. Bicepts Brachii, left and right m. Gastrocnemiuns, m. Rectus Abdominis. The muscle activation is low for all shooters in all shots at rest and after PA. Left m. Gastrocnemius was more activated in bad shots compared to good at rest (P=0.03). A positive correlation (P<0.05) between good and bad shots shows that muscle activation is not a depending factor in shooting performance. The muscle activation is individual and variations can be explained by altered shooting stance and technique. A stable stance is advantageously in standing shooting. The main results was that if an athlete activate a muscle more or less during bad or good shot is individual.

  • 1062.
    Yahaya, Ismael
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. London Sch Hyg & Trop Med, London WC1, England.
    Uthman, O
    Univ Liverpool, Liverpool Sch Trop Med, Int Hlth Grp, Liverpool L3 5QA, Merseyside, England.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Inst, Dept Publ Hlth Fdn Sci, Div Social Med, Stockholm, Sweden.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Inst, Dept Publ Hlth Fdn Sci, Div Social Med, Stockholm, Sweden.
    Social disorganization and history of child sexual abuse against girls in Sub-Saharan Africa: A multilevel analysis2013In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 13, no 33Article in journal (Refereed)
    Abstract [en]

    Background

    Child sexual abuse (CSA) is a considerable public health problem. Less focus has been paid to the role of community level factors associated with CSA. The aim of this study was to examine the association between neighbourhood-level measures of social disorganization and child sexual abuse CSA.

    Methods

    We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351 adolescents from six countries in sub-Saharan Africa between 2006 and 2008.

    Results

    The percentage of adolescents that had experienced CSA ranged from 1.04% to 5.84%. There was a significant variation in the odds of reporting CSA across the communities, suggesting 18% of the variation in CSA could be attributed to community level factors. Respondents currently employed were more likely to have reported CSA than those who were unemployed (odds ratio [OR] = 2.05, 95% confidence interval [CI] 1.48 to 2.83). Respondents from communities with a high family disruption rate were 57% more likely to have reported CSA (OR=1.57, 95% CI 1.14 to 2.16).

    Conclusion

    We found that exposure to CSA was associated with high community level of family disruption, thus suggesting that neighbourhoods may indeed have significant important effects on exposure to CSA. Further studies are needed to explore pathways that connect the individual and neighbourhood levels, that is, means through which deleterious neighbourhood effects are transmitted to individuals.

  • 1063.
    Yahaya, Ismail
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Childhood Sexual Abuse Against Girls in Sub-Saharan Africa: Individual and Contextual Risk Factors2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and objectives: Childhood sexual abuse (CSA) is a substantial public health and human rights problem, as well as a growing concern in sub-Saharan Africa (SSA). It has both short and long term effects on girls: physical and psychological, including negative sexual outcomes. Up to one-third of adolescent girls report their first sexual experience as being forced. Despite growing evidence supporting a link between contextual factors and violence, no studies have investigated the connection between CSA and contextual factors. It is therefore important to identify the extent of CSA and understand factors associated with it in SSA in order to develop interventions aimed to address the scale of the problem.

    Aim: The overall aim of this thesis is to assess the individual and contextual factors associated with CSA. In addition, the thesis aims to quantify the magnitude of CSA and describe the factors associated with CSA among women from SSA (Study I). This thesis also examines the independent contribution of individual and community socio-economic status on CSA (Study II). Moreover, it scrutinises the effect of social disorganisation on CSA (Study III) and explores the relationship between CSA and sexual risk behaviours as well as potential mediators (Study IV).

    Methods: This thesis used the Demographic and Health Survey (DHS) datasets conducted between 2006 and 2008 from six SSA countries. The thesis used multiple logistic regression models to describe and explore factors associated with CSA among 69,977 women (Study I).  It used multivariable multilevel logistic regression analysis to explore the effect of contextual level variables (neighbourhood socio-economic status) on CSA among 6,351 girls (Study II). Neighbourhood socio-economic status was operationalized with a principal component analysis using the proportion of respondents who were unemployed, illiterates, living below poverty level and rural residents. Study III applied multivariable multilevel logistic regression analysis on 6,351 girls and considered five measures of social disorganisation at the community level: neighbourhood poverty, female-headed households, residential mobility, place of residence, population density, and ethnic diversity. In study IV, 12,800 women from the Nigerian DHS were used. Structural equation modelling was applied using a two-step approach. The first step used a confirmatory factor analysis to develop an acceptable measurement model while the second step involved modifying the measurement model to represent the postulated causal model framework.

    Results: In study I, the reported prevalence of CSA ranged from 0.3% in Liberia to 4.3% in Zambia when the prevalence was based on all respondents aged between 15 and 49 years and who were present during the survey. None of the socio-economic factors were associated with CSA. In study II, where the data was restricted to permanent residents aged between 15 and 18 years, the prevalence ranged between 1.04% in Liberia to 5.8% in Zambia. At the individual level, there was no significant association between CSA and wealth status while at the community level, there was no significant association between CSA and socio-economic position. However, 22% of the variation in CSA was attributed to the community level factors. In study III, there was significant variation in the odds of reporting CSA across the communities, with community level factors accounting for 18% of the variation. In addition, respondents from communities with a high family disruption rate were 57% more likely to have reported sexual abuse in childhood. Study IV showed that there was a significant association between CSA and sexual risk behaviours and the association was mediated by alcohol and cigarette use.

    Conclusions: The study provides evidence that adolescents in the same community were subjected to common contextual influences. It also highlighted the significance of mediators in the relationship between CSA and sexual risk behaviours. It is therefore important that effective preventive strategies are developed and implemented that will cut across all socio-economic spheres in a context that both permits and encourages disclosure as well as identifying predisposing circumstances for recurrence.

  • 1064.
    Yahaya, Ismail
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Centre for Evidence-Based Global Health, Nigeria.
    Ponce de Leon, Antonio
    Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden..
    A. Uthman, Olalekan
    Warwick - Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coven try, CV4 7AL, United Kingdom.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden.
    Individual and community-level socioeconomic position and its association with adolescents experience of childhood sexual abuse: a multilevel analysis of sixcountries in Sub-Saharan Africa2013In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 6, no 1, p. 21-30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Childhood sexual abuse (CSA) is a substantial global health and human rights problem and consequently a growing concern in sub-Saharan Africa. We examined the association between individual and community-level socioeconomic status (SES) and the likelihood of reporting CSA. METHODS: We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351female adolescents between the ages of 15 and 18 years from six countries in sub-Saharan Africa, between 2006 and 2008. RESULTS: About 70% of the reported cases of CSA were between 14 and 17 years. Zambia had the highest proportion of reported cases of CSA (5.8%). At the individual and community level, we found that there was no association between CSA and socioeconomic position. This study provides evidence that the likelihood of reporting CSA cut across all individual SES as well as all community socioeconomic strata. CONCLUSIONS: We found no evidence of socioeconomic differentials in adolescents’ experience of CSA, suggesting that adolescents from the six countries studied experienced CSA regardless of their individual- and community-level socioeconomic position. However, we found some evidence of geographical clustering, adolescents in the same community are subject to common contextual influences. Further studies are needed to explore possible effects of countries’ political, social, economic, legal, and cultural impact on Childhood sexual abuse.

  • 1065.
    Yahaya, Ismail
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Centre for Evidence-Based Global Health, Nigeria.
    Ponce de Leon, Antonio
    Karolinska Institutet, Stockholm, Sweden.
    Uthman, Olalekan
    Warwick Medical School, The University of Warwick, Coventry, UK.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Childhood sexual abuse among girls and determinants of sexual risk behaviours in adultlife in sub-Saharan Africa2015In: Journal of Aggression, Conflict and Peace Research, ISSN 1759-6599, Vol. 7, no 2, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to investigate the relationship between child sexual abuse and sexual risk behaviours as well as its potential mediators. Design/methodology/approach – This cross-sectional study used data from a cross-sectional study from 12,800 women between 15 and 49 years of age included in the 2008 Nigerian Demographic and Health Survey. Structural equation modelling (SEM) was applied to assess the association between childhood sexual abuse (CSA) and sexual risk behaviours. Findings – The authors found that CSA was directly associated with sexual risk behaviours. In addition, the association between CSA and sexual risk behaviour was also partially mediated by alcohol and cigarette use. Research limitations/implications – The results show that being abused in childhood is important for the subsequent development of sexual risk behaviours in adulthood and the association is mediated by alcohol and cigarette use. Practical implications – The results may be helpful for policy makers and health care planners in designing cultural sensitive public health intervention that will reduce the burden of CSA, its long-term effects (sexual risk behaviours) and intervening mediators that increase the risks. Social implications – These findings suggest that to reduce sexual risks, interventions to address sexual abuse needs to include other social problems (smoking, alcohol) that victims result to when faced with trauma. Originality/value – The current study is the only one so far in sub-Saharan Africa to have explored the relation between CSA and sexual risk behaviours using SEM.

  • 1066.
    Yahaya, Ismail
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Uthman, Olalekan A.
    Save the Youth Initiative, PO Box 3951, Kaduna North, Kaduna, Nigeria.
    Uthman, Muhammed Mubashir B.
    Save the Youth Initiative, PO Box 3951, Kaduna North, Kaduna, Nigeria.
    Interventions for HIV-associated nephropathy2013In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 1, p. Art. no. CD007183-Article, review/survey (Refereed)
    Abstract [en]

    Background Human immunodeficiency virus-associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in human immunodeficiency virus-1 (HIV-1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV-1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretroviral therapy, angiotensin-converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated. Objectives To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all-cause mortality. Search methods In January 2012 we searched the Cochrane Renal Group's Specialised Register, AIDS Education Global Information System (AEGIS database), ClinicalTrial.gov, the WHO International Clinical Trials Registry Portal, and reference lists of retrieved articles without language restrictions. In our original review we searched CENTRAL, MEDLINE, EMBASE, and AIDSearch, in addition to contacting individual researchers, research organisations and pharmaceutical companies. Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs of any therapy used in the treatment of HIVAN. Data collection and analysis We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. For dichotomous outcomes results were to be expressed as risk ratios with 95% confidence intervals, and for continuous scales of measurement the mean difference was to be used. Main results We identified four relevant ongoing studies: one is still ongoing; two have completed recruitment but are yet to be published; and the fourth study was suspended for unspecified reasons. No completed RCTs or quasi-RCTs were identified. We summarised and tabulated the data from the observational studies, however no formal analyses were performed. Authors' conclusions There is currently no RCT-based evidence upon which to base guidelines for the treatment of HIVAN, however three ongoing studies have been identified. Data from observational studies suggest steroids and angiotensin-converting enzyme inhibitors appear to improve kidney function in patients with HIVAN, however no formal analyses were performed in this review. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.

  • 1067.
    Yang, Fei
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm.
    Pedersen, Nancy L.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm; Univ Southern Calif, Dept Psychol, Los Angeles, CA USA.
    Ye, Weimin
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm.
    Liu, Zhiwei
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm.
    Norberg, Margareta
    Umeå Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth, Umeå.
    Forsgren, Lars
    Umeå Univ, Dept Pharmacol & Clin Neurosci, Umeå.
    Lagerros, Ylva Trolle
    Karolinska Univ Hosp, Dept Med, Clin Epidemiol Unit, Stockholm; Karolinska Univ Hosp, Dept Endocrinol Metab & Diabet, Stockholm.
    Bellocco, Rino
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm; Univ Milano Bicocca, Dept Stat & Quantitat Methods, Milan, Italy.
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Jansson, Jan-Håkan
    Umeå Univ, Dept Publ Hlth & Clin Med, Skellefteå Res Unit, Umeå.
    Wennberg, Patrik
    Umeå Univ, Family Med, Dept Publ Hlth & Clin Med, Umeå.
    Galanti, Maria Rosaria
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm; Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm.
    Lager, Anton C. J.
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm; Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm.
    Araghi, Marzieh
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm.
    Lundberg, Michael
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm.
    Magnusson, Cecilia
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm; Stockholm Cty Council, Ctr Epidemiol & Community Med, Stockholm.
    Wirdefeldt, Karin
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm; Karolinska Inst, Dept Clin Neurosci, Stockholm.
    Moist smokeless tobacco (Snus) use and risk of Parkinson's disease2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 3, p. 872-880, article id dyw294Article in journal (Refereed)
    Abstract [en]

    Background: Cigarette smoking is associated with a lower risk of Parkinson's disease. It is unclear what constituent of tobacco smoke may lower the risk. Use of Swedish moist smokeless tobacco (snus) can serve as a model to disentangle what constituent of tobacco smoke may lower the risk. The aim of this study was to determine whether snus use was associated with a lower risk of Parkinson's disease. Methods: Individual participant data were collected from seven prospective cohort studies, including 348 601 men. We used survival analysis with multivariable Cox regression to estimate study-specific relative risk of Parkinson's disease due to snus use, and random-effects models to pool estimates in a meta-analysis. The primary analyses were restricted to never-smokers to eliminate the potential confounding effect of tobacco smoking. Results: During a mean follow-up time of 16.1 years, 1199 incident Parkinson's disease cases were identified. Among men who never smoked, ever-snus users had about 60% lower Parkinson's disease risk compared with never-snus users [pooled hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.28-0.61]. The inverse association between snus use and Parkinson's disease risk was more pronounced in current (pooled HR 0.38, 95% CI 0.23-0.63), moderate-heavy amount (pooled HR 0.41, 95% CI 0.19-0.90) and long-term snus users (pooled HR 0.44, 95% CI 0.24-0.83). Conclusions: Non-smoking men who used snus had a substantially lower risk of Parkinson's disease. Results also indicated an inverse dose-response relationship between snus use and Parkinson's disease risk. Our findings suggest that nicotine or other components of tobacco leaves may influence the development of Parkinson's disease.

  • 1068.
    Zeinalzadeh, Ali Hossein
    et al.
    Tabriz university of medical sciences, Iran.
    Saiyarsarai, Somaieh
    Tabriz university of medical sciences, Iran.
    Jafari-Khounigh, Ali
    Tabriz university of medical sciences, Iran.
    Soares, Joaquim J.F.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Incidence of suicide in East Azerbaijan Province, Iran2016In: Social Determinants of Health, ISSN 2423-7337, Vol. 2, no 2, p. 61-69Article in journal (Refereed)
    Abstract [en]

    Background:Suicide is a major problem world-wide. The aim of this study was to determine the incidence of suicide in East Azerbaijan province, Iran.

    Methods: A cross-sectional study conducted from 2010 to 2011. We analysed some characteristics of the cases of suicide based on the health system database. Variables such as demographics, outcomes (fatal/nonfatal), and methods used were recorded. Data were analysed using Chi-square as well as T-test.

    Results: A total of 3,768 reported cases of suicide were analysed. More cases were reported by married than single people. The incidence rate of suicide was 101.3 per 100,000. Most of the attempted suicides occurred in younger people. Attempted suicide in women (63.7%) was higher than men (36.3%). The most frequent method of suicide in both sexes was drug overdose. There was a statistically significant relationship between suicide’s outcome and gender, job, marital status and education (p<0.001). The case fatality rate among males was significantly higher than females (OR=3.7, 95% CI: 2.5–5.8). Hanging (72.3%) and drug overdose (0.9%) had the highest and lowest case fatality rate, respectively. Drug overdose was slightly more frequent among women than men (91.3% versus 84.2%). The rate of poisoning increased gradually until the age-group 45-54 years. Drug overdose was more prevalent among single than married people.

    Conclusions: Due to the high incidence of completed suicide, it is recommended to establish counselling centres for mental ill-health, especially a suicide hotline with appropriate availability to all population.

  • 1069.
    Zenic, Natasa
    et al.
    Univ Split, Fac Kinesiol, Split, Croatia..
    Ostojic, Ljerka
    Univ Split, Fac Kinesiol, Split, Croatia.;Univ Mostar, Mostar, Bosnia & Herceg.;Acad Med Sci Bosnia & Herzegovina, Sarajevo, Bosnia & Herceg..
    Sisic, Nedim
    Univ Split, Fac Kinesiol, Split, Croatia..
    Pojskic, Haris
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Peric, Mia
    Univ Split, Fac Kinesiol, Split, Croatia..
    Uljevic, Ognjen
    Univ Split, Fac Kinesiol, Split, Croatia..
    Sekulic, Damir
    Univ Split, Fac Kinesiol, Split, Croatia.; Univ Dept Hlth Care Studies, Split, Croatia..
    Examination of the community-specific prevalence of and factors associated with substance use and misuse among Rural and Urban adolescents: a cross-sectional analysis in Bosnia and Herzegovina2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 11, article id e009446Article in journal (Refereed)
    Abstract [en]

    Objective: The community of residence (ie, urban vs rural) is one of the known factors of influence on substance use and misuse (SUM). The aim of this study was to explore the community-specific prevalence of SUM and the associations that exist between scholastic, familial, sports and sociodemographic factors with SUM in adolescents from Bosnia and Herzegovina. Methods: In this cross-sectional study, which was completed between November and December 2014, the participants were 957 adolescents (aged 17 to 18 years) from Bosnia and Herzegovina (485; 50.6% females). The independent variables were sociodemographic, academic, sport and familial factors. The dependent variables consisted of questions on cigarette smoking and alcohol consumption. We have calculated differences between groups of participants (gender, community), while the logistic regressions were applied to define associations between the independent and dependent variables. Results: In the urban community, cigarette smoking is more prevalent in girls (OR= 2.05; 95% CI 1.27 to 3.35), while harmful drinking is more prevalent in boys (OR= 2.07; 95% CI 1.59 to 2.73). When data are weighted by gender and community, harmful drinking is more prevalent in urban boys (OR= 1.97; 95% CI 1.31 to 2.95), cigarette smoking is more frequent in rural boys (OR= 1.61; 95% CI 1.04 to 2.39), and urban girls misuse substances to a greater extent than rural girls (OR= 1.70; 95% CI 1.16 to 2.51, OR= 2.85; 95% CI 1.88 to 4.31, OR= 2.78; 95% CI 1.67 to 4.61 for cigarette smoking, harmful drinking and simultaneous smoking-drinking, respectively). Academic failure is strongly associated with a higher likelihood of SUM. The associations between parental factors and SUM are more evident in urban youth. Sports factors are specifically correlated with SUM for urban girls. Conclusions: Living in an urban environment should be considered as a higher risk factor for SUM in girls. Parental variables are more strongly associated with SUM among urban youth, most probably because of the higher parental involvement in children' personal lives in urban communities (ie, college plans, for example). Specific indicators should be monitored in the prevention of SUM.

  • 1070.
    Zetterholm, My
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Mobilstöd vid fysisk aktivitetHur självmätning med mobiler upplevs subjektivt, samt uttrycks på neutral nivå via ett EEG-baserat Brain Computer Interface.2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
  • 1071.
    Zettersten, Hanna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Selin, Nina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sambandet mellan anställningsform och välbefinnande: -skillander mellan kvinnor och män2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 1072.
    Zetterström Dahlqvist, Heléne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Determinants of Depressive Symptoms in Adolescents: The Role of Sexual Harassment and Implications for Preventive Interventions2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Depression is considered the worldwide leading cause of illness and disability in young people and an urgent public health issue. Within the field of public health it is of interest to deepen the understanding of determinants of depressive symptoms (DS) that are possible to address on a political or an organizational level. Also, it is of great importance to find methods to prevent depression in adolescents. To address these issues, the present thesis had two Aims: I) To study determinants of DS in adolescents, and II) to, by means of a non-randomized pragmatic trial evaluation, investigate the effectiveness a cognitive-behavioral intervention (DISA) in a real-world setting in relation to determinants of DS in adolescent girls. This was addressed by asking a) Which determinants on individual, psychosocial and structural levels are associated with DS in adolescents? (Paper I); b) What are the directional pathways between sexual harassment (SH) and DS? (Paper II); c) Which features characterize students who were assigned to a cognitive-behavioral intervention regarding levels of DS, psychosocial aspects and socioeconomic status of the respondents as well as of schools? (Paper III); d) Does DISA have an effect on DS in girls aged 14-16? (Paper IV); and e) Are there differences between the DISA participants and non-participants in the effects of psychosocial and structural determinants on DS? (Paper IV). Method: Data was collected in January 2010, 2011, and 2012, by means of a self-administered, electronic questionnaire in school. Students aged 14-16 in all nine public and one independent high school in a municipality in northern Sweden participated in the study (~1,000-1,200 students depending on the wave). All studies had DS as the single outcome variable. Individual level determinants were self-esteem and self-efficacy. Psychosocial determinants were parental/peer/teacher support; school demands; sexual harassment; and bullying. Structural determinants were family material affluence; parental foreign background, parental employment status; disrupted family, and personal relative affluence. Logistic regression was employed for research question a) (Paper I). Structural equation (SEM) cross-lag models were modeled for research question b) (Paper II). The Mann-Whitney U statistic was employed for research question c) (Paper III). SEM was used for research questions d-e) (Paper IV). Results: Determinants on individual, psychosocial and structural levels were independently associated with depressive symptoms in both genders. Self-efficacy, low teacher support, bullying victimization, and low personal relative affluence was associated with elevated levels of DS in both genders (Paper I). In girls, low parental support, high school demands, and sexual harassment victimization (SH) were also associated with elevated levels of DS. Among boys, parental migrant background was also associated with DS. Among girls, both the targeting of girls with elevated DS, and the consequence of SH explained the relationship between DS and SH victimization over time. In boys, only the predating of DS explained the association between DS and SH (Paper II). Only girls were assigned to DISA during 2011 and DISA participants reported higher levels of DS and lower levels of self-esteem than the non-participants at pre-intervention, which indicates that DISA was used as a targeted intervention for girls with elevated symptoms. Also, DISA participants reported higher levels of SH victimization, less peer support, and lower personal relative affluence (Paper III). In contrast to the non-participants, DISA participants did not increase their mean scoring on DS at an eight months follow-up. However, SEM analyses showed that the effect of DISA participation on DS at follow-up was negligible (Paper IV). Conclusions: This study showed that SH victimization was an important determinant for DS in girls followed by personal relative affluence. Among boys, personal relative affluence and parental migrant background were the most important factors. SH victimization had mental health consequences in girls only. DISA was implemented as a targeted intervention rather than as selective or universal one, and did not have an effect on DS in this group of girls. Implications for further research and health promotion practice in the school setting are discussed.

  • 1073.
    Zetterström Dahlqvist, Heléne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Dimensions of peer sexual harassment victimization and depressive symptoms in adolescence: a longitudinal cross-lagged study in a Swedish sample2017Conference paper (Other academic)
    Abstract [en]

    Sexual harassment is commonly considered unwanted sexual attention and a form of gender-based violence that can take physical, verbal and visual forms and it is assumed to cause later depression in adolescents. There is a dearth of research explicitly testing this assumption and the directional pathway remains unclear. The purpose of this study was to use a feminist theoretical framework to test competing models in respect of the direction of the relationships between dimensions of peer sexual harassment victimization and dimensions of depressive symptoms from ages14 to 16 in adolescents. The study also aimed to investigate gender differences inthese pathways. Cross-lagged models were conducted using a three-wave (2010, 2011 and 2012) longitudinal study of 2330 students (51 % females) from Sweden, adjusted for social background. Girls subjected to sexual harassment in grade seven continued to experience sexual harassment the following2 years. There was weaker evidence of repeated experience of sexual harassment among boys. Depressive symptoms were stable over time in both genders. Sexual name-calling was the dimension that had the strongest associations to all dimensions of depressive symptoms irrespective of gender. In girls, name-calling was associated with later somatic symptoms and negative affect, while anhedonia (reduced ability to experience pleasure) preceded later name-calling. Physical sexual harassment had a reciprocal relationship to somatic symptoms in girls. In boys, name-calling was preceded by all dimensions of depressive symptoms. It is an urgent matter to prevent sexual harassment victimization, as it is most likely to both cause depressive symptoms or a reciprocal cycle of victimization and depression symptoms in girls as well as boys.

  • 1074.
    Zetterström Dahlqvist, Heléne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Flickors psykiska ohälsa i skolan2017Conference paper (Other (popular science, discussion, etc.))
  • 1075.
    Zetterström Dahlqvist, Heléne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Peer sexual harassment and mental health in school: Does targeting individual resilience mean that we are avoiding social change?2015In: Being Young in a Neoliberal Time: Transnational Perspectives on Challenges and Possibilities for Resistance and Social Change / [ed] Katja Gillander Gådin and Claudia Mitchell, Sundsvall: Mid Sweden University , 2015, p. 65-77Chapter in book (Refereed)
  • 1076.
    Zetterström Dahlqvist, Heléne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gillander Gådin, Katja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Online Sexual Victimisation in Youth: Predictors and Cross-Sectional Associations with Depressive Symptoms2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 6, p. 1018-1023Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim was to analyze (i) the prevalence of online unwanted sexual solicitation (USS) victimization, (ii) predictors of online USS and (iii) the associations between online USS and depressive symptoms in Swedish pupils in grades 7–9.

    Methods

    An electronic questionnaire was disseminated in 2011 in schools in a municipality in the northern part of Sweden. Total n = 1193 (boys n = 566; girls n= 627). Logistic regression models were fitted to test the cross-sectional associations between predictors of online USS and depressive symptoms, respectively.

    Results

    One third of girls and every fifth boy reported online USS victimization. In boys, predictors associated with online USS were offline bullying and sexual harassment victimization. Only offline sexual harassment victimization was associated with online USS in girls. Girls victimized by online USS had about twice the likelihood to report depressive symptoms compared to non-victimized girls. There were no associations between online USS and depressive symptoms in boys. While offline bullying was associated with depressive symptoms in both genders, offline sexual harassment victimization increased the likelihood to report depressive symptoms in girls only.

    Conclusions

    Online USS was common among Swedish youth, particularly among girls. Schools, parents and internet safety educators should look at co-occurrence of different forms of victimization as offline victimization was a predictor of online USS. Online USS was associated with depressive symptoms in girls and may hence be a factor driving gender inequity in mental health in youth.

  • 1077.
    Zetterström Dahlqvist, Heléne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gillander Gådin, Katja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Online Sexual Victimization in Youth: Predictors of Victimization and Associations with Depressive Symptoms in a Swedish Sample2018Conference paper (Refereed)
  • 1078.
    Zetterström Dahlqvist, Heléne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Landstedt, Evelina
    Umeå universitet.
    Almqvist, Ylva B
    Stockholms Universitet.
    Gillander Gådin, Katja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    A non-randomised pragmatic trial of a school-based group cognitive-behavioural programme for preventing depression in girls2017In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 76, no 1, article id 1396146Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the effectiveness of the DISA-programme in preventing depressive symptoms (DS) in adolescent girls, as implemented in a real-world school setting, accounting for baseline socioeconomic and psychosocial factors, and to investigate whether the effects of these baseline variables on DS differed between intervention participants and non-participants. In this non-randomised pragmatic trial, an electronic questionnaire was disseminated in 2011 (baseline) and 2012 (follow-up) in schools in one municipality in northern Sweden. Pupils (total n=275; intervention participants identified in the questionnaire: n=53; non-partici-pants: n=222) were 14–15 years old at baseline. The groups were compared by means of SEM. DISA could not predict differences in DS at follow-up in this real-life setting. In the overall sample, sexual harassment victimisation (SH) at baseline was associated with DS at follow-up and the estimate for SH increased in the DISA-participants compared to the overall sample.

  • 1079.
    Zetterström Dahlqvist, Heléne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Landstedt, Evelina
    Umeå universitet.
    Gillander Gådin, Katja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    A Latent Class Analysis of Violence Poly-victimization in Youth2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 483-484Article in journal (Other academic)
    Abstract [en]

    Violence among youth is common and has been linked to poor mental health outcomes. There is some evidence that there are groups of youth who are victims of more than one form of violence but more knowledge is needed in terms of patterning of subgroups of multiple violence victimization. Aim: To explore if there are distinct subgroups of youth with particular patterns of violence victimization. Method: Survey data from a Swedish sample (n = 1,569) of youth 14-16 years old were used (females 48.4%). Using a broad definition of violence, respondents indicated if they had experienced physical violence, threat of physical violence, bullying, sexual harassment, cyber bullying, online sexual victimization, and other adverse sexual experience in the past six months as well as lifetime physical violence victimization. Distinct subgroups of youth within the data set with particular patterns of violence victimization were identified using Latent Class Analysis (LCA). Model fit was assessed using the Akaike information criterion (AIC) and the Bayesian information criterion (BIC), with smaller values indicating better model fit. Results: Preliminary results show three distinct subgroups: 1. Sexualized violence off- and online (girls 66.6%), 2. Bullying only (girls 47.5%) and 3. Multi-victimization including threat of physical violence, violence in the past six months and lifetime, sexual harassment on- and offline, bullying on- and offline as well as other adverse sexual experience (girls 47.6%). Conclusions: Three distinct subgroups of violence victimization in a sample of 14-16 year old youth was evident in the data. There was a greater representation of girls in the sexualized violence sub-group. Further research as well as preventive programs should acknowledge that many young people are victims of several types of violence. Future research should also investigate the implications of multi-victimization on mental health outcomes.

  • 1080.
    Zetterström Dahlqvist, Heléne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Landstedt, Evelina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gillander Gådin, Katja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    What students do schools allocate to a cognitive-behavioural intervention?: Characteristics of adolescent participants in Northern Sweden2015In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 74, p. 29805-Article in journal (Refereed)
    Abstract [en]

    Background. Adolescents are a vulnerable group when it comes to the risk of developing depression. Preventing the onset of depressive episodes in this group is therefore a major public health priority. In the last decades, school-based cognitive-behavioural interventions have been a common primary prevention approach. However, evidence on what girls actually are allocated to such interventions when no researchers are involved is scarce.

    Objective. To explore how a selective cognitive-behavioural program (Depression In Swedish Adolescents) developed to prevent depression in adolescents, was implemented in a naturalistic setting in schools in northern part of Sweden. The focus was on characteristics of participants allocated to the intervention.

    Design. Cross-sectional baseline data on depressive symptoms, school environment and socio-economic factors were collected in 2011 by means of questionnaires in schools in a municipality in the northern part of Sweden. Intervention participants were identified in a follow-up questionnaire in 2012. Students (n=288) included in the analyses were in the ages of 14–15.

    Results. Sixty-six girls and no boys were identified as intervention participants. They reported higher levels of depressive symptoms, lower personal relative affluence, more sexual harassment victimization and less peer support compared to female non-participants (n=222). Intervention participants were more likely to attend schools with a higher proportion of low parental education levels and a lower proportion of students graduating with a diploma.

    Conclusions. The developers of the intervention originally intended the program to be universal or selective, but it was implemented as targeted in these schools. It is important for school administrations to adhere to program fidelity when it comes to what students it is aimed for. Implications for effectivenss trials of cognitive-behavioural interventions in the school setting is discussed.

  • 1081.
    Zetterström Dahlqvist, Heléne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Landstedt, Evelina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Young, Robert
    Gillander Gådin, Katja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Causal pathways of sexual harassment and depressive symptoms in adolescence2015Conference paper (Other academic)
  • 1082.
    Zetterström Dahlqvist, Heléne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Landstedt, Evelina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Young, Robert
    MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
    Gillander Gådin, Katja
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Dimensions of Peer Sexual Harassment Victimization and Depressive Symptoms in Adolescence: A Longitudinal Cross-Lagged Study in a Swedish Sample2016In: Journal of Youth and Adolescence, ISSN 0047-2891, E-ISSN 1573-6601, Vol. 45, no 5, p. 858-873Article in journal (Refereed)
    Abstract [en]

    Sexual harassment is commonly considered unwanted sexual attention and a form of gender-based violence that can take physical, verbal and visual forms and it is assumed to cause later depression in adolescents. There is a dearth of research explicitly testing this assumption and the directional pathway remains unclear. The purpose of this study was to use a feminist theoretical framework to test competing models in respect of the direction of the relationships between dimensions of peer sexual harassment victimization and dimensions of depressive symptoms from ages 14 to 16 in adolescents. The study also aimed to investigate gender differences in these pathways. Cross-lagged models were conducted using a three-wave (2010, 2011 and 2012) longitudinal study of 2330 students (51 % females) from Sweden, adjusted for social background. Girls subjected to sexual harassment in grade seven continued to experience sexual harassment the following 2 years. There was weaker evidence of repeated experience of sexual harassment among boys. Depressive symptoms were stable over time in both genders. Sexual name-calling was the dimension that had the strongest associations to all dimensions of depressive symptoms irrespective of gender. In girls, name-calling was associated with later somatic symptoms and negative affect, while anhedonia (reduced ability to experience pleasure) preceded later name-calling. Physical sexual harassment had a reciprocal relationship to somatic symptoms in girls. In boys, name-calling was preceded by all dimensions of depressive symptoms. It is an urgent matter to prevent sexual harassment victimization, as it is most likely to both cause depressive symptoms or a reciprocal cycle of victimization and depression symptoms in girls as well as boys.

  • 1083.
    Ziaei, Reza
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Prevalence and Correlates of Health Risk Behaviors among High School Adolescents in Iran: With focus on Water-pipe Smoking, Suicide Ideation, Physical Activity and Nutrition2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Adolescence is a transitional stage from childhood into adulthood and many habits, with long-term implications for health, from this period of life can continue into adulthood. Identifying risk factors related to health risk behaviors is therefore an important part of health promotion. The main aim of this thesis was to analyze the prevalence and correlates of health risk behaviors among 15-17 year old high school adolescents in Iran. The risk behaviors explored in Papers I–IV include waterpipe smoking, suicide ideation, physical inactivity and sedentary behavior, and nutritional habits.

    Methods: Two-stage cluster sampling was used to select representative high schools and classes in the Iranian city of Tabriz. At the first stage, high schools were selected with a probability proportional to the enrollment size. At the second stage, classes were randomly selected, and all students in these selected classes were eligible to participate in the study. Overall, thirty high schools, including sixteen girls’ and fourteen boys’ high schools, ninety classes (grades 9 to 11) and 1,517 students, including 727 boys (47.9%) and 790 (52.1 %) girls participated in the study. The participants’ (students’) response rate was 84.27 %. A reliable, valid and anonymous self-administered Persian Version of the Global School-Based Student Health Survey (GSHS) questionnaire was used for data collection. Statistical methods used were Chi- square test, Fisher exact and multivariate logistic regression analyses.

    Results:

    Water pipe smoking: Overall, 21.6 % of students were classified as ever WP smokers and 9.7% as current smokers. Ten percent of students had started WP smoking when younger than 12. Ninety-one percent of current WP smokers smoked one session per day, 49% smoked at a café (Ghahvekhaneh). Ninety- five percent of students reported that their age did not prevent them from being served a WP. Ninety-one students out of 147 reported that they did not notice any health warning on the WP tobacco packages. Seven percent of students out of 1,517 participants reported that they would accept a WP if offered by their friends. Being in the third grade of high school, having experienced cigarette smoking, even one or two puffs, and accepting a WP offered by close friends showed significant odds ratios for ‘ever WP smokers’. Accepting a WP offered by close friends and gender (female) showed significant odds ratios for current WP smokers.

    Suicide ideation: Four percent of students had seriously considered attempting suicide in the past 12 months. Thirteen point two percent of students reported that they wanted to use alcohol or other drugs when they were worried. The results also revealed that 8.8% of students had been sexually abused. Also, 20.6% declared that they had been bullied in the past 30 days.

    Being worried, being a current cigarette smoker, consuming alcohol or other drugs and being sexually abused were significantly associated with suicide ideation.

    Physical activity/inactivity and sedentary behavior: The prevalence of physical inactivity (<5 days/Weeks) was 72.2% and sedentary behavior (sitting ≥3 h or more) 71.4%. Being female, having a higher BMI (being overweight or obese), walking/cycling to or from school on 1-4 days, sedentary behavior, low vegetable intake, being the victim of bullying, lack of parental support, peer support, and parental connectivity (protective factors) were directly associated with physical inactivity. Walking/cycling to or from school on 5-7 days was negatively associated with physical inactivity.

    Walking/cycling to or from school on 1-4 days, being physically inactive, inadequate fruit intake, and being bullied were positively associated with sedentary behavior.

    Fruit and vegetable intake: The prevalence of fruit intake was 76.1% (≥ 2 times/daily) and vegetable intake 23% (≥ 3 times /d). Low fruit consumption was associated with being an 11th grade student, sedentary behavior (sitting ≥3h/d), low intake of vegetables (intake < 3 daily), low or lack of parental support, low or lack of peer support, and the lack of enough food (hunger) at home. Low vegetable consumption was associated with higher BMI (overweight or obese), low consumption of fruit (< 2 daily), lack of peer support, and physical inactivity.

    Conclusion: Identified correlated factors (risk factors) should be taken into consideration by public health authorities in the development and implementation of interventions aimed at promoting health among students in the related areas.

  • 1084.
    Ziaei, Reza
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Institutet.
    Dastgiri, Saeed
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Baybordi, Elaheh
    Zeinalzade, Ali Hossein
    Rahimi, Vahab Asl
    Mohammadi, Reza
    Karolinska Institutet.
    Reliability and validity of the Persian version of Global School-based Student Health Survey adapted for Iranian school students2014In: Journal of Clinical Research & Governance, ISSN 2001-5682, Vol. 3, no 2Article in journal (Refereed)
    Abstract [en]

    Purpose: Global School-based Student Health Survey (GSHS) is a project supported by the World Health Organization to assess adolescent health-risk behaviours and protective factors. The present study reports test-retest and internal consistency reliability as well as Content Validity Index (CVI) for the Persian version of GSHS and Global Youth Tobacco Survey (GYTS) adapted for Iranian students.

    Methods: The original English GSHS, GYTS and Optional Shisha modules were translated and back-translated, pilot-tested, reformed and corrected for clarity. The back-translated and English versions were compared and the Persian version was then edited to reach consistency for two versions. In order to evaluate the performance of this measure for our study sample (n= 47), we examined its test-retest reliability, internal consistency, and correlation between total test and re-test scales score as well as CVI.

    Results: The internal consistency (Cronbach's alpha) for the whole GSHS Core modules was 0.69, and for Core-Expanded GSHS, GYTS and Optional Modules for Shisha was 0.90. Test-retest reliability varied between 0.51 and 1.00 for Core and 0.23 to 1.00 for Core-Expanded GYTS and Optional Modules of Shisha. Total test and re-test scales score for GSHS Core varied from 0.64 to 1.00, and for Core-Expanded GSHS, GYTS and Optional Modules of Shisha varied 0.67 to 0.91.

    Conclusion: The Persian version of GSHS Core, Core-Expanded and GYTS has acceptable reliability and validity, and can serve as a reliable instrument for Persian-speaking communities.

  • 1085.
    Ziaei, Reza
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Mohammadi, Reza
    Karolinska institutet.
    Dastgiri, Saeed
    Department of Community Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
    Viitasara, Eija
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asl Rahimi, Vahab
    Unit for Adolescence Health, Province Health Center, Tabriz, Iran.
    Jeddi, Abolfazl
    Unit for Adolescence Health, Province Health Center, Tabriz, Iran.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 6, p. 686-696Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of the present study was to determine the correlates of waterpipe (WP) smoking among 15–17-year-old high school students in Iran.

    Method

    Data were collected using the Global Youth Tobacco Survey (GYTS), a self-administrated questionnaire distributed to a representative sample of high school students aged 15–17 in the city of Tabriz. Current WP smoking was defined as past 30-day use, and ever WP smoking was defined as at least one or two lifetime puffs. Differences in WP use, knowledge, and attitudes were analyzed using chi-square and Fisher exact tests. Binary logistic regression estimated the association between relevant independent variables (e.g., age) and the dependent variables (current/ever WP smoking).

    Results

    Of 1517 students, 21.6 % (95 % confidence interval [CI] = 19.5, 23.8) were ever WP smokers, and 9.7 % (95 % CI = 8.2, 11.2) were current WP smokers. Of current WP smokers, 40.3 % have stated that they want to stop smoking now. Moreover, 14.1 % of non-WP smokers reported that they might enjoy smoking WP. Of current WP smokers, 49.0 % have smoked at cafés. Additionally, 95.3 % of current WP smokers reported that their age did not prevent them from being served a WP. Studying in high school third grade (adjusted odds ratios (AORs) = 1.70; 95 % CI [1.10, 2.63]), experience of cigarette smoking (AORs = 1.57; 95 % CI [1.12, 2.20]), and being prepared to accept a WP offered by close friends (AORs = 3.31; 95 % CI [2.17, 5.04]) were independently associated with ever WP smoking, and accepting a WP offered by close friends (AORs = 4.36; 95 % CI [2.69, 7.07]) and gender (female) (AORs = 0.45; 95 % CI [0.30, 0.70] were independently associated with current WP smoking.

    Conclusion

    Prevalence of current and ever WP smoking is high in Tabriz. There is an urgent need to design interventions in order to increase students’ and their parents’ awareness regarding the harmfulness of WP, and to establish legal measures to restrict adolescents’ access to WPs and tobacco in society.

  • 1086.
    Ziaei, Reza
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Viitasara, Eija
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bazarghani, Homayoun Sadeghi
    Tabriz University of Medical Sciences, Iran.
    Dastgiri, Saeed
    Tabriz University of Medical Sciences, Iran.
    Zeinalzadeh, Ali Hossein
    Tabriz University of Medical Sciences, Iran.
    Bahadori, Farhad
    Tarbiat Modares University, Iran.
    Mohammadi, Reza
    Karolinska Institutet.
    Suicidal ideation and its correlates among high school students in Iran: A cross-sectional study2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, no 1, article id 147Article in journal (Refereed)
    Abstract [en]

    Background

    Globally, the second leading cause of death among adolescents is suicide and in middle-income countries adolescents’ suicidal ideation is a neglected public health area. The present study was conducted to determine the prevalence and correlates of suicidal ideation among 15–17-year-old high school students in Iran.

    Methods

    Self-administered, Global School-based Student Health Survey (GSHS) questionnaires were distributed to a representative sample (N =1517) of high-school students aged 15–17 in the city of Tabriz. Multivariate logistic regression was used to assess the association between relevant independent variables (e.g. gender) and the dependent outcome variable (suicidal ideation in the past 12 months).

    Results

    Overall, 62 (4.1%, 95% CI= 3.1, 5.2) of 1,517 students had thoughts of suicide. Three hundred and thirteen (20.6%, 95% CI= 18.6, 22.7) students reported being bullied in the previous 30 days. In addition, 134 (8.8%, 95% CI= 7.5, 10.3) students reported having been sexually abused. Being worried that they could not eat or did not feel hungry (Adjusted Odds Ratio (AOR) = 4.15; 95% Cl [1.71, 10.07]; current cigarette smoking (AOR = 3.00; 95% CI [1.69, 5.30]; thinking about using alcohol or other drugs (AOR = 4.28; 95% CI [2.41, 7.59]; and being sexually abused (AOR = 2.63; 95% CI [1.32, 5.24]) were all factors positively associated with suicidal ideation.

    Conclusion

    The prevalence of suicidal ideation was lower in our school students than in earlier studies. Interventions that address the issue of current cigarette smoking, worries, thinking about using alcohol or other drugs and sexual abuse should be given more priority by the public health authorities.

  • 1087.
    Zinner, C.
    et al.
    Univ Wurzburg, Dept Sport Sci, Judenbuhlweg 11, D-97082 Wurzburg, Germany.
    Krueger, M.
    German Sport Univ Cologne, Inst Training Sci & Sport Informat, Sportpk Mungersdorf 6, D-50933 Cologne, Germany.
    Reed, J. L.
    Univ Ottawa, Fac Hlth Sci, Ottawa, ON K1N 6N5, Canada.
    Kohl-Bareis, M.
    Univ Appl Sci Koblenz, RheinAhrCampus Remagen, Landau, Germany.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sperlich, Billy
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Univ Wurzburg, Dept Sport Sci, Judenbuhlweg 11, D-97082 Wurzburg, Germany.
    Exposure to a combination of heat and hyperoxia during cycling at submaximal intensity does not alter thermoregulatory responses2016In: Biology of Sport, ISSN 0860-021X, E-ISSN 2083-1862, Vol. 33, no 1, p. 71-76Article in journal (Refereed)
    Abstract [en]

    In this study, we tested the hypothesis that breathing hyperoxic air (FinO2 = 0.40) while exercising in a hot environment exerts negative effects on the total tissue level of haemoglobin concentration (tHb); core (T-core) and skin (T-skin) temperatures; muscle activity; heart rate; blood concentration of lactate; pH; partial pressure of oxygen (PaO2) and carbon dioxide; arterial oxygen saturation (SaO2); and perceptual responses. Ten well-trained male athletes cycled at submaximal intensity at 21 degrees C or 33 degrees C in randomized order: first for 20 min while breathing normal air (FinO2 = 0.21) and then 10 min with FinO2 = 0.40 (HOX). At both temperatures, SaO2 and PaO2, but not tHb, were increased by HOX. Tskin and perception of exertion and thermal discomfort were higher at 33 degrees C than 21 degrees C (p < 0.01), but independent of FinO2. Tcore and muscle activity were the same under all conditions (p > 0.07). Blood lactate and heart rate were higher at 33 degrees C than 21 degrees C. In conclusion, during 30 min of submaximal cycling at 21 degrees C or 33 degrees C, T-core, T-skin and T-body, tHb, muscle activity and ratings of perceived exertion and thermal discomfort were the same under normoxic and hyperoxic conditions. Accordingly, breathing hyperoxic air (FinO2 = 0.40) did not affect thermoregulation under these conditions.

  • 1088.
    Zinner, Christoph
    et al.
    Julius Maximilians Univ Wurzburg, Dept Sport Sci, Integrat & Expt Training Sci, Wurzburg, Germany.
    Baessler, Bettina
    Univ Hosp Cologne, Dept Radiol, Cologne, Germany.
    Weiss, Kilian
    Univ Hosp Cologne, Dept Radiol, Cologne, Germany; Philips Healthcare Germany, Hamburg, Germany.
    Ruf, Jasmine
    Univ Hosp Cologne, Dept Radiol, Cologne, Germany.
    Michels, Guido
    Univ Cologne, Dept Internal Med 3, Cologne, Germany.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Univ British Columbia, Sch Kinesiol, Vancouver, BC, Canada.
    Sperlich, Billy
    Julius Maximilians Univ Wurzburg, Dept Sport Sci, Integrat & Expt Training Sci, Wurzburg, Germany.
    Effect of resistance training with vibration and compression on the formation of muscle and bone2017In: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 56, no 6, p. 1137-1142Article in journal (Refereed)
    Abstract [en]

    IntroductionIn this study we investigated the effects of resistance training with vibration in combination with leg compression to restrict blood flow on strength, muscle oxygenation, muscle mass, and bone formation. MethodsTwelve participants were tested before and after 12 weeks of resistance training with application of vibration (VIBRA; 1-2mm, 30Hz) to both legs and compression (approximate to 35mm Hg, VIBRA+COMP) to only 1 leg. ResultsVIBRA+COMP and VIBRA improved 1 repetition maximum (1-RM), increased the number of repetitions preceding muscle exhaustion, enhanced cortical bone mass, and lowered the mass and fat fraction in the thigh, with no changes in total muscle mass. The mass of cancellous bone decreased to a similar extent after VIBRA and VIBRA+COMP. DiscussionResistance training with VIBRA+COMP and VIBRA improved 1-RM, increased the number of repetitions preceding muscular exhaustion, and enhanced formation of cortical bone, with no alteration of muscle mass. 

  • 1089.
    Zinner, Christoph
    et al.
    Univ Wurzburg, Dept Sport Sci, D-97070 Wurzburg, Germany.;Mid Sweden Univ, Dept Hlth Sci, Swedish Winter Sports Res Ctr, Ostersund, Sweden..
    Hauser, Anna
    Swiss Fed Inst Sport, Sect Elite Sport, Magglingen, Switzerland..
    Born, Dennis-Peter
    Univ Wurzburg, Dept Sport Sci, D-97070 Wurzburg, Germany..
    Wehrlin, Jon P.
    Swiss Fed Inst Sport, Sect Elite Sport, Magglingen, Switzerland..
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sperlich, Billy
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Univ Wurzburg, Dept Sport Sci, D-97070 Wurzburg, Germany..
    Influence of Hypoxic Interval Training and Hyperoxic Recovery on Muscle Activation and Oxygenation in Connection with Double-Poling Exercise2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 10, article id e0140616Article in journal (Refereed)
    Abstract [en]

    Here, we evaluated the influence of breathing oxygen at different partial pressures during recovery from exercise on performance at sea-level and a simulated altitude of 1800 m, as reflected in activation of different upper body muscles, and oxygenation of the m. triceps brachii. Ten well-trained, male endurance athletes (25.3 +/- 4.1 yrs; 179.2 +/- 4.5 cm; 74.2 +/- 3.4 kg) performed four test trials, each involving three 3-min sessions on a double-poling ergometer with 3-min intervals of recovery. One trial was conducted entirely under normoxic (No) and another under hypoxic conditions (Ho; FiO2 = 0.165). In the third and fourth trials, the exercise was performed in normoxia and hypoxia, respectively, with hyperoxic recovery (HOX; FiO2 = 1.00) in both cases. Arterial hemoglobin saturation was higher under the two HOX conditions than without HOX (p<0.05). Integrated muscle electrical activity was not influenced by the oxygen content (best d = 0.51). Furthermore, the only difference in tissue saturation index measured via near-infrared spectroscopy observed was between the recovery periods during the NoNo and HoHOX interventions (P<0.05, d = 0.93). In the case of HoHo the athletes' P-mean declined from the first to the third interval (P < 0.05), whereas P-mean was unaltered under the HoHOX, NoHOX and NoNo conditions. We conclude that the less pronounced decline in P-mean during 3 x 3-min double-poling sprints in normoxia and hypoxia with hyperoxic recovery is not related to changes inmuscle activity or oxygenation. Moreover, we conclude that hyperoxia (FiO2 = 1.00) used in conjunction with hypoxic or normoxic work intervals may serve as an effective aid when inhaled during the subsequent recovery intervals.

  • 1090.
    Zinner, Christoph
    et al.
    Univ Wurzburg, Dept Sport Sci, Integrat & Expt Training Sci, Judenbhulweg 11, D-97082 Wurzburg, Germany.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sperlich, Billy
    Univ Wurzburg, Dept Sport Sci, Integrat & Expt Training Sci, Judenbhulweg 11, D-97082 Wurzburg, Germany.
    Topical application of cream containing nonivamide and nicoboxil does not enhance the performance of experienced cyclists during a 4-km time-trial2016In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 116, no 5, p. 969-974Article in journal (Refereed)
    Abstract [en]

    Topical application of nonivamide-nicoboxil cream to resting legs has been shown to enhance the level of oxygenated haemoglobin in leg muscles 15 min later. Here, we examined whether such application improves the performance of experienced cyclists in a subsequent 4-km time-trial. Nine male cyclists [26 +/- A 8 years; 176 +/- A 9 cm; 73.5 +/- A 12.8 kg; peak oxygen uptake: 50.7 +/- A 4.0 mL min(-1) kg(-1) (mean +/- A SD)] performed three 4-km time-trials on an ergometer with either topical application of nonivamide-nicoboxil cream (CREAM) or cream without active components (SHAM) to both their thigh muscles or no application (CONTROL). Only the skin temperature immediately before and after the time-trial was higher with cream than SHAM and CONTROL (best p < 0.001, best d = 1.16). All other parameters evaluated, i.e., the average power output during the time-trial (p > 0.05, best d = 0.08), the tissue saturation index of the m. vastus lateralis (p > 0.05, best d = 0.57), cardiac output, heart rate, oxygen uptake, blood lactate concentration, and perceived exertion (p > 0.05, best d = 1.1) were similar under all three conditions. Our present findings reveal that topical application of cream containing nonivamide and nicoboxil to the thighs of cyclists prior to a 4-km time-trial does not improve their power output, saturation of the m. vastus lateralis with oxygen, oxygen uptake, heart rate, cardiac parameters, or perceived level of exertion.

  • 1091.
    Zinner, Christoph
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Univ Wurzburg, Dept Sport Sci, Wurzburg, Germany.
    Morales-Alamo, David
    Univ Las Palmas Gran Canaria, Las Palmas Gran Canaria, Spain.
    Örtenblad, Niels
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Univ Southern Denmark, Inst Sports Sci & Clin Biomech, Odense, Denmark.
    Larsen, Filip J.
    Swedish Sch Sport & Hlth Sci, Stockholm.
    Schiffer, Tomas A.
    Linköping Univ, Dept Med & Hlth Sci, Linköping.
    Willis, Sarah J.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gelabert-Rebato, Miriam
    Univ British Columbia, Sch Kinesiol, Vancouver, BC, Canada.
    Perez-Valera, Mario
    Univ Las Palmas Gran Canaria, Las Palmas Gran Canaria, Spain.
    Boushel, Robert
    Univ British Columbia, Sch Kinesiol, Vancouver, BC, Canada.
    Calbet, Jose A. L.
    Univ British Columbia, Sch Kinesiol, Vancouver, BC, Canada; Univ Las Palmas Gran Canaria, Las Palmas Gran Canaria, Spain.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Univ British Columbia, Sch Kinesiol, Vancouver, BC, Canada; UiT Arctic Univ Norway, Sch Sport Sci, Tromso, Norway.
    The Physiological Mechanisms of Performance Enhancement with Sprint Interval Training Differ between the Upper and Lower Extremities in Humans2016In: Frontiers in Physiology, ISSN 1664-042X, E-ISSN 1664-042X, Vol. 7, no SEP, article id 426Article in journal (Refereed)
    Abstract [en]

    To elucidate the mechanisms underlying the differences in adaptation of arm and leg muscles to sprint training, over a period of 11 days 16 untrained men performed six sessions of 4-6 x 30-s all-out sprints (SIT) with the legs and arms, separately, with a 1-h interval of recovery. Limb-specific VO(2)peak, sprint performance (two 30-s Wingate tests with 4-min recovery), muscle efficiency and time-trial performance (TT, 5-min all-out) were assessed and biopsies from the m. vastus lateralis and m. triceps brachii taken before and after training. VO(2)peak and Wmax increased 3-11% after training, with a more pronounced change in the arms (P < 0.05). Gross efficiency improved for the arms (+8.8%, P < 0.05), but not the legs (-0.6%). Wingate peak and mean power outputs improved similarly for the arms and legs, as did TT performance. After training, VO2 during the two Wingate tests was increased by 52 and 6% for the arms and legs, respectively (P < 0.001). In the case of the arms, VO2 was higher during the first than second Wingate test (64 vs. 44%, P < 0.05). During the TT, relative exercise intensity, HR, VO2, VCO2, V-E, and V-t were all lower during arm-cranking than leg-pedaling, and oxidation of fat was minimal, remaining so after training. Despite the higher relative intensity, fat oxidation was 70% greater during leg-pedaling (P = 0.017). The aerobic energy contribution in the legs was larger than for the arms during the Wingate tests, although VO2 for the arms was enhanced more by training, reducing the O-2 deficit after SIT. The levels of muscle glycogen, as well as the myosin heavy chain composition were unchanged in both cases, while the activities of 3-hydroxyacyl-CoA-dehydrogenase and citrate synthase were elevated only in the legs and capillarization enhanced in both limbs. Multiple regression analysis demonstrated that the variables that predict TT performance differ for the arms and legs. The primary mechanism of adaptation to SIT by both the arms and legs is enhancement of aerobic energy production. However, with their higher proportion of fast muscle fibers, the arms exhibit greater plasticity.

  • 1092.
    Zinner, Christoph
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Willis, Sara
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Morales-Alamo, D
    U of Las Palmas de Gran Canaria.
    Larsen, F
    Karolinska Institutet.
    Schiffer, T
    Karolinska Institutet.
    Boushel, R
    Gymnastik och Idrottshögskolan i Stockholm.
    Örtenblad, Niels
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Syddanskt Universitet.
    Calbet, J
    U of Las Palmas de Gran Canaria.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sprint interval training or arms and legs elevates peak VO2 and improves arm exercise economy2015Conference paper (Refereed)
    Abstract [en]

    Introduction

    Interval cycle sprint training (SIT) has been shown to improve anaerobic capacity, VO2max and biomarkers of muscle oxidative capacity in as little as 2 weeks in previously untrained adults. The present study was designed to characterize and compare systemic VO2 and exercise performance after SIT engaging the arms and legs.

     

    Methods

    Sixteen healthy, untrained men (23.9 ± 3.7 yrs; 183.8 ± 6.8 cm; 80.3 ± 14.1 kg) performed six sessions of 4-6x30 sec all-out sprints with the legs then arms (or vice versa) separated by a 1-h recovery over an 11-day period. Limb-specific VO2peak, anaerobic capacity (2x30-sec Wingate tests with 4 min of recovery), a 4-min submaximal work economy test, and a 5-min all-out time trial (TT) were conducted before and after the training program. Muscle biopsies (from the m. vastus lateralis and m. triceps brachii) were taken before and after the training period.

     

    Results

    VO2peak increased by 10.6% and 5.9% with arm and leg training, respectively (p<0.05), with the increase in the arms significantly greater than in the legs (p=0.02). Work economy was improved for the arms (-9.8%, p<0.05), but not for the legs (-0.9%). Mean power during the TT rose by 13.5% for the arms and 11.8% for the legs (p<0.05). Peak power output and mean power during the two Wingate tests were elevated in both the arms (PPO: 6.7% (p<0.01) and 13.3% (p<0.01); MPO: 6.1% (p<0.01) and 8.4% (p<0.01)) and legs (PPO: 3.1% (p=0.07) and 7.1% (p=0.02); MPO: 3.3% (p<0.01) and 5.6% (p<0.01)). The activity of 3-hydroxyacyl-CoA dehydrogenase (HAD) and levels of muscle glycogen were unchanged in both limbs.

     

    Discussion

    Sprint interval training with arm or leg cycling exercise increased peak pulmonary VO2 during their respective modes over an 11-day training period with a greater increase in the arms. Sprint performance rose to a similar extent in both extremities, yet work economy was improved only in the arms. These findings suggest some limb-specific responsiveness to SIT training.

  • 1093.
    Zinner, Christoph
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Willis, Sarah
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Jonsson, Malin
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sperlich, Billy
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Heart rate responses during biathlon races of different lengths in elite athletes2014In: Science & Skiing VI / [ed] Erich Muller, Josef Kroll, Stefan Lindinger, Meyer & Meyer Sport, 2014, p. 483-494Chapter in book (Refereed)
  • 1094.
    Zoppirolli, Chiara
    et al.
    CeRiSM Res Ctr Sport Mt & Hlth, Rovereto, Italy; Univ Verona, Verona, Italy.
    Bortolan, Lorenzo
    CeRiSM Res Ctr Sport Mt & Hlth, Rovereto, Italy; Univ Verona, Verona, Italy.
    Stella, Federico
    CeRiSM Res Ctr Sport Mt & Hlth, Rovereto, Italy; Univ Verona, Verona, Italy.
    Boccia, Gennaro
    Univ Turin, NeuroMuscularFunct Res Grp, Turin, Italy.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. UiT Arctic Univ Norway, Tromso, Norway.
    Schena, Federico
    CeRiSM Res Ctr Sport Mt & Hlth, Rovereto, Italy; Univ Verona, Verona, Italy.
    Pellegrini, Barbara
    CeRiSM Res Ctr Sport Mt & Hlth, Rovereto, Italy; Univ Verona, Verona, Italy.
    Following a Long-Distance Classical Race the Whole-Body Kinematics of Double Poling by Elite Cross-Country Skiers Are Altered2018In: Frontiers in Physiology, ISSN 1664-042X, E-ISSN 1664-042X, Vol. 9, no JUL, article id 978Article in journal (Refereed)
    Abstract [en]

    Introduction: Although short-term (approximately 10-min) fatiguing DP has been reported not to alter the joint kinematics or displacement of the centre of mass (COM) of high-level skiers, we hypothesize that prolonged DP does change these kinematics, since muscular strength is impaired following endurance events lasting longer than 2 h. Methods: During the 58-km Marcialonga race in 2017, the fastest 15 male skiers were videofilmed (100 fps, FHD resolution in the sagittal plane) on two 20-m sections (inclines: 0.7 +/- 0.1 degrees) 48 km apart (i.e., 7 and 55 km from the start), approximating 50-km Olympic races. The cameras were positioned perpendicular to and about 40 m from the middle of each section and spatial dimensions adjusted for each individual track skied. Pole and joint kinematics, as well as displacement of the COM during two DP cycles were assessed. Results: The 10 skiers who fulfilled our inclusion criteria finished the race in 2 h 09 min 19 s +/- 28 s. Displacements of the joints and COM were comparable to previous observations on skiers roller skiing on a flat treadmill at similar speeds in the laboratory. 55 km after the start, cycle velocity and length were lower (P < 0.001 and P = 0.002, respectively) and the angular range of elbow joint flexion during the initial part of the poling phase reduced, while shoulder angle was greater during the first 35% of the DP cycle (all P < 0.05). Moreover, the ankle angle was increased and forward displacement of the COM reduced during the first 80% of the cycle. Conclusion: Prolonged DP reduced the forward displacement of the COM and altered arm kinematics during the early poling phase. The inefficient utilization of COM observed after 2 h of competition together with potential impairment of the stretch-shortening of arm extensor muscles probably attenuated generation of poling force. To minimize these effects of fatigue, elite skiers should focus on maintaining optimal elbow and ankle kinematics and an effective forward lean during the propulsive phase of DP.

  • 1095.
    Zoppirolli, Chiara
    et al.
    CeRiSM (Research Center Sport Mountain and Health), Rovereto, Italy .
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Pellegrini, Barbara
    CeRiSM (Research Center Sport Mountain and Health), Rovereto, Italy .
    Quaglia, Diego
    CeRiSM (Research Center Sport Mountain and Health), Rovereto, Italy .
    Bortolan, Lorenzo
    CeRiSM (Research Center Sport Mountain and Health), Rovereto, Italy .
    Schena, Federico
    CeRiSM (Research Center Sport Mountain and Health), Rovereto, Italy .
    The effectiveness of stretch-shortening cycling in upper-limb extensor muscles during elite cross-country skiing with the double-poling technique2013In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 23, no 6, p. 1512-1519Article in journal (Refereed)
    Abstract [en]

    This investigation was designed to evaluate the effectiveness of stretch-shortening cycling (SSCEFF) in upper-limb extensor muscles while cross-country skiing using the double-poling technique (DP). To this end, SSCEFF was analyzed in relation to DP velocity and performance. Eleven elite cross-country skiers performed an incremental test to determine maximal DP velocity (V-max). Thereafter, cycle characteristics, elbow joint kinematics and poling forces were monitored on a treadmill while skiing at two sub-maximal and racing velocity (85% of Vmax). The average EMG activities of the triceps brachii and latissimus dorsi muscles were determined during the flexion and extension sub-phases of the poling cycle (EMG(FLEX), EMG(EXT)), as well as prior to pole plant (EMG(PRE)). SSCEFF was defined as the ratio of aEMG(FLEX) to aEMG(EXT). EMG(PRE) and EMG(FLEX) increased with velocity for both muscles (P < 0.01), as did SSCEFF (from 0.9 +/- 0.3 to 1.3 +/- 0.5 for the triceps brachii and from 0.9 +/- 0.4 to 1.5 +/- 0.5 for the latissimus dorsi) and poling force (from 253 +/- 33 to 290 +/- 36 N; P < 0.05). Furthermore, SSCEFF was positively correlated to Vmax, to EMG(PRE) and EMG(FLEX) (P < 0.05). The neuromuscular adaptations made at higher velocities, when more poling force must be applied to the ground, exert a major influence on the DP performance of elite cross-country skiers. (C) 2013 Elsevier Ltd. All rights reserved.

  • 1096.
    Zubak, Zoran
    et al.
    Special Hosp Biograd, Biograd, Croatia; Univ Mostar, Mostar, Bosnia & Herceg..
    Terzic, Admir
    Univ Tuzla, Tuzla, Bosnia & Herceg..
    Zenic, Natasa
    Univ Split, Split, Croatia.
    Ostojic, Ljerka
    Univ Mostar, Mostar, Bosnia & Herceg.; Univ Split, Split, Croatia; Acad Med Sci, Sarajevo, Bosnia & Herceg..
    Zubak, Ivana
    Univ Zadar, Zadar, Croatia.
    Jelicic, Mario
    Univ Split, Split, Croatia.
    Pojskic, Haris
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Linnaeus Univ, Kalmar.
    Are Sports-Related Factors Correlated to the Prevalence and Initiation of Illicit Drug Misuse in Adolescence?: Prospective Study in Older Adolescents2018In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 1236284Article in journal (Refereed)
    Abstract [en]

    Sport participation is considered as a factor of potential influence on illicit drugmisuse (IDM) in adolescence, but there is an evident lack of studies which prospectively investigated this problem. This study aimed to prospectively investigate the sports-related factors related to IDM and the initiation of IDM among older adolescents. The participants were 436 adolescents (202 females; 16 years old at study baseline). They were tested at baseline and follow-up (two years later). The predictors included variables associated with different facets of sports participation and success in sports. The criteria were (i) baseline IDM, (ii) follow-up IDM, and (iii) initiation of IDM between baseline and follow-up. Crude and adjusted (controlled for parental conflict, age, socioeconomic status, and gender) logistic regressions were applied to establish correlations between predictors and criteria. There were higher odds for baseline IDM in adolescents who quit individual sports (OR: 4.2, 95% CI: 1.3-13.9), who had better competitive sports achievements (OR: 1.8, 95% CI: 1.0-3.3), and those involved in sports for a longer time (OR: 1.6, 95% CI: 1.0-2.5). The IDM at follow-up was more prevalent in adolescents who were involved in sports for a longer time (OR: 1.7, 95% CI: 1.1-2.6). Initiation of drug use was predicted by longer experience in sports (OR: 1.8, 95% CI: 1.1-3.1). Sports-related factors were more negatively than positively related to illicit drug use. Most probably, the transition from junior to senior level in sports put specific stress on those adolescents who were highly committed to sports until that time, but who then had to question their own sports abilities and future potential in sports. Sport-authorities should be informed on established results and specific public-health efforts aimed at preventing IDM in athletic adolescents are urgently needed.

  • 1097.
    Zubak, Zoran
    et al.
    Faculty of Medicine, University of Mostar; Special Orthopedic Hospital Biograd, Croatia.
    Zenic, Natasa
    Faculty of Kinesiology, University of Split.
    Ostojic, Ljerka
    Faculty of Kinesiology, University of Split.
    Zubak, Ivana
    Department for Ecology, Agronomy and Aquaculture, University of Zadar.
    Pojskic, Haris
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    A Prospective Study on the Influence of Scholastic Factors on the Prevalence and Initiation of Illicit Drug Misuse in Adolescence2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 5, article id 874Article in journal (Refereed)
    Abstract [en]

    Background: This study aimed to prospectively investigate the scholastic factors related to illicit drug misuse (IDM) and the initiation of IDM among older adolescents from Bosnia andHerzegovina. Methods: This 2-year prospective study included 436 participants (202 females), who were an average of 16 years old at the beginning of the study (baseline). The participants were tested at baseline and follow-up (20 months later). The predictors included variables of scholastic-achievement (grade point average, school absences, unexcused absences and behavioral grade). The criteria were: (i) IDM at baseline; (ii) IDM at follow-up; and (iii) initiation of IDM over the study course. Results: Logistic regression indicated increased odds of IDM in adolescents who were more frequent absent from school (baseline: Odds Ratio (OR): 3.73, 95% Confidence Interval (CI): 2.12–6.57; follow-up: OR: 2.91, 95% CI: 1.90–4.65). The lower grade point average and more unexcused absences were evidenced for adolescents who consumed drugs on follow-up(OR: 1.67, 95% CI: 1.11–2.51; OR: 1.74, 95% CI: 1.30–2.32 for grade point average and unexcused absences, respectively). Initiation of IDM was predicted by frequent absences from school (OR: 2.2,95% CI: 1.3–3.8), and lower behavioral grades (OR: 1.9, 95% CI: 1.2–3.3). Conclusions: The findings confirmed strong correlations between scholastic failure and IDM. Absences from school and lower behavioral grades at baseline were predictive of the initiation of IDM in older adolescents.

  • 1098.
    Åberg, Viktor
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Jeffrey, Wall
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Oavsiktlig vakenhet under operation - Hur kan riskerna minskas?2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Awareness defines as when a patient undergoing surgery in general anaesthesia can remember events or have sensations allthough he or she should have been uncouncious. It is a very serious complication of anesthesiology that can lead to posttraumatic stress syndrome. Approximately 0,1 – 0,2 % of all patients undergoing surgery in general anesthesia is suffering from intraoperative awareness. The most common reason is light anesthesia which, especially on patients at risk, sometimes can be hard to prevent with only the traditional monitoring at hand. Thereby further interventions are also available. Aim: The aim of this literature review was to examine if the risk for intraoperative awareness can be decreased with the use of certain drugs, measurements or other interventions. Method: This study was performed through search of literature in databases PubMed, Cinahl and SveMED+. After analyze and evaluation regarding quality, 20 articles was included in the study. Results: The included articles were divided into four categories for a better overview. These were drugs- and anesthesiology methods, EEG-methods, EEG-methods compared with traditional monitoring and other methods. The results showed that there are many methods available and that there are mixed opinions of their efficiency. Conclusion: The used methods have a margin of error and none of them are so effective that they can be used as a single method to prevent awareness. EEG-measurements can however be an effective add to the traditional monitoring.

  • 1099.
    Åkergård, Kerstin
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Samma skola - skilda världarGymnasieelevers uppfattningar om välbefinnande i skolan.2016Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
  • 1100.
    Åkerlund, Ann
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Albertsson, Elisabet
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Livet efter en hjärtinfarkt: Hur påverkas patient och familj?2013Independent thesis Basic level (degree of Bachelor), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund:Hjärtinfarkt är den vanligaste orsaken till dödsfall i Sverige. Att drabbas av akut sjukdom är en kritisk upplevelse för både patient och närstående vilket leder till ett behov av stöd för hela familjen. Syfte: Att belysa den mentala hälsan hos personer som har drabbats av en hjärtinfarkt samt återhämtningsprocessen. Metod: Litteraturöversikt där vetenskapliga artiklar via databaserna Pubmed, Psykinfo och Cinahl granskats. Utifrån artikelgranskningen uppkom tre kategorier; Den mentala hälsan och reaktioner hos patienter som drabbats av hjärtinfarkt, Återhämtningsprocessen efter en hjärtinfarkt samt Sjukvårdens roll i återhämtningsprocessen. Resultat: Reaktioner hos patienter som har drabbats av hjärtinfarkt varierar, depression drabbar cirka 50 %. Överlevnad var av central betydelse efter hjärtinfarkten. Familjen ansågs vara värdefullt stöd i återhämtningsprocessen men hade också risk att bli alltför överbeskyddande. Personal inom primärvården underskattade förekomsten av depression. Individuell rådgivning ger en bättre livskvalité. Diskussion: Vårdpersonal måste se hela människan, patienten ska ses som en individ med med individuella förutsättningar till återhämtning och vården bör planeras därefter. Tydlig information är av stor vikt till både patient och närstående ska involveras mer i vården. Slutsats: Patientens mentala hälsan har stor inverkan på återhämtningsprocessen. Framtida forskning inom området bör fokusera på i hur mycket kunskap sjuksköterskor har om patienters psykiska hälsa efter en hjärtinfarkt.

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