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The Swedish Commission on Health Inequality defined health inequality as systematic differences in health between groups in society with different social positions. All avoidable socioeconomic health inequalities are unfair, and as stated by WHO's Commission on the Social Determinants of Health, we have a moral obligation to try to reduce them. "Putting these inequities right is a matter of social justice. Reducing health inequities is, for the Commission on Social Determinants of Health, an ethical imperative." This ethical imperative is especially apparent regarding the health of children and adolescents. Children’s right to the highest attainable standard of health is also enshrined in Article 24 of the Convention on the Rights of the Child. To reach the goal of a reduction of health inequalities, research is necessary to describe the social gradients of health. Research is also needed to better understand why these gradients occur. A better understanding and knowledge about health inequalities can lead to policies that reduce these inequalities and ensure children’s right to health. This thesis investigates social inequality in child health using data from a Swedish population-based prospective birth cohort, the All Babies in Southeast Sweden (ABIS) cohort. Social inequality in obesity in the ABIS cohort is also compared with other birth cohorts participating in the Elucidating Pathways to Child Health Inequality (EPOCH) collaboration which includes cohorts from six high-income countries; Sweden, the Netherlands, Canada (one national and one cohort from Quebec), UK, Australia, and USA. In Paper 1 we show that health inequalities in overweight and obesity are detectable already at two years of age and that these inequalities increase during childhood. In adolescents, low socioeconomic status increases the risk of becoming overweight and the risk of components of the metabolic syndrome, including high blood pressure and dyslipidemia (low high-density cholesterol)., Hälsoojämlikhet definierades av den Svenska kommissionen för jämlik hälsa som "systematiska skillnader i hälsa mellan samhällsgrupper med olika social position." Debatten om de bakomliggande orsakerna till hälsoojämlikhet tog fart efter att rapporten "the Black Report" kom ut i Storbritannien på 1980-talet. I denna rapport konstaterades att ojämlikheten i hälsa hade ökat mellan socioekonomiska grupper trots införandet av fri sjukvård och andra samhällsförbättringar. Orsakerna till den ökande ojämlikheten har sedan dess debatterats och ett antal teorier har lagts fram för att förklara fenomenet. Fortfarande råder det dock oenighet kring hur de olika bakomliggande faktorerna leder fram till skillnaderna i hälsa. Internationella organisationer har samtidigt arbetat för att minska skillnaderna, bland annat WHO som 2008 bildades "the Commission on Social Determinants of Health". Denna kommission slog fast i sin rapport att vi alla har en moralisk plikt att minska skillnaderna i hälsa; "Att ställa dessa skillnader till rätta handlar om social rättvisa. Att minska hälsoojämlikhet är för kommissionen ett etiskt imperativ". Rätten till bästa möjliga hälsa slås också fast i Barnkonventionen, artikel 24. För att kunna minska hälsoojämlikheter behöver man studera inom vilka områden/sjukdomar skillnader uppstår och varför, med målet att utforma åtgärder för att minska skillnaderna. Denna avhandling syftar till att studera socioekonomiska skillnader i barns hälsa. Avhandlingen baseras på data från den svenska prospektiva födelsekohortstudien Alla Barn i Sydöstra Sverige (ABIS). Social ojämlikhet i övervikt och obesitas jämförs även med den sociala ojämlikheten i motsvarande data från födelsekohorter i fem andra höginkomstländer; Nederländerna, Kanada, Storbritannien, Australien och USA. Resultaten från Studie 1 visade att socioekonomiska skillnader i risken att utveckla obesitas kan upptäckas redan vid 2 års ålder och att denna skillnad i risk ökade under uppväxten. I tonåren fra

The Swedish Commission on Health Inequality defined health inequality as systematic differences in health between groups in society with different social positions. All avoidable socioeconomic health inequalities are unfair, and as stated by WHO's Commission on the Social Determinants of Health, we have a moral obligation to try to reduce them. "Putting these inequities right is a matter of social justice. Reducing health inequities is, for the Commission on Social Determinants of Health, an ethical imperative." This ethical imperative is especially apparent regarding the health of children and adolescents. Children’s right to the highest attainable standard of health is also enshrined in Article 24 of the Convention on the Rights of the Child. To reach the goal of a reduction of health inequalities, research is necessary to describe the social gradients of health. Research is also needed to better understand why these gradients occur. A better understanding and knowledge about health inequalities can lead to policies that reduce these inequalities and ensure children’s right to health. This thesis investigates social inequality in child health using data from a Swedish population-based prospective birth cohort, the All Babies in Southeast Sweden (ABIS) cohort. Social inequality in obesity in the ABIS cohort is also compared with other birth cohorts participating in the Elucidating Pathways to Child Health Inequality (EPOCH) collaboration which includes cohorts from six high-income countries; Sweden, the Netherlands, Canada (one national and one cohort from Quebec), UK, Australia, and USA. In Paper 1 we show that health inequalities in overweight and obesity are detectable already at two years of age and that these inequalities increase during childhood. In adolescents, low socioeconomic status increases the risk of becoming overweight and the risk of components of the metabolic syndrome, including high blood pressure and dyslipidemia (low high-density cholesterol)., Hälsoojämlikhet definierades av den Svenska kommissionen för jämlik hälsa som "systematiska skillnader i hälsa mellan samhällsgrupper med olika social position." Debatten om de bakomliggande orsakerna till hälsoojämlikhet tog fart efter att rapporten "the Black Report" kom ut i Storbritannien på 1980-talet. I denna rapport konstaterades att ojämlikheten i hälsa hade ökat mellan socioekonomiska grupper trots införandet av fri sjukvård och andra samhällsförbättringar. Orsakerna till den ökande ojämlikheten har sedan dess debatterats och ett antal teorier har lagts fram för att förklara fenomenet. Fortfarande råder det dock oenighet kring hur de olika bakomliggande faktorerna leder fram till skillnaderna i hälsa. Internationella organisationer har samtidigt arbetat för att minska skillnaderna, bland annat WHO som 2008 bildades "the Commission on Social Determinants of Health". Denna kommission slog fast i sin rapport att vi alla har en moralisk plikt att minska skillnaderna i hälsa; "Att ställa dessa skillnader till rätta handlar om social rättvisa. Att minska hälsoojämlikhet är för kommissionen ett etiskt imperativ". Rätten till bästa möjliga hälsa slås också fast i Barnkonventionen, artikel 24. För att kunna minska hälsoojämlikheter behöver man studera inom vilka områden/sjukdomar skillnader uppstår och varför, med målet att utforma åtgärder för att minska skillnaderna. Denna avhandling syftar till att studera socioekonomiska skillnader i barns hälsa. Avhandlingen baseras på data från den svenska prospektiva födelsekohortstudien Alla Barn i Sydöstra Sverige (ABIS). Social ojämlikhet i övervikt och obesitas jämförs även med den sociala ojämlikheten i motsvarande data från födelsekohorter i fem andra höginkomstländer; Nederländerna, Kanada, Storbritannien, Australien och USA. Resultaten från Studie 1 visade att socioekonomiska skillnader i risken att utveckla obesitas kan upptäckas redan vid 2 års ålder och att denna skillnad i risk ökade under uppväxten. I tonåren fra

SVENSK SAMMANFATTNING BAKGRUND: Sexuell och reproduktiv hälsa och rättigheter (SRHR) är en central bestämningsfaktor för hälsa och utgör en viktig del av livet i övergången från barndom till vuxen ålder. Den nationella SRHR-policyn i Sverige strävar mot jämlika förutsättningar för hälsa. I Sverige idag är sexuellt överförbara infektioner (STI) vanliga, vilket tyder på att det behöver ske en beteendeförändring där fler unga har säkrare sex. Resultat från tidigare forskning visar att en del grupper av unga är mer sårbara än andra och har mer erfarenheter av osäkert sex, sex mot sin vilja och sex mot ersättning. Vidare visar tidigare studier att unga inom följande sociala grupper: HBTQI+-personer, utrikesfödda unga, och unga med sämre socioekonomiska tillgångar, har sämre sexuell hälsa. Tidigare studier har inte utforskat hur jämlika förutsättningar har betydelse för hälsa i intersektionerna inom och mellan dessa sociala grupper. Lite är också känt om hur resurser som kan skapa mer jämlika förutsättningar i hälsa fördelas, sett ur ett intersektionellt perspektiv. SYFTE: Det övergripande syftet med denna avhandling är att utforska förutsättningarna för jämlik hälsa inom området sexuell och reproduktiv hälsa och rättigheter (SRHR) bland unga i åldern 16-29 år i Sverige. Mer specifikt analyseras intersektioner av sociala bestämningsfaktorer som skapar sårbarheter eller resurser i relation till SRHR. Detta övergripande syfte utforskas i fyra artiklar som berör sex olika SRHR-relaterade områden. Oskyddat sex, sex mot sin vilja och sex mot ersättning analyseras genom begreppet sårbarhet. Säkrare sex, sexuell hälsolitteracitet och nöjdhet med sexlivet analyseras genom begreppet resurser. METOD: Det empiriska materialet är hämtat från den stratifierade och randomiserade nationella befolkningsundersökningen ”Sexualitet och hälsa bland unga i Sverige” även kallad ”UngKAB15”. Undersökningen bygger på ett slumpmässigt urval av 29 950 ungdomar som drogs från Totalbefolkningsr, BACKGROUND: Sexual and reproductive health and rights (SRHR) are a core determinant of health and constitute an important part of the transition from childhood to adulthood. The national SRHR-policy in Sweden strives towards health equity. In Sweden today, sexually transmitted infections (STIs) are common, which indicates a need for an increase in the practice of safer sex. Some groups are more vulnerable and more often experience unsafe sex, sex against their will and transactional sex. Further, in all these health outcome areas previous knowledge shows that young LGBTQI+ people, foreign-born youth and young people with insufficient economic resources display poorer sexual health. However, little is known about the conditions for health equity in the intersections within and between these social groups. Little is also known about whether and how resources for health equity are distributed from an intersectional perspective. AIM: The overall aim of this thesis is to explore the conditions for health equity in sexual and reproductive health and rights (SRHR) among young people in Sweden aged 16 to 29 by analysing the processes by which intersecting social determinants create vulnerabilities or resources in relation to SRHR. This overall aim is explored in four papers that cover six SRHR-related health outcomes. The three health outcome areas of unsafe sex, sex against one’s will, and transactional sex are viewed as vulnerabilities. The health outcome areas of safer sex, sexual health literacy and sex-life satisfaction are viewed as resources. METHODS: The empirical material employed in the studies presented in this thesis is drawn from the stratified and randomised national population-based survey ‘Sexuality and health among young people in Sweden’ also referred to as ‘UngKAB15’. A random sample of 29,950 young persons was drawn from the Total Population Register. A total of 7,755 respondents answered the survey, which gave a response rate of 26 perc

Objective Individuals with psychiatric illness suffer from poorer physical health compared with the general population and have a higher risk of developing cardiovascular and metabolic diseases. This cross-sectional study aims to describe the prevalence of lifestyle and cardiovascular risk factors and the association with self-reported psychiatric symptoms in a population of 40-year-old individuals screened with targeted Health Dialogues in southern Sweden. Methods All 40-year-old individuals registered at 99 primary healthcare centers in southern Sweden were invited to participate. Self-reported lifestyle habits on a web questionnaire, anthropometric measurements, blood pressure, and blood tests were collected. The Health Dialogue resulted in a risk level assessment for different lifestyle habits and a meeting with a trained coach. Results A total of 1831 individuals completed a Health Dialogue between 1st January 2021 and 30th June 2022. There were more individuals with high-risk levels for several lifestyle habits in the group with self-reported psychiatric illness compared with the rest of the study population. The analysis showed that physical inactivity, unhealthy diet, high-risk alcohol intake, tobacco use, psychosocial strain, higher BMI, and waist-hip ratio were associated with increased levels of psychiatric symptoms after adjustment for sex and socioeconomic factors. Conclusion Unhealthy lifestyle habits were associated with self-reported psychiatric symptoms in 40-year-old individuals assessed with targeted Health Dialogues in a primary care context. Organized screening might contribute to early detection of modifiable risk factors for cardiovascular disease. Individuals with psychiatric symptoms should be prioritized for screening of unhealthy lifestyle behaviors., Funding: The Swedish Heart Lung Foundation, the Swedish Research Council, Region Scania, Swedish Governmental Funding of Clinical Research (ALF) and the National Board of Health and Welfare

The Swedish Commission on Health Inequality defined health inequality as systematic differences in health between groups in society with different social positions. All avoidable socioeconomic health inequalities are unfair, and as stated by WHO's Commission on the Social Determinants of Health, we have a moral obligation to try to reduce them. "Putting these inequities right is a matter of social justice. Reducing health inequities is, for the Commission on Social Determinants of Health, an ethical imperative." This ethical imperative is especially apparent regarding the health of children and adolescents. Children’s right to the highest attainable standard of health is also enshrined in Article 24 of the Convention on the Rights of the Child. To reach the goal of a reduction of health inequalities, research is necessary to describe the social gradients of health. Research is also needed to better understand why these gradients occur. A better understanding and knowledge about health inequalities can lead to policies that reduce these inequalities and ensure children’s right to health. This thesis investigates social inequality in child health using data from a Swedish population-based prospective birth cohort, the All Babies in Southeast Sweden (ABIS) cohort. Social inequality in obesity in the ABIS cohort is also compared with other birth cohorts participating in the Elucidating Pathways to Child Health Inequality (EPOCH) collaboration which includes cohorts from six high-income countries; Sweden, the Netherlands, Canada (one national and one cohort from Quebec), UK, Australia, and USA. In Paper 1 we show that health inequalities in overweight and obesity are detectable already at two years of age and that these inequalities increase during childhood. In adolescents, low socioeconomic status increases the risk of becoming overweight and the risk of components of the metabolic syndrome, including high blood pressure and dyslipidemia (low high-density cholesterol)., Hälsoojämlikhet definierades av den Svenska kommissionen för jämlik hälsa som "systematiska skillnader i hälsa mellan samhällsgrupper med olika social position." Debatten om de bakomliggande orsakerna till hälsoojämlikhet tog fart efter att rapporten "the Black Report" kom ut i Storbritannien på 1980-talet. I denna rapport konstaterades att ojämlikheten i hälsa hade ökat mellan socioekonomiska grupper trots införandet av fri sjukvård och andra samhällsförbättringar. Orsakerna till den ökande ojämlikheten har sedan dess debatterats och ett antal teorier har lagts fram för att förklara fenomenet. Fortfarande råder det dock oenighet kring hur de olika bakomliggande faktorerna leder fram till skillnaderna i hälsa. Internationella organisationer har samtidigt arbetat för att minska skillnaderna, bland annat WHO som 2008 bildades "the Commission on Social Determinants of Health". Denna kommission slog fast i sin rapport att vi alla har en moralisk plikt att minska skillnaderna i hälsa; "Att ställa dessa skillnader till rätta handlar om social rättvisa. Att minska hälsoojämlikhet är för kommissionen ett etiskt imperativ". Rätten till bästa möjliga hälsa slås också fast i Barnkonventionen, artikel 24. För att kunna minska hälsoojämlikheter behöver man studera inom vilka områden/sjukdomar skillnader uppstår och varför, med målet att utforma åtgärder för att minska skillnaderna. Denna avhandling syftar till att studera socioekonomiska skillnader i barns hälsa. Avhandlingen baseras på data från den svenska prospektiva födelsekohortstudien Alla Barn i Sydöstra Sverige (ABIS). Social ojämlikhet i övervikt och obesitas jämförs även med den sociala ojämlikheten i motsvarande data från födelsekohorter i fem andra höginkomstländer; Nederländerna, Kanada, Storbritannien, Australien och USA. Resultaten från Studie 1 visade att socioekonomiska skillnader i risken att utveckla obesitas kan upptäckas redan vid 2 års ålder och att denna skillnad i risk ökade under uppväxten. I tonåren fra

The Swedish Commission on Health Inequality defined health inequality as systematic differences in health between groups in society with different social positions. All avoidable socioeconomic health inequalities are unfair, and as stated by WHO's Commission on the Social Determinants of Health, we have a moral obligation to try to reduce them. "Putting these inequities right is a matter of social justice. Reducing health inequities is, for the Commission on Social Determinants of Health, an ethical imperative." This ethical imperative is especially apparent regarding the health of children and adolescents. Children’s right to the highest attainable standard of health is also enshrined in Article 24 of the Convention on the Rights of the Child. To reach the goal of a reduction of health inequalities, research is necessary to describe the social gradients of health. Research is also needed to better understand why these gradients occur. A better understanding and knowledge about health inequalities can lead to policies that reduce these inequalities and ensure children’s right to health. This thesis investigates social inequality in child health using data from a Swedish population-based prospective birth cohort, the All Babies in Southeast Sweden (ABIS) cohort. Social inequality in obesity in the ABIS cohort is also compared with other birth cohorts participating in the Elucidating Pathways to Child Health Inequality (EPOCH) collaboration which includes cohorts from six high-income countries; Sweden, the Netherlands, Canada (one national and one cohort from Quebec), UK, Australia, and USA. In Paper 1 we show that health inequalities in overweight and obesity are detectable already at two years of age and that these inequalities increase during childhood. In adolescents, low socioeconomic status increases the risk of becoming overweight and the risk of components of the metabolic syndrome, including high blood pressure and dyslipidemia (low high-density cholesterol)., Hälsoojämlikhet definierades av den Svenska kommissionen för jämlik hälsa som "systematiska skillnader i hälsa mellan samhällsgrupper med olika social position." Debatten om de bakomliggande orsakerna till hälsoojämlikhet tog fart efter att rapporten "the Black Report" kom ut i Storbritannien på 1980-talet. I denna rapport konstaterades att ojämlikheten i hälsa hade ökat mellan socioekonomiska grupper trots införandet av fri sjukvård och andra samhällsförbättringar. Orsakerna till den ökande ojämlikheten har sedan dess debatterats och ett antal teorier har lagts fram för att förklara fenomenet. Fortfarande råder det dock oenighet kring hur de olika bakomliggande faktorerna leder fram till skillnaderna i hälsa. Internationella organisationer har samtidigt arbetat för att minska skillnaderna, bland annat WHO som 2008 bildades "the Commission on Social Determinants of Health". Denna kommission slog fast i sin rapport att vi alla har en moralisk plikt att minska skillnaderna i hälsa; "Att ställa dessa skillnader till rätta handlar om social rättvisa. Att minska hälsoojämlikhet är för kommissionen ett etiskt imperativ". Rätten till bästa möjliga hälsa slås också fast i Barnkonventionen, artikel 24. För att kunna minska hälsoojämlikheter behöver man studera inom vilka områden/sjukdomar skillnader uppstår och varför, med målet att utforma åtgärder för att minska skillnaderna. Denna avhandling syftar till att studera socioekonomiska skillnader i barns hälsa. Avhandlingen baseras på data från den svenska prospektiva födelsekohortstudien Alla Barn i Sydöstra Sverige (ABIS). Social ojämlikhet i övervikt och obesitas jämförs även med den sociala ojämlikheten i motsvarande data från födelsekohorter i fem andra höginkomstländer; Nederländerna, Kanada, Storbritannien, Australien och USA. Resultaten från Studie 1 visade att socioekonomiska skillnader i risken att utveckla obesitas kan upptäckas redan vid 2 års ålder och att denna skillnad i risk ökade under uppväxten. I tonåren fra

PURPOSE: Explore perceived access to, the need for, use of, and satisfaction with telemedicine services for contraceptive counselling and prescription-renewal-only during the COVID-19 pandemic, and the impact of the COVID-19 pandemic period on the choice and use of contraceptives. MATERIALS AND METHODS: Internet-based e-survey of Swedish women of fertile age, 16-49 years. RESULTS: In total, 1016 participants completed the survey. Most participants (69.7%) rated their access to contraceptive services 'as usual'. Among the remaining participants, a higher proportion rated their access as deteriorated (73.4%) compared to improved (26.6%; p < 0.001). In total, 38.0% reported a need for contraceptive counselling, whereof 14.0% had used telemedicine for counselling and reported high satisfaction. Telemedicine for prescription-renewal-only was used by 15.1% of the total population. Two per cent reported use of another contraceptive than their intended, whereof long-acting reversible contraceptives were the most common intended method. The proportion of current contraceptive users was lower than in 2017 (62.4% vs 71.1%, p < 0.001), and current users of long-acting reversible contraception decreased from 30.6% to 19.3% (p < 0.001). CONCLUSIONS: During the COVID-19 pandemic period, most women found their access to contraceptive services unaffected, but more women felt that it had deteriorated than improved. The use of telemedicine was low, and the use of contraception overall fell. Efforts are needed to raise awareness of available services, and TM-provided interventions for maintained quality of care and informed decision-making remain to be evaluated. SHORT CONDENSATION The COVID-19 period imposed a change in contraceptive service provision, and efforts are needed to raise awareness of available services, including telemedicine. Access to all contraceptives, including LARCs, is crucial and telemedicine-provided interventions need evaluation.

Parenthood can be defined by the contradiction that it is one of the most satisfying yet stressful experiences in life. Many parents experience stress during parenthood, and some to the extent that they display symptoms of parental burnout. Nevertheless, research on parental burnout is scant and many studies have only examined the condition in Western settings. The aim of this study was to examine parental burnout among Somali mothers in Mogadishu, Somalia, and its association with certain psychological, psychosocial, and sociodemographic factors. In this cross-sectional study, questionnaire data were collected through the measurements Parental Burnout Assessment and Patient Health Questionnaire 9, as well as through social and demographic questions. A total of 882 Somali mothers in Mogadishu participated. The analysis methods used were univariate, bivariate, and multiple linear regression analysis. The results revealed that the mean parental burnout score was low in the sample. Additionally, a significant association was found between higher levels of parental burnout and higher levels of depression, perceived lack of social support, being unmarried, having a low monthly household income, and when the youngest child was of school-age.

Purpose: The reasons for and experiences during migration, as well as additional stressors in the new host country, may give rise to mental health problems and additional need for public services. The purpose of the study was to investigate factors related to service utilization among newly arrived refugee youth. Design/methodology/approach: Cross-sectional data were gathered in Sweden where 37 youth aged between 19 and 23 reported on factors related to service utilization, encompassing health-care and support services in school. These factors included predisposition (demographic), need (migration status and mental wellbeing) and enablement (living situation). Service utilization was estimated using multiple logistic regression analysis. Findings: About a fourth of the sample used psychosocial services. Use of general support was more common. Neither predisposing, need nor enabling factors were associated with the use of psychosocial or general health-related services. Originality/value: Self-reported factors related to use of health-related services have previously not been investigated for refugee youth, which is important in assuring access to appropriate services for this exposed youth population. © 2023, Camilla Nystrand, Fatumo Osman, Charles Lindell, Frida Olsson and Natalie Durbeej.

Objective: Early childhood functional difficulty poses a substantial worldwide public health challenge, leading to adverse effects on children’s quality of life and overall productivity. Moreover, it represents a significant social and economic problem in Bangladesh. Therefore, the current study aimed to identify factors contributing to childhood functional difficulty in Bangladesh within the context of urban–rural areas. Methods: A nationally representative cross-sectional survey data from Multiple Indicator Cluster Survey (MICS), 2019 in Bangladesh was used in this study. Chi-square test and multivariable logistic regression analyses were carried out to identify factors associated with childhood functional difficulty. Results: Functional difficulties were found in approximately 3.3% of children 2–4 years of age in urban areas and 2.5% in rural areas. Having a mother with functional difficulties and undernutrition were identified as significant factors common in both urban and rural areas. Further, mothers who had no formal education (AOR = 2.76, 95%CI = 1.18–6.45) and experienced infant death (AOR = 1.94, 95%CI = 1.01–3.70) were identified as significant factors of functional difficulty in urban areas. On the other hand, in rural areas, no access to mass media, children with acute respiratory infection (ARI) (AOR = 2.13, 95%CI = 1.39–3.28), female sex (AOR = 0.69, 95%CI = 0.53–0.91), child undernutrition (AOR = 1.73, 95%CI = 1.32–2.27) and poorer socio-economic status (AOR = 1.95, 95%CI = 1.08–3.55) were found significant factors. Conclusion: Functional difficulty was found to be present in one out of every 35 children age 2 to 4 years in Bangladesh. Childhood functional difficulties were reported slightly higher in urban areas as compared to rural areas. Reducing childhood difficulties in urban areas demands comprehensive strategies: quality healthcare, inclusive education, community support, better information systems, and collaboration. To achieve urban–rural p

Violence is a growing social and public health problem affecting all societies in low-middle- and high-income settings. However, teaching, research and prevention practices are often approached within single disciplines. Therefore, this perspective paper discusses an approach where violence can be seen as an object of teaching, research, and prevention practices, at the nexus of four disciplines, public health, social work, criminology, and psychology respectively.

Background: Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system. Objectives: The aim of the study was to determine whether having a named GP is associated with hospital service use. Methods: The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register). Results: A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis. Conclusion: A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized., CC BY 4.0 DEEDCC0 1.0 DEED© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Correspondence Address: E. Lautamatti; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; email: emmi.lautamatti@tuni.fiOpen access funding provided by Tampere University (including Tampere University Hospital). A personal grant was awarded to the corresponding author by the Foundation of General Practice, General Practitioners in Finland (GPF), Tampere University Hospital, The Finnish Medical Association and The Finnish Medical Foundation (No. 7045).

OBJECTIVE: This study examined BMI in young men and incident site-specific cancer to estimate population attributable fractions due to BMI based on projected obesity prevalence. METHODS: A population-based cohort study with measured height and weight at age 18. Cox regression models assessed linear associations for BMI and included age, year, and site of conscription as well as parental level of education as covariates. RESULTS: Primary analyses were performed in 1,489,115 men, of whom 78,217 subsequently developed cancer during a mean follow-up of 31 years. BMI was linearly associated with risk of developing all 18 site-specific cancers assessed (malignant melanoma; leukemia; myeloma; Hodgkin lymphoma; non-Hodgkin lymphoma; and cancer in the lungs, head and neck, central nervous system, thyroid, esophagus, stomach, pancreas, liver and gallbladder, colon, rectum, kidney, and bladder), in some instances evident at BMI levels usually defined as normal (20-25 kg/m2 ). Higher BMI was associated with lower risk of prostate cancer. The highest hazard ratios and population attributable fractions were seen for some gastrointestinal cancers. CONCLUSIONS: This study reports linear associations between BMI at age 18 and subsequent site-specific cancers, calling for rapid action to stem the obesity epidemic and to prepare the health care system for steep increases in cancer cases.

Food security is an enduring sustainability challenge in the Southern African region. Food availability, accessibility and affordability have profound health impacts and affect the quality of life of a substantial proportion of the world’s population. This article aims to explore, together with students in educational settings, questions about the relationships between food and health, including the contextual conditions of food availability, accessibility and affordability. This provides opportunities to re-embody food by contextualising it as part of natural and built environments, thus engaging with how challenges of human health intersect with animal and environmental health. The research centres on co-creating knowledge with youth based on their valued beings and doings about health and considers how their health goals relate to food and the sustainability challenges of antimicrobial resistance (AMR). By considering how youths’ understandings, evaluations and decisions regarding health, including setting health goals, intersect with the determinants of food, we come to consider their health literacy capabilities to achieve nonpredetermined health goals that align with their valued beings and doings. As such, the implementation gap between knowing and doing is bridged through practices of health and well-being contextually grounded in the lives and experiences of the student youth.

Det kan inte vara acceptabelt att tusentals svenskar ska bli sjuka varje år på grund av luften de andas. Nu finns ett guldläge för regeringen att agera, skriver en bred koalition av folkhälsoaktörer.

I årtionden har begreppen folkhälsa, hälsa och hälsofrämjande använts i relation till idrott på många sätt i såväl praktik, forskning som i policy. Att idrotten har någon slags betydelse för och koppling till folkhälsan torde vara helt klarlagt. Men hur kan vi förstå relationen eller kanske snarare relationerna mellan idrott och folkhälsa? Ett forskningsområde som tar tag i relationen idrott och folkhälsa och som också breddar vad relationen kan bestå av är forskningsfältet idrotten som hälsofrämjande arena (Health promoting sports clubs). I artikeln kommer vi därför att med utgångspunkt i forskning om idrotten som hälsofrämjande arena teoretisera relationen idrott - folkhälsa. Vi kommer därigenom diskutera och illustrera hur vi på fler än ett sätt kan öka förståelsen för idrotten som hälsofrämjande för så många som möjligt så länge som möjligt.

BACKGROUND AND OBJECTIVES: Low socioeconomic status (SES) is associated with increased risk of death and disability after stroke, but interventional targets to minimize disparities remain unclear. We aim to assess the extent to which SES-based disparities in the association between low SES and death and dependency at three months after stroke could be eliminated by offsetting differences in comorbidity, stroke severity, and acute care. METHODS: This nationwide register-based cohort study included all 72 hospitals caring for patients with acute stroke in Sweden. All patients registered with an acute ischemic stroke in the Swedish Stroke Register in 2015-2016 who were independent in activities of daily living (ADL) at the time of stroke were included. Data on survival and SES the year before stroke were retrieved by cross-linkage with other national registers. SES was defined by education and income, and categorized into low, mid, and high. Causal mediation analysis was used to study the absolute risk of death and ADL-dependency at 3 months depending on SES, and to what extent hypothetical interventions on comorbidities, stroke severity, and acute care would equalize outcomes. RESULTS: Of the 25,846 patients in the study, 6,798 (26.3%) were dead or ADL-dependent three months after stroke. Adjusted for sex and age, low SES was associated with an increased absolute risk of 5.4% (95% CI: 3.9%-6.9%; p<0.001) compared to mid SES, and 10.1% (95% CI: 8.1%-12.2%; p<0.001) compared to high SES. Intervening to shift the distribution of all mediators among patients with low SES to those of the more privileged groups would result in absolute reductions of these effects by 2.2% (95% CI: 1.2%-3.2%; p<0.001), and 4.0% (95% CI: 2.6%-5.5%; p<0.001), respectively, with the largest reduction accomplished by equalizing stroke severity. DISCUSSION: Low SES patients have substantially increased risks of death and ADL-dependency three months after stroke compared to more privile

BACKGROUND: In line with international trends acknowledging the importance of Primary Health Care (PHC) for improving population health and reducing health inequalities, the Swedish health system is undergoing a restructuring towards the coordinated development of a modern, equitable, accessible, and effective system, with PHC principles and functions at its core. Since discursive analyses of documents underpinning PHC reforms are scarce in Sweden and beyond, the aim of this study was to explore how the reorientation towards good quality and local health care has been represented in official government reports. METHODS: Based on a policy-as-discourse analysis, four Swedish Government Official Reports underpinning the good quality and local health care reform were interrogated following four questions of Bacchi's "What's the Problem Represented to be?" (WPR) approach. By applying the first WPR question, concrete proposals guiding the reorientation were identified, analyzed and thematized into candidate problem representations. These problem representations were then analyzed in relation to previous empirical and conceptual research considering WPR questions two and three, which resulted in the development of three problem representations. Potential silences that the problem representations might produce were then identified by applying WPR question four. RESULTS: The three problem representations connected the Swedish health system "problem" to a narrow mission, a siloed structure, and a front-line service disconnected, especially from the needs and preferences of individual patients. By representing the problem along these lines, the analysis also illustrated how the policy reorientation towards good quality and local health care risk silencing important PHC aspects such as health promotion, equitable access, and human resources. CONCLUSION: The results from this study indicate that as discursively framed within concrete proposals, government official reports in Swe

Background: Climate change is projected to result in increased heat events and decreased cold events. This will substantially impact human health, particularly when compounded with demographic change. This study employed the Spatial Synoptic Classification (SSC) to categorize daily weather into one of seven types. Here we estimated future mortality due to extremely hot and cold weather types under different climate change scenarios for one southern (Stockholm) and one northern (Jämtland) Swedish region. Methods: Time-series Poisson regression with distributed lags was used to assess the relationship between extremely hot and cold weather events and daily deaths in the population above 65 years, with cumulative effects (6 days in summer, 28 days in winter), 1991 to 2014. A global climate model (MPI-M-MPI-ESM-LR) and two climate change scenarios (RCP 4.5 and 8.5) were used to project the occurrence of hot and cold days from 2031 to 2070. Place-specific projected mortality was calculated to derive attributable numbers and attributable fractions (AF) of heat- and cold-related deaths. Results: In Stockholm, for the RCP 4.5 scenario, the mean number of annual deaths attributed to heat increased from 48.7 (CI 32.2–64.2; AF = 0.68%) in 2031–2040 to 90.2 (56.7–120.5; AF = 0.97%) in 2061–2070, respectively. For RCP 8.5, heat-related deaths increased more drastically from 52.1 (33.6–69.7; AF = 0.72%) to 126.4 (68.7–175.8; AF = 1.36%) between the first and the last decade. Cold-related deaths slightly increased over the projected period in both scenarios. In Jämtland, projections showed a small decrease in cold-related deaths but no change in heat-related mortality. Conclusions: In rural northern region of Sweden, a decrease of cold-related deaths represents the dominant trend. In urban southern locations, on the other hand, an increase of heat-related mortality is to be expected. With an increasing elderly population, heat-related mortality will outweigh cold-related mortality

Background: Aedes (Stegomyia)-borne diseases are an expanding global threat, but gaps in surveillance make comprehensive and comparable risk assessments challenging. Geostatistical models combine data from multiple locations and use links with environmental and socioeconomic factors to make predictive risk maps. Here we systematically review past approaches to map risk for different Aedes-borne arboviruses from local to global scales, identifying differences and similarities in the data types, covariates, and modelling approaches used. Methods: We searched on-line databases for predictive risk mapping studies for dengue, Zika, chikungunya, and yellow fever with no geographical or date restrictions. We included studies that needed to parameterise or fit their model to real-world epidemiological data and make predictions to new spatial locations of some measure of population-level risk of viral transmission (e.g. incidence, occurrence, suitability, etc.). Results: We found a growing number of arbovirus risk mapping studies across all endemic regions and arboviral diseases, with a total of 176 papers published 2002–2022 with the largest increases shortly following major epidemics. Three dominant use cases emerged: (i) global maps to identify limits of transmission, estimate burden and assess impacts of future global change, (ii) regional models used to predict the spread of major epidemics between countries and (iii) national and sub-national models that use local datasets to better understand transmission dynamics to improve outbreak detection and response. Temperature and rainfall were the most popular choice of covariates (included in 50% and 40% of studies respectively) but variables such as human mobility are increasingly being included. Surprisingly, few studies (22%, 31/144) robustly tested combinations of covariates from different domains (e.g. climatic, sociodemographic, ecological, etc.) and only 49% of studies assessed predictive performance via out-of-sampl

BACKGROUND: The per capita health expenditure (HE) and share of gross domestic product (GDP) spending on elderly healthcare are expected to increase. The gap between health needs and available resources for elderly healthcare is widening in many developing countries, like Tanzania, leaving the elderly in poor health. These conditions lead to catastrophic HEs for the elderly. This study aimed to analyse the association between measures of health, wealth, and medical expenditure in rural residents aged 60 years and above in Tanzania. METHODS: The data of this study were collected through a cross-sectional household survey to residents aged 60 years and above living in Nzega and Igunga districts using a standardised World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) and European Quality of Life Five Dimension (EQ-5D) questionnaires. The quality of life (QoL) was estimated using EQ-5D weights. The wealth index was generated from principal component analysis (PCA). The linear regression analyses (outpatient/inpatient) were performed to analyse the association between measures of health, wealth, medical expenditure, and socio-demographic variables. RESULTS: This study found a negative and statistically significant association between QoL and HE, whereby HE increases with the decrease of QoL. We could not find any significant relationship between HE and social gradients. In addition, age influences HE such that as age increases, the HE for both outpatient and inpatient care also increases. CONCLUSION: The health system in these districts allocate resources mainly according to needs, and social position is not important. We thus conclude that the elderly of lower socio-economic status (SES) was subjected to similar health expenditure as those of higher socio-economic status. Health, not wealth, determines the use of medical expenditures.

We explore staying and migration behaviour using a multigenerational perspective on local ties. Based on Swedish register data, we take a shared birthplace between young adults and one or more of their parents and grandparents as a proxy for multigenerational local ties in the young adult's birthplace. Our aim is to investigate whether the presence of this type of longstanding, multigenerational local ties in the birthplace increases one's propensity to stay or return there during young adulthood. Using multinomial logistic regressions, we model the residential trajectories between ages 18 and 30 of individuals born in 1981, 1982, and 1983 who lived in their birthplace at age 18 (i.e., stayed in, moved from, or returned to the birthplace by age 30; N = 185,897). We find that the propensity for staying in one's birthplace increases with each additional parent or grandparent with whom the birthplace is shared. Overall, differences between ties shared with parent(s) and grandparent(s) are surprisingly similar, except ties that are shared with both parents. These have a particularly strong and positive effect. Although men seem to be tied more strongly than women to their fathers and paternal grandparents, we found no differences between men and women in their ties to mothers and maternal grandparents.

Communities are aging and becoming more segregated, leading to fractured relationships between generations. Intergenerational exchange has improved cohesion, particularly when different generations engage as equal partners. This paper presents a systematic review of intergenerational studies between adolescents and older adults. Thirteen papers were reviewed using PRISMA guidelines, and outcomes, methodological quality, facilitators, and barriers identified, to better understand effectiveness and inform recommendations for future practice. The framework informed quality assessment, and the papers were rated moderate or high quality. Unfortunately, heterogeneity across studies rendered comparison challenging. Further attention is required to elucidate guidelines for implementing and reporting intergenerational studies.Contribution to the Field This review demonstrated how non-familial intergenerational programs involving adolescents and older adults provided benefits to both. Benefits for older adults included improved wellbeing, cognitive, and social engagement.Benefits for adolescents were identity formation and skill development. Shared outcomes for both generations were improved attitudes and stereotypes, reduced generational gap, and solidarity.High variability in program design, methodology, and sample size was evident across studies. However, it highlighted the suitability of IG engagement across differing contexts.Future recommendations included facilitator training, diverse samples, and longitudinal methodological designs.

Background: Patients with adrenal insufficiency (AI) have excess morbidity and mortality related to infectious disorders. Whether patients with AI have increased morbidity and mortality from COVID-19 is unknown. Methods: In this linked Swedish national register-based cohort study, patients with primary and secondary AI diagnosis were identified and followed from 1 January 2020 to 28 February 2021. They were compared with a control cohort from the general population matched 10:1 for age and sex. The following COVID-19 outcomes were studied: incidence of COVID-19 infection, rates of hospitalization, intensive care admission and death. Hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for socioeconomic factors and comorbidities were estimated using Cox regression analysis. Results: We identified 5430 patients with AI and 54,300 matched controls: There were 47.6% women, mean age was 57.1 (standard deviation 18.1) years, and the frequency of COVID-19 infection was similar, but the frequency of hospitalization (2.1% vs. 0.8%), intensive care (0.3% vs. 0.1%) and death (0.8% vs. 0.2%) for COVID-19 was higher in AI patients than matched controls. After adjustment for socioeconomic factors and comorbidities, the HR (95% CI) was increased for hospitalization (1.96, 1.59–2.43), intensive care admission (2.76, 1.49–5.09) and death (2.29, 1.60–3.28). Conclusion: Patients with AI have a similar incidence of COVID-19 infection to a matched control population, but a more than twofold increased risk of developing a severe infection or a fatal outcome. They should therefore be prioritized for vaccination, antiviral therapy and other appropriate treatment to mitigate hospitalization and death.

Background: While integral to decentralising health reforms, Community Health Workers (CHWs) in South Africa experience many challenges. During COVID-19, CHW roles changed rapidly, shifting from communities to clinics. In the contexts of new roles and re-engineered primary healthcare (PHC), the objectives were to: (a) implement a training intervention to support local decision-making capability of CHWs; and (b) assess learning and impacts from the perspectives of CHWs. Methods: CHWs from three rural villages (n = 9) were trained in rapid Participatory Action Research (PAR) with peers and community stakeholders (n = 33). Training equipped CHWs with tools and techniques to convene community groups, raise and/or respond to local health concerns, understand concerns from different perspectives, and facilitate action in communities and public services. CHWs’ perspectives before and after the intervention were gained through semi-structured interviews. Data were collected and analysed using the decision space framework to understand local actors’ power to affect devolved decision-making. Results: CHWs demonstrated significant resilience and commitment in the face of COVID-19. They experienced multiple, intersecting challenges including: limited financial, logistical and health systems support, poor role clarity, precarious employment, low and no pay, unstable organisational capacity, fragile accountability mechanisms and belittling treatment in clinics. Together, these restricted decision space and were seen to reflect a low valuing of the cadre in the system. CHWs saw the training as a welcome opportunity to assert themselves as a recognised cadre. Regular, spaces for dialogue and mutual learning supported CHWs to gain tools and skills to rework their agency in more empowered ways. The training improved management capacity, capabilities for dialogue, which expanded role clarity, and strengthened community mobilisation, facilitation and analysis skills. Development of pub, On behalf of the Verbal Autopsy with Participatory Action Research (VAPAR)/Wits/Mpumalanga Department of Health Learning Platform.Correction: Lucia D’Ambruoso, Nana Akua Abruquah, Denny Mabetha, Maria van der Merwe, Gerhard Goosen, Jerry Sigudla, Sophie Witter on behalf of the Verbal Autopsy with Participatory Action Research (VAPAR)/Wits/Mpumalanga Department of Health Learning Platform. Human Resources for Health. 2023;21;1, Article number 78. DOI: 10.1186/s12960-023-00863-z

Purpose: Sarcopenia and myosteatosis, quantified via computed tomography (CT), are associated with poor colorectal cancer outcomes. These body composition estimates can be influenced by physical exercise. We explored the correlation between pre-diagnostic physical exercise, body composition close to diagnosis, and the combined prognosis impact of these factors. Methods: We studied 519 stage I–III colorectal cancer (CRC) cases diagnosed 2000–2016 with pre-diagnostic self-reported recreational physical exercise data collected in the prospective, population-based Northern Sweden Health and Disease Study, and CT-estimated skeletal muscle index (SMI) or skeletal muscle density (SMD). Risk estimates were calculated by multivariable logistic regression and Cox proportional hazards models. Results: No association was seen between low pre-diagnostic physical exercise and sarcopenia/myosteatosis in the multivariable model adjusted for age, sex, educational level, tumor stage, and tumor location. In multivariable Cox regression models, the combination of low pre-diagnostic physical exercise and either sarcopenia or myosteatosis at the time of diagnosis was associated with cancer-specific mortality compared to the reference group of high physical exercise combined with no sarcopenia/myosteatosis (adjusted HR 1.94 95% CI 1.00–3.76 for sarcopenia and adjusted HR 2.39 95% CI 1.16–4.94 for myosteatosis). Conclusions: The combined presence of low pre-diagnostic physical exercise and sarcopenia or myosteatosis was associated with increased CRC-specific mortality. Despite the positive effect on prognosis, physical exercise did not alter body composition estimates at diagnosis, which could indicate attenuation from other factors.

Well-documented scientific evidence indicates that mobile health (mHealth) apps can improve the quality of life, relieve symptoms, and restore health for patients. In addition to improving patients' health outcomes, mHealth apps reduce health care use and the cost burdens associated with disease management. Currently, patients and health care providers have a wide variety of choices among commercially available mHealth apps. However, due to the high resource costs and low user adoption of mHealth apps, the cost-benefit relationship remains controversial. When compared to traditional expert-driven approaches, applying human-centered design (HCD) may result in more useable, acceptable, and effective mHealth apps. In this paper, we summarize current HCD practices in mHealth development studies and make recommendations to improve the sustainability of mHealth. These recommendations include consideration of factors regarding culture norms, iterative evaluations on HCD practice, use of novelty in mHealth app, and consideration of privacy and reliability across the entire HCD process. Additionally, we suggest a sociotechnical lens toward HCD practices to promote the sustainability of mHealth apps. Future research should consider standardizing the HCD practice to help mHealth researchers and developers avoid barriers associated with inadequate HCD practices.

Introduction: Interest in applying systems thinking (ST) in public health and healthcare improvement has increased in the past decade, but its practical use is still unclear. ST has been found useful in addressing the complexity and dynamics of organizations and welfare systems during periods of change. Exploring how ST is used in practice in national policy programs addressing complex and ill-structured problems can increase the knowledge of the use and eventually the usefulness of ST during complex changes. In ST, a multi-level approach is suggested to coordinate interventions over individual, organizational, and community levels, but most attempts to operationalize ST focus on the individual level. This study aimed to investigate how ST is expressed in policy programs addressing wicked problems and describe the specific action strategies used in practice in a national program in Sweden, using a new conceptual framework comprising ST principles on the organizational level as an analytical tool. The program addresses several challenges and aims to achieve systems change within women's healthcare. Methods: The case study used a rich set of qualitative, longitudinal data on individual, group, and organizational levels, collected during the implementation of the program. Deductive content analysis provided narrative descriptions of how the ST principles were expressed in actions, based on interviews, observations, and archival data. Results: The results showed that the program management team used various strategies and activities corresponding to organizational level ST. The team convened numerous types of actors and used collaborative approaches and many different information sources in striving to create a joint and holistic understanding of the program and its context. Visualization tools and adaptive approaches were used to support regional contact persons and staff in their development work. Efforts were made to identify high-leverage solutions to problems influ

Reablement aims to enable older persons with functional decline to re-engage in meaningful activities. The benefits of engagement in outdoor activities are significant; however, reablement services primarily target function in indoor environments whereas descriptions of outdoor activities are sparse. The aim of this study was to create a model that integrates outdoor recreation into reablement. We therefore elaborated on an experienced based co-design methodology to create a model that integrates outdoor recreation for older persons in reablement in an Arctic, rural context in northern Norway. Stakeholders (N = 35), including reablement participants, participated in workshops, focus groups, and individual interviews. Based on the results, we co-created a person-centred model for outdoor recreation in reablement, including an assessment tool that can guide reablement staff in goal-setting practices. Accordingly, we argue that cherished locations holds significant meaning in the lives of older people and warrant recognition in reablement programmes. There is a need to evaluate the effects and feasibility of the model and the possibility for its implementation in other health care settings.

BACKGROUND: Vaccination plays a critical role during pandemics, and mass vaccination clinics are often an imperative public health measure. These clinics usually consist of multi-disciplinary teams, which can pose significant coordination challenges, yet also present an opportunity for collectively contributing towards mitigating the impact of infection within communities. This study explores the coordination dynamics of the Region of Waterloo's coronavirus disease of 2019 (COVID-19) mass vaccination clinics in Ontario, Canada, between July 2021 and April 2022. METHODS: This qualitative study included 16 purposively selected participants working in mass vaccination clinics. Participants were individually interviewed for 40-60 min. An inductive and iterative thematic analysis was undertaken, including open coding, grouping, labelling, regrouping and making sense of the themes. RESULTS: Three interrelated themes were created: (1) unpredictable work environment, which was comprised of changing clinic processes and the impact of clinic adjustments to the running of the clinics; (2) clinic cohesion challenges, which included staff role disparities, limited job preparation and clinic system silos; and (3) adaptable and supportive work environment, which was comprised of staff adaptability, dispositional flexibility and a supportive work environment. While the first two themes created a precarious situation in the clinics, the third countered it, leading to a largely successful clinic implementation. CONCLUSIONS: The rapid evolution and high transmissibility of COVID-19 in communities required a public health response that felt like flying and building a plane simultaneously - a seemingly impossible yet necessary task. However, an adaptable and supportive work environment was critical for establishing an atmosphere that can overcome challenges from a constantly changing pandemic and the guidance of public health officials. Such lessons gained from understanding the dynamic

Beginning January of 2020, COVID-19 cases detected in Arctic countries triggered government policy responses to stop transmission and limit caseloads beneath levels that would overwhelm existing healthcare systems. This review details the various restrictions, health mandates, and transmission mitigation strategies imposed by governments in eight Arctic countries (the United States, Canada, Greenland, Norway, Finland, Sweden, Iceland, and Russia) during the first year of the COVID-19 pandemic, through 31 January 2021s31 January 2021. We highlight formal protocols and informal initiatives adopted by local communities in each country, beyond what was mandated by regional or national governments. This review documents travel restrictions, communications, testing strategies, and use of health technology to track and monitor COVID-19 cases. We provide geographical and sociocultural background and draw on local media and communications to contextualise the impact of COVID-19 emergence and prevention measures in Indigenous communities in the Arctic. Countries saw varied case rates associated with local protocols, governance, and population. Still, almost all regions maintained low COVID-19 case rates until November of 2020. This review was produced as part of an international collaboration to identify community-driven, evidence-based promising practices and recommendations to inform pan-Arctic collaboration and decision making in public health during global emergencies.

Frågan om sexuellt våld har under de senaste åren fått ett allt större utrymme i Sápmi. I denna artikel, som baseras påden populationsbaserade studien «Samisk hälsa på lika villkor» (Samisk HLV) 2021, undersöks utsatthet för sexuelltvåld bland samiska kvinnor och män i Sverige jämfört med kvinnor och män i Sveriges befolkning. Analysen visaratt sexuellt våld mot kvinnor utgör ett mycket omfattande samhällsproblem i det samiska samhället, i minst sammaomfattning som i övriga Sverige. Samiska kvinnor rapporterar en signifikant högre utsatthet för flera former av sexuelltvåld jämfört med kvinnor i Sverige, däribland utsatthet för våldtäkt och våldtäktsförsök. Analysen visar även attsamiska kvinnor är mer benägna att söka vård samt polisanmäla efter övergreppet, vilket nyanserar bilden av en tystnadkring sexuellt våld i Sápmi. Utifrån ett urfolksfeministiskt perspektiv belyser artikeln hur könade och kolonialamaktrelationer samspelar vad gäller utsatthet för sexuellt våld i Sverige och att positionen som både kvinna och sameökar utsattheten för sexuellt våld, medan att vara man och same inte gör det. Sammantaget pekar artikeln på att bådekön och samisk tillhörighet har betydelse för utsatthet för sexuellt våld och därmed på vikten av att inkludera samiskaperspektiv i framtida forskning om, och politiska insatser mot, sexuellt våld., The issue of sexual violence has in recent years gained increased attention in Sápmi. Based on the population-basedstudy «Sámi Health on Equal Terms» (SámiHET) 2021, this paper examines exposure to sexual violence among Sámiwomen and men in Sweden, compared to women and men in the Swedish population. The analysis shows that sexualviolence against women constitutes a significant problem in the Sámi society, to at least the same extent as in the restof Sweden. Sámiwomen report a significantly higher exposure to several forms of sexual violence compared towomenin Sweden, including exposure to rape and attempted rape. The analysis also shows that Sámi women are more likelyto seek healthcare and report to the police after sexual abuse, which nuances the image of a passive silence surroundingsexual violence in Sápmi. Drawing on Indigenous feminist perspectives, the article highlights how gendered andcolonial power relations interact in terms of vulnerability to sexual violence in Sweden and that the position of beinga Sámi woman increases exposure to sexual violence, while being a Sámi man does not. In sum, the results show thatboth gender and Sámi Indigeneity affect exposure to sexual violence, which points to the need to include Sámi perspectivesin future research on, and political efforts against, sexual violence.

Background: Rheumatic Heart Disease (RHD) causes high morbidity and mortality rates among children and young adults, impacting negatively on their health-related quality of life (HRQoL). This study aimed to evaluate the HRQoL and healthcare consultations of adult patients with RHD in Namibia. Methods: From June 2019 to March 2020, a questionnaire was administered to 83 RHD patients during routine follow-ups. The EQ-5D-5L instrument was used to assess the health-related quality of life before diagnosis and at the time of the survey. The Ethiopian value set for EQ-5D-5L was used to calculate Quality-Adjusted Life Years (QALY). Results: Most respondents were women (77%), young adults below the age of 30 years (42%), and individuals who grew up in rural areas (87%). The mean QALY statistically significantly improved from 0.773 pre-diagnosis to 0.942 in the last 12 months (p < 0.001). Sixty-six patients who had surgery reported a better QALY. Healthcare visits statistically significantly increased from on average 1.6 pre-diagnosis to 2.7 days in the last 12 months (p < 0.001). The mean distance to the nearest facility was 55 km, mean cost of transport was N$65, and mean time spent at the clinic was 3.6 h. The median time from diagnosis to the survey was 7 years (quartiles 4 and 14 years). Conclusion: Treatment and surgery can improve HRQoL substantially among RHD patients. Being diagnosed with RHD affects patients living in socioeconomically disadvantaged rural areas through cost and time for healthcare visits. It would be valuable with further research to understand differences between disease severities.

BACKGROUND: Nearly one-in-two Vietnamese men smoke cigarettes placing them among the highest tobacco consumers in the world. Despite the need for smoking cessation to curb the burden of tobacco-related diseases in Vietnam, this rate remains at less than 30%. Therefore, this study examines individual-, social- and policy factors associated with smoking cessation among adult male smokers in Vietnam. METHODS: We established a longitudinal International Tobacco Control study of male smokers in Hanoi, Vietnam, in September 2018. This paper analyses 1525 men who participated in baseline and one-year follow-up. We applied a weighted multivariable logistic regression to examine the association between smoking cessation and individual-, social- and policy predictors. RESULTS: At follow-up, 14.8% of participants had quit smoking for at least 30 consecutive days during the last year. Among the persistent smokers, 56.6% expressed intention to quit smoking. Factors associated with smoking cessation included a lower number of cigarettes smoked per day (aOR = 0.96, 95% CI: 0.94, 0.99) and having several attempts to quit smoking (aOR = 2.16, 95% CI 1.13, 4.12). Intention to quit smoking was associated with multiple quit attempts, a chronic condition diagnosis, more tobacco-related knowledge, greater self-efficacy, and more worries about their future health. The perceived impact of smoke-free policy and health warning labels were positively associated with intention to quit at any stage. CONCLUSIONS: Interventions aimed at increasing smoking cessation should focus on all aspects of individual, social, and policy factors. Persistent smokers are more motivated to quit if they have made multiple quit attempts, more self-efficacy of quitting and worried about their future health, indicating that increasing smokers' beliefs and knowledge may be important for behavioural change. Health warning labels and tobacco taxation policies should be maintained and promoted as they are perceived to

To estimate the effect of a 3-year commitment to remain tobacco free on tobacco uptake among high school students in Sweden. The commitment is developed in the form of a contract between a child and a significant adult, constituting the core component of Tobacco-free Duo (T-Duo), a Swedish school-based tobacco prevention program. Secondary analysis of data from a cluster randomized controlled trial. Participants were 586 students in high schools assigned to the intervention arm of T-Duo. At inception, participants attended grade 7 (i.e., age 12–13). Only students who were tobacco naïve at baseline for the respective outcome and participated in all follow-ups were included. The exposure was defined as signing a 3-year contract with a significant adult, categorized as “stable contract” (3 years contract with the same contract partner), “unstable” (signed a contract sometime during follow-up but this was not sustained over time and/or with the same partner), and “no contract” at all during the intervention period. The primary outcome was having never tried cigarette smoking at the end of grade 9. Exposure and outcomes were self-reported in yearly questionnaires. Of 586 students, 321 (55%) held a stable contract, 204 (35%) an unstable contract, and 61 (10%) did not sign a contract at all. At the end of grade 9 (age 15–16), the relative risk (RR) to remain cigarette free was 1.11 (95% CI 1.00–1.22) (Number Needed to Treat = 10) among students in any type of contract compared to students that did not write a contract at all. The RRs for remaining tobacco free (secondary outcomes) ranged from 1.07 (0.98–1.16) for regular snus use to 1.16 (1.00–1.35) for any type of tobacco use. A commitment to remain tobacco free through a child–adult contract seems to exert a preventive effect on the uptake of tobacco use among Swedish adolescents over 3 school years. The current findings apply to a selected sample of both schools and students. Registration: Current Controlled Trials ISRC

Objectives: Diabetes mellitus (DM) is a serious public health issue that places a heavy financial, social, and health-related burden on individuals, families, and healthcare systems. Self-reported health-related quality of life (HRQoL) is extensively used for monitoring the general population's health conditions and measuring the effectiveness of interventions. Therefore, this study investigated HRQoL and associated factors among patients with type 2 DM at a primary healthcare center in Indonesia. Methods: A cross-sectional study was conducted in Klaten District, Central Java, Indonesia, from May 2019 to July 2019. In total, 260 patients with DM registered with National Health Insurance were interviewed. HRQoL was measured with the EuroQol Group's validated Bahasa Indonesia version of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) with the Indonesian value set. Multivariate regression models were used to identify factors influencing HRQoL. Results: Data from 24 patients were excluded due to incomplete information. Most participants were men (60.6%), were aged above 50 years (91.5%), had less than a senior high school education (75.0%), and were unemployed (85.6%). The most frequent health problems were reported for the pain/discomfort dimension (64.0%) followed by anxiety (28.4%), mobility (17.8%), usual activities (10.6%), and self-care (6.8%). The average EuroQoL 5-Dimension (EQ-5D) index score was 0.86 (95% confidence interval [CI], 0.83 to 0.88). In the multivariate ordinal regression model, a higher education level (coefficient, 0.08; 95% CI, 0.02 to 0.14) was a significant predictor of the EQ-5D-5L utility score. Conclusions: Patients with diabetes had poorer EQ-5D-5L utility values than the general population. DM patients experienced pain/discomfort and anxiety. There was a substantial positive relationship between education level and HRQoL.