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  • 1.
    Andrews-Chavez, Johanna
    et al.
    Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA.
    Biswas, Animesh
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gifford, Mervyn
    Department of Public Health Sciences, University of Skövde, Skövde, Sweden.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Identifying households with low immunisation completion in Bangladesh2012In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 4, no 11, p. 1088-1097Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate if the mothers’ demographics and household characteristics—including type of use of cooking fuel, energy and toilet facilities—have any implication for complete immunisation rates among their children. A cross-sectional data analysis of a nationally representative sample of 4925 women with at least one child was performed. Chisquared tests and multivariate logistic regression analyses were used. Immunisation coverage was positively associated with the mother’s education and with household characteristics such as toilet facility, electricity and involvement in a microfinance group. These findings indicate the need for further advocacy for increased knowledge on the importance of vaccination and affordable public immunisation programs focusing on higher risk households such as those with pit facilities, lack of electricity and no participation in a microfinance group. Such households warrant further attention and can be targeted for immunisation coverage.

  • 2.
    Biswas, Animesh
    et al.
    Örebro University, School of Health Sciences. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Abdullah, Abu Sayeed Md
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Halim, M.A.
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Maternal complications in a geographically challenging and hard to reach district of Bangladesh: a qualitative study2016In: F1000 Research, E-ISSN 2046-1402, Vol. 5, article id 2417Article in journal (Refereed)
    Abstract [en]

    Background: Maternal complications contribute to maternal deaths in developing countries. Bangladesh still has a high prevalence of maternal mortality, which is often preventable. There are some geographically challenging and hard to reach rural districts in Bangladesh and it is difficult to get information about maternal complications in these areas. In this study, we examined the community lay knowledge of possible pregnancy complications. We also examined the common practices associated with complications and we discuss the challenges for the community.

    Methods: The study was conducted in Moulvibazar of north east Bangladesh, a geographically challenged, difficult to reach district. Qualitative methods were used to collect the information. Pregnant women, mothers who had recently delivered, their guardians and traditional birth attendants participated in focus group discussions. Additionally, in-depth interviews were conducted with the family members. Thematic analyses were performed.

    Results: The study revealed that there is a lack of knowledge of maternal complications. In the majority of cases, the mothers did not receive proper treatment for maternal complications. There are significant challenges that these rural societies need to address: problems of ignorance, traditional myths and family restrictions on seeking better treatment. Moreover, traditional birth attendants and village doctors also have an important role in assuring appropriate, effective and timely treatment.

    Conclusions: The rural community lacks adequate knowledge on maternal complications. Reduction of the societal barriers including barriers within the family can improve overall practices. Moreover, dissemination of adequate information to the traditional birth attendant and village doctors may improve the overall situation, which would eventually help to reduce maternal deaths.

  • 3.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lao, Zhinqin
    Gifford, Mervyn
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Wang, Shu-Mei
    School of Public Health, Key Laboratory of Public Health Safety Ministry of Education, Fudan University, Shanghai, China .
    Knowledge and attitudes towards childhood injury prevention: a study of parents in Shanghai, China2012In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 6, no 11, p. 3783-3789Article in journal (Refereed)
    Abstract [en]

    Childhood injuries are a major problem worldwide. The study explored the parents' knowledge and attitudes towards childhood injury prevention in relation to theirsocioeconomic status. The study also tried to compare parents' perceptions of cause and place of child injury with actual cause and place of injury. This was a cross sectional study of 986 randomly selected parents whose children (3-6 years old) were enrolled at selected kindergartens in a 'Safe Community' in Shanghai, China. Chi-square tests and bar diagrams were used. Almost all parents (97%) thought that injury was a serious problem for their children. Around half of the parents thought that child injuries could be prevented while almost one-third (29%) of parents indicated that there were risk factors in the living environment of their children. Parental perceptions of cause of injuries and place of injuries significantly differed from that of the reality. Parents identified the most common barriers of childhood injury prevention: lack of parental attention (41.6%), environment (35.6%) and children's risky behavior (22.7%). The difference between parental opinions and reality illustrated that parents had incorrect knowledge of childhood injuries, which might lead to incorrect foci of prevention programs.

    Before tackling environmental modifications to prevent child injuries, policy makers should focus on rectifying parents' incorrect perceptions and on modifying their attitudes as key players. It is important to first raise awareness about childhood injury prevention among the parents for appropriate intervention strategies.

  • 4.
    Dalal, Koustuv
    et al.
    Dept Publ Hlth Sci, Univ Skövde, Skövde, Sweden.
    Lee, Ming Shinn
    Natl Dong Hwa Univ, Dept Curriculum Design & Human Potentials Dev, Hualien, Taiwan.
    Gifford, Mervyn
    Dept Publ Hlth Sci, Univ Skövde, Skövde, Sweden.
    Male adolescents' attitudes toward wife beating: a multi-country study in South Asia2012In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 50, no 5, p. 437-442Article in journal (Refereed)
    Abstract [en]

    Purpose: This study has aimed to address the gaps in knowledge about male adolescents and their attitudes toward wife beating in multi-country study in Bangladesh, India, and Nepal.

    Methods: The study used secondary data generated from nationally representative samples of male adolescents (aged 15-19 years) in the demographic and health surveys data in Bangladesh, India, and Nepal. These were household surveys using structured questionnaires, with 275 boys in Bangladesh, 13,078 boys in India, and 939 boys in Nepal. Chi-square tests and logistic regressions were used to assess the associations.

    Results: In Bangladesh, 42% of 275 respondents had justified wife beating; in India, 51% of 13,078 male adolescents had supported wife beating; and in Nepal, 28% of 939 respondents had supported wife abuse. Individual-level factors, such as rural residency, low educational attainment, low economic status, being unemployed, and having a history of family violence, were positively associated with the justification of wife abuse.

    Conclusions: This multi-country study indicates a general trend of male adolescents' strong supportive attitude toward wife beating, and hence may suggest that policy makers can specifically target young groups of the population for various interventions for reducing violence against women.

  • 5.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Public Health Science, University of Skövde, Skövde, Sweden.
    Lee, Ming-Shinn
    National Dong Hwa University, Hualien, Taiwan.
    Ussatayeva, Ganiel
    Kazakhstan School of Public Health, Almaty, Kazakhstan.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Female genital mutilation: multi country study2015In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 9, no 4, p. 161-167Article in journal (Refereed)
    Abstract [en]

    Objective: Female genital mutilation (FGM) is a major women’s health problem and human right violation. FGM has several physical and psychological consequences. The focus of the current study is the extent of FGM, the association of demographic and economic factors with FGM and women’s beliefs and attitudes towards FGM in Egypt, Guinea, Mali and Sierra Leone.

    Methods: The study used national representative, cross-sectional, household sample surveys with large sample of women of reproductive age (15 – 49 years) from each country. Multi stage cluster sampling and face-to-face interviews were used. It was cross-sectional analysis, using DHS data. Cross tabulation, multivariate analyses and bar-diagram were used.

    Results: In Egypt 94%, in Guinea 97%, in Mali 89% and in Sierra Leone, 91%) women had genital mutilation. The majority of the respondents believe that FGM that FGM is socially acceptable and a religious obligation. Majority of the respondents believe that FGM helps to maintain virginity and that it leads to better marriage prospects and the prevention of adultery.

    Conclusions: The majority of women in the four countries argued in favor for the continuation of FGM. There is an inverse relationship between FGM and higher education and affluence. Proper policies and awareness generation among less educated and less affluent women in rural areas are warranted in an attempt to reduce FGM.

  • 6.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lin, Zhiquin
    BGI Tech, Shenzhen, China.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Svanström, Leif
    Department of Public Health Science, School of Life Sciences, University of Skövde, Skövde, Sweden.
    Economics of global burden of road traffic injuries and their relationship with health system variables2013In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 4, no 12, p. 1442-1450Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To estimate the economic loss due to road traffic injuries (RTIs) of the World Health Organization (WHO) member countries and to explore the relationship between the economic loss and relevant health system factors.

    METHODS: Data from the World Bank and the WHO were applied to set up the databases. Disability-adjusted life year (DALY) and gross domestic product per capita were used to estimate the economic loss relating to RTIs. Regression analysis was used. Data were analyzed by IBM SPSS Statistics, Versions 20.0.

    RESULTS: In 2005, the total economic loss of RTIs was estimated to be 167,752.4 million United States Dollars. High income countries (HIC) showed the greatest economic losses. The majority (96%) of the top 25 countries with the greatest DALY losses are low and middle income countries while 48% of the top 25 countries with the highest economic losses are HIC. The linear regression model indicates an inverse relationship between nurse density in the health system and economic loss due to RTI.

    CONCLUSIONS: RTIs cause enormous death and DALYs loss in low-middle income countries and enormous economic loss in HIC. More road traffic prevention programs should be promoted in these areas to reduce both incidence and economic burden of RTIs.

  • 7.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rahman, Aminur
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    The magnitude of injury problems among child labourers in a rural community of Bangladesh: findings from an injury surveillance system2016In: International Health, ISSN 1876-3405, Vol. 8, no 1, p. 73-76Article in journal (Refereed)
    Abstract [en]

    Background: Child labour is an important topic in contemporary society. In this study we have tried to explore the magnitude of injury problems among child labourers in Bangladesh using an injury surveillance system.

    Methods: An injury surveillance system (ISS) was performed under the Prevention of Child Injuries through Social intervention and Education (PRECISE) project in Bangladesh during 2006–2010 in three sub-districts covering a population of more than 700 000. We used the ISS for assessing child labour. Appropriate epidemiological methods were considered in the study.

    Results: Considering the reported main occupation of the children, 30% of children from the surveillance households were identified as child labourers. More than two thirds of child labourers were educated to primary or secondary level. The majority of boys worked as unskilled labourers and girls were employed in domestic work. The incidence of injury and deaths among child labourers was estimated as 24 per 100 000 children years. More than 19 injury related illnesses of moderate to severe intensity were found among 1000 child labourers in a year. Fractures, sprains, dislocations, cuts/wounds, animal bites, abrasions or lacerations, burns, head injuries and internal organ injuries are most common among child labourers.

    Conclusions:Working children are at risk of injury, death and illness in Bangladesh. Child labourers are now even more clearly tied to quantified morbidity and mortality.

  • 8.
    Hugelius, Karin
    et al.
    Örebro University, School of Health Sciences.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Örtenwall, Per
    Sahlgrenska Akademin, Göteborgs universitet, Göteborg, Sweden.
    Social media can be used to recruit study participants in disaster research2016Conference paper (Refereed)
  • 9.
    Hugelius, Karin
    et al.
    Örebro University, School of Health Sciences. Karlskoga Hospital, Örebro Region County Council, Karlskoga, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences.
    Örtenwall, Per
    Sahlgrenska Akademin, Gothenburg University, Gothenburg, Sweden.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Being Both Helpers and Victims: Health Professionals' Experiences of Working During a Natural Disaster2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 2, p. 117-123Article in journal (Refereed)
    Abstract [en]

    Background: In November 2013, the Haiyan typhoon hit parts of the Philippines. The typhoon caused severe damage to the medical facilities and many injuries and deaths. Health professionals have a crucial role in the immediate disaster response system, but knowledge of their experiences of working during and in the immediate aftermath of a natural disaster is limited. Aim The aim of this study was to explore health professionals' experiences of working during and in the immediate aftermath of a natural disaster.

    Method: Eight health professionals were interviewed five months after the disaster. The interviews were analyzed using phenomenological hermeneutic methods.

    Results: The main theme, being professional and survivor, described both positive and negative emotions and experiences from being both a helper, as part of the responding organization, and a victim, as part of the surviving but severely affected community. Sub-themes described feelings of strength and confidence, feelings of adjustment and acceptance, feelings of satisfaction, feelings of powerless and fear, feelings of guilt and shame, and feelings of loneliness.

    Conclusion: Being a health professional during a natural disaster was a multi-faceted, powerful, and ambiguous experience of being part of the response system at the same time as being a survivor of the disaster. Personal values and altruistic motives as well as social aspects and stress-coping strategies to reach a balance between acceptance and control were important elements of the experience. Based on these findings, implications for disaster training and response strategies are suggested. Hugelius K , Adolfsson A , Örtenwall P , Gifford M . Being both helpers and victims: health professionals' experiences of working during a natural disaster.

  • 10.
    Hugelius, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anaesthesia, Karlskoga Hospital, Karlskoga, Sweden.
    Berg, Sara
    School of Health and Medical Science, Örebro University, Örebro, Sweden; Ambulance Department, Värmland County Council, Karlstad, Sweden.
    Westerberg, Elin
    School of Health and Medical Science, Örebro University, Örebro, Sweden; Ambulance Department, Värmland County Council, Karlstad, Sweden.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Swedish ambulance managers descriptions of crisis support for ambulance staff after potentially traumatic events2014In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 29, no 6, p. 589-592Article in journal (Refereed)
    Abstract [en]

    Introduction:Ambulance staff face complex and sometimes stressful or potentially traumaticsituations, not only in disasters but also in theirroutine daily work. The aim of this study wasto survey ambulance managers’ descriptions of crisis support interventions for ambulance staffafter potential traumatic events (PTEs).

    Methods:Semistructured interviews with a qualitative descriptive design were conductedwith six ambulance managers in a health care region in central Sweden. The data wasanalyzed using content analysis.

    Result:Five categories were found in the result: (1) description of a PTE; (2) descriptionand performance of crisis support interventions; (3) impact of working in potentiallytraumatic situations; (4) the ambulance managers’ role in crisis support interventions;and (5) the ambulance managers’ suggestions for improvement.Ambulance managersdescribed crisis support interventions after a PTE as a single, mandatory group meetingwith a structure reminiscent of debriefing. The ambulance managers also expressed doubtsabout the present structures for crisis support and mentioned an alternative approachwhich is more in line with present evidence-based recommendations.

    Conclusion:The results indicated a need for increased understanding of the importanceof the managers’ attitudes for ambulance staff; a need for further implementation ofevidence-based recommendations for crisis support interventions was also highlighted.

  • 11.
    Hugelius, Karin
    et al.
    Örebro University, School of Health Sciences.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Örtenwall, Per
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences.
    Disaster radio: A tool to meet experienced needs after the Haiyan typhoon2015Conference paper (Refereed)
  • 12.
    Hugelius, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesia, Karlskoga Hospital, Karlskoga, Sweden.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Örtenwall, Per
    Sahlgrenska Akademin, Gothenburg University, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Disaster Radio for Communication of Vital messages and Health-related Information: Experiences from the Haiyan typhoon, The Philippines2016In: Disaster Medicine and Public Health Preparedness, ISSN 1935-7893, Vol. 10, no 4, p. 591-597Article in journal (Refereed)
    Abstract [en]

    Objective: Crisis communication is seen as an integrated and essential part of disaster management measures. After Typhoon Haiyan (Yolanda) in the Philippines 2013, radio was used to broadcast information to the affected community. The aim of this study was to describe how disaster radio was used to communicate vital messages and health-related information to the public in one affected region after Typhoon Haiyan.

    Methods: Mixed-methods analysis using qualitative content analysis and descriptive statistics was used to analyze 2587 logged radio log files.

    Results: Radio was used to give general information and to demonstrate the capability of officials to manage the situation, to encourage, to promote recovery and foster a sense of hope, and to give practical advice and encourage self-activity. The content and focus of the messages changed over time. Encouraging messages were the most frequently broadcast messages. Health-related messages were a minor part of all information broadcast and gaps in the broadcast over time were found.

    Conclusion: Disaster radio can serve as a transmitter of vital messages including health-related information and psychological support in disaster areas. The present study indicated the potential for increased use. The perception, impact, and use of disaster radio need to be further evaluated.

  • 13.
    Hugelius, Karin
    et al.
    Örebro University, School of Health Sciences. Karlskoga Hospital, Örebro County Council, Karlskoga, Sweden.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Örtenwall, Per
    Sahlgrenska Akademin, Gothenburg University, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences.
    Health among disaster survivors and health professionals after the Haiyan Typhoon: a self-selected Internet-based web survey2017In: International Journal of Emergency Medicine, ISSN 1865-1372, E-ISSN 1865-1380, Vol. 10, no 1, article id 13Article in journal (Refereed)
    Abstract [en]

    Background: Natural disasters affected millions of people worldwide every year. Evaluation of disaster health and health response interventions is faced with several methodological challenges. This study aimed (1) to describe survivors' and health professionals' health, 30 months after a natural disaster using a web-based self-selected Internet sample survey designed and (2) to evaluate the health effects of disaster response interventions, in the present study with a focus on disaster radio.

    Methods: A web-based survey was used to conduct a cross-sectional study approximately 30 months after typhoon Haiyan. The GHQ-12, EQ-5D-3L, and EQ-VAS instruments were used in addition to study-specific questions. A self-selected Internet sample was recruited via Facebook.

    Results: In total, 443 survivors, from what 73 were health professionals, participated in the study. The Haiyan typhoon caused both physical and mental health problems as well as social consequences for the survivors. Mental health problems were more frequently reported than physical injuries. Health professionals reported worse overall health and a higher frequency of mental health problems compared to other survivors.

    Conclusions: There were short-term and long-term physical, psychological, and social consequences for the survivors as a result of the Haiyan typhoon. Mental health problems were more frequently reported and lasted longer than physical problems. Health professionals deployed during the disaster reported worse health, especially concerning mental health problems. The survey used was found useful to describe health after disasters. Keywords: Disaster, Natural disaster, Disaster medicine, Disaster response, Mental health, Health professionals

  • 14.
    Hugelius, Karin
    et al.
    Örebro University, School of Health Sciences.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Örtenwall, Per
    Sahlgrenska Akademin, Göteborgs universitet, Göteborg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences.
    ”The turning point of everything”: Health professionals experiences of working during a natural disaster2016Conference paper (Refereed)
  • 15.
    Hugelius, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Karlskoga Hospital, Karlskoga, Sweden.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Örtenwall, Per
    Sahlgrenska Akademin, Gothenburg University, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Center for Woman’s, Family and Child Health, Faculty of Health Science, Buskerud & Vestfold University College, Kongsberg, Norway.
    "To silence the deafening silence": Survivor's needs and experiences of the impact of disaster radio for their recovery after a natural disaste2016In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 28, p. 8-13Article in journal (Refereed)
    Abstract [en]

    In the aftermath of the Haiyan typhoon, disaster radio was used to spread information and music to the affected population. The study described survivors' experiences of being in the immediate aftermath of a natural disaster and the impact disaster radio made on recovery from the perspective of the individuals affected. Twenty eight survivors were interviewed in focus groups and individual interviews analyzed with phenomenological-hermeneutic method. Being in disaster mode included physical and psychosocial dimensions of being in the immediate aftermath of the disaster. Several needs among the survivors were expressed. Disaster radio contributed to recovery by providing facts and information that helped the survivor to understand and adapt. The music played contributed to emotional endurance and reduced feelings of loneliness. To re-establish social contacts, other interventions are needed. Disaster radio is a positive contribution to the promotion of survivors' recovery after disasters involving a large number of affected people and severely damaged infrastructure. Further studies on the use and impact of disaster radio are needed.

  • 16.
    Kihlgren, Annica
    et al.
    Örebro University, School of Health Sciences.
    Svensson, Fredrik
    Region Örebro Counties, Örebro, Sweden.
    Lövbrand, Conny
    Ambulance Department, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, School of Health Örebro University, Örebro, Sweden.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences. The Centre of Women’s Health, Faculty of Health Science, Buskerud Vestfold University College, Kongsberg, Norway.
    A Decision support system (DSS) for municipal nurses encountering health deterioration among older people2016In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, article id 63Article in journal (Refereed)
    Abstract [en]

    Backgrund: This study is part of a larger project called ViSam and includes testing of a decision support system developed and adapted for older people on the basis of M (R) ETTS (Rapid Emergency Triage and Treatment System). The system is designed to allow municipal nurses to determine the optimal level of care for older people whose health has deteriorated. This new system will allow more structured assessment, the patient should receive optimal care and improved data transmission to the next caregiver.

    Methods: This study has an explanatory approach, commencing with quantitative data collection phase followed by qualitative data arising from focus group discussions over the RNs professional experience using the Decision Support system. Focus group discussions were performed to complement the quantitative data to get a more holistic view of the decision support system.

    Results: Using elements of the decision support system (vital parameters for saturation, pain and affected general health) together with the nurses' decision showed that 94 % of the older persons referred to hospital were ultimately hospitalized. Nurses felt that they worked more systematically, communicated more effectively with others and felt more professional when using the decision support system.

    Conclusions: The results of this study showed that, with the help of a decision support system, the correct patients are sent to the Emergency Department from municipal home care. Unnecessary referrals of older patients that might lead to poorer health, decreased well-being and confusion can thus be avoided. Using the decision support system means that healthcare co-workers (nurses, ambulance/emergency department/district doctor/SOS alarm) begin to communicate more optimally. There is increased understanding leading to the risk of misinterpretation being reduced and the relationship between healthcare co-workers is improved. However, the decision support system requires more extensive testing in order to enhance the evidence base relating to the vital parameters among older people and the use of the decision support system.

  • 17.
    Lao, Zhiqin
    et al.
    Independent researcher, organisation unavailable, China.
    Gifford, Mervyn
    Department of Public Health Science, School of Life Sciences, University of Skövde, Skövde, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Public Health Science, School of Life Sciences, University of Skövde, Skövde, Sweden.
    Economic cost of childhood unintentional injuries2012In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 3, no 5, p. 303-312Article in journal (Refereed)
    Abstract [en]

    Aims: This study aims to review the economic cost of childhood (0-18 years) unintentional injuries (UI) and focuses upon comparing the cost burden between developing and developed countries.

    Methods: Articles were selected from PUBMED using the search words "Economic Cost", "Unintentional injuries" and "Children". Nine articles were selected.

    Results: Studies in China focused upon cost to hospitals, in Bangladesh they focused on personal payment in rural areas, and in Vietnam they focused upon community-based cost analysis. There was one study from Norway on UI at home. There were 5 articles from the USA focusing on submersion injury, UI insurance, unintentional traumatic brain injury, UI due to firearms and UI medical costs. The cost of childhood UI is enormous, ranging from US $516,938 to US $9,550,704 per year. This represents a large economic burden on society. Additionally, there is a large gap between lower-middle income countries (LMIC) and high income countries (HIC) in the burden of injury, injury health care and insurance systems.

    Conclusion: Different bases and contexts of studies make it difficult to draw a solid conclusion about the amount of costs of UI among children. Therefore, more studies of children's unintentional injuries should be carried out in low and middle income countries.

  • 18.
    Mei, Wang Shu
    et al.
    School of Public Health, Fudan University, Shanghai, People's Republic of China.
    Deguo, Yuan
    School of Public Health, Fudan University, Shanghai, People's Republic of China.
    Jinliang, Zou
    School of Public Health, Fudan University, Shanghai, People's Republic of China.
    Mingmin, Yin
    Key Lab Public Health Safety, School Public Health, Fudan University, Shanghai, People's Republic of China.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Elderly injury prevention perspectives: a qualitative study of elderly people in different socioeconomic strata within a Safe Community in Shanghai2012In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 6, no 12, p. 4170-4178Article in journal (Refereed)
    Abstract [en]

    Injuries represent an important cause of health problems among elderly people. The study has explored the perspectives and ideas of elderly people from different socioeconomic groups in terms of their injury-related issues. This paper examines a Safe Community accredited by the WHO Community Safety program. The community has three different residential sections labeled as Section-A, Section-B and Section-C, representing high, medium and low socioeconomic status of the residents respectively. Three focus group discussions (FGDs) were organized from three residential sections separately with 8 to 12 elderly people (>60years) in each group. Elderly people from Section-A were more concerned about emotional abuse whilst those from Sections B and C thought that fall and traffic injuries were most common injures. In Section-A, the most frequent risk factors were age, mental status and other people's unsafe behavior. In Section-B risk factors were age, environment and safety procedures. In Section-C, risk factors were environments, age and disease. For injury prevention, the elderly in A and B Sections thought that education should be improved while in C Section they emphasized environmental improvements. The perspectives and needs in terms of injury prevention among elderly people from different socioeconomic levels were not the same. When local governments develop their injury prevention plans and strategies, those differences should be considered.

  • 19.
    Rasoal, Dara
    et al.
    Örebro University, School of Health Sciences.
    Skovdahl, Kirsti
    Department of Nursing and Health Sciences, University College in Southeast Norway, Campus Drammen, Norway.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Clinical ethics support for healthcare personnel: An integrative literature reviewManuscript (preprint) (Other academic)
  • 20.
    Rasoal, Dara
    et al.
    Örebro University, School of Health Sciences.
    Skovdahl, Kirsti
    Department of Nursing and Health Sciences, University College in Southeast Norway, Drammen, Norway.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Kihlgren, Annica
    Örebro University, School of Health Sciences.
    Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review2017In: HEC Forum, ISSN 0956-2737, E-ISSN 1572-8498, Vol. 29, no 4, p. 313-346Article, review/survey (Refereed)
    Abstract [en]

    This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different coun-tries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a ‘‘bot-tom-up’’ perspective might give healthcare personnel opportunities to think and reflect more than a ‘‘top-down’’ perspective. A ‘‘bottom-up’’ approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a ‘‘top-down’’ approach risks removing such moral responsibility.

  • 21.
    Shabnam, Jahan
    et al.
    Independent Researcher, ,Denmark.
    Gifford, Mervyn
    Department of Public Health Science, School of Life Sciences, University of Skövde, Skövde, Sweden.
    Dalal, Koustuv
    Department of Public Health Science, School of Life Sciences, University of Skövde, Skövde, Sweden.
    Socioeconomic inequalities in the use of delivery care services in Bangladesh: a comparative study between 2004 and 20072011In: Health, ISSN 1949-4998, Vol. 3, no 12, p. 762-771Article in journal (Refereed)
    Abstract [en]

    The study explores inequalities in the utilization of delivery care services in different administrative divisions in Bangladesh, by key socioeconomic factors. It estimates the extent of the relationship between women’s socioeconomic inequalities and their place of delivery during 2004 and 2007. Trends in relation to place of delivery in relation to residency and education over a period of thirteen years (1993-2007) have also been measured. The study analyzed the trends and patterns in utilization of institutional delivery care among mothers, using data from the Bangladesh Demographic Health Survey (BDHS) conducted during 1993-2007. The data was disaggregated by area of residence in different divisions in Bangladesh. Bi-variate analyses, concentration curves and multivariate logistic regression were employed in the analysis of the data. The study indicated slow progress in the utilization of institutional delivery care among mothers in Bangladesh between 1993 and 2007. Large variations in outcome measures were observed among the different divisions. Multivariate analyses suggested growing inequalities in utilization of delivery care services between different economic groups and parents with different educational levels. The use of institutional delivery care remains substantially lower among poor and less educated rural mothers in Bangladesh, irrespective of age and employment. Further studies are recommended to explore the specific causes relating to the non-utilization of institutional delivery care.

  • 22.
    Wang, Shu Mei
    et al.
    Fudan University, Shanghai, China.
    Zou, Jin Liang
    Fudan University, Shanghai, China.
    Gifford, Mervyn
    University of Skövde, Skövde, Sweden .
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Young students' knowledge and perception of health and fitness: A study in Shanghai, China2014In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 73, no 1, p. 20-27Article in journal (Refereed)
    Abstract [en]

    Objective: This study investigated how young urban students conceptualize health and fitness and tried to identify their sources of information about health-related issues. The findings are intended to help make suggestions for policy makers to design and develop effective health-education strategies.

    Methods: Focus group discussions (FGDs) of 20 groups, each comprised of eight 10th-grade students, were carried out. In total 160 students participated in the FGDs.

    Results: Young students' knowledge and perceptions about health and fitness had certain limitations, although most of the students emphasized the importance of good health and felt that they knew the meaning of health and fitness. They were most concerned with physical health and failed to consider other aspects of health such as mental/psychological, behavioural and social aspects. This represents a lack of awareness of contemporary conceptions of health and illness.

    Conclusion: These findings are important when considering the design of effective high school health education strategies that meet state content standards and for influencing students to continue participating in health-promoting activities.

1 - 22 of 22
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