Background: Celiac disease, a permanent gluten sensitive enteropathy, is the most common genetic disorder, although largely underestimated public health problem worldwide. The wide spectrum of its multifaceted manifestations is a continuum representing the outcome of a complex interplay of genetic and environmental factors with immunological processes suggesting its multifactorial etiopathogenesis and also involves the risk of malignancy. Despite of the new insights gained by recent advances in knowledge, etiopathogenesis still remains to be elucidated completely. Investigating the Swedish epidemic of CD by epidemiological approach has revealed the possible associations of CD with some environmental factors. Emphasizing the significance of events in early infancy in view of current CD aetiopathogenesis concepts and with relevance to the unique pattern of CD incidence trends in Swedish children, early infectious episodes emerge as seemingly important clue in etiology of CD. This study investigates the possible contribution to the risk from early infectious episodes to development of Celiac disease. Objectives: This study aims to investigate possible contribution by early infectious episodes to the risk of development of celiac disease and discusses the findings in view of current concepts of CD aetiopathogenesis. Methods: Literature-review. A review of available knowledge from studies in the aetiopathogenesis of celiac disease was done to understand the possible association with environmental factors, in particular role of infectious episodes. Study-design and data-analysis: Data from a Swedish population-based incident case-referent study with 627 confirmed cases of celiac disease and 1254 referents was analyzed to investigate a possible predisposition caused by early infections to celiac disease. Results: Current literature suggests that infections may induce, trigger the development of CD (Gl infectious episodes to the major extent) or may activate already latent CD by different mechanisms. However, our study concludes statistically significant risk associated with early infectious episodes of all types to the development of celiac disease. Besides, findings suggest higher risk associated with the combined effect of consumption of larger amounts of gluten and frequent infectious episodes. Conclusion: This study presents the first epidemiological findings concluding increased risk to development of celiac disease associated with occurrence of infectious episodes during early infancy (before the age of 6 months), and suggests possible involvement of molecular mimicry or other mechanism. The findings also suggest focusing on early infancy and to the events that precede immunopathogenetic processes. Thus, it provides implication for the further exploration of complete immunolopathogenetic mechanisms involved in pathogenesis of celiac disease and it may prove rewarding in designing innovative preventive, immunomodulatory and antigen-centered therapeutic strategies. / digitalisering@umu

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Working to strengthen the health of individuals with a state of dependence can, eventually, strengthen their independence, which can result in a life without drugs or alcohol. The purpose of the present study is to investigate the perception of social supporters of the work to strengthen the health of individuals with a addiction.  In the present study, a qualitative method was used with semi-structured interviews. Through a purposeful sampling, five people with the professional term social supporter who works in the social services of a municipality in the Mälardalen region could be interviewed. The material from the interviews was analyzed using a manifest content analysis. The results show that it is important to focus on motivational conversations, improved collaboration between social administration and other agencies, and to strengthen individuals' independence by enabling various factors such as employment can provide good health. The conclusion from the study is that social supporters' perceptions of their working methods were that they mainly work with motivational interviews and support in everyday tasks. Social supporters work from client focus and administrative work method, and that improved collaboration can benefit clients' health development. Increased education and resources from the social services and the municipality can strengthen health promotion work.   Keywords: Addiction, Empowerment, Health promotion, Motivational Interview, Participation, Social supporter

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In rural areas of South Africa, there is a lack of education and implementation of menstrual hygiene management. The purpose of the study was to evaluate the suitability and hygienic safety of the menstrual cup used by girls and young women who have harsh living conditions. The study was performed in uMkhanyakude, KZN, South Africa, where the menstrual cup was introduced. The evaluation of the menstrual cup and the usage of it was carried out through interviews, forms, discussions and observations. Finally, the results from the follow-up was compiled to adapt the menstrual cup to the environment of rural areas of South Africa. It appeared that culture related problems were those which made the menstrual cup hard to implement. To minimize these issues, an idea was developed in the form of a model of a kit with a menstrual cup, a kettle and an informatory book. / WoMensCup

Female genital schistosomiasis (FGS) is a chronic manifestation of schistosomiasis, a waterborne parasitic infection, and is estimated to impact 56 million women predominantly in Sub-Saharan Africa. Currently, there is scarce literature on FGS and related health-seeking behaviour (HSB) among at-risk women. The objective of this mixed-method study is to understand the socio-cultural determinants of HSB and the health information trust networks for women at-risk of FGS in Ghana. A cross-sectional survey and twelve focus group discussions (FGDs) were conducted in the North Tongu and Weija Districts of Ghana. A total of 863 cross-sectional surveys and 12 FGDs were administered in both districts. There was an overall lack of awareness of FGS among adult women (38.9%). Only 48.8% of women reported HSB from the 86 women who choose to talk about their FGS-related symptoms. HSB was significantly associated with monthly steady income (p-value: 0.036) and level of education (p-value: 0.15,0.27), when controlling for age group and source of trusted health information. Some of the determining themes for HSB included: environmental and systemic context, shared norms, and apprehensions. Active and passive health information-seeking behaviour also emerged through the FGDs. Taking a mixed-method approach allowed for the appraisal of both methodologies and provided validity to the results. The lack of awareness of FGS indicates the need for tailored health information campaigns in endemic communities. More research is required on the FGS diagnostic and treatment capabilities of health facilities to understand their impact on HSB of women. This investigation finds that social, environmental, and cultural determinants are involved in the HSB of women at-risk for FGS, in North Tongu and Weija.

Global health initiatives from academic medical centers have rapidly proliferated over the last decade. This paper endeavors to describe our 5-year experience as an academic medical collaborative supporting healthcare delivery, medical training, and research at Hôpital Saint Damien-Nos Petits Frères et Soeurs, the only freestanding children's hospital in Haiti. Descriptions of the history and current activities of our academic medical collaborative, its partnership and communication structure, its evolution to fill the expressed needs of our host site, its funding mechanisms, and its challenges and opportunities for the future are included.

BACKGROUND: This work serves as a cases study for the findings of the Rockefeller Foundation-Boston University Commission on Health Determinants, Data, and Decision-Making (3-D Commission). The dissertation assessed public views of what matters for health, the degree of incorporation of SDoH in Covid-19 decision-making, and the mental health consequences of SDoH disruptions in diverse contexts using multiple data sources. METHODS: An online survey collected relevant individual-level data from Brazil, China, Germany, Egypt, India, Indonesia, Nigeria, and the United States using RIWI—a professional global survey platform that uses a patented Random Domain Intercept Technology™ (RDIT™). National-level data retrieved included Covid-19 policy data from the Oxford Covid-19 Government Response Tracker (OxCGRT) and data from the International Labour Organization (ILO) on the informal labor sector. All data were used in descriptive and multivariable regression analyses. RESULTS: Of 8,754 respondents, 56.2% (95% CI: 55.1%, 57.2%) ranked healthcare as the most important determinant of health. Politics was the determinant with the greatest absolute difference between what respondents considered matters for health versus what they perceived decision-makers think matters for health. Overall, more restrictive Covid-19 stay-at-home orders were associated with a higher burden of SDoH disruptions while more expansive income support policies were associated with a lower burden of disruptions. The lowest two income quintile in all countries reported the highest burden of employment insecurity, financial insecurity, and food/supplies insecurity. The income gradient of SDoH disruptions persisted after controlling for government income support policies. Experiencing Covid-19 SDoH disruptions was then associated with a higher burden of both depression symptoms and probable post-traumatic stress disorder (PTSD). The prevalence of probable PTSD was about three times higher among people who experienced at least one Covid-19 SDoH disruption compared to those who did not experience a disruption. CONCLUSION: This research showcases the need for more investment in communication efforts around the importance of SDoH both to the general public and decision-makers. Moreover, SDoH disruptions and their association with adverse mental health outcomes during the Covid-19 pandemic highlight the lack of consideration for SDoH in the design and implementation of policies. Countries in different contexts would benefit from implementing the 3-D Commission principles and recommendations to ensure that decision-making on health is guided by equity and informed by data on SDoH. / 2024-08-30T00:00:00Z

The scope of pharmacy practice in global health has expanded over the past decade creating additional education and training opportunities for students, residents and pharmacists. There has also been a shift from short-term educational and clinical experiences to more sustainable bidirectional partnerships between high-income countries (HICs) and low- to middle-income countries (LMICs). As more institutional and individual partnerships between HICs and LMICs begin to form, it is clear that there is a lack of guidance for pharmacists on how to build meaningful, sustainable, and mutually beneficial programs. The aim of this paper is to provide guidance for pharmacists in HICs to make informed decisions on global health partnerships and identify opportunities for engagement in LMICs that yield mutually beneficial collaborations. This paper uses the foundations of global health principles to identify five pillars of global health engagement when developing partnerships: (a) sustainability, (b) shared leadership, (c) mutually beneficial partnerships, (d) local needs-based care and (e) host-driven experiential and didactic education. Finally, this paper highlights ways pharmacists can use the pillars as a framework to engage and support health care systems, collaborate with academic institutions, conduct research, and interface with governments to improve health policy.

Menstrual health is a crucial yet often ignored need during emergencies and humanitarian interventions. The present thesis aims at understanding the perception of humanitarian workers of menstrual health management and the related challenges during displacement, and the best ways how to address them. The present study is qualitative: the author conducted semi-structured interviews with humanitarian workers and examined the results with thematic analysis. The results were interpreted with the theory of needs and the theorization of the menstrual health management components. The results show that menstrual health management is an interconnected need involving several actors, especially during displacement, and it has a strong health component. The stigmatisation of period heavily influences the way how humanitarians can respond to people’s menstrual needs, also because humanitarians are not always trained on the topic. Menstrual health management is often disregarded as a need during humanitarian emergencies. Menstrual needs can be classified following the hierarchization  of  needs approach,  but  more flexibility is required in order to improve humanitarian response to such a neglected need. The sector could benefit from more prioritization of menstrual health management, more male and community participation in the interventions, increased people-centred design of facilities, more awareness raising initiatives and improved coordination among clusters and organizations.