Thesis (D.P.H.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Sept. 22, 2008). Includes bibliographical references.

Immigrants of Sweden are suffering from various non-communicable diseases more than Swedish natives which becomes a major public health concern nowadays. The objective of this systematic review is to investigate the physical activity level of Swedish immigrants compare to Swedish-born, their physical and mental health outcomes, and barriers and facilitators of being physically active. Electronic database CINAHL PLUS, PUBMED, EBSCOhost, SWEPUB was searched and 17 articles were included which was peer-reviewed, English language, based on physical activity of immigrants living in Sweden. Findings of these articles revealed that immigrants had a higher prevalence of non-communicable, anxiety, depression more than Swedish natives. Lack of motivation, weather, cultural and language barriers, environmental, infrastructure, and economic barriers are identified as barriers. Self-motivation, family and social support, culturally appropriate strategies, government-induced programs, community support are identified as facilitators of being physically active. The quality of evidence of outcomes scored by using GRADE. In conclusion, the available evidence support that immigrants are less physically active than Swedish-born and lack physical activity associated with their physical and mental health outcomes and there are several barriers and facilitators for being physically active.

Bakgrund: Isolering kan leda till psykosociala biverkningar och negativa känsloupplevelser, vilket tidigare forskning har uppmärksammat. Utifrån de identifierade omvårdnadsproblemen designades en litteraturstudie för ytterligare undersökande av patienters upplevelser vid isoleringsvård.    Syfte: Syftet var att undersöka patienters upplevelser av isolering i samband med allmänfarlig sjukdom på sjukhus.    Metod: Allmän litteraturöversikt med deskriptiv design.    Resultat: I patienternas upplevelser identifierades fem olika teman: stigmatisering, känslor, miljö, socialt liv och vård. I resultatet framkom det att patienter i isolering har många negativa upplevelser relaterat till vården och miljön i isoleringen. Även det sociala livet och känslolivet påverkas och många upplever stigmatisering. Förutom de negativa upplevelserna framkom även vissa positiva upplevelser, främst relaterat till relationen med vårdpersonal samt fördelarna med det utökade privatlivet ett eget rum innebar.    Slutsats: Syftet med studien var att undersöka patienters upplevelser av isoleringsvård. I resultatet framkom det flera negativa och positiva upplevelser som till stor del stämde överens med tidigare forskning inom området. Studien gav en fördjupad förståelse för patienters situation under isoleringsvård. Denna ökade medvetenhet och kunskap behövs för att vårdpersonal genom riktade omvårdnadsåtgärder ska kunna förbättra omvårdnaden av isolerade patienter i framtiden. / Background: Isolation can lead to a variety of psychosocial problems and negative emotional experiences, which previous studies have shown. Based on the identified nursing problems, a literature study was designed to further explore patients experiences in source isolation.    Aim: The aim was to investigate patients experiences of being isolated with a disease dangerous to public health in a hospital setting.    Method: A general literature review with descriptive design.    Result: The patients experiences were identified and categorized into 5 themes: stigma, feelings, enviornment, social life and care. The results showed that patients in isolation have a lot of negative experiences related to care and the environment in the isolation ward. The social life and feelings of the patients were also affected, and many reported that they experienced stigmatization. Aside from the negative experiences there were also some positive ones, mainly related to the relationship between the patients and the hospital staff and the extended privacy of having your own room in the ward.    Conclusion: The aim was to investigate patients experiences of source isolation. This study shows both negative and positive experiences among patients in source isolation, which mainly aligned with already existing studies. The result of this study gave a better understanding of patients experiences in source isolation. This knowledge and awereness is needed by healthcare workers to be able to improve the care of patients in isolation with targeted nursing care measures.

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付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第23823号 / 社医博第123号 / 新制||社医||12(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 木村 剛, 教授 山本 洋介 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

INTRODUCTION: Epidemiological transition theory, first postulated by Omran in 1971, provides a useful framework for understanding cause-specific mortality changes and may contribute usefully to predictions about cause-specific mortality. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners due to lack of evidence from low- and middle-income countries. Therefore, understanding of the concept and development of epidemiological transition theory as well as population burden of premature mortality attributable to risk factors is needed. OBJECTIVES: This thesis aims to understand how epidemiological transition theory has been applied in different contexts, using available evidence on mortality transitions from high, middle- and low- income countries, as well as the contribution of risk factors to mortality transitions, particularly for premature mortality. METHODS: A Medline literature search from 1971 to 2013 was conducted to synthesise published evidence on mortality transition (paper I). A descriptive analysis of trends in cause of death using INDEPTH data was conducted, focusing on specific causes of death in 12 INDEPTH sites in Africa and Asia, using the INDEPTH 2013 standard population structure for appropriate comparisons across sites (paper II). A retrospective dynamic cohort database was constructed from Swedish population registers for the age range 30-69 years during 1991-2006, to measure reductions in premature non-communicable disease mortality using a life table method (paper III). Prospective cohort data from Västerbotten Intervention Programme from 1990 to 2006 were used to measure the magnitude of premature non-communicable disease mortality reductions associated with risk factor changes for each period of time (paper IV). FINDINGS: There were changes in emphasis in research on epidemiological transition over the four decades from 1971 to 2013, from cause of death to wide-ranging aspects of the determinants of mortality with increasing research interests in low-and middle-income countries, with some unconsidered aspects of social determinants contributing to deviations from classic theoretical pathways. Mortality rates declined in most sites, with the annual reductions in premature adult mortality varied across INDEPTH sites, Sweden, which now is at late stage of epidemiological transition stage, achieved a 25% reduction in premature mortality during 1991-2006. Overall downward trends in risk factors have helped to reduce premature mortality in the population of Västerbotten County, but some benefits were offset by other increasing risks. The largest mortality changes accrued from reductions in smoking, hypertension and hypercholesterolaemia. CONCLUSIONS: This thesis established patterns of current epidemiological transition in high, middle-and low-income countries (Asia and Africa), where the theory fits the transition patterns in some countries, but with some needs for further adjustments in other settings, as well as deviations from the classical ET theory in the last four decades. It highlights the need to identify the burden of mortality and morbidity, particularly for reducing mortality occurring before the age of 70 years and its attribution to risk factors, which are a major public health challenge. This informs shifting of public health priorities and resources towards prevention and control of chronic non-communicable disease risk factors.

Non-communicable disease (NCD) (particular by cardiovascular disease, CVD) is the leading cause of death in most countries including OECD countries. WHO (World Health Organization, 2002) has emphasized the trend of disease patterns shifting from communicable diseases towards to non-communicable diseases globally. However, globalization drives economic activities vigorously and alternates work conditions, such as prolonger or irregular working time, changing patterns of job. And then, more sweating, stress and occupational safety of labors after globalization were noted by many worldwide scholars. ¡§Karoshi¡¨ (death from overwork) is a controversial issue of occupational matters in these years all over the world. According to past empirical literatures, CVD was also the major medical cause of death from overwork. Hence, we collect panel data of CVD mortality, working hours of labor and KOF index of globalization covering 19 OECD countries from a period of 1980 to 2007, and measure by panel cointegration analysis and fully modified OLS (FMOLS) to estimate the reciprocal relationship among these variables. The evidence findings show significant influence on CVD mortality if increasing working hours of labor, especially at age groups of 15 to 24 year. While significant effect on CVD mortality through by globalization was found at age group 25 to 54 year and elders, particular in social globalization.

Bakgrund: Smittsamma sjukdomar är ett ökande problem för världen med ständig utveckling av bland annat antibiotikaresistenta bakterier, vilket kan göra att patienter med smittsam sjukdom blir komplicerade att vårda. För att minska smittspridning vårdas patienter i isolering, vilket kan medföra negativa upplevelser. Problem: När patienter vårdas i isolering blir de begränsade i sin livssituation. Deras möjlighet till att socialisera och interagera med andra människor försvåras, vilket kan ge upphov till ohälsa och eventuellt lidande. Isoleringsvård innebär även tillämpning av skydds- och försiktighetsåtgärder som orsakar ökad arbetsbelastning för sjukvårdspersonal, vilket kan leda till sämre omvårdnadskvalitet för patienter som vårdas i isolering. Syfte: Beskriva patienters upplevelser av isoleringsvård vid smittsam sjukdom. Metod: Kvalitativ systematisk litteraturstudie med beskrivande syntes, där tio analyserade vetenskapliga artiklar användes i resultatet. Resultat: Det framkom både negativa och positiva upplevelser hos patienter som vårdas i isolering. Dessa delades in i två övergripande teman; Vårdas i ensamhet med tre tillhörande subteman och Behov av att förstå med två tillhörande subteman. Slutsats: Sjukvårdspersonal behöver anpassa den vård som ges med hänsyn till patienters omvårdnadsbehov. Genom att sjukvårdspersonal får utökade kunskaper om patienters positiva och negativa upplevelser av isoleringsvård kan sjukvårdspersonal anpassa vårdandet. / Background: Communicable diseases is an increasing problem world-wide due to the ongoing increase of antibiotic-resistant bacteria, which makes the diseases hard to treat. Patients are forcibly being treated in isolation due to the risk of spreading the infection to other people, this can cause negative experiences for these patients. Problem: Patients who are being treated in isolation are forced into a limited situation in their lives. Their possibilities of socializing and interacting with other people are reduced which could cause unhealthiness and suffering. Isolation care means that healthcare professionals have to apply precautionary methods with protective equipment when treating these patients. This could cause an increased workload for healthcare professionals and lead to poor quality of care for patients in isolation. Aim: To describe patients’ experience of isolation care due to communicable diseases. Method: A systematic review with a descriptive synthesis, and ten articles were analyzed for the result. Result: Both negative and positive experiences were identified of patient treated in isolation. These experiences were divided into two major themes; To receive care in loneliness with three included sub-themes and The need to understand with two included sub-themes. Conclusion: Healthcare professionals have to adapt the care to the needs of the unique patient. If healthcare professionals had more knowledge of caring for patients in isolation some of the negative experiences could be eliminated and lead to better quality of care.

Introdução: Este estudo tem como objeto as práticas de autocuidado e o cuidado familiar do indígena com Doença Crônica Não Transmissível. Objetivo: Analisar as práticas de autocuidado e do cuidado familiar, seguido pela caracterização demográfica e socioeconômica, verificação da prevalência da Doença Crônica Não Transmissível, identificação das práticas de autocuidado, das características do cuidado familiar, avaliação do desempenho das Atividades da Vida Diária e Atividades Instrumentais da Vida Diária dos índios da etnia Mura, além da associação com as variáveis do estudo. Método: Estudo exploratório, descritivo, transversal, com abordagem quantitativa, de 198 índios adultos com Doença Crônica Não Transmissível, cadastrados no Polo-base Pantaleão do município de Autazes, Amazonas. Foi aplicado um formulário com questões referentes aos dados demográficos, socioeconômicos e de condição de saúde, às práticas de autocuidado e do cuidado familiar, além dos instrumentos como o Índice de Barthel e a Escala de Lawton. Na análise descritiva, procedeu-se a descrição dos dados por meio da distribuição de frequência, porcentagem e medidas descritivas (média, desvio padrão, amplitude mínima e máxima). Na análise inferencial foram empregados os testes Qui-Quadrado de Pearson e o Exato de Fisher para associação entre as variáveis, sendo adotado um nível de significância de 5%. Resultados: Houve predomínio do sexo feminino, com média de 59 anos. Quanto às práticas de autocuidado relacionadas aos hábitos alimentares e de vida: 92,5% relataram consumir frutas, 83,8% verduras, 98,0% legumes, 68,2% carne, 88,4% frango, 96,0% peixes; 86,4% não tabagistas, 92,4% não etilistas, 85,4% não praticantes de exercício físico e 97,5% de esporte. Com relação ao cuidado familiar, a dimensão instrumental e emocional demonstrou-se mais frequente, promovida pelos familiares como as filhas e os cônjuges. A avaliação do autocuidado nas Atividades da Vida Diária e Atividades Instrumental da Vida Diária constatou que a maioria é considerada independente funcional. Dos dados analisados, foi encontrada associação estatística entre as Doenças do Sistema Circulatório com os sinais e sintomas e a etiologia para o conhecimento da Doença Crônica Não Transmissível, internação hospitalar, restrição no consumo de alimento gorduroso, no uso de sal na refeição já servida e não seguir nenhuma restrição alimentar, medicamento, quantidade de medicamento, Dieta/alimentação e o comportamento na prática de autocuidado, Dieta/alimentação nas orientações recebidas sobre o autocuidado; as Doenças Nutricional e Endócrina Metabólica com o sexo, antecedente familiar, fisiologia e não ter conhecimento da Doença Crônica Não Transmissível, consumo de frango, não seguir nenhuma restrição alimentar, quantidade de medicamento, não seguir nenhuma prática de autocuidado, os aspectos emocionais e comportamentais para as dificuldades no autocuidado, Dieta/Alimentação para as orientações recebidas sobre o autocuidado; as Doenças do Sistema Osteomuscular e Tecido Conjuntivo com idade, renda pessoal, número de refeições, quantidade de medicamento e o conforto na prática de autocuidado. As Atividades da Vida Diária apresentaram associação estatística com a idade, escolaridade, autoavaliação de saúde, consulta na unidade, consumo de frutas, não realizar nenhuma prática de autocuidado, aspectos financeiros, físicos e não ter dificuldades no autocuidado Quanto às Atividades Instrumentais da Vida Diária, teve associação estatística com a idade, escolaridade, situação ocupacional, renda pessoal e familiar, Índice de Massa Corpórea, consumo de frutas, etilismo, exercício físico, aspectos físicos para as dificuldades no autocuidado, Dieta/alimentação nas orientações recebidas sobre o autocuidado, dimensão instrumental e material no apoio social. As dimensões do apoio social apresentaram associação estatística entre o instrumental com o arranjo familiar, número de moradores; o emocional com a idade e escolaridade; material com as doenças do sistema nervoso; a interação social positiva com idade, escolaridade, arranjo familiar e as doenças dos olhos e anexos. Conclusão: Diante dos resultados obtidos neste estudo, reconhecemos a importância dos profissionais de saúde do Polo-base nas questões sobre o conhecimento das práticas de autocuidado, e o apoio social promovido pela família para a abordagem no tratamento e acompanhamento ao índio com Doença Crônica Não Transmissível. / Introduction: This study objectifies the self-care practices and family caregiving to the Indigenous individual suffering from Non-Communicable Diseases (NCDs). Objective: To analyze the self-care practices and family caregiving followed by the demographic and socioeconomic profile, assessment of the prevalence of Non-Communicable Diseases, identification of self-care practices, characteristics of the family caregiving and evaluation of the performance in the Activities of Daily Living (ADLs) and in the Instrumental Activities of Daily Living (IADLs) among Mura Indigenous individuals, besides the association with the study variables. Method: Exploratory, descriptive, crosscut, quantitative study with 198 adult Indigenous individuals, Mura ethnicity, suffering from NCDs, registered at Pantaleão Primary Health Care Center in the municipality of Autazes, Amazonas State, Brazil. A formulary was applied with questions regarding demographic, socioeconomic data, health status, self-care practices and family caregiving, as well as instruments, such as the Barthel Index and Lawton Scale. In the descriptive analysis, data description was performed by means of percentage frequency distribution, and descriptive measures (mean, standard deviation, amplitude, maximum and minimum values). Inferential Statistical Analysis was performed by means of Pearsons Chi-square Test and Fishers Exact Test for variable association, significance level of 5%. Results: Female prevalence, average age of 59 years. Regarding self-care practices related to food and lifestyle habits, 92.5% reported fruit consumption, green leaves (83.8%), vegetables (98.0%), meat (68.2%), chicken (88.4%), and fish (96.0%); non-smokers (86.4%), non-alcoholic (92.4%), 85.4% do not exercise or practice sports (97.5%). In relation to family caregiving, the instrumental and emotional dimension was the most frequent, promoted by family members, such as daughters and spouses. Self-care assessment for the ADLs and IADLs evidenced that most individuals were functionally independent. From the analyzed data, statistical association was found between circulatory system diseases (CSDs) with their signs and symptoms and the etiology for NCD knowledge, hospitalization, restriction of high-fat food intake, addition of salt to the served food, non-compliance to any dietary guidelines, medication, amount of medication, diet/food and behavior for self-care practice, diet/food under the received self-care guidance; Endocrine, nutritional and metabolic diseases were associated with gender, family history, physiology and unawareness of NCDs, chicken consumption, non-compliance to any dietary guidelines, amount of medication, non-compliance to any self-care practice; emotional and behavioral aspects were associated with self-care deficits, Diet/Food with received self-care guidance; Osteomuscular system and connective tissue diseases were associated with age, income, number of meals, amount of medication and ease on the self-care practice. ADLs were statistically associated with age, schooling, health status self-assessment, health care center visits, fruit intake, non-compliance to any self-care practice, financial and physical aspects, and ease on self-care. As for the IADLs, they were statistically associated with age, schooling, occupational status, individual and family income, Body Mass Index (BMI), fruit intake, alcoholism, exercising, physical aspects for self-care deficits, Diet/food in the received self-care guidance, instrumental and material dimensions for social support. Social support dimensions evidenced statistical association between the instrumental and the family arrangement, number of residents; the emotional social support dimension was associated with age and schooling; the material dimension with nervous system diseases; positive social interaction with age, schooling, family arrangement and eye-related diseases. Conclusion: Due to the obtained results in this study, we recognize the importance of the healthcare professionals from the referred Primary Health Care Center in the issues regarding the knowledge of self-care practices, as well as the social support promoted by the family on the treatment approach and follow up to the Indigenous individual suffering from a Non-Communicable Disease.