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Krisberedskap är ett aktuellt ämne som ur individperspektiv främst rör den egna förmågan att tillgodose sina grundläggande behov av vatten, värme, mat, kommunikation och medicin i minst 7 dygn om en kris inträffar. Detta ställer krav på individers medvetenhet och kunskap om kris och krisberedskap. Det saknas forskning på området och de studier som finns visar att medvetenheten och kunskapen är låg. Studiens syfte är att undersöka högskolestudenters oro för att en kris ska inträffa, deras kunskap och medvetenhet om kris och krisberedskap samt vilken beredskap studenter har att hantera en kris och eventuella samband mellan dessa. En kvantitativ enkätstudie genomfördes. Resultatet visar att studenternas medvetenhet och kunskap om kris och krisberedskap är låg. Studenterna har störst oro för att en terroristattack ska ske och anser det troligt att en terroristattack kan inträffa inom fem år. Generellt är dock studenternas oro för att en kris ska inträffa låg. T-test genomfördes för att undersöka eventuella samband och skillnader i krisberedskap utifrån grad av kunskap och medvetenhet. Inga signifikanta samband eller skillnader påvisades. Studiens resultat diskuteras i relation till teorierna Health belief model och Theory of planned behaviour. Då kris och krisberedskap är ett aktuellt men obeforskat ämne rekommenderas vidare studier.

Doctor of Philosophy / Department of Horticulture, Forestry, and Recreation Resources / Candice A. Shoemaker / The objectives of this study were to determine exercise intensity of common gardening tasks in older adults and to investigate if older gardeners meet the physical activity (PA) recommendations (intensity and time) through their daily gardening. Kinds of gardening tasks, body postures, and bodily pain while gardening of older gardeners were investigated and the possibility of gardening as a predictor for a physically active lifestyle and life satisfaction in older adults was determined. Older participants were randomly recruited from the community of Manhattan, KS. To determine the exercise intensity of gardening, the heart rates of older adults were measured by radiotelemetry during gardening or garden tasks, and then oxygen uptake and energy expenditure were measured via indirect calorimetry using a submaximal graded exercise test. Overall health conditions by the Short Form 36 Health Survey (SF-36), hand functions by hydraulic hand dynamometer and pinch gauge, and bone mineral density (BMD) by dual-energy x-ray absorptiometry were measured. An observational study and weekly logs were conducted to study kinds of gardening, postures, and bodily pain of older gardeners. The Community Healthy Activities Model Program for Senior (CHAMPS) questionnaire was used to measure leisure-time PAs (frequency per week of all PAs and calories expended per week in all PAs). In conclusion, the nine gardening tasks were found to be low to moderate intensity PA in healthy older adults (1.6 ± 3.6 METs). Gardening observed was moderate intensity (3.8 ± 1.4 METs) PA in older adults and the subjects met the PA recommendation, which is at least 30 minutes of moderate intensity PA on most days of the week through their daily gardening (moderate intensity; average 33 hrs/wk in May and 15 hrs/wk in June and July). The older gardeners showed higher values for hand function and some SF-36 domains (physical function, bodily pain, and physical summary) than older non-gardeners. Gripping, stooping, lifting, stretching, walking, standing, kneeling, sitting, and squatting were observed while older adults gardened and lower back pain was the main bodily pain reported. Furthermore, gardening was found to be a predictor for leading a physically active lifestyle and high life satisfaction in older adults.

Ce mémoire contribue à identifier les facteurs associés à l’occurrence de la diarrhée chez les enfants de moins de cinq ans en Haïti. Après une revue de la littérature sur les déterminants de la diarrhée infanto-juvénile dans les pays en développement, nommément Haïti, nous tirons profit de la mise en commun de quatre bases de données des Enquêtes démographiques et de santé pour nos analyses quantitatives (n = 14 481). Notre étude s’intéresse notamment à l’impact de l’eau potable améliorée, des toilettes améliorées et du réfrigérateur sur la diarrhée infanto-juvénile. Nous déterminons la robustesse des associations entre ces commodités et l’occurrence de la diarrhée par des modèles de régression logistique. La commodité la plus commune est l’eau potable améliorée (58%). La présence de plus d’une commodité est peu courante (17%). En moyenne, la prévalence de la diarrhée s’élève à 29%. L’eau potable améliorée et le réfrigérateur sont corrélés à une faible occurrence de la diarrhée chez les 24-59 mois et les toilettes améliorées à une faible occurrence chez les 1-5 et 12-23 mois. Les enfants de famille ne possédant qu’une commodité ne sont pas statistiquement différents des plus défavorisés, sauf chez les 24-59 mois. Enfin, nous ne trouvons pas de liens significatifs entre les commodités et la diarrhée chez les 6-11 mois. Nos résultats sont inédits pour Haïti, et soulignent, comme piste d’intervention en prévention de la diarrhée, la nécessité d’augmenter le nombre des commodités familiales, particulièrement les toilettes améliorées privées, qui limiteraient la contamination de l’eau et des aliments. / This master’s thesis contributes to the identification of factors linked to the occurrence of diarrhoea among children under five years of age in Haiti. Following a review of the literature on predictors of childhood diarrhoea in low-income countries, namely Haiti, we take advantage of four databases from Demographic and Health Surveys (n = 14 481) to conduct our quantitative analyses. Our study is concerned mainly with the impact of improved drinking water, improved sanitations and refrigerator on childhood diarrhoea. We use logistic regression models to assess the robustness of the associations between selected factors and the occurrence of diarrhoea among children under five years of age. The most common commodity was improved drinking water (58%). The presence of more than one commodity was infrequent (17%). On average, diarrhoea prevalence was 29%. The improved drinking water and the ownership of a refrigerator were associated with a decreased occurrence of diarrhoea for children aged 24-59 months. The improved sanitation was related to a decreased in the occurrence of diarrhea for children 1-5 and 12-23 months. Children whose family owned only one commodity were not statistically different from the most disadvantaged children, except for children 24-59 months. Lastly, there was no significant link between any commodity and diarrhoea for children 6-11 months. In the context of Haiti, these new findings highlight, as an intervention path in the prevention of childhood diarrhoea, the importance of increasing the number of commodities within families, and, more specifically, improving sanitations which may help reduce the contamination of water and food.

Pour les patients souffrants d’une maladie pulmonaire obstructive chronique (MPOC), il existe de nombreuses façons de cheminer dans le système de santé québécois. Toutefois, ces trajectoires de soins (TS) ne sont pas bien décrites dans la littérature et leur impact sur la mortalité demeure inconnu. Les objectifs du projet sont d’identifier et de caractériser les TS des patients MPOC, puis d’en évaluer l’association avec la mortalité. Pour ce faire, nous avons créé une cohorte rétrospective de 3352 Québécois, atteints d’une MPOC, ayant répondu à l’Enquête sur la santé des collectivités canadiennes (ESCC) entre 2007 et 2013. Trois banques de données administratives du Québec (RAMQ, MED-ÉCHO et RED/D) ont été jumelées aux données de l’ESCC pour mesurer les TS sur 2 ans, et ce, à l’aide de l’analyse de séquences. Les caractéristiques des patients ont été comparées entre les TS grâce au test du khi-2 et au V-test. Nous avons réalisé des modèles de Cox, bruts et ajustés pour les facteurs confondants, dans le but d’évaluer l’association entre les TS et la mortalité sur un maximum de 5 ans. Suite à l’analyse de séquences, 6 TS ont été identifiées : 1) faible utilisation des services de santé: toutes causes (44,7%); 2) utilisation moyenne des services de santé: toutes causes (27,7%); 3) grande utilisation des services de santé surtout chez l’omnipraticien: causes respiratoires (4,4%); 4) grande utilisation des services de santé surtout chez l’omnipraticien: autres causes que respiratoires (6,5%); 5) grande utilisation des services de santé surtout chez le spécialiste: autres causes que respiratoires (6,3%); 6) grande utilisation des services de santé surtout en soins aigus: toutes causes (10,4%). Les caractéristiques qui ont permis de distinguer l’appartenance des patients à une TS sont l’âge, le statut tabagique et matrimonial, le niveau d’éducation, l’indice de comorbidité et la santé perçue. Les patients des TS 2, 4 et 6 étaient significativement plus à risque de décès que les patients de la TS 1. Ainsi, une meilleure compréhension des TS et de leur association avec la mortalité pourrait aider les décideurs et les cliniciens à mieux identifier les patients à risque et allouer judicieusement les services et les ressources afin d’optimiser la gestion de la MPOC. / Patients with chronic obstructive pulmonary disease (COPD) navigate in the healthcare system in different ways. However, those trajectories of care (ToCs) are not well described and their impact on mortality is unknown. Therefore, our research project’s objectives were to identify and characterize the ToCs of COPD patients and to evaluate the association between those ToCs and mortality. To do so, we conducted a retrospective cohort study with 3352 COPD patients living in Quebec, who answered the Canadian Community Health Survey between 2007 and 2013. Three Quebec health administrative databases (RAMQ, MED-ÉCHO and RED/D) were linked to the survey data to measure ToCs over a 2-year period, using sequence analysis. Patients’ characteristics were compared between ToCs with chi-square and V tests. At last, we evaluated the association between ToCs and death over a maximum of 5 years, using Cox models adjusted for potential confounders. Following sequence analysis, 6 ToCs were identified: 1) low use of healthcare services: all causes (44.7%); 2) medium use of healthcare services: all causes (27.7%); 3) high use of healthcare services mainly with general practitioners (GPs): respiratory causes (4.4%); 4) high use of healthcare services mainly with GPs: other causes than respiratory (6.5%); 5) high use of healthcare services mainly with specialists: other causes than respiratory (6.3%) and 6) high use of healthcare services mainly in acute care: all causes (10.4%). Patients’ characteristics that best-described the trajectories’ membership were age, smoking status, marital status, level of education, comorbidity index and, patients’ perceived health. Patients belonging to trajectories 2, 4 and 6 were significantly more at risk of death than patients belonging to the first trajectory. Thus, a better understanding of the ToCs in Quebec and their association with mortality could help policymakers and clinicians for the allocation of care and health resources, thereby promoting least fatal ToCs.

Background Under five years of age child mortality rates and the violence against women are prevalent in Rwanda. The violence is known to negatively affect the women’s and their children’s health. This study aimed to examine the association between maternal experience of lifetime intimate partner violence and symptoms of common illnesses (fever, diarrhea, cough, breathing problems) among the children under five years of age in Rwanda. Methods The study was a cross-sectional, based on the data of 2019 –20 Rwanda’s Demographic Health Survey, including 1,290 women and their children. To examine the association between physical, sexual and psychological intimate partner violence and the symptoms of common illnesses, bivariate analysis was performed, followed by logistic regression, where models were adjusted for potential confounders. Results Among the mothers, 36% had experienced physical, 14.7% sexual, and 33.7% psychological intimate partner violence. Around 43% of their children had had symptoms of common illnesses within two weeks before the data collection. In adjusted regression analysis, the experience of physical (OR 1.79, CI 1.41 – 2.27), sexual (OR 1.68, CI 1.22 – 2.30) and psychological intimate partner violence (OR 2.08, CI 1.63 – 2.65) were significantly associated with symptoms of common illnesses among children under five years of age. Conclusion This study showed that maternal experience of lifetime intimate partner violence increases the likelihood of their young children having symptoms of common illnesses in Rwanda. The finding suggests the importance of investing in strategies against intimate partner violence to lower the mortality rates of children within the country.

Background  Both Intimate partner violence and under 5- child mortality are alarmingly high in the world, Nigeria is one of the leading countries. The adverse health outcomes for both women and children as a result of living in a violent environment need to be addressed and combatted. This study aimed to investigate whether there was any association between maternal exposure of lifetime violence (Emotional, physical, sexual, and any violence) and under-5 child mortality.  Method  The study was a cross-sectional study based on secondary data from Nigerian demographic health surveys (DHS) from 2018. The study sample consisted of 8389 married and non-married women, aged 15-49 years who completed the domestic violence module, with a dead or alive first-born child. To assess the associations between maternal experience of lifetime exposure of different types of violence (Emotional, physical, sexual, and any violence) and under-5 child mortality Chi-squared tests were performed, followed by logistic regression. Result In this study, the prevalence of emotional violence was 33,6 %, physical violence 21,3 %, sexual violence 7,7 % and any violence 38,5 %. Moreover, 6,7 % of the children in the sample were dead. The results showed that emotional violence, physical violence, and any violence were not significantly associated with under-5 child mortality. However, sexual violence showed an association with under-5 child mortality (P-value: 0,002). In addition, logistic regression showed that religion was associated with under-5 child mortality (P-value: <0,001). Muslim women had increased odds of child death, compared with Christian women(aOR:0,63, CI:0,50-0,78). The oldest women aged 40-49 years were found to be associated with under-5 child mortality (P-value:< 0,001). High maternal age increased the odds for under-5 child mortality (aOR: 2,08, CI:1,58-2,75). Moreover, maternal working status was associated with under-5 child mortality (P-value: <0,001). Working women had increased odds for experiencing child death, compared with the non-working women (aOR: 7,04, CI: 4,99-9,92). Finally, wealth was negatively associated with the outcome of under-5 child mortality (P-value: 0,007). The richest women had the lower odds of under-5 mortality, compared with the poorest women (aOR: 0,62, CI: 0,44-0,88). Conclusion The study showed an association between sexual violence and under-5 child mortality. Both sexual IPV and under-5 child mortality must be addressed urgently because it has detrimental effects on both women’s and children’s health in Nigeria. The study also found that high maternal age increases the odds for under-5 child mortality, and adequate age for motherhood must be promoted, to save the lives of children. Moreover, belonging to a low wealth quintile increases the risk for child death, and therefore poverty must be relived in Nigeria, so SDG 3.2.1 can be reached: “End all preventable deaths under 5 years and not more than 25 child deaths per 1000 live births by 2030”.

Philosophiae Doctor - PhD / Injuries, and head injuries in particular, are a common cause of childhood, adolescent and young adulthood morbidity and mortality. The risk factors for injuries in general have been well researched. But it remains uncertain whether these factors are similar for specific injuries, such as head injuries. The inter-relationships between individual and environmental risk factors are difficult to study. Whilst much is know of the short-term consequences of head injuries, relatively little information is available on their long-term conseque~ces. The follow-up period in most research is short (often less than 1 year) and studies are weak in terms of design. Studies generally find a variety of social, cognitive and psychological consequences in children and young adults experiencing head injuries. This study assessed in two large, nationally representative samples, a 1946 birth cohort and a 1997 cross-sectional health survey: 1) the occurrence and risk factors for childhood, adolescent and early adulthood head and other injuries, and 2) the long-term cognitive and psychiatric effects of skull injuries. The overall findings for the risk factors across the two data sets and over 5 decades of data collection were strikingly similar. Maleness was a major risk factor for the head and other injuries. Some of the behaviour and personality factors such as hyperactivity and being neurotic, even after adjusting for sex, socioeconomic status and family type, remained significantly related to injuries, particularly those affecting the head region. A clustering of demographic, socioeconomic, family and behavioural risk factors significantly increased the likelihood of injuries, particularly recurring injuries with at least one being a head injury. In the unadjusted analyses socioeconomic status and family type were less consistently related to injuries. The long-term psychiatric and cognitive consequences of skull injuries causing concussion and skull fractures in childhood and early adulthood were negligible. Other childhood factors such as educational ability, behaviour and personality, and level of education achieved were more predictive of psychiatric symptoms and cognitive problems in adulthood. This study suggests that children and adolescents with behavioural and personality problems were at greater risk of head and other injuries in childhood, adolescence and later in adulthood. Children and adolescents with behavioural and personality problems were more likely to live in manual social class families and families with a single parent or stepparent. This combination of behavioural problems and deprived socioeconomic and family circumstances may increase tendencies for violent behaviour, alcohol dependence and manual occupations later in adulthood, which all increase the risk of injuries. There is therefore a need to identify children and adolescents with behavioural and personality problems as early as possible to prevent the impact in the short- and longterm. This will not only reduce the burden of injuries but also the many other consequence of behavioural and personality problems, particularly when located within deprived socioeconomic and family circumstances.

Introducción: La seguridad alimentaria engloba cuatro dimensiones: Disponibilidad, Acceso, Utilización y estabilidad. La anemia es una enfermedad prevalente en los niños peruanos menores de 5 años. La relación entre seguridad alimentaria y anemia sigue siendo muy estudiada en diferentes enfoques. Objetivo: Evaluar la asociación entre seguridad alimentaria y la ocurrencia de anemia en niños menores de 5 años en el año 2019, a nivel regional y nacional. Metodología: Estudio analítico transversal, secundario a bases de datos. Resultados: Respecto al análisis bivariado, se observó un mayor ingreso total (soles) en niños que no tenían anemia respecto a los que sí, con 809 y 783 soles, respectivamente (p<0.001). Asimismo, se encontró que los niños sin anemia tienen mayor ingesta de hierro por miembro de familia que los niños con anemia (6.66 mg vs 6.5 mg) (p<0.001). Respecto al análisis multivariado, la inocuidad de agua medida por la prueba de cloro, la adecuada ingesta de hierro por miembro de familia y la producción de alimentos trazadores no afectados por el cambio climático aumentan un 0.63 g/dl (IC: 0.25- 1.00), 0.12 g/dl (IC: 0.02- 0.23) y 0.08 g/dl (IC: 0.1-0.10) los niveles de hemoglobina ajustada por altura, respectivamente. Conclusión: La seguridad alimentaria en sus dimensiones de utilización y estabilidad influyen positivamente en el nivel de hemoglobina ajustada por altura y, por ende, en la ocurrencia de anemia en los niños menores de 5 años en el Perú para el año 2019. / Introduction: Food Security encompasses four dimensions: Availability, Access, Utilization and Stability. Anemia is a prevalent disease in Peruvian children under 5 years old. The relationship between food security and anemia continues to be widely studied in different approaches. Objective: To evaluate the association between food security and the occurrence of anemia in children under 5 years old in 2019, regionally and nationally. Material and Method: Cross-sectional analytical study, secondary to databases. Results: Regarding the bivariate analysis, a higher total income (soles) was observed in children who did not have anemia compared to those who did, with 809 and 783 soles, respectively (p<0.001). Likewise, it was found that children without anemia have a higher intake of iron per family member than children with anemia (6.66 mg vs 6.5 mg) (p<0.001). Regarding the multivariate analysis, the safety of water measured by the chlorine test, the adequate intake of iron per family member and the production of tracer foods not affected by climate change increase by 0.63 g/dl (CI: 0.25-1.00). , 0.12 g/dl (CI: 0.02-0.23) and 0.08 g/dl (CI: 0.1-0.10) height-adjusted hemoglobin levels, respectively. Conclusions: Food security in its utilization and stability dimensions positively affects the hemoglobin level adjusted for height and, therefore, the occurrence of anemia in children under 5 years of age in Peru for the year 2019. / Tesis

Detta är en fördjupande studie baserat på en kvantitativ folkhälsoundersökning som visade samband i särskilt utsatthet bland förekomst av vilka som allvarligt övervägt självmord och demografiska faktorer hos folkbokförda i Umeå. Byggt på premissen av det pågående suicidpreventiva arbetet i Umeå tar denna studie i anspråk att utforska vilka livsomständigheter som skiljer sig åt mellan den generella populationen i Umeå jämfört med de som allvarligt övervägt självmord, samt föreslå suicidpreventiva åtgärdsförslag utifrån resultaten.    Data som omsattes i denna studie var ursprungligen insamlat av Övergripande planering Umeå kommun genom ett stratifierat urval som svarade mot olika demografiska områden av Umeå som resulterade i 2588 svaranden, med en svarsfrekvens av 37% som deltog i en folkhälsoundersökning som omfattade 102 frågor vilka var kvalitetskontrollerade av SCB.  Studieförfattarna utformade en metod för att skala ner urvalet av livsomständigheter till 15 variabler som skulle överensstämma med studiens teman: demografi, ekonomiska förutsättningar, vanor, mående och stöd som alla ställdes mot frågan: “Har du allvarligt övervägt självmord?”, där 10,7% av de tillfrågade svarade affirmativt. Slutsatser av denna studie är att undersökta livsomständigheter såsom socioekonomiska faktorer, vanor, demografiska faktorer, mående och stöd indikeras vara relaterade till en högre förekomst av att ha allvarligt övervägt självmord för folkbokförda i Umeå. Bland annat visas fulltidsanställda vara 22,9% mindre sannolika- där studerande är mer än dubbelt så sannolika- där personer som har sjuk- eller aktivitetsersättning var 444,9% mer sannolika att allvarligt ha övervägt självmord. Svaranden anger oftare sämre sömn (42,9% jämfört med 70,7%) hos de som allvarligt övervägt självmord. 77,4% av svaranden med ångestrelaterade svårigheter- 43,0% av svaranden med behov av psykisk vård som inte sökt- och 56,4% av svaranden med psykiska funktionshinder uppger att de allvarligt övervägt självmord jämfört med 10,7% hos generella svaranden. Utifrån studiens resultat föreslår studieförfattarna kompletterande lokala suicidpreventiva åtgärder, men finner behov av åtgärder med nationellt omfång för att svara mot de bredare socioekonomiska- och sociala problem som premissen och resultatet av denna studie belyser. / This is an in-depth study based on a quantitative public health survey which raised cause for concern about sociodemographic differences in occurrence of who has seriously considered suicide in the municipality of Umeå. Following the premise built on the current suicide prevention work in Umeå this study aims to give insight on which living circumstances differ regarding those with suicidal ideation in Umeå compared to the general population and what proposed actions might be indicated from the results.   The data used in this study was originally sampled by Övergripande planering, Umeå municipality using a stratified selection of different demographics in Umeå resulting in 2588 participants, an answer rate of 37% who answered a public health survey consisting of 102 questions, which was quality checked by SCB.   By process of elimination finding relevant living circumstances the authors designed a method of selection resulting in 15 variables consistent with the subtypes: demographics, economical circumstances, habits, health and support, all of which to correlate with the question translated to: “Have you seriously considered suicide?” where 10,7% of respondents answered positively.   Conclusions from this study are that certain life circumstances such as socioeconomic factors, habits, demographic factors, well-being and support is indicated being related to a higher prevalence of having seriously considered suicide amongst habitants of Umeå. Key findings include full-time employed was 22,9% less likely-, where students were more than two times more likely- and people on welfare or sick leave were 444,9% more likely to have seriously considered suicide. Respondents are less likely to have a good nights sleep (42,9% compared to 70,7%) if they have seriously considered suicide. 77,4% of those with anxiety-related issues, 43,0% of those in need of medical care for psychological health and 56,4% of respondents with psychological disability responds to have seriously considered suicide compared to the average of 10,7%. The authors provide examples of local implementations based on the findings but arrive at the need for a national scope to come to terms with the wider socio-economic and social issues that is suggested by the premise and result of this study.