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  • 1.
    Aryal, Umesh R.
    et al.
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Petzold, Max
    Akademistatistik - Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Bondjers, Göran
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Krettek, Alexandra
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg, Sweden.
    Correlates of smoking susceptibility among adolescents in a peri-urban area of Nepal: a population-based cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, no 1, p. 1-14, article id 24488Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Susceptibility to smoking is defined as an absence of firm commitment not to smoke in the future or when offered a cigarette by best friends. Susceptibility begins in adolescence and is the first step in the transition to becoming an established smoker. Many scholars have hypothesized and studied whether psychosocial risk factors play a crucial role in preventing adolescent susceptibility to smoking or discourage susceptible adolescents from becoming established smokers. Our study examined sociodemographic and family and childhood environmental factors associated with smoking susceptibility among adolescents in a peri-urban area of Nepal.

    DESIGN: We conducted a population-based cross-sectional study during October-November 2011 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) located in a peri-urban area near Kathmandu, the capital city of Nepal, where tobacco products are easily available. Trained local enumerators conducted face-to-face interviews with 352 respondents aged 14-16. We used stepwise logistic regression to assess sociodemographic and family and childhood environmental factors associated with smoking susceptibility.

    RESULTS: The percentage of smoking susceptibility among respondents was 49.70% (95% CI: 44.49; 54.93). Multivariable analysis demonstrated that smoking susceptibility was associated with smoking by exposure of adolescents to pro-tobacco advertisements (AOR [adjusted odds ratio] =2.49; 95% CI: 1.46-4.24), the teacher (2.45; 1.28-4.68), adolescents attending concerts/picnics (2.14; 1.13-4.04), and smoking by other family members/relatives (1.76; 1.05-2.95).

    CONCLUSIONS: Smoking susceptible adolescents are prevalent in the JD-HDSS, a peri-urban community of Nepal. Several family and childhood environmental factors increased susceptibility to smoking among Nepalese non-smoking adolescents. Therefore, intervention efforts need to be focused on family and childhood environmental factors with emphasis on impact of role models smoking, refusal skills in social gatherings, and discussing harmful effects of smoking with family members and during gatherings with friends.

  • 2.
    Aryal, Umesh Raj
    et al.
    Kathmandu Medical College, Nepal / Nordic School of Public Health NHV, Gothenburg.
    Petzold, Max
    Nordic School of Public Health NHV, Gothenburg, Sweden / Sahlgrenska Academy at University of Gothenburg.
    Krettek, Alexandra
    Nordic School of Public Health NHV, Gothenburg / Sahlgrenska Academy at University of Gothenburg.
    Perceived risks and benefits of cigarette smoking among Nepalese adolescents: a population-based cross-sectional study2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, article id 187Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The perceived risks and benefits of smoking may play an important role in determining adolescents' susceptibility to initiating smoking. Our study examined the perceived risks and benefits of smoking among adolescents who demonstrated susceptibility or non susceptibility to smoking initiation.

    METHODS: In October-November 2011, we conducted a population-based cross-sectional study in Jhaukhel and Duwakot Villages in Nepal. Located in the mid-hills of Bhaktapur District, 13 kilometers east of Kathmandu, Jhaukhel and Duwakot represent the prototypical urbanizing villages that surround Nepal's major urban centers, where young people have easy access to tobacco products and are influenced by advertising. Jhaukhel and Duwakot had a total population of 13,669, of which 15% were smokers. Trained enumerators used a semi-structured questionnaire to interview 352 randomly selected 14- to 16-year-old adolescents. The enumerators asked the adolescents to estimate their likelihood (0%-100%) of experiencing various smoking-related risks and benefits in a hypothetical scenario.

    RESULTS: Principal component analysis extracted four perceived risk and benefit components, excluding addiction risk: (i) physical risk I (lung cancer, heart disease, wrinkles, bad colds); (ii) physical risk II (bad cough, bad breath, trouble breathing); (iii) social risk (getting into trouble, smelling like an ashtray); and (iv) social benefit (looking cool, feeling relaxed, becoming popular, and feeling grown-up). The adjusted odds ratio of susceptibility increased 1.20-fold with each increased quartile in perception of physical Risk I. Susceptibility to smoking was 0.27- and 0.90-fold less among adolescents who provided the highest estimates of physical Risk II and social risk, respectively. Similarly, susceptibility was 2.16-fold greater among adolescents who provided the highest estimates of addiction risk. Physical risk I, addiction risk, and social benefits of cigarette smoking related positively, and physical risk II and social risk related negatively, with susceptibility to smoking.

    CONCLUSION: To discourage or prevent adolescents from initiating smoking, future intervention programs should focus on communicating not only the health risks but also the social and addiction risks as well as counteract the social benefits of smoking.

  • 3.
    Aryal, Umesh Raj
    et al.
    Kathmandu Medical College Nepal / Nordic School of Public Health NHV.
    Vaidya, Abhinav
    Kathmandu Medical College Nepal / Nordic School of Public Health NHV.
    Shakya-Vaidya, Suraj
    Nordic School of Public Health NHV / Nepal Medical College, Kathmandu Nepal.
    Petzold, Max
    Nordic School of Public Health NHV / Sahlgrenska Academy at University of Gothenburg.
    Krettek, Alexandra
    Nordic School of Public Health NHV / Sahlgrenska Academy at University of Gothenburg.
    Establishing a health demographic surveillance site in Bhaktapur district, Nepal: initial experiences and findings2012In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 5, article id 489Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A health demographic surveillance system (HDSS) provides longitudinal data regarding health and demography in countries with coverage error and poor quality data on vital registration systems due to lack of public awareness, inadequate legal basis and limited use of data in health planning. The health system in Nepal, a low-income country, does not focus primarily on health registration, and does not conduct regular health data collection. This study aimed to initiate and establish the first HDSS in Nepal.

    RESULTS: We conducted a baseline survey in Jhaukhel and Duwakot, two villages in Bhaktapur district. The study surveyed 2,712 households comprising a total population of 13,669. The sex ratio in the study area was 101 males per 100 females and the average household size was 5. The crude birth and death rates were 9.7 and 3.9/1,000 population/year, respectively. About 11% of births occurred at home, and we found no mortality in infants and children less than 5 years of age. Various health problems were found commonly and some of them include respiratory problems (41.9%); headache, vertigo and dizziness (16.7%); bone and joint pain (14.4%); gastrointestinal problems (13.9%); heart disease, including hypertension (8.8%); accidents and injuries (2.9%); and diabetes mellitus (2.6%). The prevalence of non-communicable disease (NCD) was 4.3% (95% CI: 3.83; 4.86) among individuals older than 30 years. Age-adjusted odds ratios showed that risk factors, such as sex, ethnic group, occupation and education, associated with NCD.

    CONCLUSION: Our baseline survey demonstrated that it is possible to collect accurate and reliable data in a village setting in Nepal, and this study successfully established an HDSS site. We determined that both maternal and child health are better in the surveillance site compared to the entire country. Risk factors associated with NCDs dominated morbidity and mortality patterns.

  • 4.
    Baldursdottir, Birna
    et al.
    Department of Psychology, School of Business, Reykjavik University, Iceland / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden.
    Taehtinen, Richard E.
    Department of Psychology, School of Business, Reykjavik University, Iceland / ICSRA (Icelandic Centre for Social Research and Analysis), Reykjavik University, Iceland.
    Sigfusdottir, Inga Dora
    Department of Psychology, School of Business, Reykjavik University, Iceland / ICSRA (Icelandic Centre for Social Research and Analysis), Reykjavik University, Iceland / Department of Health & Behavior Studies, Teachers College, Columbia University, New York, NY, USA.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Valdimarsdottir, Heiddis B.
    Department of Psychology, School of Business, Reykjavik University, Iceland / Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA.
    Impact of a physical activity intervention on adolescents' subjective sleep quality: a pilot study2017In: Global Health Promotion, ISSN 1757-9759, E-ISSN 1757-9767, Vol. 24, no 4, p. 14-22Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this pilot study was to examine the impact of a brief physical activity intervention on adolescents' subjective sleep quality. Cross-sectional studies indicate that physically active adolescents have better subjective sleep quality than those with more sedentary habits. However, less is known about the effectiveness of physical activity interventions in improving adolescents' subjective sleep quality.

    METHODS: In a three-week physical activity intervention, four Icelandic upper secondary schools were randomized to either an intervention group with pedometers and step diaries or a control group without pedometers and diaries. Out of 84, a total of 53 students, aged 15-16 years, provided complete data or a minimum of two days step data (out of three possible) as well as sleep quality measures at baseline and follow-up. Subjective sleep quality, the primary outcome in this study, was assessed with four individual items: sleep onset latency, nightly awakenings, general sleep quality, and sleep sufficiency. Daily steps were assessed with Yamax CW-701 pedometers.

    RESULTS: The intervention group (n = 26) had significantly higher average step-count (p = 0.03, partial η(2) = 0.093) compared to the control group (n = 27) at follow-up. Subjective sleep quality improved (p = 0.02, partial η(2) = 0.203) over time in the intervention group but not in the control group.

    CONCLUSIONS: Brief physical activity interventions based on pedometers and step diaries may be effective in improving adolescents' subjective sleep quality. This has important public health relevance as the intervention can easily be disseminated and incorporated into school curricula.

  • 5.
    Baldursdottir, Birna
    et al.
    Department of Psychology, School of Business, Reykjavik University, Reykjavik, Iceland / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Valdimarsdottir, Heiddis B.
    Department of Psychology, School of Business, Reykjavik University, Reykjavik, Iceland / Department of Oncological Sciences, Mount Sinai School of Medicine, New York, USA.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Gylfason, Haukur Freyr
    School of Business, Reykjavik University, Reykjavik, Iceland.
    Sigfusdottir, Inga Dora
    Department of Psychology, School of Business, Reykjavik University, Reykjavik, Iceland / ICSRA (Icelandic Centre for Social Research and Analysis), Reykjavik University, Reykjavik, Iceland / Department of Health & Behavior Studies, Teachers College, Columbia University, New York, USA .
    Age-related differences in physical activity and depressive symptoms among 10-19-year-old adolescents: A population based study2017In: Psychology of Sport And Exercise, ISSN 1469-0292, E-ISSN 1878-5476, Vol. 28, p. 91-99Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to examine age- and gender-related patterns of PA and depressive symptoms among students through their adolescent years. Design: Data from three population-based surveys were analysed to determine levels of moderate- to vigorous-intensity PA (MVPA), participation in organized sports and depressive symptoms among 10-19-year-old adolescents. Method: Questionnaires assessing PA and depressive symptoms were administered to 32 860 students in compulsory and upper-secondary schools in Iceland. Results: As age increased, depressive symptoms increased and PA decreased with over half of the adolescents in upper-secondary schools not achieving recommended daily PA. There were gender differences in PA and depressive symptoms with girls being less active and reporting higher levels of depressive symptoms than boys. MVPA was associated with lower levels of depressive symptoms among both genders while organized sports had more impact on depressive symptoms among girls. Conclusions: To our knowledge, this study is the first to simultaneously examine patterns of PA and depressive symptoms among students through their adolescent years. Our findings show that the decrease in PA and increase in depressive symptoms is most pronounced around the transition from compulsory to upper-secondary school, or around the age of 15-16. Thus the findings provide important information about when to tailor public health efforts to reduce the burden of depressive symptoms among adolescents, for example by employing PA interventions. (C) 2016 Elsevier Ltd. All rights reserved.

  • 6.
    Bourghardt, Johan
    et al.
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Bergström, Göran
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Krettek, Alexandra
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Sjöberg, Sara
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Borén, Jan
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Tivesten, Åsa
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden / Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg, Sweden.
    The endogenous estradiol metabolite 2-methoxyestradiol reduces atherosclerotic lesion formation in female apolipoprotein E-deficient mice2007In: Endocrinology, ISSN 0013-7227, E-ISSN 1945-7170, Vol. 148, no 9, p. 4128-4132Article in journal (Refereed)
    Abstract [en]

    Estradiol, the major endogenous estrogen, reduces experimental atherosclerosis and metabolizes to 2-methoxyestradiol in vascular cells. Currently undergoing evaluation in clinical cancer trials, 2-methoxyestradiol potently inhibits cell proliferation independently of the classical estrogen receptors. This study examined whether 2-methoxyestradiol affects atherosclerosis development in female mice. Apolipoprotein E-deficient mice, a well-established mouse model of atherosclerosis, were ovariectomized and treated through slow-release pellets with placebo, 17beta-estradiol (6 microg/d), or 2-methoxyestradiol [6.66 microg/d (low-dose) or 66.6 microg/d (high-dose)]. After 90 d, body weight gain decreased and uterine weight increased in the high-dose but not low-dose 2-methoxyestradiol group. En face analysis showed that the fractional area of the aorta covered by atherosclerotic lesions decreased in the high-dose 2-methoxyestradiol (52%) but not in the low-dose 2-methoxyestradiol group. Total serum cholesterol levels decreased in the high- and low-dose 2-methoxyestradiol groups (19%, P < 0.05 and 21%, P = 0.062, respectively). Estradiol treatment reduced the fractional atherosclerotic lesion area (85%) and decreased cholesterol levels (42%). In conclusion, our study shows for the first time that 2-methoxyestradiol reduces atherosclerotic lesion formation in vivo. The antiatherogenic activity of an estradiol metabolite lacking estrogen receptor activating capacity may argue that trials on cardiovascular effects of hormone replacement therapy should use estradiol rather than other estrogens. Future research should define the role of 2-methoxyestradiol as a mediator of the antiatherosclerotic actions of estradiol. Furthermore, evaluation of the effects of 2-methoxyestradiol on cardiovascular disease endpoints in ongoing clinical trials is of great interest.

  • 7.
    Bourghardt, Johan
    et al.
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Wilhelmson, Anna S. K.
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Alexanderson, Camilla
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    De Gendt, Karel
    Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
    Verhoeven, Guido
    Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
    Krettek, Alexandra
    Nordic School of Public Health NHV, Gothenburg, Sweden.
    Ohlsson, Claes
    Center for Bone Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Tivesten, Åsa
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Androgen receptor-dependent and independent atheroprotection by testosterone in male mice2010In: Endocrinology, ISSN 0013-7227, E-ISSN 1945-7170, Vol. 151, no 11, p. 5428-5437Article in journal (Refereed)
    Abstract [en]

    The atheroprotective effect of testosterone is thought to require aromatization of testosterone to estradiol, but no study has adequately addressed the role of the androgen receptor (AR), the major pathway for the physiological effects of testosterone. We used AR knockout (ARKO) mice on apolipoprotein E-deficient background to study the role of the AR in testosterone atheroprotection in male mice. Because ARKO mice are testosterone deficient, we sham operated or orchiectomized (Orx) the mice before puberty, and Orx mice were supplemented with placebo or a physiological testosterone dose. From 8 to 16 wk of age, the mice consumed a high-fat diet. In the aortic root, ARKO mice showed increased atherosclerotic lesion area (+80%, P < 0.05). Compared with placebo, testosterone reduced lesion area both in Orx wild-type (WT) mice (by 50%, P < 0.001) and ARKO mice (by 24%, P < 0.05). However, lesion area was larger in testosterone-supplemented ARKO compared with testosterone-supplemented WT mice (+57%, P < 0.05). In WT mice, testosterone reduced the presence of a necrotic core in the plaque (80% among placebo-treated vs. 12% among testosterone-treated mice; P < 0.05), whereas there was no significant effect in ARKO mice (P = 0.20). In conclusion, ARKO mice on apolipoprotein E-deficient background display accelerated atherosclerosis. Testosterone treatment reduced atherosclerosis in both WT and ARKO mice. However, the effect on lesion area and complexity was more pronounced in WT than in ARKO mice, and lesion area was larger in ARKO mice even after testosterone supplementation. These results are consistent with an AR-dependent as well as an AR-independent component of testosterone atheroprotection in male mice.

  • 8.
    Brackmann, Christian
    et al.
    Chalmers University of Technology, Molecular Microscopy, Department of Chemical and Biological Engineering, Göteborg, Sweden.
    Esguerra, Maricris
    Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, Department of Surgery, Göteborg, Sweden.
    Olausson, Daniel
    Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, Department of Surgery, Göteborg, Sweden.
    Delbro, Dick
    Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, Department of Surgery, Göteborg, Sweden.
    Krettek, Alexandra
    Sahlgrenska Academy at University of Gothenburg, Institute of Medicine, Department of Internal Medicine, Göteborg, Sweden.
    Gatenholm, Paul
    Chalmers University of Technology, Polymer Science, Department of Chemical and Biological Engineering, Göteborg, Sweden.
    Enejder, Annika
    Chalmers University of Technology, Molecular Microscopy, Department of Chemical and Biological Engineering, Göteborg, Sweden.
    Coherent anti-Stokes Raman scattering microscopy of human smooth muscle cells in bioengineered tissue scaffolds2011In: Journal of Biomedical Optics, ISSN 1083-3668, E-ISSN 1560-2281, Vol. 16, no 2, article id 021115Article in journal (Refereed)
    Abstract [en]

    The integration of living, human smooth muscle cells in biosynthesized cellulose scaffolds was monitored by nonlinear microscopy toward contractile artificial blood vessels. Combined coherent anti-Stokes Raman scattering (CARS) and second harmonic generation (SHG) microscopy was applied for studies of the cell interaction with the biopolymer network. CARS microscopy probing CH(2)-groups at 2845 cm(-1) permitted three-dimensional imaging of the cells with high contrast for lipid-rich intracellular structures. SHG microscopy visualized the fibers of the cellulose scaffold, together with a small signal obtained from the cytoplasmic myosin of the muscle cells. From the overlay images we conclude a close interaction between cells and cellulose fibers. We followed the cell migration into the three-dimensional structure, illustrating that while the cells submerge into the scaffold they extrude filopodia on top of the surface. A comparison between compact and porous scaffolds reveals a migration depth of <10 μm for the former, whereas the porous type shows cells further submerged into the cellulose. Thus, the scaffold architecture determines the degree of cell integration. We conclude that the unique ability of nonlinear microscopy to visualize the three-dimensional composition of living, soft matter makes it an ideal instrument within tissue engineering.

  • 9.
    Choulagai, Bishnu
    et al.
    Sahlgrenska Academy at University of Gothenburg / Tribhuvan University, Kathmandu, Nepal.
    Onta, Sharad
    Tribhuvan University, Kathmandu, Nepal.
    Subedi, Narayan
    Nepal Public Health Foundation, Kathmandu, Nepal.
    Mehata, Suresh
    Nepal Public Health Foundation, Kathmandu, Nepal.
    Bhandari, Gajananda P
    Nepal Public Health Foundation, Kathmandu, Nepal.
    Poudyal, Amod
    Tribhuvan University, Kathmandu, Nepal.
    Shrestha, Binjwala
    Tribhuvan University, Kathmandu, Nepal.
    Mathai, Matthews
    World Health Organization, Geneva, Switzerland.
    Petzold, Max
    Sahlgrenska Academy at University of Gothenburg.
    Krettek, Alexandra
    Institute of Medicine, Sahlgrenska Academy at University of Gothenburg / Nordic School of Public Health NHV Gothenburg.
    Barriers to using skilled birth attendants' services in mid- and far-western Nepal: a cross-sectional study.2013In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 13, no 1, article id 49Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in mid- and far-western Nepal.

    METHODS: This cross-sectional study examined three rural and remote districts of mid- and far-western Nepal (i.e., Kanchanpur, Dailekh and Bajhang), representing three ecological zones (southern plains [Tarai], hill and mountain, respectively) with low utilization of services by SBAs. Enumerators assisted a total of 2,481 women. All respondents had delivered a baby within the past 12 months. We used bivariate and multivariate analyses to assess the association between antenatal and delivery care visits and the women's background characteristics.

    RESULTS: Fifty-seven percent of study participants had completed at least four antenatal care visits and 48% delivered their babies with the assistance of SBAs. Knowing the danger signs of pregnancy and delivery (e.g., premature labor, prolonged labor, breech delivery, postpartum hemorrhage, severe headache) associated positively with four or more antenatal care visits (OR = 1.71; 95% CI: 1.41-2.07). Living less than 30 min from a health facility associated positively with increased use of both antenatal care (OR = 1.44; 95% CI: 1.18-1.77) and delivery services (OR = 1.25; CI: 1.03-1.52). Four or more antenatal care visits was a determining factor for the utilization of SBAs.

    CONCLUSIONS: Less than half of the women in our study delivered babies with the aid of SBAs, indicating a need to increase utilization of such services in rural and remote areas of Nepal. Distance from health facilities and inadequate transportation pose major barriers to the utilization of SBAs. Providing women with transportation funds before they go to a facility for delivery and managing transportation options will increase service utilization. Moreover, SBA utilization associates positively with women's knowledge of pregnancy danger signs, wealth quintile, and completed antenatal care visits. Nepal's health system must develop strategies that generate demand for SBAs and also reduce financial, geographic and cultural barriers to such services.

  • 10.
    Choulagai, Bishnu P.
    et al.
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Aryal, Umesh Raj
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
    Shrestha, Binjwala
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Vaidya, Abhinav
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
    Onta, Sharad
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
    Petzold, Max
    Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal: 2012 follow-up survey and use of skilled birth attendants2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, article id 29396Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Estimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted at the end of 2010. We also report on the use of skilled birth attendants (SBAs) and associated factors in the JD-HDSS at the follow-up point.

    DESIGN: We used a structured questionnaire to survey 3,505 households in the JD-HDSS, Bhaktapur, Nepal. To investigate the use of SBAs, we interviewed 434 women who had delivered a baby within the prior 2 years. We compared demographic and health indicators at baseline and follow-up and assessed the association of SBA services with background variables.

    RESULTS: Due to rising in-migration, the total population and number of households in the JD-HDSS increased (13,669 and 2,712 in 2010 vs. 16,918 and 3,505 in 2012). Self-reported morbidity decreased (11.1% vs. 7.1%, respectively), whereas accidents and injuries increased (2.9% vs. 6.5% of overall morbidity, respectively). At follow-up, the proportion of institutional delivery (93.1%) exceeded the national average (36%). Women who accessed antenatal care and used transport (e.g. bus, taxi, motorcycle) to reach a health facility were more likely to access institutional delivery.

    CONCLUSIONS: High in-migration increased the total population and number of households in the JD-HDSS, a peri-urban area where most health indicators exceed the national average. Major morbidity conditions (respiratory diseases, fever, gastrointestinal problems, and bone and joint problems) remain unchanged. Further investigation of reasons for increased proportion of accidents and injuries are recommended for their timely prevention. More than 90% of our respondents received adequate antenatal care and used institutional delivery, but only 13.2% accessed adequate postnatal care. Availability of transport and use of antenatal care was associated positively with institutional delivery.

  • 11.
    Choulagai, Bishnu P.
    et al.
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Nepal Public Health Foundation, Kathmandu, Nepal.
    Onta, Sharad
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Nepal Public Health Foundation, Kathmandu, Nepal.
    Subedi, Narayan
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Nepal Public Health Foundation, Kathmandu, Nepal.
    Bhatta, Dharma N.
    Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
    Shrestha, Binjwala
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
    Petzold, Max
    Health Metrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden, / School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    A cluster-randomized evaluation of an intervention to increase skilled birth attendant utilization in mid- and far-western Nepal2017In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 32, no 8, p. 1092-1101Article in journal (Refereed)
    Abstract [en]

    Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees with low SBA utilization among 1-year intervention and control groups. The eligible participants for the survey were women that had delivered a baby within the past 12 months preceding the survey. Implementation was administered by trained health volunteers, youth groups, mothers' groups and health facility management committee members. Post-intervention, we used difference-in-differences and mixed-effects regression models to assess and analyse any increase in the utilization of skilled birth care and antenatal care (ANC) services. All analyses were done by intention to treat. Our trial registration number was ISRCTN78892490 (http://www.isrctn.com/ISRCTN78892490). Interviewees included 1746 and 2098 eligible women in the intervention and control groups, respectively. The 1-year intervention was effective in increasing the use of skilled birth care services (OR = 1.57; CI 1.19-2.08); however, the intervention had no effect on the utilization of ANC services. Expanding the intervention with modifications, e.g. mobilizing more active and stable community groups, ensuring adequate human resources and improving quality of services as well as longer or repeated interventions will help achieve greater effect in increasing the utilization of SBA.

  • 12.
    Dollery, Clare M.
    et al.
    Leducq Ctr. for Cardiovasc. Research, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.
    Owen, Caroline A.
    Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.
    Sukhova, Galina K
    Leducq Ctr. for Cardiovasc. Research, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.
    Krettek, Alexandra
    Leducq Ctr. for Cardiovasc. Research, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
    Shapiro, Steven D.
    Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.
    Libby, Peter
    Leducq Ctr. for Cardiovasc. Research, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States / Brigham and Women's Hospital, Harvard Medical School, EBRC 307, 221 Longwood Ave., Boston, MA 02115, United States.
    Neutrophil elastase in human atherosclerotic plaques: production by macrophages2003In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 107, no 22, p. 2829-2836Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Catabolism of the extracellular matrix (ECM) contributes to vascular remodeling in health and disease. Although metalloenzymes and cysteinyl proteinases have garnered much attention in this regard, the role of serine-dependent proteinases in vascular ECM degradation during atherogenesis remains unknown. We recently discovered the presence of the metalloproteinase MMP-8, traditionally associated only with neutrophils, in atheroma-related cells. Human neutrophil elastase (NE) plays a critical role in lung disease, but the paucity of neutrophils in the atheromatous plaque has led to neglect of its potential role in vascular biology. NE can digest elastin, fibrillar and nonfibrillar collagens, and other ECM components in addition to its ability to modify lipoproteins and modulate cytokine and MMP activity.

    METHODS AND RESULTS: Fibrous and atheromatous plaques but not normal arteries contained NE. In particular, NE abounded in the macrophage-rich shoulders of atheromatous plaques with histological features of vulnerability. Neutrophil elastase and macrophages colocalized in such vulnerable plaques (n=7). In situ hybridization revealed NE mRNA in macrophage-rich areas, indicating local production of this enzyme. Freshly isolated blood monocytes, monocyte-derived macrophages, and vascular endothelial cells in culture produced active NE and contained NE mRNA. Monocytes produced NE constitutively, with little regulation by cytokines IL-1beta, TNF-alpha, or IFN-gamma but released it when stimulated by CD40 ligand, a cytokine found in atheroma.

    CONCLUSIONS: These findings point to a novel role for the serine protease, neutrophil elastase, in matrix breakdown by macrophages, a critical process in adaptive remodeling of vessels and in the pathogenesis of arterial diseases.

  • 13.
    Fagman, Johan B.
    et al.
    Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wilhelmson, Anna S.
    Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Motta, Benedetta M.
    Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pirazzi, Carlo
    Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Alexanderson, Camilla
    Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    De Gendt, Karel
    Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
    Verhoeven, Guido
    Laboratory for Experimental Medicine and Endocrinology, Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
    Holmäng, Agneta
    Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Anesten, Fredrik
    Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Jansson, John-Olov
    Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Levin, Malin
    Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Borén, Jan
    Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ohlsson, Claes
    Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Krettek, Alexandra
    Nordic School of Public Health, Gothenburg, Sweden / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Romeo, Stefano
    Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Tivesten, Åsa
    Wallenberg Laboratory for Cardiovascular and Metabolic Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The androgen receptor confers protection against diet-induced atherosclerosis, obesity, and dyslipidemia in female mice2015In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 29, no 4, p. 1540-1550Article in journal (Refereed)
    Abstract [en]

    Androgens have important cardiometabolic actions in males, but their metabolic role in females is unclear. To determine the physiologic androgen receptor (AR)-dependent actions of androgens on atherogenesis in female mice, we generated female AR-knockout (ARKO) mice on an atherosclerosis-prone apolipoprotein E (apoE)-deficient background. After 8 weeks on a high-fat diet, but not on a normal chow diet, atherosclerosis in aorta was increased in ARKO females (+59% vs. control apoE-deficient mice with intact AR gene). They also displayed increased body weight (+18%), body fat percentage (+62%), and hepatic triglyceride levels, reduced insulin sensitivity, and a marked atherogenic dyslipidemia (serum cholesterol, +52%). Differences in atherosclerosis, body weight, and lipid levels between ARKO and control mice were abolished in mice that were ovariectomized before puberty, consistent with a protective action of ovarian androgens mediated via the AR. Furthermore, the AR agonist dihydrotestosterone reduced atherosclerosis (-41%; thoracic aorta), subcutaneous fat mass (-44%), and cholesterol levels (-35%) in ovariectomized mice, reduced hepatocyte lipid accumulation in hepatoma cells in vitro, and regulated mRNA expression of hepatic genes pivotal for lipid homeostasis. In conclusion, we demonstrate that the AR protects against diet-induced atherosclerosis in female mice and propose that this is mediated by modulation of body composition and lipid metabolism.-Fagman, J. B., Wilhelmson, A. S., Motta, B. M., Pirazzi, C., Alexanderson, C., De Gendt, K., Verhoeven, G., Holmäng, A., Anesten, F., Jansson, J. -O., Levin, M., Borén, J., Ohlsson, C., Krettek, A., Romeo, S., Tivesten, A. The androgen receptor confers protection against diet-induced atherosclerosis, obesity, and dyslipidemia in female mice.

  • 14.
    Fink, Helen
    et al.
    Institute of Medical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Ahrenstedt, Lage
    School of Biotechnology, Royal Institute of Technology, Division of Glycoscience, Alba Nova University Centre, Stockholm, Sweden.
    Bodin, Aase
    Chalmers University of Technology, Chemical and Biological Engineering, Gothenburg, Sweden.
    Brumer, Harry
    School of Biotechnology, Royal Institute of Technology, Division of Glycoscience, Alba Nova University Centre, Stockholm, Sweden.
    Gatenholm, Paul
    Chalmers University of Technology, Chemical and Biological Engineering, Gothenburg, Sweden.
    Krettek, Alexandra
    Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Nordic School of Public Health, Gothenburg, Sweden.
    Risberg, Bo
    Institute of Medical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Bacterial cellulose modified with xyloglucan bearing the adhesion peptide RGD promotes endothelial cell adhesion and metabolism--a promising modification for vascular grafts2011In: Journal of Tissue Engineering and Regenerative Medicine, ISSN 1932-6254, E-ISSN 1932-7005, Vol. 5, no 6, p. 454-463Article in journal (Refereed)
    Abstract [en]

    Today, biomaterials such as polytetrafluorethylene (ePTFE) are used clinically as prosthetic grafts for vascular surgery of large vessels (>5 mm). In small diameter vessels, however, their performance is poor due to early thrombosis. Bacterial-derived cellulose (BC) is a new promising material as a replacement for blood vessels. This material is highly biocompatible in vivo but shows poor cell adhesion. In the native blood vessel, the endothelium creates a smooth non-thrombogenic surface. In order to sustain cell adhesion, BC has to be modified. With a novel xyloglucan (XG) glycoconjugate method, it is possible to introduce the cell adhesion peptide RGD (Arg-Gly-Asp) onto bacterial cellulose. The advantage of the XG-technique is that it is an easy one-step procedure carried out in water and it does not weaken or alter the fiber structure of the hydrogel. In this study, BC was modified with XG and XGRGD to asses primary human vascular endothelial cell adhesion, proliferation, and metabolism as compared with unmodified BC. This XG-RGD-modification significantly increased cell adhesion and the metabolism of seeded primary endothelial cells as compared with unmodified BC whereas the proliferation rate was affected only to some extent. The introduction of an RGD-peptide to the BC surface further resulted in enhanced cell spreading with more pronounced stress fiber formation and mature phenotype. This makes BC together with the XG-method a promising material for synthetic grafts in vascular surgery and cardiovascular research.

  • 15.
    Hultén, Lillemor Mattsson
    et al.
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg, Sweden.
    Ullström, Christina
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg, Sweden.
    Krettek, Alexandra
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg, Sweden.
    van Reyk, David
    Department of Health Sciences, University of Technology, Sydney, Australia.
    Marklund, Stefan L.
    Medical Biosciences, Clinical Chemistry, Umeå University Hospital, Umeå, Sweden.
    Dahlgren, Claes
    Phagocyte Research Laboratory, Department of Rheumatology and Inflammation Research, University of Göteborg, Göteborg, Sweden.
    Wiklund, Olov
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, Göteborg, Sweden.
    Human macrophages limit oxidation products in low density lipoprotein2005In: Lipids in Health and Disease, ISSN 1476-511X, E-ISSN 1476-511X, Vol. 4, article id 6Article in journal (Refereed)
    Abstract [en]

    This study tested the hypothesis that human macrophages have the ability to modify oxidation products in LDL and oxidized LDL (oxLDL) via a cellular antioxidant defence system. While many studies have focused on macrophage LDL oxidation in atherosclerosis development, less attention has been given to the cellular antioxidant capacity of these cells. Compared to cell-free controls (6.2 +/- 0.7 nmol/mg LDL), macrophages reduced TBARS to 4.42 +/- 0.4 nmol/mg LDL after 24 h incubation with LDL (P = 0.022). After 2 h incubation with oxLDL, TBARS were 3.69 +/- 0.5 nmol/mg LDL in cell-free media, and 2.48 +/- 0.9 nmol/mg LDL in the presence of macrophages (P = 0.034). A reduction of lipid peroxides in LDL (33.7 +/- 6.6 nmol/mg LDL) was found in the presence of cells after 24 h compared to cell-free incubation (105.0 +/- 14.1 nmol/mg LDL) (P = 0.005). The levels of lipid peroxides in oxLDL were 137.9 +/- 59.9 nmol/mg LDL and in cell-free media 242 +/- 60.0 nmol/mg LDL (P = 0.012). Similar results were obtained for hydrogen peroxide. Reactive oxygen species were detected in LDL, acetylated LDL, and oxLDL by isoluminol-enhanced chemiluminescence (CL). Interestingly, oxLDL alone gives a high CL signal. Macrophages reduced the CL response in oxLDL by 45% (P = 0.0016). The increased levels of glutathione in oxLDL-treated macrophages were accompanied by enhanced catalase and glutathione peroxidase activities. Our results suggest that macrophages respond to oxidative stress by endogenous antioxidant activity, which is sufficient to decrease reactive oxygen species both in LDL and oxLDL. This may suggest that the antioxidant activity is insufficient during atherosclerosis development. Thus, macrophages may play a dual role in atherogenesis, i.e. both by promoting and limiting LDL-oxidation.

  • 16.
    Hägg, Daniel
    et al.
    Research Center for Endocrinology and Metabolism, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden.
    Sjöberg, Sara
    Research Center for Endocrinology and Metabolism, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden.
    Hultén, Lillemor Mattsson
    Wallenberg Laboratory for Cardiovascular Research, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden.
    Fagerberg, Björn
    Wallenberg Laboratory for Cardiovascular Research, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden.
    Wiklund, Olov
    Wallenberg Laboratory for Cardiovascular Research, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden.
    Rosengren, Annika
    Department of Acute and Cardiovascular Medicine, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Carlsson, Lena M. S.
    Research Center for Endocrinology and Metabolism, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden.
    Borén, Jan
    Wallenberg Laboratory for Cardiovascular Research, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden.
    Svensson, Per-Arne
    Research Center for Endocrinology and Metabolism, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden / Wallenberg Laboratory for Cardiovascular Research, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden.
    Krettek, Alexandra
    Wallenberg Laboratory for Cardiovascular Research, Department of Metabolism and Cardiovascular Research, Göteborg, Sweden.
    Augmented levels of CD44 in macrophages from atherosclerotic subjects: a possible IL-6-CD44 feedback loop?2007In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 190, no 2, p. 291-297Article in journal (Refereed)
    Abstract [en]

    The cell-adhesion molecule CD44 likely participates in atherosclerosis development. We have shown previously that pro-inflammatory cytokines affect CD44 expression. Therefore, this work examined the role of elevated CD44 levels in human macrophages. Macrophages from human atherosclerotic subjects (n=15) showed elevated levels of CD44 transcript and protein (1.5-fold) compared to matched controls (n=15) (P=0.050 and 0.044, respectively). To test whether genetic factors influence CD44 expression, two single nucleotide polymorphisms in the CD44 gene were analyzed but these were not associated with coronary artery disease. We also examined the potential connection between plasma cytokine levels and CD44 expression. In atherosclerotic subjects, elevated CD44 expression correlates (P=0.012) with enhanced macrophage IL-6 secretion (3.13+/-2.5 pg/mL versus 0.32+/-0.16 pg/mL in controls, P=0.021). Additionally, CD44-deficient mice exhibit less circulating IL-6 than wild-type controls (9.8+/-0.7 pg/mL versus 14.3+/-0.7 pg/mL; P=0.032). Furthermore, IL-6 augments CD44 expression in primary human macrophages after 24 h (P=0.038) and 48 h (P=0.015). Taken together, our data show an IL-6-CD44 feedback loop in macrophages. Such a positive feedback loop may aggravate atherosclerosis development.

  • 17.
    Kharkova, Olga A.
    et al.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway,Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Grjibovski, Andrej M.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia / Department of Public Health, North-Eastern Federal University, Yakutsk, Russia / Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Nieboer, Evert
    Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.
    Odland, Jon Ø.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
    Effect of Smoking Behavior before and during Pregnancy on Selected Birth Outcomes among Singleton Full-Term Pregnancy: A Murmansk County Birth Registry Study2017In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 8, p. 1-11, article id E867Article in journal (Refereed)
    Abstract [en]

    The aim of our study was to assess associations between smoking behavior before and during pregnancy and selected adverse birth outcomes. This study is based on the Murmansk County Birth Registry (MCBR). Our study includes women who delivered a singleton pregnancy after 37 weeks of gestation (N = 44,486). Smoking information was self-reported and assessed at the first antenatal visit during pregnancy. We adjusted for potential confounders using logistic regression. The highest proportion of infants with low values of birth weight, birth length, head circumference, ponderal index and of the Apgar score at 5 min was observed for women who smoked both before and during pregnancy. We observed a dose-response relationship between the number of cigarettes smoked per day during pregnancy and the odds of the aforementioned adverse birth outcomes; neither were there significant differences in their occurrences among non-smokers and those who smoked before but not during pregnancy. Moreover, smoking reduction during pregnancy relative to its pre-gestation level did not influence the odds of the adverse birth outcomes. Our findings emphasize a continued need for action against tobacco smoking during pregnancy.

  • 18.
    Kharkova, Olga A.
    et al.
    UiT The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Grjibovski, Andrej M.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia / Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway / Department of Preventive Medicine, International Kazakh-Turkish University, Kazakhstan / Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway / Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Nieboer, Evert
    Department of Biochemistry and Biomedical Sciences, Hamilton, ON, Canada.
    Odland, Jon Ø.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
    First-trimester smoking cessation in pregnancy did not increase the risk of preeclampsia/eclampsia: A Murmansk County Birth Registry study2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, article id e0179354Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although prior studies have shown that smoking reduces preeclampsia/eclampsia risk, the consequence of giving up this habit during pregnancy should be assessed. The aims of the current study were threefold: (i) describe maternal characteristics of women with preeclampsia/eclampsia; (ii) examine a possible association between the number of cigarettes smoked daily during pregnancy and the development of this affliction; and (iii) determine if first-trimester discontinuation of smoking during pregnancy influences the risk.

    METHODS: A registry-based study was conducted using data from the Murmansk County Birth Registry (MCBR). It included women without pre-existing hypertension, who delivered a singleton infant during 2006-2011 and had attended the first antenatal visit before 12 week of gestation. We adjusted for potential confounders using logistic regression.

    RESULTS: The prevalence of preeclampsia/eclampsia was 8.3% (95%CI: 8.0-8.6). Preeclampsia/eclampsia associated with maternal age, education, marital status, parity, excessive weight gain and body mass index at the first antenatal visit. There was a dose-response relationship between the number of smoked cigarettes per day during pregnancy and the risk of preeclampsia/eclampsia (adjusted OR1-5 cig/day = 0.69 with 95%CI: 0.56-0.87; OR6-10 cig/day = 0.65 with 95%CI: 0.51-0.82; and OR≥11 cig/day = 0.49 with 95%CI: 0.30-0.81). There was no difference in this risk among women who smoked before and during pregnancy and those who did so before but not during pregnancy (adjusted OR = 1.10 with 95%CI: 0.91-1.32).

    CONCLUSIONS: Preeclampsia/eclampsia was associated with maternal age, education, marital status, parity, excessive weight gain, and body mass index at the first antenatal visit. There was a negative dose-response relationship between the number of smoked cigarettes per day during pregnancy and the odds of preeclampsia/eclampsia. However, women who gave up smoking during the first trimester of gestation had the same risk of preeclampsia/eclampsia as those who smoked while pregnant. Consequently, antenatal clinic specialists are advised to take these various observations into account when counselling women on smoking cessation during pregnancy.

  • 19.
    Kharkova, Olga A.
    et al.
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Grjibovski, Andrej M.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia / Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway / Department of Preventive Medicine, International Kazakh-Turkish University, Turkestan, Kazakhstan / North-Easten Federal University, Yakutsk, Russia.
    Nieboer, Evert
    Department of Biochemistry and Biomedical Sciences, Hamilton, ON, Canada.
    Odland, Jon Øyvind
    Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway / School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
    Prevalence of smoking before and during pregnancy and changes in this habit during pregnancy in Northwest Russia: a Murmansk county birth registry study2016In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 13, no 1, p. 1-9, article id 18Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Smoking during pregnancy leads to adverse maternal and birth outcomes. However, the prevalence of smoking among women in Russia has increased from < 5 % in the 1980s to > 20 % in the 2000s. We conducted a registry-based study in Murmansk County, Northwest Russia. Our aims were twofold: (i) assess the prevalence of smoking before and during pregnancy; and (ii) examine the socio-demographic factors associated with giving up smoking or reducing the number of cigarettes smoked once pregnancy was established.

    METHODS: This study employs data from the population-based Murmansk County Birth Registry (MCBR) collected during 2006-2011. We used logistic regression to investigate associations between women's socio-demographic characteristics and changes in smoking habit during pregnancy. To avoid departure from uniform risk within specific delivery departments, we employed clustered robust standard errors.

    RESULTS: Of all births registered in the MCBR, 25.2 % of the mothers were smokers before pregnancy and 18.9 % continued smoking during pregnancy. Cessation of smoking during pregnancy was associated with education, marital status and parity but not with maternal age, place of residence, and ethnicity. Women aged ≤ 20-24 years had higher odds of reducing the absolute numbers of cigarettes smoked per day during pregnancy than those aged ≥ 30-34 years. Moreover, smoking nulliparae and pregnant women who had one child were more likely to reduce the absolute numbers of cigarettes smoked per day compared to women having ≥ 2 children.

    CONCLUSIONS: About 25.0 % of smoking women in the Murmansk County in Northwest Russia quit smoking after awareness of the pregnancy, and one-third of them reduced the number cigarettes smoked during pregnancy. Our study demonstrates that women who have a higher education, husband, and are primiparous are more likely to quit smoking during pregnancy. Maternal age and number of children are indicators that influence reduction in smoking during pregnancy. Our findings are useful in identifying target groups for smoking intervention campaigns.

  • 20.
    Kovalenko, Anton A.
    et al.
    The Arctic University of Norway, Tromsø, Norway / Northern State Medical University, Arkhangelsk, Russia.
    Anda, Erik Eik
    The Arctic University of Norway, Tromsø, Norway.
    Odland, Jon Øyvind
    The Arctic University of Norway, Tromsø, Norway.
    Nieboer, Evert
    McMaster University, Hamilton, ON, Canada.
    Brenn, Tormod
    The Arctic University of Norway, Tromsø, Norway.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. The Arctic University of Norway, Tromsø, Norway / Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Risk Factors for Ventricular Septal Defects in Murmansk County, Russia: A Registry-Based Study2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 7, article id E1320Article in journal (Refereed)
    Abstract [en]

    Cardiovascular malformations are one of the most common birth defects among newborns and constitute a leading cause of perinatal and infant mortality. Although some risk factors are recognized, the causes of cardiovascular malformations (CVMs) remain largely unknown. In this study, we aim to identify risk factors for ventricular septal defects (VSDs) in Northwest Russia. The study population included singleton births registered in the Murmansk County Birth Registry (MCBR) between 1 January 2006 and 31 December 2011. Infants with a diagnosis of VSD in the MCBR and/or in the Murmansk Regional Congenital Defects Registry (up to two years post-delivery) constituted the study sample. Among the 52,253 infants born during the study period there were 744 cases of septal heart defects (SHDs), which corresponds to a prevalence of 14.2 [95% confidence interval (CI) of 13.2⁻15.3] per 1000 infants. Logistic regression analyses were carried out to identify VSD risk factors. Increased risk of VSDs was observed among infants born to mothers who abused alcohol [OR = 4.83; 95% CI 1.88⁻12.41], or smoked during pregnancy [OR = 1.35; 95% CI 1.02⁻1.80]. Maternal diabetes mellitus was also a significant risk factor [OR = 8.72; 95% CI 3.16⁻24.07], while maternal age, body mass index, folic acid and multivitamin intake were not associated with increased risk. Overall risks of VSDs for male babies were lower [OR = 0.67; 95% CI 0.52⁻0.88].

  • 21.
    Kovalenko, Anton A.
    et al.
    Department of Community Medicine, UiT -The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Brenn, Tormod
    Department of Community Medicine, UiT -The Arctic University of Norway, Tromsø, Norway.
    Odland, Jon Øyvind
    Department of Community Medicine, UiT -The Arctic University of Norway, Tromsø, Norway.
    Nieboer, Evert
    Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Community Medicine, UiT -The Arctic University of Norway, Tromsø, Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Anda, Erik Eik
    Department of Community Medicine, UiT -The Arctic University of Norway, Tromsø, Norway.
    Risk Factors for hypospadias in Northwest Russia: A Murmansk County Birth Registry Study2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0214213Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hypospadias is the most common congenital anomaly of the penis, but its causes are mainly unknown. Of the risk factors identified, the most plausible are hormonal and genetic. The aim of this study was to identify risk factors for hypospadias in Northwest Russia based on registry data.

    METHODS: The study population included male infants registered in the Murmansk County Birth Registry between 1 January 2006 and 31 December 2011 (n = 25 475). These infants were followed-up for 2 years using the Murmansk Regional Congenital Defects Registry to identify cases of hypospadias not diagnosed at birth. We used logistic regression analysis to examine the contributions of hypospadias risk factors.

    RESULTS: Out of 25 475 male infants born during the study period, 148 had isolated hypospadias. The overall prevalence rate was 54.2 (95% CI 53.6-54.8) per 10 000 male infants. Those born to mothers with preeclampsia (OR = 1.65; 95% CI 1.03-2.66) or infant birthweight < 2500 g (OR = 2.06; 95% CI 1.18-3.60) exhibited increased risk for hypospadias. Maternal age, smoking during pregnancy, folic acid intake during pregnancy or hepatitis B surface antigen positivity did not associate with increased risk of hypospadias.

    CONCLUSIONS: Combining data from a birth registry with those from a congenital defects registry provided optimal information about the prevalence of hypospadias and its association with low infant birthweight and preeclampsia. These factors have in common changes in hormone levels during pregnancy, which in turn may have contributed to hypospadias development.

  • 22.
    Kovalenko, Anton A.
    et al.
    Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Brenn, Tormod
    Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Odland, Jon Øyvind
    Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Nieboer, Evert
    Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Anda, Erik Eik
    Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Under-reporting of major birth defects in Northwest Russia: a registry-based study2017In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 76, no 1, p. 1-10, article id 1366785Article in journal (Refereed)
    Abstract [en]

    The objective was to assess the prevalence of selected major birth defects, based on data from two medical registries in Murmansk County, and compare the observed rates with those available for Norway and Arkhangelsk County, Northwest Russia. It included all newborns (≥22 completed weeks of gestation) registered in the Murmansk County Birth Registry (MCBR) and born between 1 January 2006 and 31 December 2009 (n=35,417). The infants were followed-up post-partum for 2 years through direct linkage to the Murmansk Regional Congenital Defects Registry (MRCDR). Birth defects identified and confirmed in both registries constituted the "cases" and corresponded to one or more of the 21 birth defect types reportable to health authorities in Moscow. The overall prevalence of major birth defects recorded in the MRCDR was 50/10,000 before linkage and 77/10,000 after linkage with the MCBR. Routine under-reporting to the MRCDR of 40% cases was evident. This study demonstrates that birth registry data improved case ascertainment and official prevalence assessments and reduced the potential of under-reporting by physicians. The direct linkage of the two registries revealed that hypospadias cases were the most prevalent among the major birth defects in Murmansk County.

    ABBREVIATIONS: ICD-10, International Classification of Diseases, 10th revision; MCBR, Murmansk County Birth Registry; MRCDR, Murmansk Regional Congenital Defects Registry; MGC, Murmansk Genetics Center.

  • 23.
    Krettek, Alexandra
    et al.
    The Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Fager, G.
    The Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sweden.
    Jernberg, P.
    The Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sweden.
    Östergren-Lundén, G.
    The Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sweden.
    Lustig, F.
    The Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sweden.
    Quantitation of platelet-derived growth factor receptors in human arterial smooth muscle cells in vitro1997In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 17, no 11, p. 2395-2404Article in journal (Refereed)
    Abstract [en]

    Platelet-derived growth factor (PDGF) is suggested to play an important role in the development of atherosclerosis as a migratory and mitogenic stimulus to arterial smooth muscle cells (ASMCs). Stimulated and unstimulated ASMCs were studied with respect to PDGF receptor (PDGF-R) mRNA and protein expression. Quantitative RT-PCR was developed for simultaneous evaluation of both PDGF-R alpha and -R beta mRNA expression and a quantitative ELISA for estimation of corresponding PDGF-R subunits. On the mRNA level, the overall PDGF-R beta expression was approximately 100 times lower than that of PDGF-R alpha. Furthermore, although PDGF-R alpha mRNA levels were high irrespective of hASMC phenotype, PDGF-R beta mRNA was influenced by serum stimulation with lower copy numbers in proliferating and confluent cells compared with quiescent cells. On the protein level, quiescent hASMCs expressed 10 times more PDGF-R beta than PDGF-R alpha. Serum stimulation decreased cell surface PDGF-Rs, with most prominent loss of PDGF-R alpha (ELISA and immunohistochemistry). Our results suggest a differential regulatory pattern for PDGF-R alpha and -R beta and are compatible with the usage of alternative promoters for regulation of -R alpha expression. Further, it seems that the number of available receptor subunits is not the only determinant of variations in cell stimulation with different PDGF isoforms.

  • 24.
    Krettek, Alexandra
    et al.
    Wellenberg Lab. for Cardiovasc. Res., Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden / Wallenberg Lab. for Cardiovasc. Res., Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Fager, G.
    Wellenberg Lab. for Cardiovasc. Res., Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Lindmark, H.
    Wellenberg Lab. for Cardiovasc. Res., Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Simonson, C.
    Wellenberg Lab. for Cardiovasc. Res., Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Lustig, F.
    Wellenberg Lab. for Cardiovasc. Res., Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Effect of phenotype on the transcription of the genes for platelet-derived growth factor (PDGF) isoforms in human smooth muscle cells, monocyte-derived macrophages, and endothelial cells in vitro1997In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 17, no 11, p. 2897-2903Article in journal (Refereed)
    Abstract [en]

    Proliferation of arterial smooth muscle cells (ASMCs) contributes considerably to enlargement of the arterial wall during atherosclerosis. The platelet-derived growth factor (PDGF) is a well-known mitogen and chemoattractant for ASMCs. Quantitative reverse transcription-polymerase chain reaction showed that cells appearing in atherosclerotic lesions, such as ASMCs, endothelial cells, and monocytes/macrophages, expressed mRNAs for both PDGF A and B chains in vitro, with the highest expression in endothelial cells. On proliferation, ASMCs and endothelial cells upregulated PDGF A mRNA. Differentiation of macrophages increased the amount of both mRNAs. Thus, the regulation of PDGF A- and B-chain expression depends on cell types and phenotypic states of the cells, which have also been found in vivo in human atherosclerotic lesions. PDGF A can be produced as short and long isoforms. The latter binds with high affinity to glycosaminoglycans. Irrespective of phenotype, only the minor part of total PDGF A mRNA consisted of the long variant in ASMCs, while endothelial cells produced 40% of total PDGF A as the long form. The differentiation of macrophages increased the production of the long PDGF A mRNA from 10% to 40%. Thus, increasing numbers of stimulated cells in the atherosclerotic lesion may increase the transcription of PDGF isoforms, and particularly of the long PDGF A isoform. Together with increasing amounts of ASMC-derived proteoglycans in developing lesions, this may contribute to accumulation of PDGF in the arterial wall matrix, resulting in prolonged stimulation of ASMCs.

  • 25.
    Krettek, Alexandra
    et al.
    Division of Evolutionary Molecular Systematics, University of Lund, Lund, Sweden.
    Gullberg, Anette
    Division of Evolutionary Molecular Systematics, University of Lund, Lund, Sweden.
    Arnason, Ulfur
    Division of Evolutionary Molecular Systematics, University of Lund, Lund, Sweden.
    Sequence analysis of the complete mitochondrial DNA molecule of the hedgehog, Erinaceus europaeus, and the phylogenetic position of the Lipotyphla1995In: Journal of Molecular Evolution, ISSN 0022-2844, E-ISSN 1432-1432, Vol. 41, no 6, p. 952-957Article in journal (Refereed)
    Abstract [en]

    The sequence of the mitochondrial DNA (mtDNA) molecule of the European hedgehog (Erinaceus europaeus) was determined. The length of the sequence presented is 17,442 nucleotides (nt). The molecule is thus the largest eutherian mtDNA molecule so far reported. The organization of the molecule conforms with that of other eutherians, but the control region of the molecule is exceptionally long, 1,988 nt, due to the presence of repeated motifs at two different positions in the 3' part of the control region. The length of the control region is not absolute due to pronounced heteroplasmy caused by variable numbers of the motif TACGCA in one of the repetitive regions. The sequence presented includes 46 repeats of this type. The other repeated region is composed of different AT-rich repeats. This region was identical among four clones studied. Comparison of mitochondrial peptide-coding genes identified a separate position of the hedgehog among several mammalian orders. The concatenated protein sequence of the 13 peptide-coding genes was used in a phylogenetic study using the opossum as outgroup. The position of the hedgehog sequence was basal among the other eutherian sequences included: human, rat, mouse, cow, blue whale, harbor seal, and horse. The analysis did not resolve the relationship among carnivores, perissodactyls, and artiodactyls/cetaceans, suggesting a closer relationship among these orders than acknowledged by classical approaches.

  • 26.
    Krettek, Alexandra
    et al.
    Nordic School of Public Health NHV, Gothenburg, Sweden / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Karlsson, Leena Eklund
    Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
    Toan, Tran Khanh
    Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam.
    Thi Kim Chuc, Nguyen
    Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam.
    Nordic School of Public Health NHV and its legacy in global health2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 16 suppl, p. 36-45Article in journal (Refereed)
    Abstract [en]

    This article describes the legacy of the Nordic School of Public Health NHV (NHV) in global health. We delineate how this field developed at NHV and describe selected research and research training endeavours with examples from Vietnam and Nepal as well as long-term teaching collaborations such as BRIMHEALTH (Baltic RIM Partnership for Public HEALTH) in the Baltic countries and Arkhangelsk International School of Public Health in Russia.

  • 27.
    Krettek, Alexandra
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Avdelningen för invärtesmedicin och klinisk nutrition, Institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet.
    Magnusson, Maria
    Enheten för kommunikation och folkhälsa, Angereds närsjukhus.
    Hallmyr, Moa
    Enheten för kommunikation och folkhälsa, Angereds närsjukhus.
    Ascher, Henry
    Avdelningen för samhällsmedicin och folkhälsa, Institutionen för medicin, Sahlgrenska akademin, Göteborgs universitet / FoU-enheten och flyktingbarnteamet, Angereds närsjukhus.
    Apropå! »Alla vet att man ska äta frukt och grönt och röra på sig«2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id E3YZArticle in journal (Other (popular science, discussion, etc.))
  • 28.
    Krettek, Alexandra
    et al.
    Nordic School of Public Health, Gothenburg, Sweden / Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Sjöberg, Sara
    Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    CD44 - a new cardiovascular drug target or merely an innocent bystander?2009In: Cardiovascular & hematological disorders drug targets, ISSN 2212-4063, Vol. 9, no 4, p. 293-302Article, review/survey (Refereed)
    Abstract [en]

    CD44, short for cluster of differentiation 44, is an adhesion molecule of the hyaluronate receptor family. Expressed on the surface of most vertebrate cells, it functions as a receptor for several extracellular matrix components, e.g., hyaluronan, collagen, laminin, fibronectin, and osteopontin. CD44 has in recent years been intensively studied in connection with different forms of cancer, where CD44 may regulate invasiveness and tumor progression. Although major functions involve adhesion and migration, CD44 also affects leukocyte homing and recruitment, phagocytosis, matrix remodeling, proliferation, and apoptosis. As such, CD44 is an interesting putative molecule in cardiovascular drug therapy. Accumulating evidence from human studies point to CD44 as involved in inflammatory diseases such as atherosclerosis and human abdominal aneurysms. To date, several animal studies have shown that the role of CD44 in atherogenesis may vary depending on experimental model. In this Review, we trace CD44 and its potential role in the context of cardiovascular diseases by highlighting both human and animal studies that may help us understand; is CD44 a new cardiovascular drug target or merely an innocent bystander?

  • 29.
    Krettek, Alexandra
    et al.
    Brigham and Women's Hospital, Harvard Medical School, Boston, United States.
    Sukhova, Galina K.
    Brigham and Women's Hospital, Harvard Medical School, Boston, United States.
    Libby, Peter
    Brigham and Women's Hospital, Harvard Medical School, Boston, United States.
    Elastogenesis in human arterial disease: A role for macrophages in disordered elastin synthesis2003In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 23, no 4, p. 582-587Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Elastin, an extracellular matrix protein, constitutes about 30% of the dry weight of the arteries. Elastolysis induced by inflammatory processes is active in chronic arterial diseases. However, elastogenesis in arterial diseases has received little attention. In this work we hypothesized that disordered elastogenesis is active in matrix remodeling in atheroma and abdominal aortic aneurysm (AAA).

    METHODS AND RESULTS: Human AAA and atheroma have 4- to 6-fold more tropoelastin protein than nondiseased arteries. The smooth muscle cell-containing media and fibrous cap of atherosclerotic arteries contain ordered mature elastin, whereas macrophage (MPhi)-rich regions often have disorganized elastic fibers. Surprisingly, in addition to smooth muscle cells, MPhis in diseased arteries also produce the elastin precursor tropoelastin, as shown by double immunostaining, in situ hybridization, and reverse transcription-polymerase chain reaction for tropoelastin mRNA. Cultured monocyte-derived MPhis can express the elastin gene. AAA have 9-fold but atheroma only 1.6-fold lower levels of desmosine, a marker for mature cross-linked elastin, than normal arteries.

    CONCLUSIONS: This study demonstrates ongoing but often ineffective elastogenesis in arterial disease and establishes human macrophages as a novel source for this important matrix protein. These results have considerable import for understanding mechanisms of extracellular matrix remodeling in arterial diseases.

  • 30.
    Krettek, Alexandra
    et al.
    Harvard Medical School, Boston, Massachusetts.
    Sukhova, Galina K.
    Schönbeck, Uwe
    Libby, Peter
    Enhanced expression of CD44 variants in human atheroma and abdominal aortic aneurysm: possible role for a feedback loop in endothelial cells2004In: American Journal of Pathology, ISSN 0002-9440, E-ISSN 1525-2191, Vol. 165, no 5, p. 1571-1581Article in journal (Refereed)
    Abstract [en]

    CD44, a polymorphic hyaluronate receptor, may participate in chronic inflammation. We hypothesized that CD44 variants contribute to the development of arterial diseases. CD44 levels vary in normal and diseased arterial tissues in the following order: unaffected arteries < fibrous plaques < or = abdominal aortic aneurysm < atheromatous plaques; and correlate with macrophage content. Furthermore, plaque microvessels express CD44, and anti-CD44v3 or anti-CD44v6 treatment reduces endothelial cell proliferation but not apoptosis in vitro, suggesting functionality of these receptors. Endothelial cells express CD44H and CD44v6 after exposure to interleukin-1beta and tumor necrosis factor-alpha. Macrophages, a major source of abundant CD44 in vitro, express not only CD44H but also variants CD44v4/5, CD44v6, and CD44v7/8, isoforms distinctively regulated by proinflammatory cytokines. Several proinflammatory cytokines induce shedding of CD44 from the surface of macrophages and endothelial cells. Soluble CD44 stimulates the expression and release of interleukin-1beta from endothelial cells, suggesting a positive feedback loop of this cytokine. By demonstrating augmented expression of CD44 and variants within human atheroma and in abdominal aortic aneurysm as well as the vascular cell release of sCD44, a process regulated by proinflammatory cytokines, this study provides new insights on the functions of CD44 in arterial diseases.

  • 31.
    Krettek, Alexandra
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Folkhälsovetenskaplig utbildning på distans med unik profil för framtiden2017In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 94, no 3, p. 327-339Article in journal (Refereed)
    Abstract [en]

    Public Health at University of Skövde is expanding as a strategic effort by the University. The ambition is to provide unique public health education that gives students preparedness to work with current and future public health challenges. To date, University of Skövde offers three educational programmes in public health; the two-year Health Coach, the three-year Public Health Sciences Study Programme and the master’s programme in Public Health Science: Infection Prevention and Control. The latter is unique and one-of-a-kind in both Sweden and the Nordic countries. All educational programmes are given as distance education with a few gatherings on campus. The article therefore also highlights challenges and possibilities with distance education and provides advice on how to make students successfully progress through such educational programmes.

  • 32.
    Krettek, Alexandra
    et al.
    Nordic School of Public Health, Gothenburg Sweden / Sahlgrenska Academy, University of Gothenburg.
    Thorpenberg, Stefan
    Nordic School of Public Health, Gothenburg Sweden / Lund University, Sweden.
    Transdisciplinary Higher Education –: A Challenge for Public Health Science2011In: Education Research International, ISSN 2090-4002, E-ISSN 2090-4010, p. 1-6, article id 649539Article in journal (Refereed)
    Abstract [en]

    This paper highlights and discusses issues associated with transdisciplinary teaching and suggests ways to overcome the challenges posed by different epistemologies, methods, and ethical positions. Our own transdisciplinary teaching experience in public health helped us identify some important questions including (i) what is transdisciplinary research in practice, and does methods triangulation yield more valid results?, (ii) from a teaching perspective, how do biopsychosocial and medical research differ?, (iii) what is the difference between deductive and inductive research, and does each discipline represent a different ethical position?, and (iv) does pure inductive research lack theories, and does it require a hypothesis—a “rule of thumb”—on how to proceed? We also suggest ways to facilitate and enhance transdisciplinary teaching, focusing on what unites us and not on what sets us apart, openly underlining and highlighting our differences. Using diverse methodologies, a newly educated transdisciplinary workforce will likely extend current knowledge and facilitate solutions for complex public health issues.

  • 33.
    Krettek, Alexandra
    et al.
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Östergren-Lundén, G.
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Fager, G.
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Rosmond, C.
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Bondjers, G.
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Lustig, F.
    Wallenberg Laboratory for Cardiovascular Research, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
    Expression of PDGF receptors and ligand-induced migration of partially differentiated human monocyte-derived macrophages. Influence of IFN-gamma and TGF-beta2001In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 156, no 2, p. 267-275Article in journal (Refereed)
    Abstract [en]

    In the early atherosclerotic lesion, monocytes accumulate at sites of inflammation and endothelial injury. Platelet-derived growth factor (PDGF), produced for example by macrophages, is a chemoattractant for smooth muscle cells and possibly also for macrophages. During early differentiation into macrophages, human monocytes (early hMDM) showed lower expression of PDGF alpha-receptor (PDGF-Ralpha) than beta-receptor (PDGF-Rbeta) mRNA. Early hMDM showed increased random motility (chemokinesis) in the presence of PDGF of the long (BB(L)) but not short (BB(S)) B-chain homodimer. Neither PDGF-AA(S) nor PDGF-AA(L) affected early hMDM motility. Since increased cytokine levels accompany inflammation, the influence of interferon-gamma (IFN-gamma) and transforming growth factor-beta (TGF-beta) on PDGF-R expression and migratory response were studied. Only PDGF-Ralpha mRNA was highly upregulated by IFN-gamma. TGF-beta only had minor effects on receptor mRNAs. Upregulation of PDGF-Ralpha levels by IFN-gamma was accompanied by significantly increased migration (chemotaxis) towards PDGF-AA(L) only. Consequently, IFN-gamma modulates PDGF-Rs expression in early hMDM and, subsequently, the chemotactic activity of PDGF-AA(L) on IFN-gamma-stimulated early hMDM. This suggests that PDGF-AA(L) may be involved in attracting activated monocytes to sites of inflammation and injury.

  • 34.
    Makarova, Maria
    et al.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Krettek, Alexandra
    Nordic School of Public Health NHV, Gothenburg, Sweden / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Valkov, Mikhail Y.
    Department of Radiology and Clinical Oncology, Northern State Medical University, Arkhangelsk, Russia.
    Grjibovski, Andrej M.
    International School of Public Health, Northern State Medical University, Arkhangelsk, Russia / Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway / Institute of Community Medicine, University of Tromsø, Tromsø, Norway.
    Hepatitis B and C viruses and survival from hepatocellular carcinoma in the Arkhangelsk region: a Russian registry-based study2013In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 72, article id 20282Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The prevalence of hepatitis B (HBV) and C (HCV) in Russia was 7.6 and 5.4 per 100,000, respectively. The aim of this study was to assess the proportion of HCV and HBV infection among HCC patients, to evaluate associations between HCV, HBV and stage of HCC and to compare survival of HCC patients by their HBV/HCV status in the Arkhangelsk region of northwest Russia.

    MATERIALS AND METHODS: A retrospective cohort study was conducted using data on all histologically confirmed HCC cases. Proportions of infected and non-infected HCC cases were calculated by Wilson's method. The associations between HBV, HCV and severity of HCC were assessed by Pearson's Chi-squared test. Survival data were presented using Kaplan-Meier curves and median survival. Survival time between the groups was compared using log-rank tests. Adjustment for potential confounders (sex, age groups, stage of HCC and cirrhosis stage by Child-Paquet scale) was performed using Cox regression.

    RESULTS: There were 583 histologically confirmed HCC cases. The viral status was registered in 311 of patients with pre-mortem diagnosis, where 124 or 39.9% (95% confidence interval (CI), 34.4-45.4) had HBV, 54 or 17.4% (95% CI, 13.5-21.9) had HCV and 16 or 5.1% (95% CI, 3.2-8.2) were infected with both HBV and HCV. The median survival rates of patients were 3 months (95% CI, 2.3-3.8), 3 months (95% CI, 2.0-3.9) and 1 month (95% CI, 0.0-0.6) for patients with HBV, HCV and HBV and HCV, respectively. For virus-free patients, it was 5 months (95% CI, 3.5-6.5), log-rank test=10.74, df=3, p=0.013. Crude Cox regression showed increased risk of death for HBV and HBV and HCV groups in comparison with virus-free patients, and not reaching the level of statistical significance for HCV. After adjustment, the hazard ratios (HRs) decreased to non-significant levels or even reversed, with only exception for the group of patients infected with both hepatitis viruses.

    CONCLUSIONS: We found that more than half of HCC patients were infected with HBV or HCV. The study did not reveal an association between viral status of HCC patients and stage of HCC. The viral hepatitis may have an impact on survival of HCC patients.

  • 35.
    Medin, Jennie
    et al.
    Nordic Council of Ministers, Nordic School of Public Health, Göteborg, Sweden.
    Krettek, Alexandra
    Nordic Council of Ministers, Nordic School of Public Health, Göteborg, Sweden.
    An apple a day keeps the doctor away: interdisciplinary approaches to solving major public health threats2008In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 8, p. 857-858Article in journal (Refereed)
  • 36.
    Morelli, Paula I.
    et al.
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden / Wallenberg Laboratory, Sahlgrenska University Hospital, Göteborg, Sweden.
    Martinsson, Sofia
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Östergren-Lundén, Gunnel
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Fridén, Vincent
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Moses, Jonatan
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Bondjers, Göran
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Krettek, Alexandra
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Lustig, Florentyna
    Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    IFN gamma regulates PDGF-receptor alpha expression in macrophages, THP-1 cells, and arterial smooth muscle cells2006In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 184, no 1, p. 39-47Article in journal (Refereed)
    Abstract [en]

    The recruitment of monocyte-derived macrophages (MDMs) and arterial smooth muscle cells (ASMCs) contributes to inflammation and development of intimal hyperplasia during atherosclerosis. Platelet-derived growth factor (PDGF) is a potent mitogen for SMC, signalling through PDGF-receptor subunits alpha (Ralpha) and beta (Rbeta). We have previously found that interferon gamma (IFNgamma) upregulates PDGF-Ralpha mRNA expression in human MDM (hMDM) which causes an increased migration towards PDGF. In the present study, we found that IFNgamma mediated an upregulation of PDGF-Ralpha mRNA also in THP-1 cells. The induction of PDGF-Ralpha in both hMDM and THP-1 cells was caused by STAT1 binding to the PDGF-Ralpha promoter. In human ASMCs, IFNgamma again stimulated a transient STAT1-binding to the PDGF-Ralpha promoter. However, this was not followed by an upregulation of PDGF-Ralpha mRNA. IFNgamma-stimulation resulted in augmented expression of PDGF-Ralpha protein in differentiated hMDM. Early hMDM only expressed an immature and not fully glycosylated form of the PDGF-Ralpha protein. In contrast, THP-1 cells did not synthesize PDGF-Ralpha protein, implying further posttranscriptional inhibition. Our results contribute to a better understanding of the complex regulation of PDGF-Ralpha expression and how proinflammatory factors may contribute to PDGF-related hyperplasia in vascular diseases.

  • 37.
    Oli, Natalia
    et al.
    Kathmandu Medical College, Nepal.
    Vaidya, Abhinav
    Kathmandu Medical College, Nepal.
    Eiben, Gabriele
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Sahlgrenska Academy at University of Gothenburg, Sweden / UiT The Arctic University of Norway, Tromsø.
    Changes in children’s diet and physical activity as perceived by their mothers: Impact of a health promotion intervention for mothers in a sub-urban area of Nepal2018In: Journal of Kathmandu Medical College, ISSN 2091-1785, Vol. 7, no 4, p. 140-146Article in journal (Refereed)
    Abstract [en]

    Background:

    Unhealthy diet and physical inactivity contribute to the growing burden of cardiovascular diseases in Nepal. Lifestyle is formed in childhood and in the Nepalese context influenced mainly by mothers, it is to date unknown how influential mothers are.

    Objectives:

    To assess changes in children’s diet and physical activity as perceived by their mothers after a health promotion intervention.

    Methodology:

    The Heart-Health Associated Research, Dissemination and Intervention in the Community is a community trial conducted in the Jhaukhel-Duwakot Health Demographic Surveillance site, in Bhaktapur district of Nepal. We conducted a health promotion intervention on diet and physical activity targeted at mothers with children aged one to nine years old in August-November 2016. Duwakot was randomized as the intervention site and Jhaukhel as the control. We conducted a follow-up study after three months to determine the outcome of the intervention. Nine trained enumerators conducted door-to-door visits to all households with eligible mothers. We calculated mean, frequency and percent changes for children’s behavior.

    Results:

    As responded by mothers, children in Duwakot consumed more healthy snacks after the intervention compared to Jhaukhel. Children in Duwakot increased consumption of water and milk. Children’s consumption of packet juices and soft drinks was decreased by 30% and 4% respectively. There was 21% increment in the duration of outdoor playing among the children at Duwakot during follow-up.

    Conclusion:

    The Heart-Health Associated Research, Dissemination and Intervention in the Community that focused on mothers showed indirect positive impact on their young children’s diet and physical activity behavior. In future, the longterm effects of such intervention should be assessed.

  • 38.
    Oli, Natalia
    et al.
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Department of Community Medicine, Kathmandu Medical College, Nepal.
    Vaidya, Abhinav
    Department of Community Medicine, Kathmandu Medical College, Nepal.
    Eiben, Gabriele
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
    Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, p. 1-12, article id 1670033Article in journal (Refereed)
    Abstract [en]

    Background: Nepal, like many low- and middle-income countries, exhibits rising burden of cardiovascular diseases. Misconceptions, poor behavior, and a high prevalence of risk factors contribute to this development. Health promotion efforts along with primary prevention strategies, including risk factor reduction in both adults and children, are therefore critical. Objectives: This study assessed the effectiveness of a health promotion intervention on mothers' knowledge, attitude and practice (KAP) and their children's behavior regarding diet and physical activity. Methods: The Heart-health Associated Research, Dissemination and Intervention in the Community (HARDIC), a community-based trial, used peer education to target mothers with 1-9-year-old children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal, during August-November 2016. In the intervention area, 47 peer mothers were trained to conduct four education classes for about 10 fellow mothers (N = 391). After 3 months, all eligible mothers in the intervention and control areas were interviewed and the results were compared with the KAP of all eligible mothers at baseline. Results: Post-intervention, mothers' KAP median scores had improved regarding heart-healthy diet and physical activity. More mothers had 'good' KAP (>75% of maximum possible scores), and mothers with 'good' knowledge increased from 50% to 81%. Corresponding control values increased only from 58% to 63%. Mothers' attitude and practice improved. Additionally, mothers in the intervention area reported improvement in their children's diet and physical activity behavior. Moreover, Difference in Differences analysis showed that the HARDIC intervention significantly increased mothers' KAP scores and children's behavior scores in the intervention area compared to the control area. Conclusions: Our intervention improves KAP scores regarding diet and physical activity and shows potential for expansion via community health workers, volunteers, and/or local women. Moreover, HARDIC can contribute to Nepal's Package of Essential Noncommunicable Diseases Initiative, which currently lacks a specific package for health promotion.

  • 39.
    Oli, Natalia
    et al.
    Sahlgrenska Academy at University of Gothenburg, Sweden / Kathmandu Medical College, Kathmandu, Nepal.
    Vaidya, Abhinav
    Kathmandu Medical College, Kathmandu, Nepal.
    Pahkala, Katja
    University of Turku, Finland.
    Eiben, Gabriele
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. University of Gothenburg, Sweden.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Sahlgrenska Academy at University of Gothenburg, Sweden / UiT The Arctic University of Norway, Tromsø, Norway.
    Knowledge, attitude and practice on diet and physical activity among mothers with young children in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 7, article id e0200329Article in journal (Refereed)
    Abstract [en]

    The prevalence of cardiovascular diseases is increasing in low and middle-income countries; Nepal's population shows a high prevalence of behavioral risk factors. Our cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), located near the capital Kathmandu, explored knowledge, attitude, and practice (KAP) of mothers with young children regarding diet and physical activity and mothers' perception of their children's attitude and behavior toward the same issues. The purpose of our study was to assess needs of the mothers concerning cardiovascular health in general and more specifically regarding diet and physical activity, and to establish a baseline for future intervention in the community by comparing two villages of JD-HDSS. In August-November 2014, nine trained enumerators interviewed all mothers of children aged 1-7 years (N = 962). We scored responses on dietary and physical activity KAP, then categorized the scores based on the percentage obtained out of the maximum possible scores into "poor," "fair," and "good." More highly educated mothers scored higher for KAP (all p<0.001); the children's behavior score reflected their mother's education level (p = 0.007). Most respondents were unfamiliar with the concept of healthy and unhealthy food. Overall, 57% of respondents in JD-HDSS had "good" knowledge, 44.6% had "good" attitude, and most (90%) had "poor" practice. We observed no significant differences between the villages regarding mothers' knowledge and attitude or children's behavior. Practice score of mothers in Jhaukhel was higher than those in Duwakot regarding diet and physical activity (p<0.001). Mothers' perceived barriers for improving lifestyle were high cost of healthy food, taste preference of other family members, and lack of knowledge regarding healthy food. Barriers for physical activity were lack of leisure time, absence of parks and playgrounds, busy caring for children and old people, feeling lazy, and embarrassed to be physically active in front of others. Our findings suggest that a health education intervention promoting a healthy lifestyle for mothers and children might improve KAP and also improve cardiovascular health. To address mothers' gap between knowledge and practice, a future intervention should consider perceived barriers.

  • 40.
    Oli, Natalia
    et al.
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Vaidya, Abhinav
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
    Subedi, Madhusudan
    Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal.
    Eiben, Gabriele
    Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway.
    Diet and physical activity for children's health: a qualitative study of Nepalese mothers' perceptions2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 9, article id e008197Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Non-communicable diseases account for 50% of all deaths in Nepal and 25% result from cardiovascular diseases. Previous studies in Nepal indicate a high burden of behavioural cardiovascular risk factors, suggesting a low level of knowledge, attitude and practice/behaviour regarding cardiovascular health. The behavioural foundation for a healthy lifestyle begins in early childhood, when mothers play a key role in their children's lives. This qualitative study, conducted in a Nepalese peri-urban community, aimed to explore mothers' perception of their children's diet and physical activity.

    DESIGN: We notated, tape-recorded and transcribed all data collected from six focus group discussions, and used qualitative content analysis for evaluation and interpretation.

    SETTING: The study was conducted in the Jhaukhel-Duwakot Health Demographic Surveillance Site in the Bhaktapur district of Nepal.

    PARTICIPANTS: Local health workers helped recruit 61 women with children aged 5-10 years. We distributed participants among six different groups according to educational status.

    RESULTS: Although participants understood the importance of healthy food, they misunderstood its composition, perceiving it as unappetising and appropriate only for sick people. Furthermore, participants did not prioritise their children's physical activities. Moreover, mothers believed they had limited control over their children's dietary habits and physical activity. Finally, they opined that health educational programmes would help mothers and recommended various intervention strategies to increase knowledge regarding a healthy lifestyle.

    CONCLUSIONS: Our data reveal that mothers of young children in a peri-urban community of Nepal lack adequate and accurate understanding about the impact of a healthy diet and physical activity. Therefore, to prevent future cardiovascular disease and other non-communicable diseases among children, Nepal needs health education programmes to improve mothers' cardiovascular health knowledge, attitude and behaviour.

  • 41.
    Oli, Natalia
    et al.
    Kathmandu Medical College, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Vaidya, Abhinav
    Kathmandu Medical College, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Subedi, Madhusudan
    Patan Academy of Health Sciences, Lalitpur, Nepal.
    Krettek, Alexandra
    Sahlgrenska Academy at University of Gothenburg / Nordic School of Public Health NHV, Gothenburg.
    Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community.2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 24023Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice.

    OBJECTIVE: This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients' viewpoint.

    DESIGN: We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories.

    RESULTS: Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness.

    CONCLUSIONS: This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community's cardiovascular health literacy and preventive practices.

  • 42.
    Onta, Sharad
    et al.
    Tribhuvan University, Kathmandu, Nepal .
    Choulagai, Bishnu
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy, University of Gothenburg, Sweden.
    Shrestha, Binjwala
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy, University of Gothenburg, Sweden.
    Subedi, Narayan
    Nepal Public Health Foundation, Kathmandu, Nepal .
    Bhandari, Gajananda P
    Nepal Public Health Foundation, Kathmandu, Nepal .
    Krettek, Alexandra
    Sahlgrenska Academy, University of Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg, Sweden.
    Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 1-9, article id 24580Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care.

    DESIGN: We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers.

    RESULTS: Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities.

    CONCLUSIONS: Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

  • 43.
    Povlsen, Lene
    et al.
    Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
    Aryal, Umesh Raj
    Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Sweden / Public Health and Environment Research Centre, Katmandu, Nepal.
    Petzold, Max
    Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Sweden.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Sweden / Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Adolescents' knowledge and opinions about smoking: a qualitative study from the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal2018In: International Journal of Adolescent Medicine and Health, ISSN 0334-0139, E-ISSN 2191-0278, Vol. 30, no 1, article id 20150124Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of tobacco products among adolescents in Southeast Asia represents a major public health burden. Two out of ten adolescents attending school are tobacco users and several factors influence them to initiate tobacco use. Most studies related to tobacco use are quantitative, whereas qualitative studies exploring adolescents' smoking behavior and their views, knowledge and experiences are scarce.

    OBJECTIVE: To gain a deep understanding of Nepalese adolescents' knowledge and opinions about smoking and reasons for smoking initiation.

    SUBJECTS: Adolescents from four secondary schools in the Bhaktapur district, Nepal.

    METHODS: Eight focus-group discussions were conducted with 71 adolescents aged 13-16 years and from grades 8-10. Data were analyzed using manifest qualitative content analysis.

    RESULTS: The participants knew that smoking represents health risks as well as socio-economic risks, but few described the addictive nature of tobacco and health risks related to passive smoking. Most participants related smoking initiation to the smoking behavior of peers and family members, but easy accessibility to cigarettes, ineffective rules and regulations, and exposure to passive smoking also created environments for smoking. Some expressed confidence to resist peer pressure and refuse to start smoking, but also expressed the need for prevention strategies in schools and for governmental initiatives, such as more strict implementation of tobacco control and regulations to prevent and reduce smoking.

    CONCLUSION: Curbing the tobacco epidemic in Nepal requires healthy public policies and multifaceted interventions to address the knowledge gap on health consequences associated with smoking among adolescents, teachers and parents/adults.

  • 44.
    Rydberg, Ellen Knutsen
    et al.
    Wallenberg Lab. for Cardiovasc. Res., Sahlgrenska University Hospital, Göteborg, Sweden.
    Krettek, Alexandra
    Wallenberg Lab. for Cardiovasc. Res., Sahlgrenska University Hospital, Göteborg, Sweden.
    Ullström, Christina
    Wallenberg Lab. for Cardiovasc. Res., Sahlgrenska University Hospital, Göteborg, Sweden.
    Ekström, Karin
    Wallenberg Lab. for Cardiovasc. Res., Sahlgrenska University Hospital, Göteborg, Sweden.
    Svensson, Per-Arne
    Res. Ctr. for Endocrinol./Metabolism, Sahlgrenska Univ. Hospital, Göteborg, Sweden.
    Carlsson, Lena M. S.
    Res. Ctr. for Endocrinol./Metabolism, Sahlgrenska Univ. Hospital, Göteborg, Sweden.
    Jönsson-Rylander, Ann-Cathrine
    Molecular Pharmacology and DMPK, AstraZeneca R and D, Mölndal, Sweden.
    Hansson, Göran I.
    Bioanalytical Chemistry, AstraZeneca R and D, Mölndal, Sweden.
    McPheat, William
    Molecular Pharmacology and DMPK, AstraZeneca R and D, Mölndal, Sweden.
    Wiklund, Olov
    Wallenberg Lab. for Cardiovasc. Res., Sahlgrenska University Hospital, Göteborg, Sweden.
    Ohlsson, Bertil G.
    Wallenberg Lab. for Cardiovasc. Res., Sahlgrenska University Hospital, Göteborg, Sweden.
    Hultén, Lillemor Mattsson
    Wallenberg Lab. for Cardiovasc. Res., Sahlgrenska University Hospital, Göteborg, Sweden.
    Hypoxia increases LDL oxidation and expression of 15-lipoxygenase-2 in human macrophages2004In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 24, no 11, p. 2040-2045Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Macrophage-mediated oxidation of low-density lipoprotein (LDL) by enzymes, such as the lipoxygenases, is considered of major importance for the formation of oxidized LDL during atherogenesis. Macrophages have been identified in hypoxic areas in atherosclerotic plaques.

    METHODS AND RESULTS: To investigate the role of hypoxia in macrophage-mediated LDL oxidation, we incubated human monocyte-derived macrophages with LDL under normoxic (21% O2) or hypoxic (0% O2) conditions. The results showed that hypoxic macrophages oxidized LDL to a significantly higher extent than normoxic cells. Interestingly, the mRNA and protein expression of 15-lipoxygenase-2 (15-LOX-2) as well as the activity of this enzyme are elevated in macrophages incubated at hypoxia. Both the unspliced 15-LOX-2 and the spliced variant 15-LOX-2sv-a are found in macrophages. In addition, 15-LOX-2 was identified in carotid plaques in some macrophage-rich areas but was only expressed at low levels in nondiseased arteries.

    CONCLUSIONS: In summary, these observations show for the first time that 15-LOX-2 is expressed in hypoxic macrophages and in atherosclerotic plaques and suggest that 15-LOX-2 may be one of the factors involved in macrophage-mediated LDL oxidation at hypoxia.

  • 45.
    Shakya-Vaidya, Suraj
    et al.
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden.
    Aryal, Umesh Raj
    Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal.
    Grjibovski, Andrej M.
    Department of International Public Health, Norwegian Institute of Public Health, Norway / International School of Public Health, Northern State Medical University, Arkhangelsk, Russia.
    Krettek, Alexandra
    Nordic School of Public Health NHV, Gothenburg, Sweden / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden.
    Visual status in primary open-angle glaucoma: a hospital-based report from Nepal2014In: Journal of Kathmandu Medical College, ISSN 2091-1785, Vol. 3, no 2, p. 49-57Article in journal (Refereed)
    Abstract [en]

    Background: Primary open-angle glaucoma (POAG) is the commonest cause of irreversible blindness. Most hospitals in Nepal are carrying out opportunistic glaucoma screening for those attending hospitals for any eye consultation. However, there are no reports detailing the visual damage at the time of diagnosis confirming the early detection of cases.

    Objectives: This study aimed to investigate the clinical features and visual status at the time of diagnosis of POAG in the Nepalese population.

    Methods: We evaluated 173 newly diagnosed consecutive cases of POAG from three hospitals across Nepal. Glaucoma evaluation was carried out detailing the findings of visual acuity and visual fields. Continuous data were presented as means and standard deviations (SD) and categorical data as proportions (95% CI). Unpaired t-tests compared continuous variables with p value set at a 5% level of significance.

    Results: Out of total patients, 82.1% were diagnosed incidentally while they visited the hospital for symptoms not expected to be for glaucoma. Only 9.8% of cases were aware of them being at risk of developing glaucoma and thus attended hospitals for regular check-up. Visual field examination revealed mean scores of mean deviation (MD) as low as -13.24 dB and pattern standard deviation of 7.34 dB. Glaucoma hemifield test was outside normal limits in 61.5% of eyes tested. Additionally, 4.7% patients were blind.

    Conclusion: POAG cases presented late with significant visual damage. Existing opportunistic screening for glaucoma in Nepal needs to be combined with community-based glaucoma awareness programs to bring more people to hospital at the early stage of the disease.

  • 46.
    Shakya-Vaidya, Suraj
    et al.
    Nepal Medical College Teaching Hospital, Kathmandu, Nepal / Nordic School of Public Health NHV, Gothenburg, Sweden.
    Aryal, Umesh Raj
    Nordic School of Public Health NHV, Gothenburg, Sweden / Kathmandu Medical College, Kathmandu, Nepal.
    Upadhyay, Madan
    B.P. Eye Foundation, Kathmandu, Nepal.
    Krettek, Alexandra
    Nordic School of Public Health NHV, Gothenburg, Sweden / Sahlgrenska Academy at University of Gothenburg, Sweden.
    Do non-communicable diseases such as hypertension and diabetes associate with primary open-angle glaucoma?: Insights from a case-control study in Nepal2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 22636-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Non-communicable diseases (NCDs) such as hypertension and diabetes are rapidly emerging public health problems worldwide, and they associate with primary open-angle glaucoma (POAG). POAG is the most common cause of irreversible blindness. The most effective ways to prevent glaucoma blindness involve identifying high-risk populations and conducting routine screening for early case detection. This study investigated whether POAG associates with hypertension and diabetes in a Nepalese population.

    METHODS: To explore the history of systemic illness, our hospital-based case-control study used non-random consecutive sampling in the general eye clinics in three hospitals across Nepal to enroll patients newly diagnosed with POAG and controls without POAG. The study protocol included history taking, ocular examination, and interviews with 173 POAG cases and 510 controls. Data analysis comprised descriptive and inferential statistics. Descriptive statistics computed the percentage, mean, and standard deviation (SD); inferential statistics used McNemar's test to measure associations between diseases.

    RESULTS: POAG affected males more frequently than females. The odds of members of the Gurung ethnic group having POAG were 2.05 times higher than for other ethnic groups. Hypertension and diabetes were strongly associated with POAG. The overall odds of POAG increased 2.72-fold among hypertensive and 3.50-fold among diabetic patients.

    CONCLUSION: POAG associates significantly with hypertension and diabetes in Nepal. Thus, periodic glaucoma screening for hypertension and diabetes patients in addition to opportunistic screening at eye clinics may aid in detecting more POAG cases at an early stage and hence in reducing avoidable blindness.

  • 47.
    Shakya-Vaidya, Suraj
    et al.
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Povlsen, Lene
    Nordic School of Public Health NHV, Gothenburg, Sweden .
    Shrestha, Binjwala
    Sahlgrenska Academy University of, Gothenburg, Sweden / Tribhuvan University, Maharajgunj, Kathmandu, Nepal .
    Grjibovski, Andrej M
    Norweigan Institute of Public Health, Oslo, Norway .
    Krettek, Alexandra
    Sahlgrenska Academy, University of Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg Sweden.
    Understanding and living with glaucoma and non-communicable diseases like hypertension and diabetes in the Jhaukhel-Duwakot Health Demographic Surveillance Site:: a qualitative study from Nepal2014In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 25358-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Primary open-angle glaucoma (POAG) is one of the most common causes of irreversible blindness. A possible association between POAG and non-communicable diseases such as hypertension and diabetes suggests that the incidence of POAG may increase. People with POAG in Nepal usually present late to hospital and have poor knowledge of glaucoma.

    OBJECTIVES: Anticipating a knowledge gap regarding these diseases, this study aimed to explore the knowledge of POAG, hypertension, and diabetes in the community and barriers to health care.

    DESIGN: We conducted this qualitative study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), a peri-urban community near Kathmandu, a capital city of Nepal. To study how disease influences knowledge, we conducted focus group discussions separately for men and women with and without pre-existing POAG, hypertension, and diabetes. Data were analyzed using the framework analysis approach.

    RESULTS: Although people suffering from POAG, hypertension, and/or diabetes exhibited adequate knowledge of hypertension and diabetes, they lacked in-depth knowledge of POAG. People believed mostly in internal health locus of control. Perception of disease consequences and impact of disease on daily life was influenced by pre-existing POAG, hypertension, and/or diabetes but only in men. Gender disparity was observed regarding health literacy, health perception, and health barriers, which put women in a more difficult situation to tackle their health. We also revealed a gap between knowledge, attitude, and practice of health among women and healthy men.

    CONCLUSION: Although people in JD-HDSS exhibited adequate knowledge regarding hypertension and diabetes, they lacked in-depth knowledge about POAG. This study demonstrated gender difference in health literacy and access to health care, making women more vulnerable towards disease. We also demonstrated a gap between knowledge, attitude, and practice of health. However, tailored health literacy programs may bring changes in the health status in the community.

  • 48.
    Shrestha, Binjwala
    et al.
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden.
    Devkota, Bhimsen
    Development Resource Centre, Kathmandu, Nepal / Institute of Education, Tribhuvan University, Kathmandu, Nepal.
    Khadka, Badri Bahadur
    National Health Education Information and Communication Centre, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.
    Choulagai, Bishnu
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden.
    Pahari, Durga Prasad
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
    Onta, Sharad
    Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
    Petzold, Max
    Akademistatistik – Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Sweden.
    Krettek, Alexandra
    Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg, Sweden.
    Knowledge on uterine prolapse among married women of reproductive age in Nepal2014In: International Journal of Women's Health, ISSN 1179-1411, E-ISSN 1179-1411, Vol. 6, p. 771-779Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Uterine prolapse (UP), which affects about 10% of women of reproductive age in Nepal, is the most frequently reported cause of poor health in women of reproductive age and postmenopausal women. Currently, women's awareness of UP is unknown, and attempts to unravel the UP problem are inadequate. This study aims to assess UP knowledge among married reproductive women, and determine the association between UP knowledge and socioeconomic characteristics.

    METHODS: Our cross-sectional descriptive study investigated 25 districts representing all five administrative regions, three ecological zones, and urban and rural settings. We used structured questionnaires to interview 4,693 married women aged 15-49 years. We assessed UP knowledge by asking women whether they had ever heard about UP, followed by specific questions about symptoms and preventive measures. Descriptive statistics characterized the study population regarding socioeconomic status, assessed how many participants had ever heard about UP, and determined UP knowledge level among participants who had heard about the condition. Simple regression analysis identified a possible association between socioeconomic characteristics, ever heard about UP, and level of UP knowledge.

    RESULTS: Mean age of participants was 30 years (SD [standard deviation] 7.4), 67.5% were educated, 48% belonged to the advantaged Brahmin and Chhetri groups, and 22.2% were Janajati from the hill and terai zones. Fifty-three percent had never heard about UP. Among women who had heard about UP, 37.5% had satisfactory knowledge. Any knowledge about UP was associated with both urban and rural settings, age group, and education level. However, satisfactory knowledge about UP was associated with administrative region, ecological zones, caste/ethnic group, and age group of women.

    CONCLUSION: Fifty-three percent of participants had never heard about UP, and UP knowledge level was satisfactory in 37.% of those who had ever heard about UP. Any knowledge was associated with urban/rural setting, age group, and education level, whereas satisfactory knowledge was associated with geography, caste/ethnic group, and age group. UP-related health promotion programs should target women from all caste/ethnic groups, age groups, and education levels, including urban and rural communities.

  • 49.
    Shrestha, Binjwala
    et al.
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Onta, Sharad
    Tribhuvan University, Kathmandu, Nepal.
    Choulagai, Bishnu
    Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg.
    Paudel, Rajan
    Tribhuvan University, Kathmandu, Nepal.
    Petzold, Max
    University of Gothenburg / University of the Witwatersrand, Johannesburg, South Africa.
    Krettek, Alexandra
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Sahlgrenska Academy at University of Gothenburg / UiT The Arctic University of Norway.
    Uterine prolapse and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal2015In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, p. 1-9, article id 28771Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Uterine prolapse (UP) is a reproductive health problem and public health issue in low-income countries including Nepal.

    OBJECTIVE: We aimed to identify the contributing factors and stages of UP and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site of Bhaktapur, Nepal.

    DESIGN: Our three-phase study used descriptive cross-sectional analysis to assess quality of life and stages of UP and case-control analysis to identify contributing factors. First, a household survey explored the prevalence of self-reported UP (Phase 1). Second, we used a standardized tool in a 5-day screening camp to determine quality of life among UP-affected women (Phase 2). Finally, a 1-month community survey traced self-reported cases from Phase 1 (Phase 3). To validate UP diagnoses, we reviewed participants' clinical records, and we used screening camp records to trace women without UP.

    RESULTS: Among 48 affected women in Phase 1, 32 had Stage II UP and 16 had either Stage I or Stage III UP. Compared with Stage I women (4.62%), almost all women with Stage III UP reported reduced quality of life. Decreased quality of life correlated significantly with Stages I-III. Self-reported UP prevalence (8.7%) included all treated and non-treated cases. In Phase 3, 277 of 402 respondents reported being affected by UP and 125 were unaffected. The odds of having UP were threefold higher among illiterate women compared with literate women (OR=3.02, 95% CI 1.76-5.17), 50% lower among women from nuclear families compared with extended families (OR=0.56, 95% CI 0.35-0.90) and lower among women with 1-2 parity compared to >5 parity (OR=0.33, 95% CI 0.14-0.75).

    CONCLUSIONS: The stages of UP correlated with quality of life resulting from varied perceptions regarding physical health, emotional stress, and social limitation. Parity, education, age, and family type associated with UP. Our results suggest the importance of developing policies and programs that are focused on early health care for UP. Through family planning and health education programs targeting women, as well as women empowerment programs for prevention of UP, it will be possible to restore quality of life related to UP.

  • 50.
    Shrestha, Binjwala
    et al.
    Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Sahlgrenska Academy at University of Gothenburg, Sweden .
    Onta, Sharad
    Institute of Medicine, Tribhuvan University, Kathmandu, Nepal .
    Choulagai, Bishnu
    Institute of Medicine, Tribhuvan University, Kathmandu, Nepal / Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden .
    Poudyal, Amod
    Institute of Medicine, Tribhuvan University, Kathmandu, Nepal .
    Pahari, Durga Prasad
    Institute of Medicine, Tribhuvan University, Kathmandu, Nepal .
    Uprety, Aruna
    Rural Health and Education Trust, Kathmandu, Nepal .
    Petzold, Max
    University of Gothenburg, Sweden .
    Krettek, Alexandra
    Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Nordic School of Public Health NHV, Gothenburg, Sweden .
    Women's experiences and health care-seeking practices in relation to uterine prolapse in a hill district of Nepal2014In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 14, no 1, article id 20Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women's experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices.

    METHODS: Using a convenience sampling method, we conducted 115 semi-structured and 16 in-depth interviews with UP-affected women during September-December 2012. All interviews occurred in outreach clinics in villages of the Dhading district.

    RESULTS: Study participants were 23-82 years of age. Twenty-four percent were literate, 47.2% had experienced a teenage pregnancy, and 29% had autonomy to make healthcare decisions. Most participants (>85%) described the major physical discomforts of UP as difficulty with walking, standing, working, sitting, and lifting. They also reported urinary incontinence (68%) bowel symptoms (42%), and difficulty with sexual activity (73.9%). Due to inability to perform household chores or fulfill their husband's sexual desires, participants endured humiliation, harassment, and torture by their husbands and other family members, causing severe emotional stress. Following disclosure of UP, 24% of spouses remarried and 6% separated from the marital relationship. Women perceived the causes of UP as unsafe childbirth, heavy work during the postpartum period, and gender discrimination. Prior to visiting these camps some women (42%) hid UP for more than 10 years. Almost half (48%) of participants sought no health care; 42% ingested a herb and ate nutritious food. Perceived barriers to accessing health care included shame (48%) and feeling that care was unnecessary (12.5%). Multiple responses (29%) included shame, inability to share, male service provider, fear of stigma and discrimination, and perceiving UP as normal for childbearing women.

    CONCLUSIONS: UP adversely affects women's daily life and negatively influences their physical, mental, and social well-being. The results of our study are useful to generate information on UP symptoms and female health care seeking practices. Our findings can be helpful for effective development of UP awareness programs to increase service utilization at early stages of UP and thereby might contribute to both primary and secondary prevention of UP.

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