Publications by authors named "Jens Aagaard-Hansen"

35 Publications

Perceptions of risk and motivation for healthy living among immigrants from non-western countries with prior gestational diabetes mellitus living in Denmark.

Health Psychol Behav Med 2021 30;9(1):761-777. Epub 2021 Aug 30.

Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.

Objective: To explore perceptions of risk and motivation for healthy living among immigrant women from non-western countries with prior gestational diabetes mellitus (GDM) living in Denmark.

Design: Seventeen semi-structured interviews were conducted with 12 female immigrants with prior GDM from non-western countries living in Denmark. The women were recruited through a public hospital and other health services and nongovernmental organisations. The theoretical approach was inspired by Arthur Kleinman's Explanatory Models. Data were analysed using qualitative content analysis.

Results: A diagnosis of GDM entailed great worry for the future. Participants' fears were primarily linked to the potential later development of type 2 diabetes (T2D) and poor health. Women's perceptions of GDM reflected their experiences with T2D-related complications and even death among relatives. The risk perception of GDM was also influenced by participants' challenges and trauma unrelated to diabetes. Their motivation for healthy living was strengthened by their experiences with T2D among relatives, while unrelated challenges and trauma generally reduced their capacity for healthier behaviours.

Conclusion: Among women with a non-western immigrant background and prior GDM living in Denmark, experiences with T2D among family members and their close communities affect their perceptions of risk and motivation to prevent the development of T2D. Furthermore, the challenges of daily life and past trauma were critical factors in their levels of available resources for health. Health promotion in this population should address health in a holistic way by integrating mental and social health with interventions aimed at preventing the development of T2D.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/21642850.2021.1969235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409963PMC
August 2021

Long-term blood pressure trajectories and associations with age and body mass index among urban women in South Africa.

Cardiovasc J Afr 2021 Jul-Aug 23;32(4):208-214. Epub 2021 Jul 26.

MRC Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Background: Blood pressure (BP) is known to increase inevitably with age. Understanding the different ages at which great gains could be achieved for intervention to prevent and control BP would be of public health importance.

Methods: Data collected between 2003 and 2014 from 1 969 women aged 22 to 89 years were used in this study. Growth curve models were fitted to describe intra- and inter-individual trajectories. For BP tracking, the intra-class correlation coefficient (ICC) was used to measure dependency of observations from the same individual.

Results: Four patterns were identified: a slow decrease in BP with age before 30 years; a period of gradual increase in midlife up to 60 years; a flattening and slightly declining trend; and another increase in BP in advanced age. These phases persisted but at slightly lower levels after adjustment for body mass index. Three groups of increasing trajectories were identified. The respective number (%) in the low, medium and highly elevated BP groups were 1 386 (70.4%), 482 (24.5%) and 101 (5.1%) for systolic BP; and 1 167 (59.3%), 709 (36.0%) and 93 (4.7%) for diastolic BP. The ICC was strong at 0.71 and 0.79 for systolic and diastolic BP, respectively.

Conclusions: These results show that BP preventative and control measures early in life would be beneficial for control later in life, and since increase in body mass index may worsen hypertension, it should be prevented early and independently.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5830/CVJA-2021-014DOI Listing
July 2021

Developmental Origins of Health and Disease: Towards a combined bio-social life-course perspective.

Acta Paediatr 2021 08 7;110(8):2306-2309. Epub 2021 Jun 7.

Health Promotion, Steno Diabetes Center Copenhagen, Copenhagen, Denmark.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apa.15905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361991PMC
August 2021

Transitions between body mass index categories, South Africa.

Bull World Health Organ 2020 Dec 28;98(12):878-885I. Epub 2020 Sep 28.

SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, 27 St Andrew's Road, Parktown, Johannesburg 2193, South Africa.

Objective: To profile the prevalence of the three body mass index (BMI) categories by sociodemographic characteristics, and to calculate the percentage transitioning (or not) from one BMI category to another, to inform South African health policy for the control of obesity and noncommunicable diseases.

Methods: We used data from the National Income Dynamics Study, including sociodemographic characteristics and BMI measurements collected in 2008, 2010, 2012, 2014 and 2017. For each data collection wave and each population group, we calculated mean BMI and prevalence by category. We also calculated the percentage making an upwards transition (e.g. from overweight to obese), a downwards transition or remaining within a particular category. We used a multinomial logistic regression model to estimate transition likelihood.

Findings: Between 2008 and 2017, mean BMI increased by 2.3 kg/m. We calculated an increased prevalence of obesity from 19.7% (3686/18 679) to 23.6% (3412/14 463), with the largest increases in prevalence for those aged 19-24 years and those with at least high school education. The percentages of upwards transitions to overweight or obese categories increased sharply between the ages of 19 and 50 years. Once overweight or obese, the likelihood of transitioning to a normal BMI is low, particularly for women, those of higher age groups, and those with a higher income and a higher level of education.

Conclusion: In the development of national strategies to control obesity and noncommunicable diseases, our results will allow limited public health resources to be focused on the relevant population groups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2471/BLT.20.255703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716104PMC
December 2020

Health literacy meets the life-course perspective: towards a conceptual framework.

Glob Health Action 2020 12;13(1):1775063

Health Promotion, Steno Diabetes Center Copenhagen , Copenhagen, Denmark.

This paper presents a novel conceptual framework combining the concepts of health literacy and life-course to guide public health planning and research. Health literacy is a key competence that enables individuals to navigate health-care systems and health promotion activities. The life-course perspective places emphasis on how disease risk accumulates along the life trajectory from fetal life onwards, and how it can even pass from one generation to the next. Our conceptual framework illustrates how different domains of health literacy are required, and how the unequal distribution of health literacy may be influenced by social determinants at different times in the life-course. Thus, it is essential to disaggregate health literacy into sub-themes and analyse them as they unfold in a long-term life-course perspective. The suggested framework would allow these patterns to be mapped, thereby enabling public health planners to strategically target health literacy promotion programmes to the right population segments at the right time.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/16549716.2020.1775063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480652PMC
December 2020

Variations in the Delivery of Primary Diabetes Care in Malaysia: Lessons to Be Learnt and Potential for Improvement.

Health Serv Res Manag Epidemiol 2020 Jan-Dec;7:2333392820918744. Epub 2020 Apr 15.

Steno Diabetes Center Copenhagen, Gentofte, Denmark.

Background: The article describes variations in the organization of clinical services for diabetes patients in 10 public primary health clinics in Malaysia with the view to learn from current innovations and improve diabetes service provision.

Methods: This study combined the use of secondary data and a qualitative multicase study approach applying observations in 10 randomly selected Ministry of Health (MOH) health clinics in Kuala Lumpur and Selangor and semistructured interviews of the family medicine specialists from the same clinics.

Results: Although there are specific MOH guidelines for diabetes care, some clinics had introduced innovations for diabetes care such as the novel 'personalized care', 'one-stop-centre' and utilization of patients' waiting time for health education. Analysis showed that there was room for improvement in terms of task shifting to free precious time of staff with specialized functions, streamlining appointments for various examinations, increasing continuity of consultations with same doctors, and monitoring of performance.

Conclusion: We contend that there is a potential for increased effectiveness and efficiency of primary diabetes care in Malaysia without increasing the resources - a potential that may be tapped into by systematic learning from ongoing innovation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2333392820918744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160766PMC
April 2020

Impact of continuing medical education for primary healthcare providers in Malaysia on diabetes knowledge, attitudes, skills and clinical practices.

Med Educ Online 2020 Dec;25(1):1710330

Steno Diabetes Center Copenhagen, Gentofte, Denmark.

: Continuing Medical Education (CME) is a cornerstone of improving competencies and ensuring high-quality patient care by nurses and physicians. The Ministry of Health (MOH) Malaysia collaborated with Steno Diabetes Centre to improve diabetes-related competencies of general physicians and nurses working in primary care through a six-month training programme called the Steno REACH Certificate Course in Clinical Diabetes Care (SRCC).: This impact evaluation aimed to assess the effect of participation of general physicians and nurses in the SRCC in selected public primary healthcare clinics in Kuala Lumpur and Selangor, Malaysia.: The quasi-experimental, embedded, mixed-methods study used concurrent data collection and the Solomon four-group design. Participants in an intervention group (Arm 1) and control group (Arm 3) were assessed by pre-and post-test, and participants in separate intervention (Arm 2) and control (Arm 4) groups were assessed by post-test only. Quantitative and qualitative methods were used to assess the effect of the programme.: Thirty-four of the 39 participants in the intervention groups (Arms 1 and 2) completed the SRCC and were included in the analysis. All 35 participants in the control groups (Arms 3 and 4) remained at the end of the study period. Significant improvements in diabetes-related knowledge, skills and clinical practise were found among general physicians and nurses in the intervention group after the six-month SRCC, after controlling the pretest effects. No clear changes could be traced regarding attitudes.: SRCC participants had significant improvements in knowledge, skills and clinical practice that meet the current needs of general physicians and nurses working in primary care in Malaysia. Thus, SRCC is an effective CME approach to improving clinical diabetes care that can be scaled up to the rest of the country and, with some modification, beyond Malaysia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10872981.2019.1710330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968562PMC
December 2020

Geographical influence on the distribution of the prevalence of hypertension in South Africa: a multilevel analysis.

Cardiovasc J Afr 2020 Jan/Feb 23;31(1):47-54. Epub 2019 Sep 20.

Department of Statistics, University of Pretoria, Pretoria, South Africa.

Background: As a response to the growing burden of non-communicable diseases, the South African government has set targets to reduce the prevalence of people with raised blood pressure, through lifestyle changes and medication, by 20% by the year 2020. It has also recognised that the prevalence varies at local administrative level. The study aim was to determine the geographical variation by district of the prevalence of hypertension among South African adults aged 15 years and above.

Methods: Data from all five waves of the National income Dynamics Study, a panel survey, were used for estimation by both design-based and multilevel analysis methods. In the multilevel analysis, a three-level hierarchy was used with panel participants in the first level, repeated measurements on patients in the second level, and districts in the third level.

Results: After accounting for demographic, behavioural, socio-economic and environmental factors, significant variation remained in the prevalence of hypertension at the district level. Districts with higher-than-average prevalence were found mostly in the south-western part of the country, while those with a prevalence below average were found in the northern area. Age, body mass index and race were the individual factors found to have a strong effect on hypertension prevalence for this sample.

Conclusions: There were significant differences in hypertension prevalence between districts and therefore the method of analysis and the results could be useful for more targeted preventative and control programmes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5830/CVJA-2019-047DOI Listing
November 2020

What are the public health implications of the life course perspective?

Glob Health Action 2019 ;12(1):1603491

e MRC Lifecourse Epidemiology Unit, Faculty of Medicine , University of Southampton , Southampton , UK.

During the past decades innovative research has shown that exposure to harmful events during pregnancy and early infancy ('the first 1000 days') has an impact on health at subsequent stages of the life course and even across generations. Recently it has been shown that even the pre-conception period is of outmost importance, and other scholars have made the case that the 1000 days should be extended to a period of 8000 days post-conception. The present contribution aims to bridge further the gap between research evidence and public health policy by applying a holistic 'full-cycle' perspective. Thus, a conceptual framework is suggested for guiding public health prioritization, including the variables of 'impact on the next generation', 'plasticity' and 'available interventions with documented impact'. This framework could guide decision makers in selecting at which stages of the life course to invest (and not), and furthermore it points to some pertinent research priorities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/16549716.2019.1603491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508051PMC
August 2019

Danish 'add-in' school-based health promotion: integrating health in curriculum time.

Health Promot Int 2020 Feb;35(1):e70-e77

Health Promotion, Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Niels Steensens Vej 6, Gentofte, Denmark.

Schools provide an important setting for health promotion and health education. In countries where health education is not a specific subject, it is typically undertaken by teachers in health-integrating subjects such as biology, home economics or physical education. More ambitious and holistic frameworks and whole school approaches such as health promoting schools have been considered best practice for the past three decades. Recently, more attention has been given to policy initiatives integrating health activities into school curriculum time. This paper discusses potentials and challenges of school-based health promotion applying an 'add-in' approach, that integrates health activities into teachers' curricular obligations without taking time away from them, based on a presentation of three Danish cases. This may serve as a supplement to health promotion activities that have been initiated over and above the day-to-day teaching (add-on). We contend that an 'add-in' approach to school health promotion provides a potential win-win situation where both health and core education stand to gain; makes it possible to reach a wider range of schools; mobilizes additional resources for health promotion; and leads to more sustainable activities. However, potential limitations including not addressing structural aspects of health promotion and reliance on a relatively limited evidence base should also be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/heapro/day095DOI Listing
February 2020

Children as visionary change agents in Danish school health promotion.

Health Promot Int 2019 Oct;34(5):e18-e27

Steno Diabetes Center Copenhagen, Health Promotion, Gentofte, Copenhagen, Denmark.

This paper describes children's perceptions and visions for a healthier social and physical environment in the setting of a primary school on the Danish island of Bornholm. Guided by an everyday-life perspective and applying participatory action research methods including social imagination and visual techniques within the framework of future creating workshops, the study engaged 50 children aged 6-9 years in creative processes of identifying health-related problem areas and solutions in their school setting. The study observed that the children were very capable of articulating their thoughts, ideas and visions for a better and healthier school environment. Identified problem areas and solutions differed widely and represented a broad perspective of health including social, physical, environmental and emotional aspects. The paper discusses advantages and challenges of involving children in decision-making processes and concludes that children are visionary and creative agents of change in health promotion projects provided that applied participatory methods are appealing to the children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/heapro/day049DOI Listing
October 2019

Health in All local Policies: Lessons learned on intersectoral collaboration in a community-based health promotion network in Denmark.

Int J Health Plann Manage 2019 Jan 16;34(1):216-231. Epub 2018 Aug 16.

Health Promotion, Steno Diabetes Center Copenhagen, Gentofte, Denmark.

Health promotion increasingly involves collaboration with civil society organisations and the private sector rather than being implemented exclusively by public sector stakeholders. Health in All Policies (HiAP) is an approach that promotes health in policy-making across public sectors. This study explored intersectoral integration and collaboration for health promotion at a local community level through a qualitative single case study of a local community network in Denmark: the Husum Health Network. The paper describes and discusses strengths, weaknesses, and challenges of HiAP-inspired local efforts to build alliances and supportive environments for health within an inter-organisational community-based network. The data were generated from participant observations made at 11 meetings and events organised by the network partners and nine qualitative, semi-structured interviews with Husum Health Network partners conducted from August 2014 to February 2015. The data were analysed using a theoretical framework introduced by Axelsson and Axelsson (2006) to characterise aspects of integration and differentiation between organisations. With high levels of structural and functional differentiation between the partners, the network provided an opportunity to exercise inter-organisational integration at the local level. Integration was fostered by knowledge sharing, face-to-face interaction, and communal events. However, the loose structure of the network was a challenge to its sustainability and achievement. We argue that Health in All local Policies is a meaningful concept in the context of local community development only when referring to the polices and strategies of all stakeholder organisations involved in decision-making and agenda setting, and not just local government institutions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hpm.2620DOI Listing
January 2019

Project SoL-A Community-Based, Multi-Component Health Promotion Intervention to Improve Healthy Eating and Physical Activity Practices among Danish Families with Young Children Part 2: Evaluation.

Int J Environ Res Public Health 2018 07 18;15(7). Epub 2018 Jul 18.

Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens Vej 6, DK-2820 Gentofte, Denmark.

Project SoL is implemented over a period of four years with the aim to promote healthy eating and physical activity among children aged 3⁻8 years by targeting the families in a Danish municipality based on the multi-component, supersetting strategy. Interventions are implemented in childcare centres, schools and supermarkets in three local communities as well as in local mass media and social media during a 19 months period in the Municipality of Bornholm. The matching Municipality of Odsherred serves as a control site based on its similarity to Bornholm regarding several socio-demographic and health indicators. The present paper gives an account of the design used for the summative and formative evaluation based on a realistic evaluation and a mixed methods approach combining qualitative and quantitative methods. Summative studies are conducted on changes of health behaviours among the involved families and within the municipalities in general, changes in community awareness of the project, changes in purchase patterns, changes in overweight and obesity among the targeted children and changes in knowledge and preferences among children due to sensory education workshops. The formative research comprises studies on children's perceptions of health, perceptions of staff at supermarkets and media professionals on their roles in supporting the health promotion agenda, and motivations and barriers of community stakeholders to engage in health promotion at community level. The paper discusses operational issues and lessons learnt related to studying complex community interventions, cross-disciplinarily, interfaces between practice and research and research capacity strengthening; and suggests areas for future research. The development and implementation of the intervention and its theoretical foundation is described in a separate paper.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph15071513DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069463PMC
July 2018

Project SoL-A Community-Based, Multi-Component Health Promotion Intervention to Improve Eating Habits and Physical Activity among Danish Families with Young Children. Part 1: Intervention Development and Implementation.

Int J Environ Res Public Health 2018 05 28;15(6). Epub 2018 May 28.

Center for Clinical Research and Prevention, Capital Region, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.

Project SoL was implemented over a period of four years from 2012⁻2015 with the aim to promote healthy eating and physical activity among families with children aged 3⁻8 years, living in selected communities in two Danish municipalities. This was done by applying the supersetting approach to implement complex multi-component interventions in a participatory, coordinated, and integrated manner in childcare centres, schools, and supermarkets in three local communities, as well as in local media during a 19-month period in the Regional Municipality of Bornholm, which served as the intervention site. The matching municipality of Odsherred served as a control site based on its similarity to Bornholm regarding several socio-demographic and health indicators. The present paper describes the design of Project SoL as well as the processes of developing and implementing its complex interventions. Moreover, the theoretical and conceptual framework of the project is described together with its organisational structure, concrete activities, and sustainability measures. The paper discusses some of the key lessons learned related to participatory development and the implementation of a multi-component intervention. The paper concludes that coordinated and integrated health promotion activities that are implemented together with multiple stakeholders and across multiple settings in the local community are much more powerful than individual activities carried out in single settings. The supersetting approach was a useful conceptual framework for developing and implementing a complex multi-component health promotion intervention and for fostering ownership and sustainability of the intervention in the local community. The research and evaluation approach of the project is described in a separate paper (Part 2).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph15061097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025396PMC
May 2018

Using Social Network Analysis as a Method to Assess and Strengthen Participation in Health Promotion Programs in Vulnerable Areas.

Health Promot Pract 2017 03 24;18(2):175-183. Epub 2017 Jan 24.

2 Steno Diabetes Center, Gentofte, Denmark.

This article provides an example of the application of social network analysis method to assess community participation thereby strengthening planning and implementation of health promotion programming. Community health promotion often takes the form of services that reach out to or are located within communities. The concept of community reflects the idea that people's behavior and well-being are influenced by interaction with others, and here, health promotion requires participation and local leadership to facilitate transmission and uptake of interventions for the overall community to achieve social change. However, considerable uncertainty exists over exact levels of participation in these interventions. The article draws on a mixed methods research within a community development project in a vulnerable neighborhood of a town in Denmark. It presents a detailed analysis of the way in which social network analysis can be used as a tool to display participation and nonparticipation in community development and health promotion activities, to help identify capacities and assets, mobilize resources, and finally to evaluate the achievements. The article concludes that identification of interpersonal ties among people who know one another well as well as more tenuous relationships in networks can be used by community development workers to foster greater cohesion and cooperation within an area.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1524839916686029DOI Listing
March 2017

Pre-pregnancy community-based intervention for couples in Malaysia: application of intervention mapping.

BMC Public Health 2016 11 17;16(1):1167. Epub 2016 Nov 17.

Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.

Background: Malaysia is experiencing a nutrition transition with burgeoning obesity, particularly in women, and a growing prevalence of non-communicable disease. These health burdens have severe implications not only for adult health but also across generations. Pre-conception health promotion could address the intergenerational risk of metabolic disease. This paper describes the development of the "Jom Mama" intervention using Intervention Mapping (IM). The Jom Mama intervention aims to improve the health of young adult couples in Malaysia prior to conception.

Methods: IM comprises of five steps prior to the last one, which involves the evaluation of the intervention. We used the five steps to develop the Jom Mama intervention.

Results: Both the process and evidence is documented providing the rationale to the selection of the key objectives of the intervention: (i) increasing healthy dietary practice; (ii) increasing physical activity levels, (iii) reducing sedentary activity; and (iv) improving social support to offset stressful lifestyles. From the IM process, Jom Mama will be health-system centred approach that uniquely combines both community health promoters and an electronic-health platform to deliver the complex intervention.

Conclusion: IM is an iterative process that systematically gathers "best" evidence, selects appropriate theories of behaviour change, and facilitates formative research so as to develop a complex intervention. Though the IM process is time consuming, complex, and costly, it has enriched the Jom Mama intervention with a number of notable advantages: (i) intervention fashioned on formative work with stakeholders and in the target group; (ii) intervention combines research evidence with theory; (iii) intervention acknowledges multiple dynamics of influence; and (iv) intervention is embedded within health service priorities in Malaysia for greater scale-up possibility.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-016-3827-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114777PMC
November 2016

How do socio-economic factors and distance predict access to prevention and rehabilitation services in a Danish municipality?

Prim Health Care Res Dev 2016 11 12;17(6):578-585. Epub 2016 Aug 12.

2Health Promotion Research, Steno Diabetes Center,Denmark.

Aim The aim was to explore the extent to which a Danish prevention centre catered to marginalised groups within the catchment area. We determined whether the district's socio-economic vulnerability status and distance from the citizens' residential sector to the centre influenced referrals of citizens to the centre, their attendance at initial appointment, and completion of planned activities at the centre.

Background: Disparities in access to health care services is one among many aspects of inequality in health. There are multiple determinants within populations (socio-economic status, ethnicity, and education) as well as the health care systems (resource availability and cultural acceptability).

Methods: A total of 347 participants referred to the centre during a 10-month period were included. For each of 44 districts within the catchment area, the degree of socio-economic vulnerability was estimated based on the citizens' educational level, ethnicity, income, and unemployment rate. A socio-economic vulnerability score (SE-score) was calculated. Logistic regression was used to calculate the probability that a person was referred to the centre, attended the initial appointment, and completed the planned activities, depending on sex, age, SE-score of district of residence, and distance to the centre. Findings Citizens from locations with a high socio-economic vulnerability had increased probability of being referred by general practitioners, hospitals, and job centres. Citizens living further away from the prevention centre had a reduced probability of being referred by their general practitioners. After referral, there was no difference in probability of attendance or completion as a function of SE-score or distance between the citizens' district and the centre. In conclusion, the centre is capable of attracting referrals from districts where the need is likely to be relatively high in terms of socio-economic vulnerability, whereas distance reduced the probability of referral. No differences were found in attendance or completion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1463423616000268DOI Listing
November 2016

A complex behavioural change intervention to reduce the risk of diabetes and prediabetes in the pre-conception period in Malaysia: study protocol for a randomised controlled trial.

Trials 2016 Apr 27;17(1):215. Epub 2016 Apr 27.

MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Background: Over the past two decades, the population of Malaysia has grown rapidly and the prevalence of diabetes mellitus in Malaysia has dramatically increased, along with the frequency of obesity, hyperlipidaemia and hypertension. Early-life influences play an important role in the development of non-communicable diseases. Indeed, maternal lifestyle and conditions such as gestational diabetes mellitus or obesity can affect the risk of diabetes in the next generation. Lifestyle changes can help to prevent the development of type 2 diabetes mellitus. This is a protocol for an unblinded, community-based, randomised controlled trial in two arms to evaluate the efficacy of a complex behavioural change intervention, combining motivational interviewing provided by a community health promoter and access to a habit formation mobile application, among young Malaysian women and their spouses prior to pregnancy.

Method/design: Eligible subjects will be Malaysian women in the age group 20 to 39 years, who are nulliparous, not diagnosed with diabetes and own a smartphone. With an alpha-value of 0.05, a statistical power of 90 %, 264 subjects will need to complete the study. Subjects with their spouses will be randomised to either the intervention or the control arm for an 8-month period. The primary endpoint is change in waist circumference from baseline to end of intervention period and secondary endpoints are changes in anthropometric parameters, biochemical parameters, change in health literacy level, dietary habits, physical activity and stress level. Primary endpoint and the continuous secondary endpoints will be analysed in a linear regression model, whereas secondary endpoints on an ordinal scale will be analysed by using the chi-squared test. A multivariate linear model for the primary endpoint will be undertaken to account for potential confounders. This study has been approved by the Medical Research and Ethics Committee of the Ministry of Health Malaysia (protocol number: NMRR-14-904-21963) on 21 September 2015.

Discussion: This study protocol describes the first community-based randomised controlled trial, to examine the efficacy of a complex intervention in improving the pre-pregnancy health of young Malaysian women and their spouses. Results from this trial will contribute to improve policy and practices regarding complex behavioural change interventions to prevent diabetes in the pre-conception period in Malaysia and other low- and middle-income country settings.

Trial Registration: This trial is registered with ClinicalTrials.gov (www.clinicaltrials.gov) on 30 November 2015, Identifier: NCT02617693 .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-016-1345-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847351PMC
April 2016

Prevalence and determinants of overweight, obesity, and type 2 diabetes mellitus in adults in Malaysia.

Asia Pac J Public Health 2015 Mar 18;27(2):123-35. Epub 2014 Dec 18.

Steno Diabetes Centre, Gentofte, Denmark.

This systematic review aimed to examine trends in overweight, obesity, and type 2 diabetes mellitus (T2DM) among Malaysian adults, and to identify its underlying determinants. A review of studies published between 2000 and 2012 on overweight, obesity, and T2DM was conducted. The Cochrane library of systematic reviews, MEDLINE, EMBASE, Biosis, Scopus, and MyJurnal digital database were searched. According to national studies, the prevalence of overweight increased from 26.7% in 2003 to 29.4% in 2011; obesity prevalence increased from 12.2% in 2003 to 15.1% in 2011, and T2DM prevalence was reported as 11.6% in 2006 and 15.2% in 2011. Distal determinants of increased risk of overweight, obesity, and T2DM were as follows: female, Malay/Indian ethnicity, and low educational level. The limited number of studies on proximal determinants of these noncommunicable diseases (NCDs) indicated that an unhealthy diet was associated with increased risk, whereas smoking was associated with decreased risk. However, more studies on the proximal determinants of overweight, obesity, and T2DM within the Malaysian context are needed. Overall, our findings provide insights for designing both future investigative studies and strategies to control and prevent these NCDs in Malaysia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1010539514562447DOI Listing
March 2015

Action research led to a feasible lifestyle intervention in general practice for people with prediabetes.

Prim Care Diabetes 2014 Apr 19;8(1):23-9. Epub 2013 Dec 19.

Steno Health Promotion Centre, Steno Diabetes Centre, Gentofte, Denmark. Electronic address:

Aim: To develop and pilot a feasible lifestyle intervention for people with prediabetes tailored for general practice. The study was designed to explore (i) what resources and competencies would be required and (ii) which intervention components should be included.

Methods: In the first of two action research cycles various interventions were explored in general practice. The second cycle tested the intervention described by the end of the first cycle. In total, 64 patients, 8 GPs and 10 nurses participated.

Results: An intervention comprising six consultations to be delivered during the first year after identified prediabetes was found feasible by the general practice staff in terms of resources. Practice nurses possessed the adequate competences to undertake the core part of the intervention. The intervention comprised fixed elements according to structure, time consumption and educational principles, and flexible elements according to educational material and focus points for behaviour change. Clinical relevant reductions in patients' BMI and HbA1c were found.

Conclusion: A prediabetes lifestyle intervention for Danish general practice with potential for diabetes prevention was developed based on action research. The transferability of the developed intervention to other general practices depends on the GPs priorities, availability of practice nurses to deliver the core part, and the remuneration system for general practice. The long-term feasibility in larger patient populations is unknown.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pcd.2013.11.007DOI Listing
April 2014

Scepticism towards insecticide treated mosquito nets for malaria control in rural community in north-western Tanzania.

Tanzan J Health Res 2012 Apr;14(2):96-103

National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania.

Despite existence of effective tools for malaria control, malaria continues to be one of the leading killer diseases especially among under-five year children and pregnant women in poor rural populations of Sub Saharan Africa. In Tanzania Mainland the disease contributes to 39.4% of the total OPD attendances. In terms of mortality, malaria is known to be responsible for more than one third of deaths among children of age below 5 years and also contributes for up to one fifth of deaths among pregnant women. This paper is based on a study conducted in a rural community along the shores of Lake Victoria in Mwanza region, North-Western Tanzania. The study explores reasons for scepticism and low uptake of insecticide treated mosquito nets (ITNs) that were promoted through social marketing strategy for malaria control prior to the introduction of long lasting nets (LLN). The paper breaks from traditional approach that tend to study low uptake of health interventions in terms of structural practical constraints--cost, accessibility, everyday priorities--or in terms of cognition--insufficient knowledge of benefits e.g. ignorance of public health messages. This paper has shown that, the majority of people who could afford the prices of ITNs and who knew where to obtain the insecticides did not necessarily buy them. This suggests that, although people tend to report cost-related factors as a barrier against the use of ITNs, there are other critical concerns at work. Without underestimating the practical factors, our study have recommended to consider critical examinations of those other concerns that hinder optimal utilization of ITN for malaria control, and the basis for those concerns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4314/thrb.v14i2.2DOI Listing
April 2012

Population movement: a key factor in the epidemiology of neglected tropical diseases.

Trop Med Int Health 2010 Nov;15(11):1281-8

Steno Health Promotion Center, Steno Diabetes Center, Gentofte, Denmark.

This review provides an overview of the complex ways in which population movements are linked to spread and control of neglected tropical diseases – often exacerbated by insufficient medical services and sanitary infrastructure. A new typology of population movements is suggested which builds on previous work but offers a more comprehensive typology based on the variables of 'onset', 'cause', 'direction' and 'motivation'. Schistosomiasis and leishmaniasis provide examples of the intricate ways in which population movements may play a role. A thorough and context-specific understanding of these patterns combined with the ability and will to launch targeted public health interventions is needed to achieve adequate control of neglected tropical diseases as well as other infectious diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1365-3156.2010.02629.xDOI Listing
November 2010

Staff attrition among community health workers in home-based care programmes for people living with HIV and AIDS in western Kenya.

Health Policy 2010 Oct 8;97(2-3):232-7. Epub 2010 Jun 8.

Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya.

Objectives: This paper examines trends and underlying causes of attrition among volunteer community health workers in home-based care for people living with HIV and AIDS in western Kenya.

Methods: Ethnographic data were collected between January and November 2006 through participant observation, focus group discussions and in-depth interviews with 30 CHWs, NGO staff and health care providers and 70 PLWHA.

Results: An attrition rate of 33% was observed among the CHWs. The reasons for dropout included: the cultural environment within which CHWs operated; lack of adequate support from area NGOs; poor selection criteria for CHWs; and power differences between NGO officials and CHWs which fostered lack of transparency in the NGOs' operations.

Conclusions: In order to achieve well functioning and sustainable HBC services, factors which influence retention/dropout of CHWs should be addressed taking into account the socio-cultural, programmatic and economic contexts within which CHW activities are implemented.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.healthpol.2010.05.004DOI Listing
October 2010

A comprehensive approach to risk assessment and surveillance guiding public health interventions.

Trop Med Int Health 2009 Sep 22;14(9):1034-9. Epub 2009 Jun 22.

DBL-Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Frederiksberg, Denmark.

Tools are required to identify 'multi-endemic' population segments - in order to benefit the most vulnerable people and to make public health interventions cost-effective. The article suggests a comprehensive risk assessment and surveillance system approach based on a combination of epidemiological, environmental and social determinants. Such a cross-disciplinary approach will combine the advantages of forecasting upcoming disease 'hot spots' with provision of evidence for long-term planning under more stable conditions, and it may in principle apply to any combination of public health problems depending on the local context.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1365-3156.2009.02330.xDOI Listing
September 2009

Social research on neglected diseases of poverty: continuing and emerging themes.

PLoS Negl Trop Dis 2009 24;3(2):e332. Epub 2009 Feb 24.

Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pntd.0000332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643480PMC
March 2010

Benefit--a neglected aspect of health research ethics.

Dan Med Bull 2008 Nov;55(4):216-8

Faculty of Life Sciences, DBL--Centre for Health Research and Development, University of Copenhagen, Frederiksberg C, Denmark.

In research ethics, provision of potential benefits to study participants is linked to the principles of beneficence and distributive justice. However, in most research ethical codes the notion of benefit is only superficially elaborated which is extended in vague and general benefit assessments in research proposals and in Research Ethical Committee's (REC) recommendations. The issue gains additional importance in collaborative projects where researchers, study populations and donors from both developing and developed countries are involved. We introduce a checklist for planning and assessment of benefits as part of research ethics and suggest as a first step in unfolding the concept of benefits that research project and RECs as a minimum should address who (the target groups), when (the period of time during which the services are planned to be rendered) and what (the nature of the benefits).
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2008

Local perceptions and practices in regard to opisthorchiasis in two villages in Lao PDR.

Southeast Asian J Trop Med Public Health 2008 Jan;39(1):19-26

DBL-Center for Health Research and Development, Department of Veterinary Pathobiology, Faculty of Life Sciences, University of Copenhagen, Charlottenlund, Denmark.

The aim of the present study was to assess local perceptions and practices in regard to opisthorchiasis in a village receiving treatment and health education compared to a village where no intervention was offered. The study was conducted two years after a health education campaign had been carried out. Focus group discussions and semi-structured interviews were performed among 68 men and women. The results of the study show there were distinct differences in perceptions about opisthorchiasis when comparing the two villages. It appears that introducing health education alongside treatment does have an effect on knowledge and change in behavior. Eating raw fish was mainly practiced by men, however women were not aware they were exposed to opisthorchiasis while preparing food. Although there is no locally derived term, a medically appointed term for opisthorchiasis was acknowledged. Due to the vague disease symptoms, no treatment seeking behavior was found in relation to the disease. Further studies are needed to shed light on gender differences in regard to eating behavior and to assess infection risk among different Lao dishes containing freshwater fish.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2008

Traditional Bhutanese medicine (gSo-BA Rig-PA): an integrated part of the formal health care services.

Southeast Asian J Trop Med Public Health 2007 Jan;38(1):161-7

Pharmaceutical and Research Unit, Institute of Traditional Medicine Services, Ministry of Health, Thimphu, Bhutan.

Traditional medicine in Bhutan is known as gSo-ba Rig-pa and is one of the oldest surviving medical traditions in the world. Other medical systems, such as Chinese medicine, Indian Ayurvedic medicine, Unani medicine, Greco-Roman medicine and the country's rich cultures and traditions have greatly influenced the way traditional Bhutanese medicine evolved. However, Buddhist philosophy remains the mainstream of this medical system. gSo-ba Rig-pa's principles are based on the perception the human body is composed of three main elements: rLung ('Air'), mKhris-pa ('Bile') and Bad-kan ('Phlegm'). When these three elements are balanced in the body a person is said to be healthy. The pathophysiology is also different from other medical systems, and the close link to Buddhism is reflected in the spiritual dimensions and the perception that all suffering is caused by ignorance. The treatment of diseases includes behavioral modification, physiotherapy, herbal medicines, minor surgery and spiritual healing. This makes the traditional Bhutanese medicine a unique and holistic health care system. The traditional medicine is an integrated and recognized part of the formal health care services in Bhutan under the auspices of the Ministry of Health. The article highlights three main points which can be learned from the Bhutanese experience: (1) the strong tradition of herbal medicines within gSo-ba Rig-pa forms a unique opportunity to prospect for new leads for development of pharmaceuticals, (2) the availability of the traditional medicine along with biomedicine broadens the health care choices for patients, and (3) the experiences of integrating two conceptually very different health care systems within one ministry contains important managerial lessons to be learned.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2007

Entomophagy among the Luo of Kenya: a potential mineral source?

Int J Food Sci Nutr 2006 May-Jun;57(3-4):198-203

Department of Epidemiology, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.

Primary objective To determine the iron, zinc, and calcium content in different insects commonly eaten among the Luo of Kenya. Research design A cross-sectional design was chosen for the study in order to determine the insects eaten and their mineral content during a specific season.Methods and procedures Five different insect species were identified and collected with the help of local informants in the Nyang'oma sublocation of the Bondo district in western Kenya, and were analysed for iron, zinc and calcium contents. Main outcomes and results The iron content ranged from 18 to 1562 mg/100 g dry matter, the zinc content from 8 to 25 mg/100 g, and the calcium content from 33 to 341 mg/100 g in five different insects, onyoso mammon (ant), oyala (termite), ogawo (termite), agaor (termite), onjiri mammon (cricket). Conclusions Insect eating could prove to be a valuable measure to combat, especially, iron and zinc deficiency in developing countries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09637480600738252DOI Listing
July 2007

Similarities between Human and Livestock Illnesses among the Luo in Western Kenya.

Anthropol Med 2006 Apr;13(1):13-24

The objective of this study was to compare perceptions and practices in relation to human and livestock illness among the Luo in Western Kenya. Qualitative methods of data collection such as key informant interviews, open-ended, in-depth interviews, focus group discussions, narratives, and participant- and direct observations were applied. The study showed that there were significant parallels between human and livestock illnesses regarding terminology, perceptions of pathogenesis and treatment seeking practices. Even practitioners and their medications were often the same. The rationale behind pathogenesis in both cases was usually that illnesses resulted from some form of inhibition of flow through blockage or clogging of the various 'channels' in the body. Treatment aimed at decongesting or unblocking these channels so as to create openness that would guarantee normal flows and restore health. The study concludes that the domain of animal illness be taken more into account in human medical anthropological studies and vice versa. It further argues the case for considering these similarities when planning and implementing health care services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/13648470500516220DOI Listing
April 2006
-->