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  • 1.
    Andrews, Johanna Y.
    et al.
    Karolinska Institute.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Umbilical cord-cutting practices and place of delivery in Bangladesh2011In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 114, no 1, p. 43-46Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate place of delivery, umbilical cord-cutting instruments used, and substances applied to the cord stump in Bangladesh. Methods: A cross-sectional data analysis was performed on a nationally representative sample of 4925 women of reproductive age (15-49 years) with at least 1 child. Results: More than 80% of women delivered at home. In 6% of cases, blades from a clean-delivery kit (CDK) were used to cut the cord; in 90% of cases, the blades used were from another source; in 4% of cases, other instruments such as bamboo strips and scissors were used to cut the cord. In 51% of cases, a substance (e.g. antibiotic powder/ointment, alcohol/spirit, mustard oil with garlic, boric powder, turmeric, and chewed rice) was applied to the stump after the cord was cut. Conclusion: The present findings underscore the need for further advocacy, availability, and use of cord-cutting instruments from CDKs, especially for deliveries that occur outside healthcare facilities.

  • 2.
    Aremu, Olatunde
    et al.
    Karolinska Institutet.
    Lawoko, Stephen
    Karolinska Institutet.
    Dalal, Koustuv
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Childhood vitamin A capsule supplementation coverage in Nigeria: a multilevel analysis of geographic and socioeconomic inequities.2010In: TheScientificWorldJournal, ISSN 1537-744X, Vol. 10, p. 1901-1914Article in journal (Refereed)
    Abstract [en]

    Vitamin A deficiency (VAD) is a huge public health burden among preschool-aged children in sub-Saharan Africa, and is associated with a high level of susceptibility to infectious diseases and pediatric blindness. We examined the Nigerian national vitamin A capsule (VAC) supplementation program, a short-term cost-effective intervention for prevention of VAD-associated morbidity for equity in terms of socioeconomic and geographic coverage. Using the most current, nationally representative data from the 2008 Nigerian Demographic and Health Survey, we applied multilevel regression analysis on 19,555 children nested within 888 communities across the six regions of Nigeria. The results indicate that there was variability in uptake of VAC supplement among the children, which could be attributed to several characteristics at individual, household, and community levels. Individual-level characteristics, such as maternal occupation, were shown to be associated with receipt of VAC supplement. The results also reveal that household wealth status is the only household-level characteristic that is significantly associated with receipt of VAC, while neighborhood socioeconomic disadvantage and geographic location were the community-level characteristics that determined receipt of VAC. The findings from this study have shown that both individual and contextual socioeconomic status, together with geographic location, is important for uptake of VAC. These findings underscore the need to accord the VAC supplementation program the much needed priority with focus on characteristics of neighborhoods (communities), in addition to individual-level characteristics.

  • 3.
    Aremu, Olatunde
    et al.
    Karolinska Institutet.
    Lawoko, Stephen
    Karolinska Institutet.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis2011In: International Journal of Women's Health, ISSN 1179-1411, Vol. 3, p. 167-174Article in journal (Refereed)
    Abstract [en]

    Background: High maternal mortality continues to be a major public health problem in most part of the developing world, including Nigeria. Understanding the utilization pattern of maternal healthcare services has been accepted as an important factor for reducing maternal deaths. This study investigates the effect of neighborhood and individual socieconomic position on the utilization of different forms of place of delivery among women of reproductive age in Nigeria.

    Methods: A population-based multilevel discrete choice analysis was performed using the most recent populationbased 2008 Nigerian Demographic and Health Surveys data of women aged between 15 and 49 years. The analysis was restriced to 15,162 ever-married women from 888 communities across the 36 states of the federation including the Federal Capital Territory of Abuja.

    Results: The choice of place to deliver varies across the socioeconomic strata. The results of the multilevel discrete choice models indicate that with every other factor controlled for, the household wealth status, women's occupation, women's and partner's high level of education attainment, and possession of health insurance were associated with use of private and government health facilities for child birth relative to home delivery. The results also show that higher birth order and young material age were associated with use of home delivery. Living in a highly socioeconomic disadvantaged neighborhood is associated with home birth compared with the patronage of government health facilities. More specifically, the result revealed that choice of facility-based delivery is clustered around the neighborhoods.

    Conclusion: Home delivery, which cuts across all socioeconomic strata, is a common practice among women in Nigeria. Initatives that would encourage the appropriate use of healthcare facilities at little or no cost to the most disadvantaged should be accorded the utmost priority.

     

  • 4.
    Aremu, Olatunde
    et al.
    Karolinska Institute.
    Lawoko, Stephen
    Karolinska Institute.
    Moradi, Tahereh
    Karolinska Institute.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Socio-economic determinants in selecting childhood diarrhoea treatment options in Sub-Saharan Africa: A multilevel model2011In: ITALIAN JOURNAL OF PEDIATRICS, ISSN 1720-8424, Vol. 37, no 13Article in journal (Refereed)
    Abstract [en]

    ackground: Diarrhoea disease which has been attributed to poverty constitutes a major cause of morbidity and mortality in children aged five and below in most low-and-middle income countries. This study sought to examine the contribution of individual and neighbourhood socio-economic characteristics to caregivers treatment choices for managing childhood diarrhoea at household level in sub-Saharan Africa. less thanbrgreater than less thanbrgreater thanMethods: Multilevel multinomial logistic regression analysis was applied to Demographic and Health Survey data conducted in 11 countries in sub-Saharan Africa. The unit of analysis were the 12,988 caregivers of children who were reported to have had diarrhoea two weeks prior to the survey period. less thanbrgreater than less thanbrgreater thanResults: There were variability in selecting treatment options based on several socioeconomic characteristics. Multilevel-multinomial regression analysis indicated that higher level of education of both the caregiver and that of the partner, as well as caregivers occupation were associated with selection of medical centre, pharmacies and home care as compared to no treatment. In contrast, caregivers partners occupation was negatively associated with selection medical centre and home care for managing diarrhoea. In addition, a low-level of neighbourhood socio-economic disadvantage was significantly associated with selection of both medical centre and pharmacy stores and medicine vendors. less thanbrgreater than less thanbrgreater thanConclusion: In the light of the findings from this study, intervention aimed at improving on care seeking for managing diarrhoea episode and other childhood infectious disease should jointly consider the influence of both individual SEP and the level of economic development of the communities in which caregivers of these children resides.

  • 5.
    Bendtsen, Preben
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hazardous Drinking Concepts, Limits and Methods: Low Levels of Awareness, Knowledge and Use in the Swedish Population.2011In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 46, no 5, p. 638-645Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the awareness and knowledge of hazardous drinking limits among the general population in Sweden and the extent to which people estimate their alcohol consumption in standard drinks to assess their level of drinking.

    Methods: A population-based study involving 6000 individuals selected from the total Swedish population was performed. Data were collected by means of a postal questionnaire. The mail survey response rate was 54.3% (n = 3200) of the net sample of 5891 persons.

    Results: With regard to drinking patterns, 10% of the respondents were abstainers, 59% were sensible drinkers and 31% were classified as hazardous drinkers. Most of the abstainers (80%), sensible drinkers (64%) and hazardous drinkers (56%) stated that they had never heard about the standard drink method. Familiarity with the hazardous drinking concept also differed between the three categories although ∼61% of sensible and hazardous drinkers expressed awareness of the concept (46% of the abstainers). Knowledge about the limits for sensible drinking was very poor. Between 94 and 97% in the three categories did not know the limit. There was a statistically significant association between having visited health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits. Similarly, there was a significant association between having had at least one alcohol conversation in health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits.

    Conclusion: The results can be seen as a major challenge for the health-care system and public health authorities because they imply that a large proportion of the Swedish population does not know when alcohol consumption becomes a threat to their health. The current strategy to disseminate knowledge about sensible drinking limits to the population through the health-care system seems to have failed and new means of informing the population are warranted.

  • 6.
    Biswas, Animesh
    et al.
    Centre for Injury prevetion Research, Dhaka Bangladesh.
    Rahman, Aminur
    Centre for Injury prevetion Research, Dhaka Bangladesh.
    Mashreky, Saidur
    Centre for Injury prevetion Research, Dhaka Bangladesh.
    Rahman, Fazlur
    Centre for Injury prevetion Research, Dhaka Bangladesh.
    Dalal, Koustuv
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Unintentional injuries and parental violence against children during flood: a study in rural Bangladesh2010In: Rural and remote health, ISSN 1445-6354, Vol. 10, no 1, p. 1199-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Violence and injuries are under-reported in developing countries, especially during natural disasters such as floods. Compounding this, affected areas are isolated from the rest of the country. During 2007 Bangladesh experienced two consecutive floods which affected almost one-third of the country. The objective of this study was to examine unintentional injuries to children in rural Bangladesh and parental violence against them during floods, and also to explore the association of socioeconomic characteristics. METHODS: A cross-sectional rural household survey was conducted in the worst flood-affected areas. A group of 638 randomly selected married women of reproductive age with at least one child at home were interviewed face-to-face using pre-tested structured questionnaires. The chi2 test and logistic regression were used for data analysis. RESULTS: The majority of families (90%) were affected by the flood and were struggling to find food and shelter, resulting in the parents becoming violent towards their children and other family members in the home. Cuts (38%), falls (22%) and near drowning (21%) comprised the majority of unintentional injuries affecting children during the floods. A large number of children were abused by their parents during the floods (70% by mothers and 40% by fathers). The incidence of child injuries and parental violence against children was higher among families living in poor socio-economic conditions, whose parents were of low occupational status and had micro-credit loans during the floods. CONCLUSIONS: Floods can have significant effects on childhood injury and parental violence against children. The improvement of socio-economic conditions would assist in preventing child injuries and parental violence.

  • 7.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Does economic empowerment protect women from intimate partner violence?2011In: Journal of Injury and Violence Research, ISSN 2008-2053, Vol. 3, no 1, p. 35-44Article in journal (Refereed)
    Abstract [en]

    Background: The current study compared working and non-working groups of women in relation to intimate partner violence. The paper aims to explore the relationship between women's economic empowerment, their exposures to IPV and their help seeking behaviour using a nationally representative sample in India.

    Methods: This was a cross sectional study of 124,385 ever married women of reproductive age from all 29 member states in India. Chi-square tests were used to examine differences in proportions of dependent variables (exposure to IPV) and independent variables. Multivariate logistic regressions were used to assess the independent contribution of the variables of economic empowerment in predicting exposure to IPV.

    Results: Out of 124,385 women, 69432 (56%) were eligible for this study. Among those that were eligible 35% were working. In general, prevalence of IPV (ever) among women in India were: emotional violence 14%, less severe physical violence 31%, severe physical violence 10% and sexual violence 8%. For working women, the IPV prevalence was: emotional violence 18%, less severe physical violence 37%, severe physical violence 14% and sexual violence 10%; whilst for non-working women the rate was 12, 27, 8 and 8 percents, respectively. Working women seek more help from different sources.

    Conclusions: Economic empowerment is not the sole protective factor. Economic empowerment, together with higher education and modified cultural norms against women, may protect women from IPV.

  • 8.
    Dalal, Koustuv
    et al.
    Department of Public Health Sciences, Social Medicine, Karolinska Institutet.
    Dawad, Suraya
    University of KwaZulu Natal, Durban, South Africa.
    Non-utilization of public health care facilities: examining the reasons through a national study of women in India2009In: Rural and remote health, ISSN 1445-6354, Vol. 9, no 3, p. 1178-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: This article examines women's opinions about their reasons for the non-utilization of appropriate public health care facilities, according to categories of their healthcare seeking in India. METHODS: This cross-sectional article uses nationally representative samples from the Indian National Family Health Surveys NFHS-3 (2005-2006), which were generated from randomly selected households. Women of reproductive age (15-49 years) from the 29 states of India participated (n = 124 385 women). The respondents were asked why they did not utilize public health care facilities when members of their households were ill, identifying their reasons with a yes/no choice. The following five reasons were of primary interest: (1) 'there is no nearby facility'; (2) 'facility timing is not convenient'; (3) 'health personnel are often absent'; (4) 'waiting time is too long'; and (5) 'poor quality of care'. RESULTS: Results from logistic regression analyses indicate that respondents' education, economic status and standard of living are significant predictors for non-utilization of public health care facilities. Women who sought the services of care delivery and health check-ups indicated that health personnel were absent. Service seekers for self and child's medical treatments indicated that there were no nearby health facilities, service times were inconvenient, there were long waiting times and poor quality health care. CONCLUSIONS: This study concludes that improving public health care facilities with user-friendly opening times, the regular presence of staff, reduced waiting times and improved quality of care are necessary steps to reducing maternal mortality and poverty.

  • 9.
    Dalal, Koustuv
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Lawoko, Stehpen
    Karolinska Institute.
    Jansson, Bjarne
    Karolinska Institute.
    Womens attitudes towards discontinuation of female genital mutilation in Egypt   2010In: Journal of Injury & Violence Research, ISSN 2008-2053, Vol. 2, no 1, p. 41-47Article in journal (Refereed)
    Abstract [sv]

    BACKGROUND: To examine women’s attitude towards discontinuation of female genital mutilation (FGM) in association with their access to information, knowledge of health effects and cultural beliefs concerning FGM in Egypt. METHODS: A cross-sectional study of 9159 women, using data from the household survey in Egypt by Demographic and Health survey 2003. A comprehensive questionnaire covering attitudes towards FGM, demographics, and access to information was used. Chi-square analysis and logistic regression were applied to investigate how demographics, level of education, access to information, knowledge of health consequences and cultural beliefs influence women’s attitudes towards FGM. RESULTS: Among the demographic variables, discontinuation of FGM was independently associated with urban residency and post-secondary education. Moreover, women who were informed by the media, and those who had attended community meetings, church, or mosque where FGM was discussed, as well as women who were aware of the negative health consequences of FGM, were more likely to support discontinuation of FGM. By contrast, women with positive cultural conceptions of FGM were less likely to favour its discontinuation. CONCLUSIONS: Public education and information dissemination aiming to change current cultural notions favouring FGM practice – through community and religious leaders, and radio and television programs – may play an important role in modifying women’s attitudes towards FGM. These findings have some implications for intervention and policy.

  • 10.
    Dalal, Koustuv
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Lawoko, Stephen
    Karolinska Institutet.
    Jansson, Bjarne
    Karolinska Institutet.
    The relationship between intimate partner violence and maternal practices to correct child behavior: a study on women in Egypt2010In: J of Injury & Violence Research, ISSN 2008-2053, Vol. 2, no 1, p. 25-33Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This paper scrutinizes the association between maternal practices to correct child behavior and the mothers’ exposure to and attitudes towards intimate partner violence (IPV). METHODS: Nationally representative data comprising 14016 married women were retrieved from the Egyptian Demographic and Health Survey, 2005. Data on practices used to correct child behavior, exposure to IPV, attitudes towards IPV were our primary interest. Data were analyzed using Chi-square test and logistic regression. RESULTS: The majority of the mothers reported use of violent methods, like shouting (90.6%), striking (69.1%) and slapping (39.3%) to correct child behavior. Seven percent of the mothers used only the explanation option. Exposure to physical IPV and tolerant attitudes towards IPV were associated with an augmented risk of using violent methods (shouting, striking or slapping) to correct child behavior. On the other hand non-tolerant attitudes towards IPV were associated with increased likelihood of sole use of the explanation method. CONCLUSIONS: We thus recommend the implementation of local parental education programs focusing on communicative skills to reduce IPV and related child abuse. 

  • 11.
    Dalal, Koustuv
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A National Study of the Prevalence and Correlates of Domestic Violence Among Women in India2012In: ASIA-PACIFIC JOURNAL OF PUBLIC HEALTH, ISSN 1010-5395, Vol. 24, no 2, p. 265-277Article in journal (Refereed)
    Abstract [en]

    This article estimates the national prevalence rate of domestic violence in India and examines the demographic and socioeconomic status of the victims of domestic violence. The study used the Indian National Family Health Survey 3, a cross-sectional national survey of 124 385 ever-married women of reproductive age from all the 29 member states. chi(2) Analysis and logistic regression were used. Lifetime experiences of violence among respondents were as follows: emotional violence, 14%; less severe physical violence, 31%; severe physical violence, 10%; and sexual violence, 8%. Women of scheduled castes and Muslim religion were most often exposed to domestic violence. Womens poorer economic background, working status, and husbands controlling behavior emerged as strong predictors for domestic violence in India. Elimination of structural inequalities inherent in the indigenous oppressive institutions of religion, caste, and the traditional male hierarchy in society could prevent domestic violence.

  • 12.
    Dalal, Koustuv
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Rahman, Fazlur
    Centre for Injury Prevention & Research, Dhaka.
    Jansson, Bjarne
    Karolinska Institute.
    WIFE ABUSE IN RURAL BANGLADESH2009In: JOURNAL OF BIOSOCIAL SCIENCE, ISSN 0021-9320, Vol. 41, no 5, p. 561-573Article in journal (Refereed)
    Abstract [en]

    Intimate partner violence (IPV) is a global public health and gender problem, especially in low-income countries. The study focused oil verbal abuse, physical abuse and abuse by restricting food provision to wives by their husbands by victim and perpetrator characteristics, emphasizing the socioeconomic context of rural Bangladesh. Using a cross-sectional household survey of 4411 randomly selected married women of reproductive age, the study found that a majority of the respondents are exposed to verbal abuse (79%), while 41% are exposed to physical abuse. A small proportion (5%) of the women had suffered food-related abuse. Risk factors observed were age of the wife, illiteracy (of both victims and perpetrators), alcohol misuse, dowry management, husbands monetary greed involving parents-in-law, and wifes suspicions concerning husbands extramarital affairs. Well-established risk factors for wife abuse, along with dowry and husbands monetary greed, have a relatively high prevalence in rural Bangladesh.

  • 13.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    School of Health & Medical Sciences, Department of Public Health Science, Örebro University, Örebro, Sweden.
    Impact of social standing on traffic injury prevention in a WHO safe community2012In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 4, no 4, p. 216-221Article in journal (Other academic)
    Abstract [en]

    The objective of the current study was to evalu- ate outcomes of a program to prevent traffic injuries among the different social strata under WHO Safe Community Program. A quasi-experi- mental design was used, with pre- and post- implementation registrations in the program im- plementation area (population 41,000) and in a neighbouring control municipality (population 26,000) in Östergötland County, Sweden. The traffic injury rate in the not vocationally active households was twice than employed or self- employed households in the intervention area. In the employed and not vocationally active households, males showed higher injury rates than females in both areas. In the self-employed households females exhibited higher injury rates than males in the intervention area. Males from not vocationally active households displayed the highest post-intervention injury rate in both the intervention and control areas. After 6 years of Safe Community program activity, the injury rates for males in employed category, injury rates for females in self-employed category, and males/females in non- vocationally active cate- gory displayed a decreasing trend in the inter- vention area. However, in the control area injury rate decreased only for males of employed households. The study indicated that there was almost no change in injury rates in the control area. Reduction of traffic injuries in the inter- vention area between 1983 and 1989 was likely to be attributable to the success of safety pro- motion program. Therefore, the current study concludes that Safe Community program seems to be successful for reducing traffic injuries in different social strata.

  • 14.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    The impact of child safety promotion on different social strata in a WHO Safe Community2012In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 4, no 1, p. 20-25Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The objective of the current study was to evaluate outcomes of a program to prevent severe and less severe unintentional child injuries among the different social strata under WHO Safe Community program. Specifically, the aim was to study effectiveness of Safe Community program for reducing child injury.

    METHODS: A quasi-experimental design was used, with pre- and post-implementation registrations covering the children (0 -15 years) in the program implementation area (population 41,000) and in a neighboring control municipality (population 26,000) in Ostergotland County, Sweden.

    RESULTS: Boys from not vocationally active households displayed the highest pre-intervention injury rate in both the control and intervention areas. Also in households in which the vocationally significant member was employed, boys showed higher injury rates than girls. Households in which the vocationally significant member was self-employed, girls exhibited higher injury rates than boys in the intervention area. After 6 years of program activity, the injury rates for boys and girls in employed category and injury rates for girls in self-employed category displayed a decreasing trend in the intervention area. However, in the control area injury rate decreased only for boys of employed families.

    CONCLUSIONS: The study indicated that almost no changes in injury rates in the control area suggested that the reduction of child injuries in the intervention area between 1983 and 1989 was likely to be attributable to the safety promotion program. Therefore, the current study indicates that Safe Community program seems to be successful for reducing child injuries.

  • 15.
    Liu, Yanmei
    et al.
    MPH Student, Karolinska Institutet, Sweden.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Review of Cost-Effectiveness Analysis of Medical Treatment For Myocardial Infarction2011In: International Journal of Preventive Medicine, ISSN 2008-7802, Vol. 2, no 2, p. 64-72Article in journal (Refereed)
    Abstract [en]

    Objectives: Myocardial infarction (MI) is a leading cause of death in both the industrialized and developing countries globally. The economic evaluation of MI is undertaken to rationale the allocation of scarce healthcare resource. The objective is to review cost-effectiveness analysis of MI with medications.

    Methods: We searched PubMed using the key words: "cost effectiveness analysis" and "myocardial infarction". After applying the selection criteria, eight articles were selected for the present study.

    Results: Out of eight articles, five had studied thrombolytic agents. All of these papers clearly explain the costs and benefits of different drugs for MI. ICER was assessed in six out of the eight articles to compare the costs and health effects between alternative medications. ICER was expressed in different effect units.

    Conclusions: This study found that various medications including thrombolytic agents, ACEI and heparin are administered to treat MI in many countries. It is also found that five of eight studies focus on thrombolytic therapies. It implies that thrombolytic is generally very cost effective for MI to the whole society.

  • 16.
    Medeiros, S E
    et al.
    Charles R Drew University of Medicine and Science,.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Mohammadi, R
    Karolinska Institute.
    Bazargan-Hejazi, S
    Charles R Drew University of Medicine and Science.
    JUSTIFYING PHYSICAL VIOLENCE AGAINST MEN AND WOMEN: A STUDY OF FEMALE INTIMATE PARTNER VIOLENCE VICTIMS IN MALAWI in JOURNAL OF INVESTIGATIVE MEDICINE, vol 58, issue 1, pp 112-1122010In: JOURNAL OF INVESTIGATIVE MEDICINE, Slack Incorporated , 2010, Vol. 58, no 1, p. 112-112Conference paper (Refereed)
    Abstract [en]

    n/a

  • 17.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping.
    McCambridge, Jim
    University of London London School Hyg and Trop Med, England .
    Karlsson, Nadine
    Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    When is it appropriate to address patients alcohol consumption in health care-national survey of views of the general population in Sweden2012In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 37, no 11, p. 1211-1216Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the Swedish populations beliefs and attitudes on when it is appropriate to address patients alcohol in health care services and to identify the characteristics of those who are most supportive of this alcohol-preventive work. A cross-sectional study of 5981 nationally representative individuals (18-64 years) was done using confidential mail questionnaires. Alcohol consumption was assessed with AUDIT-C and respondents were classified into four levels of drinking status. Sociodemographic data were also collected. Thirty-four percent completely agreed that health care providers should routinely ask patients about their alcohol habits and 33% completely agreed that providers should ask but only if patients have consulted them with alcohol-related symptoms. There was limited support for a statement that alcohol conversations should be premised on the patient bringing up the issue and even less support for the notion that alcohol habits are peoples own business and not something that health care providers should address. Thirty-four percent believed that people did not answer honestly when asked about their alcohol habits in health care. There appears to be considerable support in the general population for alcohol prevention in Swedish health care services that involves questions being asked routinely about alcohol. This should be helpful in ongoing efforts to improve the implementation of alcohol screening and brief interventions in Sweden. Further studies on the views of hazardous and excessive drinkers appear particularly important.

  • 18.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Evaluation of health research: measuring costs and socioeconomic effects2011In: International Journal of Preventive Medicine, ISSN 2008-7802, Vol. 2, no 4, p. 203-215Article in journal (Refereed)
    Abstract [en]

    Objectives: The topic of this work is health research evaluation including basic and clinical medical research, as well as healthcare research. The main objects are to explore possible approaches for valuing research in economic terms and to prepare an analytical model for evaluation of health research using the Swedish context. The study also aims to identify potential effects and their significance, and to provide a basis for discussions about the effects of research investments.

    Methods: The study has reviewed ten articles indicating positive effects, in the form of improved health and economic growth. The study also developed a model applied to Swedish health research.

    Results: The review indicates that positive effects, in the form of improved health and economic growth, have a value that greatly exceeds the costs of the research investments. The tentative model applied to Swedish health research also indicates predominantly positive returns, but in a lower range than the review would imply. Methodological problems, however, entail major uncertainty in the cited results.

    Conclusions: Accurate determination of the economic value of research would require significantly better basic data and better knowledge of relationships between research, implementation of new knowledge, and health effects. Information in support of decisions about future allocation of research resources is preferably produced by a combination of general analyses and strategically  selected case studies.

  • 19.
    Stenbacka, Marlene
    et al.
    Karolinska Institutet.
    Leifman, A
    Karolinska Institutet.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Jansson, B
    Karolinska Institutet.
    Early predictors of injury mortality among Swedish conscripts: a 35-year cohort study2011In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 43, no 1, p. 228-234Article in journal (Refereed)
    Abstract [en]

    Injuries represent an important cause of mortality among young adults. We studied the associations between adolescents' family, psychological, behavioural and drug-related risk factors in relation to unintentional injury death. A population-based cohort of 49,411 Swedish conscripts aged 18-20 years was followed for 35 years. The end-point of study was injury death up to 2004. The relationship between two family, four psychological and eight behavioural risk factors and injury death were analysed with Cox proportional hazards analyses and X(2) tests. Among 485 unintentional injury deaths, 40% occurred in subjects aged 25 years or under. The incidence per 1000 person years was 0.29 (95% CI, 0.26-0.31) and the mean age of death was 33 years. Problem drinking at both adolescent and adulthood was more strongly associated with injury death (HR=5.40) than illicit drug use (HR=2.70) even after adjusted for behavioural risk factors: (HR=3.43) and (HR=1.75), respectively. Adolescent risk factors such as contact with police and juvenile authorities, low emotional control, conduct problems at school and low social maturity were significant predictors of injury death in multivariate analyses. Young adults with social, behavioural and psychological problems and especialla alcohol and drug use at both adolescent and adulthood have a high mortality rate due to road traffic injuries and all kind of injuries. Early identification of vulnerable groups of adolescents with psychological and behavioural problems including alcohol and drug use at local levels could make a difference.

  • 20.
    Wang, S
    et al.
    School of Public Health, Fudan University, Shanghai, China.
    Zou, J
    School of Public Health, Fudan University, Shanghai, China.
    Yin, M
    School of Public Health, Fudan University, Shanghai, China.
    Yuan, D
    School of Public Health, Fudan University, Shanghai, China.
    Dalal, Koustuv
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Injury Epidemiology in a Safe Community Health Service Center in Shanghai, China2011In: HEALTHMED, ISSN 1840-2291, Vol. 5, no 3, p. 479-485Article in journal (Refereed)
    Abstract [en]

    The current study has investigated the injury epidemiology in a community health service center (CHSC) under a Safe Community in Shanghai, China. It was a cross sectional study with data generated from hospital records and Injury Report Card (IRC). Open wounds constituted 571 (50.8%) injuries. Majority of the injuries (99.64%) did not need any hospitalization. Among the injured victims, 59.16% were floating population and occupied in the manufacturing or transportation sector (31.49% of the injury), commercial services and farms. Finger, toes, head and face were most affected part of the body due to injuries. Mechanical objects and falls constituted nearly 95% causes of injuries. During start of working hours (9am) and during Wednesday and Thursday the frequencies of injuries were highest. In a WHO Safe Community program, injury epidemiology has great emphasize as it dwelled with proper scientific evidences of the injury etiologies. The study had identified some important issues within its objected framework. Education and supervision of the floating workers can be effective for reducing injuries.

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