Terrestrial ecosystems export large amounts of organic carbon (t-OC) but the net effect of this OC on the productivity of recipient aquatic ecosystems is largely unknown. In this study of boreal ...lakes, we show that the relative contribution of t-OC to individual top consumer (fish) biomass production, and to most of their potential prey organisms, increased with the concentration of dissolved organic carbon (DOC; dominated by t-OC sources) in water. However, the biomass and production of top consumers decreased with increasing concentration of DOC, despite their substantial use (up to 60%) of t-OC. Thus, the results suggest that although t-OC supports individual consumer growth in lakes to a large extent, t-OC input suppresses rather than subsidizes population biomass production.
PM10 concentrations exceed the guidelines in some Swedish cities and the limit values will likely be further reduced in the future. In order to gain more knowledge of emission factors for road ...traffic and concentrations of PM10 and PM2.5, existing monitoring stations in two cities, Gothenburg and Umea, with international E-road thoroughfares, were complemented with some PM2.5 measurements. Emission factors for PM10 and PM2.5 were estimated using NOX as a tracer. Monitoring data from kerbside and urban background sites in Gothenburg during 2006-2010 and in Umea during 2006-2012 were used. NOX emissions were estimated from the traffic flow and emission factors calculated from the HBEFA3.1 model. PM2.5 constitutes the finer part of PM10. Emissions of the coarser part of PM10 (PM10-PM2.5) are suppressed when roads are wet and show a maximum during spring when the roads dry up and studded tyres are still used. Less than 1% of the road wear caused by studded tyres give rise to airborne PM2.5-10 particles. The NOX emission factors decrease with time in the used model, due to the renewal of the vehicle fleet. However, the NOX concentrations resulting from the roads show no clear trend. The air dispersion is an important factor controlling the PM concentration near the road. The dispersion has a minimum in winter and during midnight. The average street level concentrations of PM10 and PM2.5 in Gothenburg were 21 plus or minus 20 and 8 plus or minus 6 mu g m-3 respectively, which is 36% and 22% higher than the urban background concentrations. Despite the four times lower traffic flow in Umea compared to Gothenburg, the average particle concentrations were very similar; 21 plus or minus 31 and 7 plus or minus 5 mu g m-3 for PM10 and PM2.5 respectively. These concentrations were, however, 108% and 55% higher than the urban background concentrations in Umea. The emission factors for PM10 decreased with time, and the average factor was 0.06 g km-1 vehichle-1. The emission factors for PM2.5 are very uncertain due to the small increments in PM2.5 concentration at the thoroughfares, and were on average 0.02 g km-1 vehichle-1.
Background: Diabetic individuals must adhere to their medications to control their glucose levels and prevent diabetes-related complications. However, there is limited evidence of medication ...adherence in patients with type 2 diabetes in Bangladesh.
Objectives: We assessed the level of adherence and factors associated with low adherence to anti-diabetic medication among patients with type 2 diabetes at different health facilities in southern Bangladesh.
Methods: This cross-sectional study included 2,070 patients with type 2 diabetes who presented at five health facilities in the Chittagong Division between November 2018 and June 2019. We assessed medication adherence using a self-reported, structured, eight-item questionnaire and performed multiple logistic regression to investigate the factors associated with low medication adherence.
Results: The overall prevalence of low medication adherence was 46.3% (95% CI: 41.4-55.8%) of our study population. Multiple logistic regression analysis revealed that males (OR: 1.37; 95% CI: 1.13-1.67), those with a family income of < 233 USD (OR: 1.54, 95% CI: 1.17-2.03), and those with a diabetic ulcer (OR: 1.42, 95% CI: 1.04-1.94) showed low adherence. Diabetic ulcers, retinopathy, and obesity were relatively more elevated among diabetic patients with low medication adherence.
Conclusion: Low medication adherence among patients with type 2 diabetes in southern Bangladesh is a key public health challenge. Factors such as male sex, low annual family income, and diabetic ulcers were associated with low medication adherence. Patient counseling and awareness programs may enhance medication adherence among people with type 2 diabetes. Our findings will help physicians and public health workers to develop targeted strategies to increase awareness of the same among their patients.
This study aimed to illuminate very old people's experiences and expressions of spirituality and is a part of the Umeå 85+/Gerontological Regional Database (GERDA). The participants (n = 12) had ...declared an interest in spirituality, were 86-99 years of age, and were interviewed in their own homes. The interviews were analyzed using qualitative content analysis. The findings revealed that spirituality was experienced as being in communion, transcending life's circumstances, and living in a spiritual reality. Spirituality was expressed as an inner sense of communion with God and with other people, and as a spiritual reality. The participants expressed a desire to talk about spiritual experiences and personal beliefs but regarded spirituality as an uncommon topic. Nurses and other professionals need to be aware of spiritual needs and prepared to give spiritual care.
Studies of trends in population changes and epidemiological profiles in the developing world have overwhelmingly relied upon the concepts of demographic, epidemiological, and health transitions, even ...though their usefulness in describing and understanding population and health trends in developing countries has been repeatedly called into question. The issue is particularly relevant for the study of population health patterns in Africa and sub-Saharan Africa, as the history and experience there differs substantially from that of Western Europe and North America, for which these concepts were originally developed.
The aim of this study is two-fold: to review and clarify any distinction between the concepts of demographic transition, epidemiological transition and health transition and to identify summary indicators of population health to test how well these concepts apply in Africa.
Notwithstanding the characteristically diverse African context, Africa is a continent of uncertainties and emergencies where discontinuities and interruptions of health, disease, and mortality trends reflect the enduring fragility and instability of countries and the vulnerabilities of individuals and populations in the continent. Africa as a whole remains the furthest behind the world's regions in terms of health improvements and longevity, as do its sub-Saharan African regions and societies specifically. This study documents: 1) theoretically and empirically the similarities and differences between the demographic transition, epidemiological transition, and health transition; 2) simple summary indicators that can be used to evaluate their descriptive and predictive features; 3) marked disparities in the onset and pace of variations and divergent trends in health, disease, and mortality patterns as well as fertility and life expectancy trajectories among African countries and regions over the past 60 years; 4) the rapid decline in infant mortality and gains in life expectancy from the 1950s through the 1990s in a context of preponderant communicable diseases in all African countries; 5) the salient role of adult mortality, mostly ascribed to HIV/AIDS and co-morbidities, since the 1990s in reversing trends in mortality decline, its interruption of life expectancy improvements, and its reversal of gender differences in life expectancies disadvantaging women in several countries with the highest prevalence of HIV/AIDS; 6) the huge impact of wars in reversing the trends in under-five mortality decline in sub-Saharan countries in the 1990s and beyond. These assessments of these transition frameworks and these phenomena were not well documented to date for all five regions and 57 countries of Africa.
Prevailing frameworks of demographic, epidemiological, and health transitions as descriptive and predictive models are incomplete or irrelevant for charting the population and health experiences and prospects of national populations in the African context.
Definitions can generate actionable consensus for a given subject matter by resolving important differences in philosophy and best practices and by streamlining activities for a stronger strategic ...direction. Interest in the global dimensions of oral health, a generally neglected area of global health, is growing; yet, no previously published research has defined the term 'global oral health.' As such, the Global Oral Health Interest Group of the Consortium of Universities for Global Health determined a need for an introductory definition of 'global oral health' to guide program planning, implementation, and evaluation. With the oversight of an expert senior Task Force for the Definition of Global Oral Health, we employed a mixed-methods approach using the more common expert consensus-building Delphi technique combined with the lesser utilized Q methodology. This approach allowed us to identify the interconnectedness of global oral health themes and integrate multiple, seemingly disparate, topics into a single streamlined concept. Our resulting definition is as follows: Global Oral Health aims for optimal oral health for all people and elimination of global health inequities through health promotion, disease prevention, and appropriate oral care approaches that consider common determinants and solutions and acknowledge oral health as part of overall health. The purpose of this short communication is to generate a narrative around our proposed definition of global oral health to support establishing guidelines and developing best practices for academic global oral health programs, policies, and practices that aim to achieve a goal of oral health globally.
Reliable civil registration and vital statistics (CRVSs) are essential for estimating mortality rates and population changes, and are critical for public health and socio-economic planning. CRVSs are ...largely incomplete in Africa, thus Health and Demographic Surveillance Systems (HDSSs) fill gaps in CRVSs, albeit existing HDSSs in South Africa are in rural areas. This limits the generalisability of such data in a country such as South Africa where over 60% live in urban areas, and where there are limitations to access health and social services. We describe the approaches, achievements, challenges and lessons learned in setting up a HDSS site in Soweto and Thembelihle (SaT-HDSS), Johannesburg; which is the first urban-based HDSS in Southern Africa. We also highlight a number of studies being implemented in the HDSS. In 2017-2020, the HDSS has enrolled 124,169 individuals and followed up 95% of this population through 3 rounds of data collection. Several challenges were encountered during the initiation of the HDSS, including difficulties in community mobilisation and entry, stakeholders' engagement and participation, inaccessibility problems and concerns about safety of fieldworkers, and difficulty in getting/recruiting technical staff with requisite experience. Nevertheless, the SaT-HDSS was successfully established through application of several strategies, including continuous community engagement and stakeholders' mobilisation; in-depth training and retraining of all study staff; technical support from well-established HDSS sites across Africa, and international academic collaborations. Despite the challenges of undertaking routine surveillance of a hard-to-reach and highly mobile population, the SaT-HDSS was successfully established with a high-retention rate. The HDSS offers an important lens on morbidity and mortality and serves as a platform for pilots of interventions and programmes aimed at improving health and well-being of an urban population.
Purpose
– Little attention has been paid to the initial development of programs. The purpose of this paper is to explore co-creation as an alternative strategic approach for program management. ...Co-creation of programs means that the projects within the program are created by the users and producers of the projects.
Design/methodology/approach
– The paper is based on a case study of the co-creation approach of the Umeå 2014 European Capital of Culture program. The empirical material analyzed consists of qualitative interviews with members of the Umeå 2014 team and the politicians involved, as well as secondary data on the program.
Findings
– The Umeå 2014 Capital of Culture program takes the form of a platform that makes meetings and interactions possible. Co-creation allows for creative cultural projects to emerge, but the program becomes reliant on the different actors involved. Balancing dilemmas of multiple stakeholders and maintaining control while enabling the emergence of ideas is key.
Practical implications
– These findings have practical implications for the management of more emergent program structures. A flexible organization with guiding values and criteria to balance the different projects can be used to achieve program goals when multiple stakeholders have their own agendas.
Originality/value
– This paper contributes to research on program management by introducing the concept of co-creation as a strategic approach for program management. The creative and innovative benefits of co-creation can be reached in the development of programs but other challenges for their management are involved.
Regional competitiveness has become a truism for many places today. In line with this "competitive discourse", planners in Umeå, Northern Sweden, are seeking to create a "sticky" place where capital ...and people are attracted by enhancing the cultural sector through the hosting of events. By implementing the bid for the title of European Capital of Culture in 2014 through a positive growth-oriented discourse, it is hoped that a multitude of stakeholders will come together in a network of "co-creation", and enhance an image of the city as a creative and gushing place with endless development possibilities. This paper studies how a development proposal is implemented among the stakeholders by seeking to create positive expectations. With a point of departure in stakeholder theory and interdiscursive analysis, this study explores the role of discourse in stakeholder dynamics and engagement. The results of this study show that implementation is not merely a marketing process, but different opinions will emerge that may contest the "official" discourse, and that the outcomes of the implementation strategy may be hard to control unless the "official" discourse is consciously elaborated to adapt to these counter-discourses.
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