Louise Stjernberg

5-y Follow-up Study of Patients with Neuroborreliosis

The objective of this follow-up study was to determine the long-term outcome of strictly classified cases of neuroborreliosis treated with antibiotics. A 1-y prospective population-based survey of Lyme borreliosis was conducted in southern Sweden between 1992 and 1993. A total of 349 identified cases with suspected neuroborreliosis were followed up 5 y later. Medical records were reviewed and all participants filled in a questionnaire. Of those patients classified with definite neuroborreliosis, 114/130 completed the follow-up, of whom 111 had completed the initial antibiotic treatment. Of the 114 patients followed up, 86 (75%) had recovered completely and 70 (61%) had recovered within 6 months. Residual neurological symptoms, such as facial palsy, concentration disorder, paresthesia and/or neuropathy, were reported by 28/114 patients. No significant differences between different antibiotic treatments were observed in terms of the occurrence of sequelae. To conclude, we found that 25% (95% confidence interval 17-33%) of the patients suffered from residual neurological symptoms 5 y post-treatment. However, the clinical outcome of treated neuroborreliosis is favorable as only 14/114 (12%) patients had sequelae that influenced their daily activities post-treatment. Early diagnosis and treatment would seem to be of great importance in order to avoid such sequelae.

Risk of Acquiring Tick Bites in South-eastern Sweden

The incidence and the temporal pattern of tick bites were studied in a population frequently out-of-doors in a tick-endemic area in south-eastern Sweden between May 2000 and March 2001. The participants, who were well aware of tick-borne diseases, inspected their skin daily from May until September and completed a diary sheet, registering visited geographical places, time out-of-doors, observed tick bites, etc. The participants were also given questionnaires in both the initial and final stages of the study, asking questions about their earlier history of tick bites, previous tick-borne diseases and out-of-doors activities. The incidence was 0.04 [95% confidence interval (95% CI) 0.02-0.06] tick-bitten participants/10 h spent out-of-doors. In total, the participants registered 1767 tick bites, i.e. an incidence of 0.14 (95% CI 0.10-0.18) tick bites/10 h out-of-doors. Within 6 months after the registration period, 8/235 (3%) had been treated for physician-diagnosed Lyme borreliosis. In conclusion, this study found a 4% risk of being tick-bitten per 10 h spent out-of-doors. The risk of contracting Lyme borreliosis was 1/221 tick bites (0.5%, 95% CI 0.44-0.56). Thus, the results indicate a low risk of acquiring Lyme borreliosis when using daily tick checks and we underline the opinion of not recommending routine prophylactic treatment for observed tick bites.

Teaching Ethics in Schools of Public Health in the European Region: Findings from a Screening Survey

Public health ethics is gaining recognition as a vital topic for public health education. The subject was highlighted in a Delphi survey of future priorities of member schools of The Association of Schools of Public Health in the European Region (ASPHER). We conducted a survey of teaching public health ethics in Bachelors and Masters of Public Health programmes targeting all 82 ASPHER member schools in 2010/2011, as an initiative toward improving ethics education in European Schools of Public Health. An eight-items questionnaire collected information on teaching of ethics in public health. A 52 percent response rate (43/82) revealed that nearly all of the responding schools (40 or 95% of the respondents with valid data) included the teaching of ethics in at least one of its programmes. They also expressed the need for support, (e.g., a model curriculum (n=25), case studies (n=24)), which indicates an area for further work to be met by the ASPHER Working Group on Ethics and Values in Public Health. This survey will help guide development of this topic as a teaching priority in public health education in Europe.

Age and gender effect on the use of herbal medicine products and food supplements among the elderly

Objective. To describe the users of herbal medicine products and food supplements with regard to age and gender specifically among persons aged ≥60 years. Design. A descriptive study with baseline data from a longitudinal study of the elderly, stratified into different age cohorts (60–69, 70–79, 80–89, and ≥90 years). Setting. Blekinge county, situated in south-eastern Sweden. Subjects. In total 1380 persons aged 60–96 years (median age 78 years). Main outcome measures. Current use of herbal medicine products and the use of food supplements. Results. Of the participants, 264/1380 (19.1%) used at least one herbal medicine product, 184/1380 (13.3%) used at least one food supplement and 382/1380 (27.7%) used herbal medicine products and/or food supplements. In all regression models, women had a higher probability of using herbal medicine and/or food supplements in comparison with men. Focusing on the use of herbal medicine products alone and the combination of using herbal medicine and/or food supplements, decreased use was seen with increasing age. However, 27.9% were still users of herbal medicine products and/or food supplements in the age group 80–89 years. In comparison, 14% were users in the age group ≥90 years. Age did not have an impact on the probability of taking food supplements. Conclusion. General practitioners need to consider the high use of herbal medicine products and food supplements among the elderly when making decisions on treatment.

A gender perspective on factors that influence outdoor recreational physical activity among the elderly

BackgroundPhysical activity (PA) is part of a healthy lifestyle and prevents many chronic health problems, in addition to promoting mental health. PA performed outdoors has been found particularly good for promoting ones well-being. The aim of this study was to investigate the extent to which outdoor recreational PA was carried out during 1 year, and the factors influencing such activities from a gender perspective among persons ≥ 60 years of age.MethodsThis study included 999 individuals 60-96 years of age living in the south eastern part of Sweden. Data collection was carried out during the years of 2001-2003. We measured the amount of regular light and/or intense outdoor recreational PA performed during the last year and determined the probability of performing PA as a function of 10 variables covering individual and socioeconomic factors.ResultsOur results suggest that being independent physically and healthy enough to manage ones personal hygiene and having access to areas for country walks were the most important factors associated with the probability of engaging in outdoor recreational PA for both men and women. Despite the level of performance being almost equal for the sexes as two-thirds of both had performed outdoor recreational PA during the preceding year more factors, i.e., living alone, being unable to cover an unexpected cost, fear of being violated, and fear of falling, were associated with the possibilities of engaging in outdoor recreational PA among women. Also increasing age seems to affect activities among women negatively to a higher extent than men.ConclusionMen and women seem to have different opportunities and needs with respect to performing PA. These considerations do not seem to be sufficiently taken into account today and improvements could be made concerning e.g., health-promoting activities suggested to the elderly by healthcare personnel and spatial planning within society. Promoting outdoor recreational PA that has restorative effects on well-being needs to focus on activities which are attractive and affordable for the majority of both men and women.

Detecting ticks on light versus dark clothing

It is a common belief that ticks are more visible and easier to detect on light clothing in comparison with dark clothing. We studied which of the clothing, light or dark, had the least attractive effect on Ixodes ricinus, thus minimizing exposure and thereby in theory helping to prevent tick-borne diseases in humans. 10 participants, exposed by walking in tick endemic areas, wore alternately light and dark clothing before every new exposure. Nymphal and adult ticks on the clothing were collected and counted. In total, 886 nymphal ticks were collected. The overall mean in found ticks between both groups differed significantly, with 20.8 more ticks per person on light clothing. All participants had more ticks on light clothing in all periods of exposure. Dark clothing seems to attract fewer ticks.

Parenthood and factors that influence outdoor recreational physical activity from a gender perspective

BackgroundA physically active life promotes both physical and mental health, increasing well-being and quality of life. Physical activity (PA) performed outdoors has been found to be particularly good for promoting well-being. However, participation in PA can change during the course of a lifetime. Parenthood has been found to be a life event associated with decreased PA, especially among women, although studies in the field are sparse. The aim of this study was to investigate participation in outdoor recreational PA, and factors influencing participation among parents-to-be, with and without previous children, from a gender perspective.MethodsThis study included baseline data from parents-to-be, 224 women and 208 men, from the municipality of Karlskrona in south-east Sweden. Data collection was carried out during 2008-2009. We measured the self-reported amount of outdoor recreational PA undertaken during the last year and analysed the probability of participating in this PA using 25 variables covering individual and socioeconomic factors.ResultsSeventy-six per cent of the women and 65% of the men had participated in outdoor recreational PA, varying from several times per month to every day, over a 12-month period prior to one month before pregnancy. Participation in PA indoors and owning a dog or a horse emerged as the most important factors associated with the probability of participation in outdoor recreational PA. Men were affected by a greater number of factors than women, for example men who had a family situation that permitted outdoor recreational PA participated in activities to a greater extent than men without such a family situation. The physical aspect, i.e. improved physical condition, staying power and vigour, also played a significant role with regard to participation among men.ConclusionsBecoming a parent is a life-changing event that affects participation in PA. By offering family-oriented PA choices that involve both parents and children, midwives and health promoters can encourage parents to be active and to support each other. The promotion of outdoor recreational PA, which also has restorative effects on well-being, needs to focus on activities which are attractive and affordable for the majority of both women and men.

A newly detected tick-borne encephalitis (TBE) focus in south-east Sweden: A follow-up study of TBE virus (TBEV) seroprevalence

In 2002, two cases of tick-borne encephalitis (TBE) were diagnosed in inhabitants of a tick endemic area on the island of Aspö in south-east Sweden. During the previous 25 y, only 2 other cases of TBE had been diagnosed in that region of Sweden. To investigate the presence and evolution of seroprevalence of antibodies to TBE virus (TBEV), we compared inhabitants’ anti-TBEV immunoglobulin G (IgG) levels in blood samples drawn in 1991 and 2002. A significant increase in IgG antibody levels was observed in 24/200 (12.0%) 2002 blood samples compared to 7/200 (3.5%) 1991 samples. However, neutralizing antibodies were detected in only 4 of the 2-step enzyme-linked immunosorbent assay (ELISA) IgG positive sera against TBEV, corresponding to a TBEV neutralizing test (NT) prevalence of 2%. Significantly more men than women were seropositive for TBEV antibodies. Compared to other age groups, the greatest increase in TBEV antibody levels was observed in the 20–29-y age group. However, the majority of seropositive samples were from participants >50 y of age. Recommending preventative measures, including vaccination against TBE, to individuals who reside in or regularly visit TBEV endemic areas is suggested.

Values and ethics amidst the economic crisis.

The current protracted economic crisis is giving rise to the scarcity of public health resources across Europe. In response to budgetary pressures and the Eurozone public debt crisis, decision-make ...

Factors associated with active commuting among parents-to-be in Karlskrona, Sweden

Aim: The purpose of the present study is to examine the prevalence of active commuting and factors associated with participation in active commuting in the municipality of Karlskrona, Sweden. Active commuting is defined here as walking or cycling to and from school/work for at least 15 minutes one-way. Method: A cross-sectional study was carried out, which included baseline data from parents-to-be. Pregnant females and their partners were invited to participate in the study when they contacted either of the municipality’s two antenatal clinics. Data collection ran from March 2008 to February 2009. When completing the questionnaire, the participants were asked to reflect on their situation one month before the female became pregnant. The final sample consisted of 432 participants (response rate 51.9% for females and 85.0% for males). Results: The main mode of commuting was motor vehicle (63.0%), with active commuters forming a minority (8.3%). The main facilitating factor for active commuting was living in an urban as opposed to a rural area. Regular participation in outdoor recreational physical activity was significantly positively associated with active commuting. Being Swedish and being surrounded by a green space environment were significantly negatively associated with active commuting. Conclusions: This study found that the number of people who are active commuters is modest and other modes of transportation are preferred. Several facilitating and impeding factors associated with active commuting were also found, indicating the importance of applying a broad health-promoting approach to encouraging active commuting.