Young adults’ thoughts and experiences regarding condom use: a qualitative study from Oslo

Master i folkehelsevitenskap med vekt på endringer av livsstilsvaner, 2017Norsk sammendrag: Introduksjon: Folkehelseinstituttet rapporterer en økning av seksuelt overførbare infeksjoner (SOI) som klamydia og gonore i Norge. Flere SOI kan resultere i barnløshet. Det er i aldersgruppen 20-24 hvor majoriteten diagnostiseres. En undersøkelse utført av Helsedirektoratet oppdaget at unge voksne oppgir at å “unngå uønsket graviditet” er deres prioritet når det kommer til bruk av kondom ved samleie. Hormonelle prevensjonsmidler er den mest brukte prevensjonsmetoden blant unge i aldersgruppen 20-24 år, disse beskytter derimot ikke mot SOI. Sett i et folkehelseperspektiv er det relevant å oppnå mer kunnskap om hvilke tanker unge voksne har rundt kondombruk. I fremtiden kan resultatene fra denne oppgaven bli brukt til å bidra med innsikt på temaet fra deltakernes perspektiv, som et supplement til fremtidig forskning. Metode: Dette er en kvalitativ studie av 7 unge voksne som bor i Oslo, alle deltakerne meldte seg frivillig og ble rekruttert gjennom helsestasjonen Sex og Samfunn og gjennom “snowball-sampling”. Datainnsamlingen ble gjennomført gjennom individuelle intervjuer, ved bruk av en semi-strukturert intervjuguide. Analysen ble gjennomført ved bruk av tematisk analyse av Braun & Clarke (2006). Resultat: Deltakerne hadde forskjellige tanker og erfaringer med kondombruk, men hadde også flere felles oppfatninger. De fleste deltakerne skilte mellom en ukjent partner og en fast partner. Flere av deltakerne mente alkohol og one-night stands var faktorer som kunne gjøre det mer utfordrende å bruke kondom. “Tillit” i relasjon til en samleiepartner var for det meste forbundet med ærlighet rundt det å fortelle om eventuelle SOI. Samleiepartnerens ukjente reaksjon til kondombruk opplevdes som en barriere for flere av de kvinnelige deltakerne som gjorde det utfordrende for dem å ta opp kondom. De fleste av deltakerne snakket om SOI med en avslappet holdning. Diskusjon: Resulatene av denne studien støtter tidligere forskning som fremhever at unge voksne har en lav trussel-oppfatning når det kommer til SOI. Konteksten rundt et samleie og flere andre faktorer påvirker unges beslutningsvurdering rundt bruk av kondom. Ytterligere undervisning på skolen som inneholder informasjon om hyppigheten og konsekvensene av SOI, kombinert med grundigere undervisning om det sosiale aspetket rundt sex, som fokuserer på å bygge opp unges mestringstro, og forbereder dem på ulike situasjoner som kan oppstå rundt kondombruk kan vise seg fffektive.English abstract: Introduction: Recent reports measure an increase of sexually transmitted infections (STIs) such as chlamydia and gonhorrea in Norway. Untreated, these conditions can lead to iinfertility. It is in the age group 20-24 were the majority are being diagnosed. A study conducted by the Norwegian directorate of health discovered that young adults do not fear STIs and report “avoiding unwanted pregnancies” to be their priority when deciding to use condoms in sexual encounters. Most young adults use hormonal prevention methods, these do not protect against STIs. In a public health context it is relevant to collect more information about what perspectives young adults have in relation to condom use. In the future the findings can be used to provide some insight on the topic from the participant’s point of view, as a supplement in future research. Methods: This is a qualitative study of 7 young adults who live in Oslo, all the participants’ volunteered and were recruited through the health clinic Sex og Samfunn and through “snowball-sampling”. The collection of data was done through in-depth interviews completed with a semi-structured interview-guide. The data was analysed by using Braun & Clarkes’ (2006) thematic analysis. Results: The participants of the study had different thoughts and experiences with STIs and condom use, but there were also several common conceptions. Few of the participants had any recollection of the sex education they had received in school. Several of the participants identified alcohol and one-night stands as factors that could make it more challenging to use condoms. Trust” in a partner was for the most part associated with honesty in terms of disclosing possible STIs. The female participants described uncertainty regarding the partners’ unknown reaction to condom use as factor that made it challenging to bring up condom use. Most of the participants of the study talked about STIs in a light-hearted manner. Discussion: The findings of this study support previous research findings that have identified a low threat-perception of STIs among young adults. The context in which the sexual encounter takes place and several other factors influence young peoples decision-making regarding condom use. More elaborate education in schools about the consequences and frequencies of STIs, as well as about the social circumstance surrounding sex, so that they can develop self-efficacy in communicating condom use to a partner and preparing them for different situations that can arise with condom use, could prove effective in increasing condom use

Taking real steps in virtual nature: a randomized blinded trial

Studies show that green exercise (i.e., physical activity in the presence of nature) can provide the synergistic psychophysiological benefits of both physical exercise and nature exposure. The present study aimed to investigate the extent to which virtual green exercise may extend these benefits to people that are unable to engage in active visits to natural environments, as well as to promote enhanced exercise behavior. After watching a video validated to elicit sadness, participants either performed a treadmill walk while exposed to one of two virtual conditions, which were created using different techniques (360° video or 3D model), or walked on a treadmill while facing a blank wall (control). Quantitative and qualitative data were collected in relation to three overarching themes: “Experience,” “Physical engagement” and “Psychophysiological recovery.” Compared to control, greater enjoyment was found in the 3D model, while lower walking speed was found in the 360° video. No significant differences among conditions were found with respect to heart rate, perceived exertion, or changes in blood pressure and affect. The analysis of qualitative data provided further understanding on the participants’ perceptions and experiences. These findings indicate that 3D model-based virtual green exercise can provide some additional benefits compared to indoor exercise, while 360° video-based virtual green exercise may result in lower physical engagement.publishedVersio

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.

BACKGROUND: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS: Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION: Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING: Bill & Melinda Gates Foundation

Young adults’ thoughts and experiences regarding condom use: a qualitative study from Oslo

Norsk sammendrag: Introduksjon: Folkehelseinstituttet rapporterer en økning av seksuelt overførbare infeksjoner (SOI) som klamydia og gonore i Norge. Flere SOI kan resultere i barnløshet. Det er i aldersgruppen 20-24 hvor majoriteten diagnostiseres. En undersøkelse utført av Helsedirektoratet oppdaget at unge voksne oppgir at å “unngå uønsket graviditet” er deres prioritet når det kommer til bruk av kondom ved samleie. Hormonelle prevensjonsmidler er den mest brukte prevensjonsmetoden blant unge i aldersgruppen 20-24 år, disse beskytter derimot ikke mot SOI. Sett i et folkehelseperspektiv er det relevant å oppnå mer kunnskap om hvilke tanker unge voksne har rundt kondombruk. I fremtiden kan resultatene fra denne oppgaven bli brukt til å bidra med innsikt på temaet fra deltakernes perspektiv, som et supplement til fremtidig forskning. Metode: Dette er en kvalitativ studie av 7 unge voksne som bor i Oslo, alle deltakerne meldte seg frivillig og ble rekruttert gjennom helsestasjonen Sex og Samfunn og gjennom “snowball-sampling”. Datainnsamlingen ble gjennomført gjennom individuelle intervjuer, ved bruk av en semi-strukturert intervjuguide. Analysen ble gjennomført ved bruk av tematisk analyse av Braun & Clarke (2006). Resultat: Deltakerne hadde forskjellige tanker og erfaringer med kondombruk, men hadde også flere felles oppfatninger. De fleste deltakerne skilte mellom en ukjent partner og en fast partner. Flere av deltakerne mente alkohol og one-night stands var faktorer som kunne gjøre det mer utfordrende å bruke kondom. “Tillit” i relasjon til en samleiepartner var for det meste forbundet med ærlighet rundt det å fortelle om eventuelle SOI. Samleiepartnerens ukjente reaksjon til kondombruk opplevdes som en barriere for flere av de kvinnelige deltakerne som gjorde det utfordrende for dem å ta opp kondom. De fleste av deltakerne snakket om SOI med en avslappet holdning. Diskusjon: Resulatene av denne studien støtter tidligere forskning som fremhever at unge voksne har en lav trussel-oppfatning når det kommer til SOI. Konteksten rundt et samleie og flere andre faktorer påvirker unges beslutningsvurdering rundt bruk av kondom. Ytterligere undervisning på skolen som inneholder informasjon om hyppigheten og konsekvensene av SOI, kombinert med grundigere undervisning om det sosiale aspetket rundt sex, som fokuserer på å bygge opp unges mestringstro, og forbereder dem på ulike situasjoner som kan oppstå rundt kondombruk kan vise seg fffektive

Taking real steps in virtual nature: a randomized blinded trial

Studies show that green exercise (i.e., physical activity in the presence of nature) can provide the synergistic psychophysiological benefits of both physical exercise and nature exposure. The present study aimed to investigate the extent to which virtual green exercise may extend these benefits to people that are unable to engage in active visits to natural environments, as well as to promote enhanced exercise behavior. After watching a video validated to elicit sadness, participants either performed a treadmill walk while exposed to one of two virtual conditions, which were created using different techniques (360° video or 3D model), or walked on a treadmill while facing a blank wall (control). Quantitative and qualitative data were collected in relation to three overarching themes: “Experience,” “Physical engagement” and “Psychophysiological recovery.” Compared to control, greater enjoyment was found in the 3D model, while lower walking speed was found in the 360° video. No significant differences among conditions were found with respect to heart rate, perceived exertion, or changes in blood pressure and affect. The analysis of qualitative data provided further understanding on the participants’ perceptions and experiences. These findings indicate that 3D model-based virtual green exercise can provide some additional benefits compared to indoor exercise, while 360° video-based virtual green exercise may result in lower physical engagement

Taking real steps in virtual nature: a randomized blinded trial

Studies show that green exercise (i.e., physical activity in the presence of nature) can provide the synergistic psychophysiological benefits of both physical exercise and nature exposure. The present study aimed to investigate the extent to which virtual green exercise may extend these benefits to people that are unable to engage in active visits to natural environments, as well as to promote enhanced exercise behavior. After watching a video validated to elicit sadness, participants either performed a treadmill walk while exposed to one of two virtual conditions, which were created using different techniques (360° video or 3D model), or walked on a treadmill while facing a blank wall (control). Quantitative and qualitative data were collected in relation to three overarching themes: “Experience,” “Physical engagement” and “Psychophysiological recovery.” Compared to control, greater enjoyment was found in the 3D model, while lower walking speed was found in the 360° video. No significant differences among conditions were found with respect to heart rate, perceived exertion, or changes in blood pressure and affect. The analysis of qualitative data provided further understanding on the participants’ perceptions and experiences. These findings indicate that 3D model-based virtual green exercise can provide some additional benefits compared to indoor exercise, while 360° video-based virtual green exercise may result in lower physical engagement

Adult non-communicable disease mortality in Africa and Asia : evidence from INDEPTH Health and Demographic Surveillance System sites

Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available.; To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15-64 years) and older (65+ years) NCD mortality.; All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates.; A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15-64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality.; These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian setting This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work