Health promotion research in the Nordic countries - a scoping review of PhD dissertations 2008-2018

Background

The Nordic countries are welfare states that also have been claimed to be in the forefront in developing health promotion, in relation to theory, research, policy and practice. This scoping review was performed by members of the Nordic Health Promotion Research Network with the objectives to collect and identify the scope and theoretical basis of doctoral (PhD) dissertations on health promotion in a Nordic context.

Methods

Searches for dissertations, published 2008-2018, were performed in several databases in Denmark, Finland, Iceland, Norway, and Sweden. Those labelled “health promotion” present in titles, abstract or key words were included in the scoping review. Data was extracted based on a common template including title, aims, university, individual-national level, setting, type of study and collaboration.

Results

The search strategy had to be modified to include manual searches at university sites as no national data base was available. In total, 353 health promotion dissertations had been published at 41 different universities. Most dissertations were Swedish (193), while 56 came from Denmark, 53 from Norway and 51 from Finland, but non from Iceland. The main content was lifestyle (28%), mental or psychosocial health (14%), critical health promotion (8%), empowerment (7%) or refugee and immigrants (5%). The most common approach was settings (31%), including health care setting (14%), followed by societal (28%) and individual (28%) approaches. Mixed methods approach was most common research method (45%) followed by quantitative (32%) and qualitative methods (23%). Large country variations were seen in the health promotion.

Conclusions

Health promotion research in the Nordic countries can be characterised by focusing on lifestyle, settings approach, and primarily using a mixed methods approach. However, there are large variations between different health promotion PhDs, also including dissertations on critical health promotion and empowerment.

Key messages

Analysis of PhD dissertations can contribute to more comprehensive insight in disciplinary development. The research training will have implications for the future public health workforce. The Nordic collaboration enabled an extensive scoping review of PhD dissertations on health promotion research in the Nordic countries and shows what has characterized the field of research.

Herpesvirus antibodies and vascular complications in essential hypertension

Antibodies against herpes simplex virus (HSV) and cytomegalovirus (CMV) were examined in sera from 132 patients with essential hypertension and 54 normotensive healthy subjects of the same age and sex. Prevalences of HSV and CMV antibodies (titre greater than or equal to 4) were equal in patients and controls. A HSV antibody tire greater than or equal to 64 was found in 39.5% (17/53) of patients with WHO stage III hypertension, in 26.2% (22/85) of patients with stage I-II hypertension, and in only 9.4% (5/54) of normotensive subjects (p less than 0.0005). The HSV antibodies were mainly of type 1. No association between CMV antibodies and vascular complications could be demonstrated.

Respiratory tract infections in cytomegalovirus-excreting and nonexcreting infants

BACKGROUND

There is evidence of an immunosuppressive effect of cytomegalovirus (CMV), and CMV has been claimed to be a copathogen in respiratory tract infections (RTI). We therefore studied the significance of CMV viral load in infants with RTI, compared the frequency of infection with respiratory viruses and followed the course of RTI in CMV-excreting vs. nonexcreting infants.

METHODS

We examined 201 infants consecutively admitted to the Department of Pediatrics for RTI. At admission nasopharyngeal aspirates, throat swabs and urine were examined for CMV, and nasopharyngeal aspirates were examined for respiratory viruses.

RESULTS

In these patients 23.3% had CMV in the urine, 15.3% had CMV in the throat and 10.9% had CMV in the nasopharynx; 26.2% excreted CMV in at least one site. No relationship was found between CMV viral load and clinical symptoms. Infection with respiratory viruses was as common in infants excreting CMV as in nonexcreting infants. Symptoms and the course of infection were not different in the two groups except that CMV-excreting infants had a significantly higher frequency of rhonchi at admission (P = 0.007) and a tendency for longer duration of cough (P = 0.06).

CONCLUSION

CMV viral load was not related to clinical symptoms. The frequency of infection with common respiratory viruses in infants was independent of CMV excretion. The course of infection was not more complicated in infants excreting CMV; however, a higher frequency of rhonchi was demonstrated in patients with CMV.

The impact of CMV on the respiratory burst of macrophages in response to Pneumocystis carinii

Infection of human monocyte-derived macrophages with CMV decreased the respiratory burst when cells were stimulated with opsonized zymosan or Pneumocystis carinii (P. carinii). Such an effect, though smaller, was also seen with heat-inactivated CMV, but only when triggered by zymosan. The effect was most pronounced in cells obtained from CMV antibody-negative donors. Dexamethasone further reduced the respiratory burst, both in uninfected and CMV-infected cells. Interferon-gamma increased the response in uninfected cells and, to a lesser extend, in cells treated with heat-inactivated CMV, whereas no effect was seen with infective CMV. No overt productive infection or cytopathology could be detected, however, the monocytes incubated with infective but also heat-inactivated CMV formed clusters, a phenomenon that was equally pronounced in cultures from CMV antibody positive and negative-donors. These results might help explain the worse prognosis of P. carinii pneumonia in patients coinfected with CMV and receiving dexamethasone.

Comparison between in-line and rollerskating injury. A prospective study

Rollerskating is an activity that has become increasingly popular over the past several years among children and adults in Denmark. During a 7-month period in 1997, 300 in-line skaters and 107 roller skaters were treated in the Emergency Department, Esbjerg County Hospital. Of these, 60.4% had minor injuries (sprains, bruises, lacerations) and 39.6% fractures. There was no statistical significant difference in the types of injury between skater groups. The most common serious injury was fracture of the wrist, which occurred in both skater groups (25%, n=102). Almost all of the fractures of the wrist and elbow occurred among skaters who did not wear wrist or elbow guards Only 20% of the skaters used protective equipment. In-line skaters used protective equipment more often than did roller skaters. Of all accidents, 69% occurred on public roads (street and sidewalk).

Increased risk of multiple sclerosis after late Epstein-Barr virus infection: a historical prospective study

An association between infectious mononucleosis (IM) and MS has been proposed. In a historical prospective study we used records from the Danish State Serum Institute on heterophile antibody (HA) tests for IM performed in all Danish patients over a number of years. Included in the analysis were 6853 HA-positive persons analyzed from 1968 to 1978 (except 1975) and 12,886 HA-negative per sons analyzed in the years 1968, 1969, 1970 and 1978. A search for these persons in the central nationwide Danish Multiple Sclerosis Registry (DMSR) was performed. Among the HA-positive persons 16 cases of MS which met the diagnostic criteria were found with onset of MS after the year of the HA test and before follow-up on 1 January 1991. The expected number for a Danish population, matched by sex, age and year at start of observation, was 5.70 (P < 0.05), the risk ratio being 2.81. No patient had developed MS before contracting IM. Among the HA-negative persons 12 were registered with onset of MS after the year of the HA test and before follow-up, the expected number being 10.47 (P > > 0.05). Although Epstein-Barr virus is not suggested in itself to be the cause of MS, we propose that it is a co-factor in the pathogenesis of this disease.

Boneloc cemented total hip prostheses. Loosening in 28/43 cases after 3-38 months

We report our early results with 43 total hip prostheses (25 Charnley and 18 LMT) inserted during 1991 with Boneloc cement. The indication was primary arthrosis (38) and rheumatoid arthritis (5). After 18 (3-38) months, 28 stems were loose and 18 hips have been revised 1-4 years after primary surgery.

[Pattern of injuries at a Danish sports college]

A batch of college students was followed with the object of describing the pattern of athletic injuries. Men sustained the greatest number of acute injuries while no sex difference was observed in the number of stress injuries. The majority of injuries occurred in connection with gymnastics but, when all ball games are considered together, ball game injuries exceeded the gymnastic injuries in number. This difference is further increased when the fact that, in this college, twice as much time is spent on gymnastics as on ball games, is taken into consideration.

Is multiple sclerosis caused by a dual infection with retrovirus and Epstein-Barr virus?

Although the etiology of multiple sclerosis is as yet unknown, epidemiological observations strongly point toward one or more infectious agent(s) being involved in the disease. In recent years some studies have indicated involvement of retrovirus in multiple sclerosis (MS). However, an intrafamilial epidemiological study revealed that MS and the known human retroviruses had a divergent epidemiology. Some studies have shown the association of Epstein-Barr virus (EBV) with MS and one recent study revealed dual infection by retrovirus and EBV in a cell line established from a patient with an MS-like disease. Our hypothesis for the development of MS and MS-like diseases is that a hitherto uncharacterized retrovirus is the etiological agent, but development of neurologic disease is related to or even dependent on a delayed EBV infection. The dual infection hypothesis is analyzed and found to be consistent with the epidemiological characteristics of MS.

[Accidents with home-made metal-tube fireworks]

At the turn of the year 1988/89, injuries caused by home-made fireworks were treated in the orthopaedic-surgical casualty department. Four accidents are described. Construction and use of home-made fireworks are warned against.

A biotin-avidin-amplified inhibition enzyme immunoassay for detection of CMV antibodies in human serum

In this inhibition immunoassay undiluted serum reacts in solution with crude cellular CMV antigen in wells of microtestplates coated with hyperimmune CMV-reactive monkey IgG. CMV antibodies in the serum under test block (completely or partial) the fixation of antigen to the capture layer. Unblocked antigenic activity is in subsequent steps measured by the use of biotinylated CMV-reactive monkey IgG and peroxidase-conjugated avidin. The assay was evaluated in comparison with the CF test and was found superior both in terms of qualitative and quantitative detection of CMV antibodies. The results were uninfluenced by the presence in the sera of rheumatoid factor or autoantibodies (antinuclear antibodies). A characteristic feature of this inhibition immunoassay was the absence of equivocal results as demonstrated by analysis of 500 donor sera which were classified in two distinct separate groups: reactive and nonreactive. The assay is simple and reproducible and provides for a good reagent economy. Crude antigen can be used without sacrifice of specificity. Antigen from one Roux bottle proved sufficient for 25,000 duplicate tests.

An enzyme labelled nuclear antigen immunoassay for detection of cytomegalovirus IgM antibodies in human serum: specific and non-specific reactions

A mu-capture enzyme linked immunosorbent assay was developed for detection of IgM antibody to cytomegalovirus (CMV). Virus-specific IgM was detected using horseradish peroxidase labelled nuclear CMV antigen (CMV-ELA). False-positive reactions caused by Paul-Bunnell-Davidsohn (PBD) positive sera and antinuclear antibody (ANA) positive sera were identified in a combination assay employing enzyme labelled nuclear control antigen (CO-ELA) in parallel to the CMV-ELA. Four of five PBD positive and 30 of 31 ANA positive sera reactive with the CMV-ELA were identified as false positive reactions in the combined ELA-assay. The reactivity in PBD-positive sera could not be explained by antigenic cross reactivity between CMV and Epstein-Barr virus, and the results further suggested that different cell specified components of the CMV-ELA were responsible for the reactivity of PBD-positive as compared to ANA-positive sera. One of 314 healthy blood donors, 12 of 12 patients with primary CMV infection, and 11 of 15 patients with secondary CMV infection had detectable CMV IgM antibodies. Comparison of different CMV-ELAs revealed that pronounced differences in specificity as well as sensitivity may exist.

Parathyroid glands, calcium, and vitamin D in experimental fluorosis in pigs

The purpose of this study was to determine whether total serum calcium, parathyroid gland structure, and/or levels of parathyroid hormone, 1,25 and 24,25 DHCC, are altered in pigs with dental and skeletal fluorosis. Eight experimental animals receiving 2 mg F-/kg b.w. per day from age 8-14 months were compared with eight controls. Concentrations of plasma fluoride and total plasma calcium were assessed at intervals throughout the experiment and during a 48 hour period at day 110-111 of the experiment. At the same time, concentrations of immunoreactive parathyroid hormone were measured using a homologous labeled antibody for porcine hormone, and a radioimmunoassay was used to assess concentrations of 1,25 DHCC and 24,25 DHCC. Parathyroid tissue volumes were assessed at the end of the experiment by quantitative histology using volumetry and point counting. Plasma fluoride increased from 0.0007 +/- 0.0001 mmol/liter to 0.0127 +/- 0.002 mmol/liter in pigs receiving fluoride. In spite of this increase, total plasma calcium remained the same throughout the experiment. Volumes of parathyroid tissue, and levels of circulating parathyroid hormone 1,25 DHCC and 24,25 DHCC, were not significantly changed. It was therefore concluded that disturbance of calcium homeostasis is not an obligatory finding in dental and skeletal fluorosis and consequently does not play an essential role in the pathogenesis of these hard tissue lesions.

Non-immune hydrops fetalis: changing contribution to perinatal mortality

During the decade to 1979, 203 hydropic infants died in the State of Victoria, Australia. Non-immune hydrops fetalis (NIHF) became more common than immune hydrops fetalis as a cause of fetal hydrops, and its contribution to the total perinatal mortality increased from 0.1% to 3%. The perinatal mortality rate of infants with NIHF was virtually 100%. The most consistent finding at post-mortem was pulmonary hypoplasia which was probably due to compression from serous cavity effusions. Survival may be improved by early diagnosis and termination of the pregnancy in selected patients with viable infants before the development of gross serous cavity effusions. The most constant clinical sign associated with hydrops fetalis was polyhydramnios which is an indication for ultrasonography and cardiotocography to detect cases of NIHF and to select the optimum time for delivery.

Rapid method for selecting appropriate solid media for the enumeration of aerobic micro-organisms

A quick and cheap method for selecting appropriate solid culture media has been devised. It consists in the rapid picking of fragments of test colonies with the aid of a rubber strip in which pins are fixed in parallel, dispensing up to 8 colonies simultaneously in the wells of a Microtiter plate and streaking 4 strains at the same time on square Petri dishes containing the media under comparison. The approximate diameters of well-isolated colonies are measured with the aid of a series of calibrated spots. The results corresponded with those given by the spiral plate method used as a reference for colony count and diameter measure.

Protective effect of implanted autologous splenic tissue in splenectomized rats exposed to i.v. Streptococcus pneumoniae

The protective effect of splenic implantation or hemisplenectomy on the survival rate was studied in 34 Wistar rats inoculated intravenously with 8.5 x 10(6) CFU Streptococcus pneumoniae type 25, 4 months prior to the bacterial challenge, different surgical procedures were performed, dividing the animals into 5 equally large groups: (1) sham operation, (2) hemisplenectomy, (3) splenectomy with a 100% reimplantation, (4) splenectomy with a 50% reimplantation, and (5) splenectomy without reimplantation. The observation period after the bacterial inoculation was 13 d. Differences in mean survival rates were found: (1) 13 d, (2) 10.6 d, (3) 7.1 d, (4) 5.6 d, and (5) 3.1 d. The increasing survival rates correlated with increasing weights of the residual splenic tissue. This animal study indicates that residual splenic tissue may account for a lesser tendency to infection.

Antibodies to lens antigens in cataract and after cataract surgery

By means of an enzyme-linked immunosorbent assay (ELISA) antibodies to whole lens homogenate were found in 50.0% of 38 patients with senile cataract and in 57.3% of 75 controls. The antibody titres were in the range of 10-160 in both groups. IgG antibodies occurred in 44.7% of patients and in 45.3% of controls, whereas IgM antibodies were found in 21.1% of the patients and in 40.0% of the controls (not significant). Postoperative uveitis occurred in 5 (31.6%) of 19 patients, who had antibodies in serum prior to the operation and in only 2 (10.5%) of 19 antibody-negative patients (P = 0.10).