A survey targeting ASPHER members was launched in 2010/11, being a first initiative in improving ethics education in European Schools of Public Health. An 8-items questionnaire collected information on teaching of ethics in public health. A 52% response rate (43/82) revealed that almost all of the schools (95% out of 40 respondents with valid data) included the teaching of ethics in at least one of its programmes. They also expressed the need of support, (e.g.: a model curriculum (n=25), case studies (n=24)), which indicates further work to be met by the ASPHER Working Group on Ethics and Values in Public Health.

BACKGROUND: The nursing profession has undergone several changes in the past decades, and new challenges are to come in the future; patients are now cared for in their home, hospitals are more specialized, and primary care will have a key role. Health informatics is essential in all core competencies in nursing. From an educational perspective, it is of great importance that students are prepared for the new demands and needs of the patients. From a societal point of view, the society, health care included, is facing several challenges related to technological developments and digitization. Preparation for the next decade of nursing education and practice must be done, without the advantage of certainty. A training for not-yet-existing technologies where educators should not be limited by present practice paradigms is desirable. This study presents the design, method, and protocol for a study that investigates undergraduate nursing students' internet use, knowledge about electronic health (eHealth), and attitudes to technology and how experiences of eHealth are handled during the education in a multicenter study.

OBJECTIVE: The primary aim of this research project is to describe the design of a longitudinal study and a qualitative substudy consisting of the following aspects that explore students' knowledge about and relation to technology and eHealth: (1) what pre-existing knowledge and interest of this area the nursing students have and (2) how (and if) is it present in their education, (3) how do the students perceive this knowledge in their future career role, and (4) to what extent is the education capable of managing this knowledge?

METHODS: The study consists of two parts: a longitudinal study and a qualitative substudy. Students from the BSc in Nursing program from the Blekinge Institute of Technology, Karlskrona, Sweden, and from the Swedish Red Cross University College, Stockholm/Huddinge, Sweden, were included in this study.

RESULTS: The study is ongoing. Data analysis is currently underway, and the first results are expected to be published in 2019.

CONCLUSIONS: This study presents the design of a longitudinal study and a qualitative substudy. The eHealth in Nursing Education eNursEd study will answer several important questions about nursing students' attitudes toward and use of information and communications technology in their private life, their education, and their emerging profession. Knowledge from this study will be used to compare different nursing programs and students' knowledge about and relation to technology and eHealth. Results will also be communicated back to nursing educators to improve the teaching of eHealth, health informatics, and technology.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14643.

This study aimed to provide an understanding of nursing students' self-reported eHealth literacy in Sweden and Poland. This cross-sectional multicentre study collected data via a questionnaire in three universities in Sweden and Poland. Descriptive statistics, the Spearman's Rank Correlation Coefficient, Mann-Whitney U, and Kruskal-Wallis tests were used to analyse different data types. Age (in the Polish sample), semester, perceived computer or laptop skills, and frequency of health-related Internet searches were associated with eHealth literacy. No gender differences were evidenced in regard to the eHealth literacy. Regarding attitudes about eHealth, students generally agreed on the importance of eHealth and technical aspects of their education. The importance of integrating eHealth literacy skills in the curricula and the need to encourage the improvement of these skills for both students and personnel are highlighted, as is the importance of identifying students with lacking computer skills.

Aim: The aim in this survey was to study the clinical characteristics of infections caused by Borrelia genospecies in patients with erythema migrans where Borrelial origin was confirmed by polymerase chain reaction. The aim was also to study factors influencing the clinical appearance of erythema migrans. Methods: The study was conducted in southern Sweden from May 2001 to December 2003 on patients 18 years and older attending with erythema migrans at outpatient clinics. All erythema migrans were verified by polymerase chain reaction, photographed and categorized into “annular” or “non-annular” lesions. A logistic regression model was used to analyze relations between the appearance of the erythema migrans (i.e., annular or non-annular) and factors that influenced its clinical appearances. Results: A total of 118 patients, 54 women (45.8%) and 64 men (54.2%), fulfilled the inclusion criteria. Of these patients, 74% were infected by B. afzelii, 26% by B. garinii ( p < 0.001). A total of 45% (38/85) of the erythema migrans were annular, 46% (39/85) were non-annular and 9.4% (8/85) were atypical. For men infected by B. afzelii the odds ratio of developing non-annular erythema migrans was 0.09 (95% CI: 0.03 - 0.33) in comparison with women with the same infection. Conclusions: In this prospective study of a large series of erythema migrans, where infecting genospecies were confirmed by polymerase chain reaction, the sex of patients infected with B. afzelii had a strong influence on the appearance of the rash. Patients infected by B. garinii more often had non-annular erythema migrans and a more virulent infection with more individuals presenting with fever, raised levels of C-reactive protein and seroreactivity in the convalescence sera.

The aim is to highlight the influence of patients’ gender on Lyme borreliosis and especially erythema migrans (EM), focusing on exposure to tick bites, epidemiology, and the clinical picture. All studies were conducted in the county of Blekinge, located in southeastern Sweden. A prospective study was conducted in 235 individuals (women, n=110; men, n=125) engaged in recreational or occupational activities focusing on exposure to tick bites. A retrospective epidemiological study evaluating 123,495 electronic patients´ records (women, n=61,712; men, n=61,783) and a prospective clinical study including 118 patients (women, n=54; men, n=64) 18 years or older seeking care for EM > 5 cm in diameter with genospecies verified by polymerase chain reaction were conducted. Results: Women 40 years or older had a 48% higher risk than men 40 years or older and 42% higher risk than women younger than 40 years of attracting tick bites (0.0188 versus 0.0127 and 0.0188 versus 0.0132 tick bites respectively per hour). Additionally they had a 96% higher risk than men younger than 40 years of attracting tick bites (0.0188 versus 0.0096). The annual incidence rate of EM in women was 506 and in men 423 cases per 100,000 inhabitants (p<0.001). Significant differences in incidence rates occurred in those 40 years or older. Odds ratios for males infected with Borrelia afzelii developing nonannular EM were 0.09 (95% confidence interval [CI] 0.03 to 0.33) in comparison with females infected by Borrelia afzelii. Conclusions: Significant gender differences in the risk of contracting tick bites, incidence rates, and clinical picture of EM have been observed. Exposure to tick bites alone may not explain these observations and further studies need to be done to clarify the biologic, immunologic, and sociological mechanisms causing these differences.

In this paper an audio processing solution for video conference based aerobics is presented. The proposed solution leaves the workout music unaltered by separating it from the speech and processing each signal separately. The speech signal processing is also performed at a lower sample rate, which saves computational power. Real time evaluation of the system shows that high quality music as well as a good two-way communication is maintained during the aerobic session.

The objective of this follow-up study was to determine the long-term outcome of strictly classified cases of neuroborreliosis treated with antibiotics. A one-year 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 years later. Medical records were reviewed and all participants filled in a questionnaire. Of those 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. No significant differences between different antibiotic treatments were observed in terms of occurrence of sequelae. To conclude, we found that 25% (95% confidence interval 17-33%) of the patients suffered from residual neurological symptoms 5 years post-treatment. However, the clinical outcome of treated neuroborreliosis is favourable as only 14/114 (12%) of the patients had sequelae that influenced their daily activity post-treatment. Early diagnosis and treatment would seem to be of great importance in order to avoid such sequelae.

The development of the public health workforce is acornerstone in WHO's Action Plan for Strengthening Public HealthServices and Capacities. Public health education shall combineEssential Public Health Operations – surveillance; monitoring; healthprotection and promotion; disease prevention; service delivery;communication and research – with the competences needed within:public health methods; population health and its social, economicand environmental determinants; and man-made systems andinterventions to improve population health. An authorised publichealth profession founded on graduation from comprehensive publichealth education is needed. The capacity and standards of Schoolsof Public Health should accordingly be continuously developed.

The aim of this short communication is to stimulate a discussion on the state of a public health profession in Europe and actions which need to be taken to authorise public health professionals based on their competencies. While regulated professions such as medical doctors, nurses, lawyers, and architects can enjoy the benefits of the 2005/ 36/EC Directive amended by 2013/55/EU Directive on the recognition of professional qualifications, public health professionals are left out from these elite. Firstly, we use the profession traits theory as a framework in arguing whether public health can be a legitimate profession in itself, second, we explain who public health professionals are and what usually is required for shaping the public health profession, and thirdly, we attempt to sketch the road to the authorisation or licencing of public health professionals. Finally, we will propose some recommendation.

Background: The growing presence of digital technologies in health care requires the health workforce to have proficiency in subjects such as informatics. This has implications in the education of nursing students, as their preparedness to use these technologies in clinical situations is something that course administrators need to consider. Thus, students' attitudes toward technology could be investigated to assess their needs regarding this proficiency. Objective: This study aims to investigate attitudes (enthusiasm and anxiety) toward technology among nursing students and to identify factors associated with those attitudes. Methods: Nursing students at 2 universities in Sweden and 1 university in Poland were invited to answer a questionnaire. Data about attitudes (anxiety and enthusiasm) toward technology, eHealth literacy, electronic device skills, and frequency of using electronic devices and sociodemographic data were collected. Descriptive statistics were used to characterize the data. The Spearman rank correlation coefficient and Mann -Whitney U test were used for statistical inferences. Results: In total, 646 students answered the questionnaire-342 (52.9%) from the Swedish sites and 304 (47.1%) from the Polish site. It was observed that the students' technology enthusiasm (techEnthusiasm) was on the higher end of the Technophilia instrument (score range 1-5): 3.83 (SD 0.90), 3.62 (SD 0.94), and 4.04 (SD 0.78) for the whole sample, Swedish students, and Polish students, respectively. Technology anxiety (techAnxiety) was on the midrange of the Technophilia instrument: 2.48 (SD 0.96), 2.37 (SD 1), and 2.60 (SD 0.89) for the whole sample, Swedish students, and Polish students, respectively. Regarding techEnthusiasm among the nursing students, a negative correlation with age was found for the Swedish sample ( P <.001; rho (Swedish) =- 0 . 201 ) who were generally older than the Polish sample, and positive correlations with the eHealth Literacy Scale score ( P <.001; rho (all) =0.265; rho (Swedish) = 0 . 190 ; rho (Polish) = 0 . 352 ) and with the perceived skill in using computer devices ( P <.001; rho (all) =0.360; rho (Swedish) = 0 . 341 ; rho (Polish) =0.309) were found for the Swedish, Polish, and total samples. Regarding techAnxiety among the nursing students, a positive correlation with age was found in the Swedish sample ( P <.001; rho (Swedish) =0.184), and negative correlations with eHealth Literacy Scale score ( P <.001; rho (all) =-0.196; rho (Swedish) =- 0 . 262 ; rho (Polish) =- 0 . 133 ) and with the perceived skill in using computer devices ( P <.001; rho (all) =-0.209; rho (Swedish )=- 0 . 347 ; rho (Polish) =- 0 . 134 ) were found for the Swedish, Polish, and total samples and with the semester only for the Swedish sample ( P <.001; rho (Swedish) =-0.124). Gender differences were found regarding techAnxiety in the Swedish sample, with women exhibiting a higher mean score than men (2.451, SD 1.014 and 1.987, SD 0.854, respectively). Conclusions: This study highlights nursing students' techEnthusiasm and techAnxiety, emphasizing correlations with various factors. With health care's increasing reliance on technology, integrating health technology-related topics into education is crucial for future professionals to address health care challenges effectively.

In response to the increased demand from the public health labour market, various bachelor and master programmes have been developed in recent years throughout Europe. As an example, in the European ASPHER survey 18 Schools and Departments of Public Health delivered 977 bachelor degrees per year (2011/12) with a median of 55 per institution. The expectations of – present and potential - employers of professionals, trained in public health, are largely unknown. However, in comparison to the attention paid and the knowledge generated around postgraduate/master education in public health, still relatively little is known about the provision of bachelor degrees. Furthermore, while real efforts have and are made to define professional and academic frameworks, including accreditation schemes for master programmes, the roles, practices and competences for bachelor programmes are somehow blur. This presentation will report on the work of the ASPHER's Working Group on Undergraduate Public Health Education in Europe aiming to promote collaboration initiatives on bachelor programmes across Europe among academic institutions, share best practices and generate knowledge on employability and career progression of public health bachelor graduates. In particular, the results of the survey carried out by ASPHER across over 100 schools of public health in early 2014 will be presented bringing up the current and full picture as regards the undergraduate education in Public Health in Europe.

Open access journal

Objectives: Follow changing physical activity (PA) patterns among women and men during pregnancy compared to before pregnancy. Study design: Longitudinal study. Methods: The study involved 280 individuals, 145 women and 135 men (who were partners to the women), from the municipality of Karlskrona, Sweden. Data were collected during 2008–2009. We measured the self-reported amount of PA performed outdoors and indoors during the 12 months before pregnancy and throughout the entire pregnancy. Results: Among both women and men, we found changes in PA patterns during pregnancy compared to before pregnancy. Women and men were more physically active before pregnancy than during pregnancy. Similar patterns were found among women and men with regard to the type of activity, with both groups taking more exercise and pursuing aquatic sports, indoor PA and non-strenuous activities before pregnancy and more strolling/walking during pregnancy. Conclusions: Our findings contribute new knowledge about changes in men’s PA patterns from pre-pregnancy to pregnancy that is an unexplored field. Changes in the women’s activity patterns during pregnancy also affect the men. Women seem to adjust their activity patterns during the pregnancy. The changes in activity patterns among the men are more tentative but follow the pattern for the women, which could be explained by the couples sharing their everyday lives. Midwives should consider providing information to men about the importance of being physically active during pregnancy and informing them about their role in encouraging women to be physically active.

Background Due to health effects from participating in physical activity (PA) it is from a public health perspective important to study how participation PA may change over a lifetime and how different life events impact on the participation. Although studies in the field are sparse, parenthood has been found to be a life event associated with decreased PA, especially among women. We studied physical activities performed among women and men with and without children. Methods This study includes data for from parents-to-be, 224 women and 208 men, from Karlskrona municipality, situated in the south eastern part of Sweden. Data collection was carried out during 2008–2009. When contacting the antenatal clinics in the municipality all expectant parents were asked by the midwife about participation in the study. Respondents completed a questionnaire about age, socioeconomic status, level of education, previous children, smoking and alcohol habits, Body Mass Index, self estimated health, and participation in different kinds of outdoor and indoor recreational PA. We measured the self-reported amount of outdoor recreational PA undertaken during the last year. Results Both women and men without children performed more outdoor and indoor PA compared to those who had children. Women walked significantly more (p = 0.017) than men irrespective of whether or not they had children. Women with children participated in significantly more gardening (p = 0.009) and winter sports (p = 0.013) than women without children, and women without children participated in significantly more PA indoors (p = 0.001) than women with children. Men with children participated in significantly more gardening (p = 0.001) than men without children, and men without children participated in significantly more PA indoors (p = 0.006). Conclusions Becoming a parent is a life event that affects participation in PA, both concerning duration and the kind of activities performed. To gain deeper understanding and more insight about reasons for these changed patterns of PA as well as the effects on the outcome of the parents health in a short- and long term would be important to follow prospectively.

Background: Realizing the essential prerequisite of regular physical activity (PA) it is essential to have knowledge about how different life change events may influence individual's participation. Many studies have documented that pregnancy and the transition to parenthood are life change events associated with decreased PA among women however, the examination of changes of PA in the male parent during this major life change event has been largely neglected in scientific literature and a significant research gap can be found. In the light of this, this longitudinal study aimed to follow changing PA patterns among women and men during pregnancy and 8 months postpartum compared to pre-pregnancy. Methods: In this study, 123 women and 112 men (partners of the women) that lived in the municipality of Karlskrona, Sweden, were included. Data were collected between 2008 and 2010. The self-reported amount of PA performed outdoors and indoors before pregnancy throughout the entire pregnancy, and 8 months postpartum, were measured. Results: We found similar changes in PA patterns among both women and men during pregnancy and 8 months postpartum when compared to pre-pregnancy. In almost all the activities studied except for walking/strolling, a significant decline was found. Conclusions: Our findings contribute new knowledge about changes in men's PA patterns from pre-pregnancy to pregnancy and postpartum. As couples seem to change activity patterns similarly, it is important to promote family-based PA initiatives and encourage couples to be active together during pregnancy and postpartum.

Purpose: The aim of the current study was twofold. The first aim was to investigate, from the aspects of gender, age and Body Mass Index, the prevalence of fear among individuals with osteoarthritis that their joints would be harmed if they performed physical activity. The second aim was to determine if a patient education programme might lessen this fear.

Method: A total of 100 participants were enrolled in a randomised controlled study and completed measures on two occasions over the course of six months. The participants were randomised to either an intervention group or to a control group.

Results: More than a quarter of the participants feared that their joints would be harmed if they performed physical activity. This was reported by significantly more men than women. Age and Body Mass Index did not seem to have any significant impact on the fear. The patient education programme for osteoarthritis reduced fear significantly (p = 0.010).

Conclusions: A patient education programme appear to be one way of reducing the fear among individuals with osteoarthritis, that the joints would be harmed by physical activity.

Background: A 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. Methods: This 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. Results: Seventy-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. Conclusions: Becoming 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.

Background Physical 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 one's 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. Methods This 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. Results Our results suggest that being independent physically and healthy enough to manage one's 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. Conclusion Men 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.

Sjukdomar associerade till fästingar har ökat över hela världen och näst efter myggor är fästingen den vektor som orsakar mest sjukdom hos människan. I Sverige sprider fästingen sjukdomar såsom borreliainfektion, fästingfeber (erlichia) och fästingburen hjärninflammation (TBE) vilka orsakas av såväl bakterier som virus. Borreliainfektion är den vanligaste fästingburna sjukdomen i Sverige och mer än 10 000 personer drabbas årligen. Syftet med denna undersökning var att, ur ett epidemiologiskt perspektiv studera de vanligast förekommande fästingburna sjukdomarna i Sverige, med fokus speciellt på risker och prevention. I en uppföljningsstudie studerades risken för kvarvarande symtom 5 år efter antibiotikabehandlad neuroborrelios. Vidare studerades risken att bli fästingbiten, risken att utveckla fästingburen sjukdom och aspekter på preventiva åtgärder inom populationer som lever eller vistas i områden där fästingar är potentiella smittbärare inom södra Sverige. I en populationsbaserad studie genomförd i södra Sverige 1992-1993, fann Berglund att 16 % av patienterna diagnostiserade med borreliainfektion behandlades med antibiotika för neuroborrelios. Då deras hälsotillstånd undersöktes 5 år efter behandling upplevde 25 % av deltagarna fortfarande kvarvarande symtom som de fått i samband med sin neuroborrelios. Bland de vuxna upplevde kvinnor oftare kvarvarande symtom än män. Av de deltagare som upplevde kvarvarande symtom, ansåg 12 % att detta i någon form påverkade eller begränsade deras dagliga liv. Tidig diagnos och tidig behandlig av borreliainfektion är av stor vikt för att undvika symtom som riskerar kvarstå flera år efter behandling. Tidigare studier har identifierat olika populationer som bor eller vistas ofta i fästingrika områden såsom skärgårdsbefolkning, scouter, hundägare, skogsarbetare etcetera, som utsatta för att bli fästingbitna och utveckla fästingburen sjukdom. I undersökningen där en riskpopulation följdes under en fästingsäsong, blev 84 % av deltagarna bitna trots att de inspekterade kroppen efter fästingar dagligen. Det uppskattade antalet fästingbett var 0.10 vid 10 timmars utomhusvistelse. Innan nästa fästingsäsong hade 3,4 % av deltagarna utvecklat borreliainfektion. Med hänsyn till mängden fästingbett (1767) var risken för infektion låg, endast 1/221 bett eller 0,5 % per fästingbett. Personliga förebyggande åtgärder och förebyggande åtgärder i omgivningen rekommenderas i syfte att minska utsattheten för fästingbett och fästingburna sjukdomar. Åtgärder i omgivningen för att förhindra fästingförekomst kan vara att; - hålla gräs och sly kort i trädgården, - använda insektsmedel eller pesticider, - begränsa värddjurens förekomst genom stängsel (eventuellt elstängsel), - förebygga fästingar på husdjur Personliga förebyggande åtgärder kan vara att; - undvika områden där fästingar finns, - använda skyddande kläder som täcker större delen av kroppen med byxbenen instoppade innanför strumpor och stövlar - byta kläder och/eller duscha, efter exponering i fästingrik miljö, - inspektera kroppen noggrant och leta efter fästingar som kryper omkring eller har bitit sig fast, - ta bort fastsatta fästingar snarast efter upptäckt. Den fästing som sprider sjukdomar i Sverige, Ixodes ricinus, har inga ögon och lite är känt om dess synuppfattningsförmåga. Möjligen kan den uppfatta gestalter eller skepnader. Då den söker värd att inta blodmål från, klättrar den upp på ett grässtrå och orienterar sig främst genom sina känselorgan. Den reagerar på vibrationer från rörelser i marken, koldioxidhalter, temperaturskillnader, dofter och fuktförhållande. Runt om i världen rekommenderas, att i förebyggande syfte, använda ljusa kläder hellre än mörka vid exponering för fästingar. Fästingen förväntas upptäckas lättare på ljusa kläder jämfört med mörka och kan då plockas bort innan den biter sig fast. I den experimentella studien jämfördes antalet fästingar på kläderna då deltagarna bar ljusa respektive mörka färger. Totalt insamlades 886 nymfer varav 62 % fanns på de ljusa kläderna och 38 % fanns på de mörka kläderna. Sammanlagt hade alla deltagare flera fästingar på de ljusa kläderna jämfört med de mörka kläderna. Ixodes ricinus verkar mer benägen att välja en värd med ljus klädsel framför en värd med mörk klädsel. För att minska risken att bli fästingbiten och därmed minska risken att drabbas av fästingburen sjukdom görs i folkhälsosyfte insatser för att öka medvetenheten hos människor som lever i eller uppehåller sig mycket i områden där fästingar är vanliga. Hur denna medvetenhet påverkar människors benägenhet att göra förebyggande åtgärder, och vilka faktorer som styr om preventiva åtgärder genomförs eller inte, studerades efter fästingsäsongen 2002 i en befolkning som lever i miljö rik på fästingar. Alla deltagare hade valt att vaccinera sig mot TBE (70 % av den bofasta befolkningen) som nyligen upptäckts etablera sig i det geografiska området. Utöver vaccination, gjorde 69 % av dem regelbundet personliga förebyggande åtgärder eller förebyggande åtgärder i miljön. Kvinnor gjorde mer åtgärder jämfört med män, liksom de som tidigare blivit behandlade för fästingburna sjukdomar jämfört med som inte blivit behandlade. Då alla de variabler som kan tänkas bestämma att förebyggande åtgärder genomförs analyserades tillsammans, visade sig mindre tid spenderad på ön samt fästingbett samma fästingsäsong öka sannolikheten att göra förebyggande åtgärder. Hos män ökade sannolikheten att göra förebyggande åtgärder först efter att de blivit fästingbitna. En tredjedel av alla deltagarna ansåg att deras fritidsaktiviteter utomhus påverkades på grund av fästingförekomsten. Sammanfattningsvis beskriver avhandlingen konsekvenser av och människors förhållningssätt relaterade till de risker som fästingar upplevs medföra samt aspekter på förebyggande åtgärder. Majoriteten av de människor som uppehåller sig i fästingrik miljö blir bitna trots en stor medvetenhet om fästingförekomst, förebyggande åtgärder och de risker det kan medföra att bli fästingbiten. Lyckligtvis utvecklas endast ett fåtal av alla dessa bett till sjukdom. Emellertid finns risk bland dem som utvecklar sjukdom att symtom kvarstår och påverkar deras hälsotillstånd många år efter sjukdomen startat. Denna risk är högre ju längre tid som gått mellan symtom och behandling. Kvinnor upplever symtomen under längre tid jämfört med män. Många personer följer rekommenderade förebyggande åtgärder eller finner egna sätt att minska de potentiella riskerna. En stor del människor undvek eller anpassade sin livssituation, bland annat genom att begränsa sin tid ute i fästingrik natur, och kan därmed inte ta del av de fördelar dessa naturupplevelser innebär för välbefinnandet. Resultaten i dessa studier bidrar till en ökad kunskap om vikten av, och ger exempel på hur fästingbett och fästingburna sjukdomar kan förebyggas

En allmän uppfattning är att fästingar syns bättre, och därmed upptäcks lättare på ljusa kläder jämfört med mörka kläder. Vi studerade vilka kläder, ljusa eller mörka, som drog till sig flest fästingar (Ixodes ricinus), i syfte att finna metoder att förebygga fästingburna infektioner hos människor. Tio deltagare, exponerade genom att vandra i områden endemiska för fästingar, bar omväxlande ljusa och mörka kläder vid varje exponering. Nymfer och vuxna fästingar samlades från kläderna och antalet fästingar räknades. Totalt samlades 886 nymfer in. I medelvärde skiljde sig antalet funna fästingarna på ljusa respektiva mörka kläder signifikant med 20,8 flera fästingar per person på de ljusa kläderna. Samtliga deltagare hade flera fästingar på de ljusa kläderna i samtliga exponeringsområden. Mörka kläder verkar dra till sig mindre antal fästingar i jämförelse med ljusa kläder.

Comments and reply on; Stjernberg L, Berglund J. Garlic as an insect repellent

Objectives: To study if Swedish marine conscripts are a population of high risk to tick-bites and tick-borne diseases and if tick-bites could be prevented by consumption of garlic. Design: Prospective, randomised double blind intervention trial. Subjects: 100 individuals from south-eastern Sweden in military service during 1998. Interventions: The survey participants consumed 1200 mg Allium sativum/placebo for eight weeks, had a wash-out period then changed to placebo/Allium sativum consumption for another ten weeks. All participants had uniform clothes, the same diet, participated in similar activities, stayed equal time in tick-endemic nature etceteras. Main outcome measures: Tick-bites were registered in a diary-sheet after daily inspection of the skin. Results: Totally 286 tick-bites were registered by the participants. On average the participants registered 0.2 tick-bites per week during military service compared to 0.03 tick-bites during leave. Results shows significant reduction in tick-bites when consuming garlic compared to placebo (p<0.05). Furthermore, during placebo consumption, a greater number of the participants were bitten by ticks (incidence per 10 weeks = garlic, intention to treat 0.5, per protocol 0.6, placebo, intention to treat 0.5, per protocol 0.7). Swedish marine conscripts are at high risk of tick bites during military service. Preventive measures, including vaccinations against tick-transmitted diseases, should be considered. However, our results suggest that garlic may be considered as a tick repellent for individuals and populations at high risk for tick bite, rather than other agents that might have more adverse effects.

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-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-door activities. The incidence was 0.04 (95% confidence interval 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 spent 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 to be 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, our 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.

Aims: To describe environmental and personal tick preventive measures and their predictors, taken by a population living in a highly tick-endemic area. Methods: Due to the recent confirmation of human tick-borne encephalitis cases, vaccination against tick borne encephalitis was offered to the population living in the endemic area through the use of leaflets and media campaigns. At the time for the initial dose, information and enrollment to this cohort study was carried out. Participants´ characteristics, frequency of tick-bites and preventive measures were included in questionnaires. Logistic analysis was used to determine behavioural differences in activities taken in order to prevent tick-bites. Conclusion: In total, 70% of the permanent residents had themselves vaccinated before the next tick-season. Of the studied participants 356/517 (69%) regularly took preventive measures in their environment and/or personally. Women in particular, and those previously treated for a tick-borne disease took significantly more preventive measures. When analysing all variables together, spending less time in tick-endemic area and being tick-bitten the latest tick-season significantly increased the probability of taking preventive measures. After being tick-bitten, men were more inclined to start taking preventive measures than women. Awareness of the risks caused by living in a high endemic area to ticks influenced the participant’s daily life through preventive activities. Public health action should be considered thus encouraging out-of-door activities for the population, without anxiety for risks for contracting tick-borne disease after being tick-bitten.

OBJECTIVE: To describe the users of herbal medicine products and food supplements with regard to age and gender specifically among persons aged > or = 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 > or = 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 > or = 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.

Background. In 2002, 2 cases of tick-borne encephalitis were diagnosed among inhabitants living in a tick endemic area on the island of Aspö in south-eastern Sweden. During the previous 25 years, only 2 additional cases had been diagnosed in that region of Sweden. To study presence and evolution of seroprevalence of antibodies to the tick-borne encephalitis virus we carried out a follow-up study, comparing inhabitants´ immunoglobulin G antibody levels against the virus in blood samples drawn in 1991 and 2002. Method. The island of Aspö is located in the south-eastern archipelago by the Baltic Sea in the county of Blekinge, Sweden. Due to the confirmed cases of tick-borne encephalitis, permanent and part-time residents were offered tick-borne encephalitis vaccination in the autumn of 2002. Blood samples were collected and analyzed by the two-step enzyme-linked immunosorbent assay to detect immunoglobulin G antibodies against tick-borne encephalitis virus. Also, questionnaires including questions about sex, age, earlier history of and previous vaccination against tick-borne encephalitis, residency on Aspö, history of observed tick-bites and earlier history of Lyme borreliosis and human granulocytic erhlichiosis, was filled in. All those individuals who had participated in a study on LB performed in 1991, and where available blood samples made it possible to compare tick-borne encephalitis immunoglobulin G seroprevalence, were included in the follow-up. Results. A significant increase in immunoglobulin G levels was seen during the follow-up with 24 (12.0%) of 200 blood samples being seropositive in 2002 versus 7 (3,5%) of 200 blood samples in 1991. However, only five participants converted from seronegative level during the 11 y follow-up and one of these participants had been vaccinated against tick-borne encephalitis during the observation period. In only four of all positive sera from 2002 and in no sera from 1991, were neutralizing antibodies against tick-borne encephalitis virus demonstrated. Compared with women, significantly more men were seropositive. In comparison with other age groups the greatest increase was seen in the age group 20 to 29 years. However, most seropostive levels were seen among those >50 years. Conclusion. Although we found seropositive blood samples in this area already in 1991, the existence of tick-borne encephalitis virus at that time is doubtful since no neutralizing antibodies against tick-borne encephalitis virus were demonstrated. During the 11 years follow-up an obvious increase of tick-borne encephalitis immunoglobulin G seropositive levels in humans was seen. Recommending preventing measures, including vaccination against tick-borne encephalitis is of importance for people regularly staying in this endemic area.

In 2002, two cases of tick-borne encephalitis (TBE) were diagnosed in inhabitants of a tick endemic area on the island of Aspö in southeastern Sweden. During the previous 25 y, only two 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 two-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.

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 min 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.