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New Master’s Programme in Global Health

2-year Master of Science in Public Health, specializing in Global Health at NTNU. In this video some of the challenges regarding global health is presented.

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Six weeks of data collection in Sri Lanka’s hill country tea plantations

Bloggers: Jennifer J. Infanti (Department of Public Health and General Practice, NTNU), Ragnhild Lund (Department of Geography, NTNU) and Kumudu Wijewardene (Department of Community Medicine, University of Sri Jayawardenepura, Sri Lanka)

 

Tea plantation near Ella, Sri Lanka

Tea plantation near Ella, Sri Lanka (Photo: Jennifer Infanti)

Sri lanka is one of the world’s largest exporters of tea. The origins of the tea plantations date back to the mid-1800s when the country was under British rule.

During this era, the British tea planters brought low-caste, primarily Tamil-speaking labourers from villages in South India to Sri Lanka to work in the plantations. For most of their history in Sri Lanka, the plantation workers were not recognised as citizens of Sri Lanka and therefore had few entitlements or rights in the country. They could not vote, own land, access government health services, open bank accounts, or secure employment outside the tea plantations.

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Technology for a better world?

Elisabeth DarjBlogger: Elisabeth Darj
professor in Global Health

 

Last week, the conference Appropriate Health Technology for Low Resource Settings, was held in London. Access to healthcare through technology, development and research was discussed. How to promote health in rural areas, where no doctors, few health workers and no appropriate equipment are available?

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Global Health Day 2014: Health challenges in low income countries

Health challenges in low income countries is the theme of this years’ Global Health Day. The is seminar organised by The Faculty of Medicine at NTNU,  Sør-Trøndelag University College and St. Olavs University Hospital.

Konsultasjon Sør-Afrika

The seminar will take place on 21 October in Øya helsehus (Aud. 1), and focus on:

  • Health care systems in low income countries
  • Violence against women

 Speakers

Professor Staffan Bergström, Karolinska Institute. Specialist in Obstetrics and Gynecology.
Staffan Bergström has experiences from several African countries on how to save mothers and newborns in places where there is a shortage of doctors. He points to the importance of health workers without medical training. It is they who are the backbone of health care system in low income countries.

“On the African continent only 5,000 doctors are educated annually. African countries are thus forced use health workers without medical training. They do a tremendous job, without having spent even a day at medical school. Simply training midwives in life saving skills can make a big difference” says Professor Bergström. He has had great influence internationally on the task-shifting debate. The last three years Bergström has worked in Tanzania with “Maternal Health Initiative

Dean Sylvia Kaaya, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, Tanzania.
Silvia Kaaya is professor of psychiatry. Her research interest is children and mental health. Professor Kaaya’s publications trades extensively to detect and treat mental illness and depression in different groups e.g pregnant women, children, youths and how HIV positivity affects mental health. Recently NTNU and MUHAS signed a MoU in research and student exchange.

Professor Charlotte Watts, London School of Hygiene and Tropical Medicine, UK.
In the mid-90s Charlotte Watts did her fieldwork in Zimbabwe. The findings from her study illustrates not only the extent to which violence against women is widespread throughout the world, but also that there is considerable variation in the levels of violence – both within the country as well as between countries. Although the causes of violence are complex, this suggests local variation and that there may be local conditions that affect the extent to which women are subjected to violence. A better understanding of the causes of this variation can be used to identify how to prevent future violence.

Programme and registration

Programme for Global Health Day 2014 (pdf)

The seminar, lunch and pizza are free. Please register for the seminar before 10 October 2014.

Target audience

The target group are persons engaged in research, teaching or clinical activities targeted towards developing countries as well as students in health sciences or medicine.

About the seminar

Global health research embodies research on health problems related to challenges that particularly affect people in low- and middle income countries. The Faculty of Medicine, NTNU, has increased its investment in global health, in close cooperation with St. Olavs University Hospital, Sør-Trøndelag University College (HiST), as well as partner institutions in low- and middle income countries. The seminar aims to increase cooperation, networking and further research activity while providing professional input and inspiration. The Research Council of Norway has given financial support to this seminar.

If you have any questions about the seminar, please contact Elin Yli Dvergsdal

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Cardiovascular disease is associated with increased risk of rheumatoid arthritis

Blogger: Vibeke VidemVibeke Videm. Foto: Geir Mogen

Twice as many of those who got rheumatoid arthritis between the HUNT2 population-based health survey in 1995-1997 and the next survey (HUNT3) in 2006-2008, reported previous cardiovascular disease at HUNT2. They either had angina or had suffered a myocardial infarction or stroke. The data indicate that there may be a causative link.

(…) chronic inflammation in one part of the body intensifies chronic inflammatory processes in other parts

Atherosclerosis, the most common cause of cardiovascular disease, is caused by chronic inflammation in the vessel walls. Rheumatoid arthritis is due to a gradual process with increasing dysregulation of the immune system that finally leads to inflammation in the joints. The inflammation due to atherosclerosis probably intensifies the process leading to rheumatoid arthritis. The study was recently published in the scientific journal  Arthritis Research and Therapy.

leddgiktinfarkt

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30 years of research on small-for-gestational-age and very-low-birth-weight children

boy reachingThirty years ago, the first research project on Small-for-gestation-age (SGA)was started at the Department of Public Health and General Practice at NTNU in Trondheim. At the same time, a separate Very-low-birth-weight (VLBW) children study was organized at the Department of Laboratory Medicine, Women’s and Children’s Health, NTNU.

As for the SGA study, a contract worth $ 686,000 that took effect on June 1, 1984 was the first of its kind between the Faculty of Medicine and an external funding agency. On behalf of the National Institute of Child Health and Human Development (NICHD) and in cooperation with Uppsala University and the University of Bergen, the faculty planned, organized and conducted a detailed study of mothers through pregnancy and at birth. A follow-up of selected children during their first year of life (1986-89) and again at 5 years of age (1991-94) was later funded by a second contract ($ 618,000).

A vast amount of data are now available from pregnancy and delivery, at birth and through the first to five years of life which can be analysed longitudinally and/or cross sectionally. In addition to clinical and other information regarding development, health, behaviour, aptitudes and skills an overwhelming amount of serum samples are stored in a modernised biobank. Serum samples were collected longitudinally throughout pregnancy and at birth and are available for research purposes. The study is still in progress with new results from later follow-up studies of the mothers and their offspring.

The VLBW study is chaired by  Professors Ann-Mari Brubakk and Jon Skranes, who have amongst others, followed up around 230 of the Scandinavian SGA study in Trondheim at 14-15 at 19-20 years of age. Comprehensive clinical data have been collected in addition to information about physical development, behaviour, mental qualities, aptitudes, education, and psychiatric disorders and symptoms. A cerebral MRI scan has been conducted on both occasions. An interdependent and interdisciplinary cooperation has been established between the SGA and VLBW studies. The young adults are currently being followed up at age 26 years

An international seminar will now be held to mark the first 30 Years of the NICHD Scandinavian Successive Small for Gestational Age (SGA) Births Study.
The seminar will span Monday 16 June and Tuesday 17 June 2014, is sponsored by the Faculty of Medicine, NTNU and organized by the Department of Public Health and General Practice.
Professor Geir W. Jacobsen has since 1998 been the Principal Investigator of the SGA study and will act as host.

The program can be found on http://www.ntnu.no/ism/sgaseminar
More information on the SGA studies can be found on http://www.ntnu.no/ism/forskning/sga

For participation, please contact: Guri.Helmersen@ntnu.no

 

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Training in qualitative research methods in Nepal

Blogger: Jennifer InfantiJennifer Infanti

Photos: Jennifer Infanti & Elisabeth Darj (NTNU), Chandra Yogal (Dhulikhel Hospital-Kathmandu University Hospital)

 

 

Elisabeth Darj and I arrived under blue skies at Tribhuvan International Airport on Monday morning, March 24th, 2014. Elisabeth negotiated a price and a verbal guarantee of “safe driving” with a local taxi driver, Rajesh, and we set off with Rajesh on the 30 kilometres drive from the airport to Dhulikhel, the administrative capital of Kavrepalanchok district, Nepal.

Dhulikhel, Kavrepalanchok district, Nepal

Dhulikhel, Kavrepalanchok district, Nepal

Dhulikhel’s population of approximately 14 000 people (2011) is comprised primarily of Newār people who are indigenous to the Kathmandu Valley. The Newārs are traditionally farmers and agriculture continues to be a primary source of livelihood for the majority of people in the community. Our visit coincided with the start of the wheat harvest, and we arrived to landscapes of golden fields and terraced hills.

Elisabeth and I settled into our accommodation at Dhulikhel Lodge Resort and later met our other colleagues from the Department of Public Health and General Practice, Aslak Steinsbekk and Ingunn Harstad, as they returned to the lodge following the first day of Aslak’s week-long course on qualitative research being held at Dhulikhel Hospital.

Dhulikhel Hospital-Kathmandu University Hospital

Dhulikhel Hospital-Kathmandu University Hospital

Dhulikhel Hospital is the teaching hospital of Kathmandu University. It is an independent, not-for-profit institution, serving a population area of approximately 2 million people. NTNU has been formally collaborating with Kathmandu University since 2002 in a variety of disciplines: engineering, natural and social sciences.

In 2007, the Faculty of Medicine (DMF) at NTNU established an official collaboration with the Kathmandu University School of Medical Sciences and Dhulikhel Hospital to facilitate teaching and research exchanges of students and staff between the two institutions. Ingunn Harstad is the current coordinator of this partnership, and the reason we were all in Nepal on this occasion.

With increasing numbers of students from Nepal enrolled in NTNU degree programmes, Ingunn has been encouraging efforts by DMF to offer Master- and PhD-level credit courses locally in Nepal. Aslak agreed to teach his course, Qualitative Research Methods (SMED8015), as the pilot initiative of this project. On this occasion, most of the participants only took part in the week-long course but a few signed up to obtain the full course credits and thus have continued after the week with the required assignments.

Kathmandu University School of Medical Sciences

Kathmandu University School of Medical Sciences

Elisabeth and I are working on a research study led by Berit Schei, “Evaluating interventions in antenatal care to identify and assist victims of gender-based violence in Nepal and Sri Lanka”. This study employs two NTNU PhD students from Nepal, Poonam Rishal and Kunta Devi Pun, both of whom were enrolled in the qualitative research course.

For the next four days then, Elisabeth and I joined Aslak, Ingunn, Poonam, Kunta and the 15 other students in the course for a series of lectures and group-based project work. Between breaks for masala tea and lunches of dal baht or momos (Nepali dumplings) at the hospital canteen, we learned strategies to collect data using interviews and focus groups and became more familiar with the techniques of thematic qualitative data analysis. Overall, the course participants were enthusiastic and diligent, and the quality of the group conversations and project presentations more than met teaching expectations. Elisabeth and I also had the opportunity to work with our two PhD students in the evenings on their projects, making it a very productive week for all of us.

Course on Qualitative Research Methods

Course on Qualitative Research Methods

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Data sharing from The Nord-Trøndelag Health Study contributes to breakthrough in diabetes research

This is a story about a small contribution. A contribution that will help explain how hereditary traits can prevent illness for some, whilst seemingly same persons become ill. A contribution that could help develop new medicines against diabetes. In this story, The Nord-Trøndelag Health Study (HUNT) does not play the main part, rather a supporting one. But then – there are Oscars for supporting roles, too. And as in many fields, it takes many small contributions to reach a bigger goal. A small contribution from HUNT included, in this case.

This story started as a puzzle. Notwithstanding their age, high BMI and a certain lifestyle, two elderly men who were included in a research project in Sweden and Finland did not have diabetes. It turned out that they were carriers of a mutation in a gene that was known to raise the risk of getting diabetes. The gene codes for a zink transporter called ZnT8 that has its effect in the pancreas, where insulin is made. With one copy of the gene destroyed, these men seemed to be protected from getting diabetes. This was so intriguing that more participants were included into the study. Indeed, more people were detected who did not have diabetes despite high age and often being obese.

To obtain more certainty of the association found, the research team now wanted to include a really large group of individuals and study this gene. With only one out of 2000 persons carrying this mutation, they need to include many cohorts, and HUNT was among these. In total, 150.000 participants from 14 cohorts contributed with their genetic material, among them HUNT. The pooled results were published in Nature Genetics in March, 2nd, 2014. They show that having the gene mutation reduces the risks for getting diabetes with about two-thirds. People with this mutation seem to produce more insulin and have lower blood sugar levels throughout their lives, and this protects them to a large extent against diabetes. The next step is to try and develop new drugs against diabetes that may act in a similar manner as this gene mutation.

This is an example of what The Nord-Trøndelag Health Study can contribute to when we share our data with other researchers both home and abroad.

picture Nature Genetics, overview genetic findings by cohort

Picture: overview of genetic findings from the contributing cohorts. HUNT er visible as the middle green dot. Reproduced with permission from Nature Genetics.

Flannick J, Thorleifsson G, Beer NL et al. Loss-of-function mutations in SLC30A8 protect against type 2 diabetes. Nature Genetics, 2014 March 2. Read more in Norwegian at forskning.no
Read international news item at  MedScape

 

 

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Improving antenatal care for pregnant women experiencing domestic violence

Blogger: Jennifer J. Infanti Jennifer Infanti

 

 

 

The Faculty of Medicine at NTNU is delighted to welcome four doctors/researchers from Nepal to Trondheim between January 15th and 17th. The visiting delegates are members of an international collaboration of researchers investigating strategies to improve antenatal care for pregnant women experiencing domestic violence in Nepal and Sri Lanka. This research team is led by Professor Berit Schei of The Department of Public Health and General Practice and funded by the Research Council of Norway under its GLOBVAC programme.

Domestic violence is a profound global health problem.

Visit from Nepal

At the Obstetrics & Gynaecology Department at St. Olavs Hospital. From left to right, the people are: Dr. Rajendra Koju, Dr. Sunil Kumar Joshi, Dr. Chanda Karki, Dr. Meena Thapa. (Photo: Jennifer Infanti)

The guests from Nepal include Dr. Chanda Karki, Professor in the Department of Obstetrics and Gynaecology and Principal (Dean) of Kathmandu Medical College and Teaching Hospital (KMC); Dr. Meena Thapa, Associate Professor of Obstretics and Gynaecology at KMC; Dr. Sunil Kumar Joshi, Associate Professor in the Medical Education Department at KMC; and Dr. Rajendra Koju, medical doctor at Dhulikhel Hospital and Associate Dean of the Kathmandu University School of Medical Sciences.

Domestic violence is a profound global health problem, posing significant risks for the physical, sexual and psychological health and well-being of women and children in particular. Domestic violence crosses all geographic, economic and cultural barriers and borders. Despite the significant risks of domestic violence for poor health, rigorously conducted research on the interventions, services and policies that work best to prevent and respond to domestic violence is limited.

Visit from Nepal

The four guests from Nepal are standing or sitting from left to right as follows: Dr. Sunil Kumar Joshi (standing), Dr. Chanda Karki, Dr. Rajendra Koju, Dr. Meena Thapa. (Photo: Jennifer Infanti).

In addition, addressing such a widespread public health challenge requires cooperative actions and solutions which bridge many sectors of society – for example, governments, non-profit organisations, researchers, and health care. Professor Schei’s project strengthens the formal partnership of NTNU and Kathmandu University to advance such a cross-cultural exchange of skills, knowledge and experiences to tackle domestic violence.

The visiting doctors/researchers from Nepal will have the opportunity to meet with some of Trondheim’s service providers for victims of domestic violence during their stay, including the Sexual Assault Care Centre team at St. Olavs Hospital, staff at the Trondheim Crisis Centre, and victim support officers and investigators at the police station. In addition, they will be sharing their experiences in obstetrics and public health in Nepal at various meetings and seminars at St. Olavs hospital and NTNU.

Visit from Nepal

Dr. Chanda Karki is speaking at the podium. (Photo: Jennifer Infanri)

Importantly for the research project, the visit will allow time to further develop two PhD proposals – the funding from the Norwegian Research Council for this project will allow two students from Nepal to complete PhD degrees at NTNU over the next three years. The doctoral projects aim to develop culturally and contextually sensitive screening tools to identify pregnant women experiencing domestic violence in antenatal care settings in the Kathmandu area of Nepal. In addition, the PhD students will each develop training and education interventions to support health care professionals in their work with victims of domestic violence. The goal of the interventions is to improve the safety of pregnant women by either reducing the recurrence of abuse or mitigating its impact and consequences.

Professor Schei’s study aligns with the strategic efforts of the Faculty of Medicine at NTNU and St. Olavs Hospital to build competency in the field of global health. The Faculty will benefit from the skills and knowledge of health care practitioners from other countries. With Norway’s population becoming increasingly multicultural, this will help us prepare for patients coming to the hospitals from diverse cultural and ethnic backgrounds, contributing to a more culturally responsive health care system.

 

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Global health in Trondheim

Blogger: Elisabeth DarjElisabeth Darj

 

 

 

On the first of September I started my work as the first professor in Global Health at NTNU and I have now been asked to present myself. I’m most honored to have this job opportunity and it has been two intense, interesting and exciting months. My office is at Department of Public Health and General Practice.

I am a Swedish obstetrician and gynecologist and have been working clinically for many years. Simultaneously I have always been engaged in education and research. While employed at Uppsala University in Sweden I have taught medical students, midwives, nurses and biomedical assistants among others.

My research profile is in obstetrics and gynecology, but for more than ten years I have focused on reproductive health in low income countries, mainly in East-Africa, where I have supervised PhD and Master’s students. I have conducted research in women’s health from different angles: maternal health and mortality, support in the post-partum period, abortions, violence against women and children, adolescents’ reproductive health, infectious diseases, such as STI/HIV and health systems. I am now involved in a project at NTNU on violence against women in Nepal and Sri Lanka, and have applied for funds for other projects with others.

Mother and child participating in a research project  in rural Tanzania. (Photo: Elisabeth Darj)

Mother and child in Tanzania

Global health is defined as health issues that transcend national boundaries and call for research and actions to improve health for all, irrespective of where we live. “Collaborative international research and action for promoting health for all”. As health is influenced by politics, society, culture and the environment, solutions to health problems not only reside within health systems, but also elsewhere. I have already met a lot of people in Trondheim with strong interests in global health who are engaged in different research projects in various faculties. In the medical faculty there are well-established cooperations and projects in Nepal, Sierra Leone, Malawi and South-Africa. I recently lectured to a large group of medical students and almost all of them had been travelling outside Europe. They showed knowledge and great interest in global health and in solutions to challenging issues. So I think it is timely that the medical faculty has now decided that Global Health shall be included in all education.A new two-year international Master’s program in global health will be developed, which is exciting and challenging, and I’m sure it will benefit research and education.

Furthermore, we wish to increase collaboration with other faculties, institutions, HiST and other actors. At the moment, we are updating the global health program that already exists for medical students. Two weeks ago there was the annual Global Health Day, held for the fourth year, and showing a growing interest in the topic with, now almost 200 participants. There were many stimulating presentations during the day, focusing on two main themes; our technological and educational possibilities from Norway to influence the health situations in low-and middle income countries, and opportunities to meet other researchers and teachers.

NTNU’s vision «Knowledge for a better world» and the medical faculty’s vision «Health for a better world» is comprehensive and relevant to the global world we live in, in Trondheim and elsewhere. Last but not least, I would like to thank all for the warm reception I have received in my new inspiring job.

 

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