Alexandra Krettek

• Doctor of Philosophy (PhD) Medicine
• Professor (Full) at University of Skövde

The burden of cardiovascular diseases (CVDs) and the risk factors in adolescents are rising in Nepal, a low-income setting. Therefore, focusing on health education related to diet and physical activity for adolescents in their formative years is urgent. A digital medium may be an efficient way to reach this technologically oriented group. We develo...

Abstract [en] The burden of cardiovascular diseases (CVDs) and the risk factors in adolescents are rising in Nepal, a low-income setting. Therefore, focusing on health education related to diet and physical activity for adolescents in their formative years is urgent. A digital medium may be an efficient way to reach this technologically oriented gr...

Background Cardiovascular disease (CVD) is the leading cause of death in Nepal. As CVD risks can develop early in life, a life course approach for non-communicable disease (NCD) prevention is needed. Due to its potentially acceptable delivery mode, digital health education could be a promising way forward to increase adolescents’ CVD knowledge. Pu...

The anthropometric index that best predicts cardiometabolic risk remains inconclusive. This study therefore assessed the prevalence of obesity using six indices and compared their associations with obesity-related cardiometabolic disorders. We determined obesity prevalence according to body mass index, waist circumference, waist-to-hip ratio, waist...

Link to the article: Online Published. http://kumj.com.np/?page=viewIssue&issue=82

Background Stronger Sense of Coherence (SOC) associates with better health, quality of life, and coping strategies. We translated and applied the SOC-13 questionnaire for the first time in Nepal. In this process we identified difficulties in response patterns. The findings necessitated further evaluation of the Nepali version of the questionnaire....

High prevalence of behavioral risk factors for cardiovascular disease (CVD) warrants a life course approach to efficiently prevent CVD. Our previous HARDIC trial in a semi-urban community of Nepal shows conventional CVD educational interventions for mothers improved knowledge, attitude, practice (KAP). Digital interventions for cardiovascular healt...

High prevalence of behavioral risk factors for cardiovascular disease (CVD) warrants a life course approach for efficient prevention. Our previous HARDIC trial in semi-urban Nepal shows conventional CVD educational interventions for mothers improved knowledge, attitude, and practice (KAP). Digital cardiovascular health promotion provides opportunit...

Background Work-related health problems, such as work stress, fatigue, and burnout constitute a global challenge within the nursing profession. Work-related health among nurses is not yet a prioritized phenomenon in Nepal. Health-promoting approaches to maintaining and sustaining nurses’ health are therefore essential. The aim of this study was to...

Associations between obesity and socio-demographic and behavioral characteristics vary between populations. Exploring such differences should throw light on factors related to obesity. We examined associations between general obesity (GO, defined by body mass index) and abdominal obesity (AO, defined by waist-to-hip ratio) and sex, age, socio-econo...

Background Nursing professionals exhibit high prevalence of stress-related health problems. Job demands and job resources are parallel drivers of health and well-being among employees. Better job resources associate with better job satisfaction, job motivation and engagement even when job demands are high. To date, there is limited research which e...

Games for health is one of the most prominent areas for serious games, i.e. games with a purpose beyond only entertainment. The purpose of a health game may be to inform about health related issues; promote healthy lifestyles and even to drive behavioral change. This paper outlines the initial game design considerations and some future research dir...

Background Obesity is an epidemic of XXI century, as its prevalence doubled during the last forty years. As Russia and Norway are countries with different life expectancy there could be differences in obesity and its correlates. Purpose To investigate and compare prevalence and socio-economic and behavioral factors associated with obesity in Russi...

Background Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals' overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal. Aim T...

Background: Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals’ overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal. O...

We currently experience rapid technological development and societal changes. Most notably, health care is transformed with preventive medicine and public health efforts being driven by use of new digital health technologies. This leads to an unexpected development for Public Health Science, the discipline that provides the scientific platform for...

Registered nurses and midwives are in short supply and have among the highest rates of sick leave in the global workforce. The aim of this study was therefore to explore and gain a deeper understanding of how nurses and midwives experience their everyday work, with a view toward promoting and sustaining their work-related health. Nine registered nu...

Background: Two important aspects for the development of anxiety disorders are genetic predisposition and alterations in the hypothalamic-pituitary-adrenal (HPA) axis. In order to identify genetic risk-factors for anxiety, the aim of this exploratory study was to investigate possible relationships between genetic polymorphisms in genes important f...

Background: Nursing as a profession exhibits high levels of work-related stress and psychosocial disorders. Daily, nurses face job-related ethical challenges, high job stress and risk of burnout. Emotional distress, lack of support from the employer, bad working and employment conditions contribute to illness and sickness. To retain nurses and to r...

Background Hypospadias is the most common congenital anomaly of the penis, but its causes are mainly unknown. Of the risk factors identified, the most plausible are hormonal and genetic. The aim of this study was to identify risk factors for hypospadias in Northwest Russia based on registry data. Methods The study population included male infants...

Background: Nepal, like many low- and middle-income countries, exhibits rising burden of cardiovascular diseases. Misconceptions, poor behavior, and a high prevalence of risk factors contribute to this development. Health promotion efforts along with primary prevention strategies, including risk factor reduction in both adults and children, are the...

Background: Unhealthy diet and physical inactivity contribute to the growing burden of cardiovascular diseases in Nepal. Lifestyle is formed in childhood and in the Nepalese context influenced mainly by mothers, it is to date unknown how influential mothers are. Objectives: To assess changes in children’s diet and physical activity as perceived by...

The prevalence of cardiovascular diseases is increasing in low and middle-income countries; Nepal’s population shows a high prevalence of behavioral risk factors. Our cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), located near the capital Kathmandu, explored knowledge, attitude, and practice (KAP) of m...

Study tool, english version. (PDF)

Dataset. Raw data of the study. (SAV)

Study tool, nepali version. (PDF)

Cardiovascular malformations are one of the most common birth defects among newborns and constitute a leading cause of perinatal and infant mortality. Although some risk factors are recognized, the causes of cardiovascular malformations (CVMs) remain largely unknown. In this study, we aim to identify risk factors for ventricular septal defects (VSD...

p> Background: Prehypertension is clinically defined as a level of blood pressure between normal and hypertension, i.e. elevated systolic blood pressure between120-139 or diastolic blood pressure between 80-89 mm Hg. Prehypertension remains neglected as a public health problem, and has not been explored in mothers with small children in Nepal. Obj...

p> Background: Though cardiovascular diseases are mostly seen in adulthood, foundation of diet and physical activity is largely formed during childhood. The study aimed to explore children’s preference for diet and physical activity in a peri-urban area of Nepal because this is an important dimension to explore in the life-course approach to combat...

The objective was to assess the prevalence of selected major birth defects, based on data from two medical registries in Murmansk County, and compare the observed rates with those available for Norway and Arkhangelsk County, Northwest Russia. It included all newborns (≥22 completed weeks of gestation) registered in the Murmansk County Birth Registr...

Background Although prior studies have shown that smoking reduces preeclampsia/eclampsia risk, the consequence of giving up this habit during pregnancy should be assessed. The aims of the current study were threefold: (i) describe maternal characteristics of women with preeclampsia/eclampsia; (ii) examine a possible association between the number o...

The aim of our study was to assess associations between smoking behavior before and during pregnancy and selected adverse birth outcomes. This study is based on the Murmansk County Birth Registry (MCBR). Our study includes women who delivered a singleton pregnancy after 37 weeks of gestation (N = 44,486). Smoking information was self-reported and a...

Skilled birth attendant (SBA) utilization is low in remote and rural areas of Nepal. We designed and implemented an evaluation to assess the effectiveness of a five-component intervention that addressed previously identified barriers to SBA services in mid- and far-western Nepal. We randomly and equally allocated 36 village development committees w...

Background Mothers with young children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance site of Bhaktapur district have misconceptions and poor behavioural practice regarding diet and physical activity. We developed the Heart-health Associated Research, Dissemination and Intervention in the Community trial - a health promotion int...

Background: Factors contributing to perinatal mortality (PM) in Northwest Russia remain unclear. This study investigated possible associations between selected maternal and fetal characteristics and PM based on data from the population-based Murmansk County Birth Registry. Objective: This study investigated possible associations between selected ma...

Background: Small for gestational age (SGA) births have been associated with both short- and long-term adverse health outcomes. Although social risk factors for SGA births have been studied earlier, such data are limited from Northern Russia. Objective: We assessed maternal social risk factors for term SGA births based on data from the populatio...

Objectives The aim of this study was to examine age- and gender-related patterns of PA and depressive symptoms among students through their adolescent years. Design Data from three population-based surveys were analysed to determine levels of moderate- to vigorous-intensity PA (MVPA), participation in organized sports and depressive symptoms among...

Background: Globally, about 11% of all liveborn infants are preterm. To date, data on prevalence and risk factors of preterm birth (PTB) in Russia are limited. The aims of this study were to estimate the prevalence of PTB in Murmansk County, Northwestern Russia and to investigate associations between PTB and selected maternal factors using the Mur...

Background: The aim of this pilot study was to examine the impact of a brief physical activity intervention on adolescents' subjective sleep quality. Cross-sectional studies indicate that physically active adolescents have better subjective sleep quality than those with more sedentary habits. However, less is known about the effectiveness of physi...

Background Smoking during pregnancy leads to adverse maternal and birth outcomes. However, the prevalence of smoking among women in Russia has increased from < 5 % in the 1980s to > 20 % in the 2000s. We conducted a registry-based study in Murmansk County, Northwest Russia. Our aims were twofold: (i) assess the prevalence of smoking before and duri...

The use of tobacco products among adolescents in Southeast Asia represents a major public health burden. Two out of ten adolescents attending school are tobacco users and several factors influence them to initiate tobacco use. Most studies related to tobacco use are quantitative, whereas qualitative studies exploring adolescents’ smoking behavior a...

Background: Estimates of disease burden in Nepal are based on cross-sectional studies that provide inadequate epidemiological information to support public health decisions. This study compares the health and demographic indicators at the end of 2012 in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) with the baseline conducted...

Uterine prolapse (UP) is a main contributor to reproductive health problems that infl uence women’s quality of life. In Nepal, the UP prevalence ranges from 7-27%. Women experience various diffi culties and symptoms due to UP, which are determined by the type as well as thestage of UP.Objectives: This study aimed to explore the knowledge, prevalenc...

Objectives Non-communicable diseases account for 50% of all deaths in Nepal and 25% result from cardiovascular diseases. Previous studies in Nepal indicate a high burden of behavioural cardiovascular risk factors, suggesting a low level of knowledge, attitude and practice/behaviour regarding cardiovascular health. The behavioural foundation for a h...

Uterine prolapse (UP) is a reproductive health problem and public health issue in low-income countries including Nepal. We aimed to identify the contributing factors and stages of UP and its impact on quality of life in the Jhaukhel-Duwakot Health Demographic Surveillance Site of Bhaktapur, Nepal. Our three-phase study used descriptive cross-sectio...

This article describes the legacy of the Nordic School of Public Health NHV (NHV) in global health. We delineate how this field developed at NHV and describe selected research and research training endeavours with examples from Vietnam and Nepal as well as long-term teaching collaborations such as BRIMHEALTH (Baltic RIM Partnership for Public HEALT...

Androgens have important cardiometabolic actions in males, but their metabolic role in females is unclear. To determine the physiologic androgen receptor (AR)-dependent actions of androgens on atherogenesis in female mice, we generated female AR-knockout (ARKO) mice on an atherosclerosis-prone apolipoprotein E (apoE)-deficient background. After 8 w...

Background: Primary open-angle glaucoma (POAG) is one of the most common causes of irreversible blindness. A possible association between POAG and non-communicable diseases such as hypertension and diabetes suggests that the incidence of POAG may increase. People with POAG in Nepal usually present late to hospital and have poor knowledge of glauco...

Background Uterine prolapse (UP), which affects about 10% of women of reproductive age in Nepal, is the most frequently reported cause of poor health in women of reproductive age and postmenopausal women. Currently, women’s awareness of UP is unknown, and attempts to unravel the UP problem are inadequate. This study aims to assess UP knowledge amon...

Background: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design: We conducted 24 focus group discussi...

Background Susceptibility to smoking is defined as an absence of firm commitment not to smoke in the future or when offered a cigarette by best friends. Susceptibility begins in adolescence and is the first step in the transition to becoming an established smoker. Many scholars have hypothesized and studied whether psychosocial risk factors play a...

Background: Inadequate fruit and vegetable intake and other adverse dietary habits – along with tobacco and alcohol abuse and sub-optimal physical activity-make up the four most important behavioural risk factors of non-communicable diseases. Low fruit and vegetable intake is particularly associated with burden of high cardiovascular disease. It ha...

Background: Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice. Objective: This qualitative study aimed to deepen understanding of the community perspective on cardiovascular he...

Introduction: Cognitive susceptibility to smoking is defined as absence of firm commitment not to smoke in the future or if offered a cigarette by best friends. It begins in adolescence and is the first step in the transition to current smoking. Psychosocial risk factors play a crucial role to discourage susceptible adolescents from becoming establ...

Nepal, a low-income South Asian country, is facing a growing epidemic of atherosclerotic cardiovascular diseases. Information on how well its population knows about the underlying risk factors and possible prevention and control strategies is an important determinant in tackling the epidemic. Studies indicate Nepalese people have poor knowledge reg...

Behavioral risk factors, particularly the major four- tobacco consumption, harmful use of alcohol, unhealthy diet and physical inactivity- are accountable for a major proportion of cardiovascular disease burden. Driven by urbanization and globalization, these risk factors are rising in many of the low- income countries including Nepal. Population-b...

(Introduction) Nepal, a low-income South Asian country, is facing a growing epidemic of atherosclerotic cardiovascular diseases. Information on how well its population knows about the underlying risk factors and possible prevention and control strategies is an important determinant in tackling the epidemic. Studies indicate Nepalese people have poo...

(Introduction) Behavioral risk factors, particularly the major four- tobacco consumption, harmful use of alcohol, unhealthy diet and physical inactivity- are accountable for a major proportion of cardiovascular disease burden. Driven by urbanization and globalization, these risk factors are rising in many of the low- income countries including Nepa...

Physical inactivity is a leading risk factor for cardiovascular and other noncommunicable diseases in high-, low- and middle-income countries. Nepal, a low-income country in South Asia, is undergoing an epidemiological transition. Although the reported national prevalence of physical inactivity is relatively low, studies in urban and peri-urban loc...

Although uterine prolapse (UP) occurs commonly in Nepal, little is known about the physical health and care-seeking practices of women with UP. This study aimed to explore women's experiences of UP and its effect on daily life, its perceived causes, and health care-seeking practices. Using a convenience sampling method, we conducted 115 semi-struct...

Skilled birth attendants (SBAs) provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. However, utilization and coverage of services by SBAs remain poor, especially in rural and remote areas of Nepal. This study examined the characteristics associated with utilization of SBA services in...

Background Non-communicable diseases (NCDs) such as hypertension and diabetes are rapidly emerging public health problems worldwide, and they associate with primary open-angle glaucoma (POAG). POAG is the most common cause of irreversible blindness. The most effective ways to prevent glaucoma blindness involve identifying high-risk populations and...

This study determined the knowledge, attitude and practice/behaviour of cardiovascular health in residents of a semiurban community of Nepal. To increase the understanding of knowledge, attitude and practice/behaviour towards cardiovascular health, we conducted in-home interviews using a questionnaire based on the WHO STEPwise approach to surveilla...

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The prevalence of hepatitis B (HBV) and C (HCV) in Russia was 7.6 and 5.4 per 100,000, respectively. The aim of this study was to assess the proportion of HCV and HBV infection among HCC patients, to evaluate associations between HCV, HBV and stage of HCC and to compare sur...

Background The perceived risks and benefits of smoking may play an important role in determining adolescents’ susceptibility to initiating smoking. Our study examined the perceived risks and benefits of smoking among adolescents who demonstrated susceptibility or non susceptibility to smoking initiation. Methods In October–November 2011, we conduc...

Background A health demographic surveillance system (HDSS) provides longitudinal data regarding health and demography in countries with coverage error and poor quality data on vital registration systems due to lack of public awareness, inadequate legal basis and limited use of data in health planning. The health system in Nepal, a low-income countr...

Cardiovascular diseases (CVDs) are on the rise in low- and middle-income countries (LMICs) but have not received adequate priority. With a lack of concrete policy and programs, the present emphasis of CVD management in most LMICs is on curative aspects. Nepal is a prototype in this trend as it is treatment centric, particularly in urban areas. A ma...

Today, biomaterials such as polytetrafluorethylene (ePTFE) are used clinically as prosthetic grafts for vascular surgery of large vessels (>5 mm). In small diameter vessels, however, their performance is poor due to early thrombosis. Bacterial-derived cellulose (BC) is a new promising material as a replacement for blood vessels. This material is hi...

The integration of living, human smooth muscle cells in biosynthesized cellulose scaffolds was monitored by nonlinear microscopy toward contractile artificial blood vessels. Combined coherent anti-Stokes Raman scattering (CARS) and second harmonic generation (SHG) microscopy was applied for studies of the cell interaction with the biopolymer networ...

This paper highlights and discusses issues associated with transdisciplinary teaching and suggests ways to overcome the challenges posed by different epistemologies, methods, and ethical positions. Our own transdisciplinary teaching experience in public health helped us identify some important questions including (i) what is transdisciplinary resea...

The atheroprotective effect of testosterone is thought to require aromatization of testosterone to estradiol, but no study has adequately addressed the role of the androgen receptor (AR), the major pathway for the physiological effects of testosterone. We used AR knockout (ARKO) mice on apolipoprotein E-deficient background to study the role of the...

The future toll of the obesity epidemic will likely hit hardest in low- and middle-income countries. Ongoing urbanization promotes risk factors including sedentary lifestyle and fat- and sugar-laden diets. Low-income countries like Nepal experience a double disease burden: infectious diseases as well as rising incidence of noncommunicable diseases...

CD44, short for cluster of differentiation 44, is an adhesion molecule of the hyaluronate receptor family. Expressed on the surface of most vertebrate cells, it functions as a receptor for several extracellular matrix components, e.g., hyaluronan, collagen, laminin, fibronectin, and osteopontin. CD44 has in recent years been intensively studied in...

Vascular and inflammatory cells express adhesion molecule CD44. We demonstrated previously that enhanced CD44 localizes in human atherosclerotic lesions. Apolipoprotein E/cd44 double-deficient mice and apolipoprotein E-deficient mice transplanted with CD44-deficient bone marrow (BM) exhibit reduced atherosclerosis. Since CD44 is a novel factor in a...

Estradiol, the major endogenous estrogen, reduces experimental atherosclerosis and metabolizes to 2-methoxyestradiol in vascular cells. Currently undergoing evaluation in clinical cancer trials, 2-methoxyestradiol potently inhibits cell proliferation independently of the classical estrogen receptors. This study examined whether 2-methoxyestradiol a...

The cell-adhesion molecule CD44 likely participates in atherosclerosis development. We have shown previously that pro-inflammatory cytokines affect CD44 expression. Therefore, this work examined the role of elevated CD44 levels in human macrophages. Macrophages from human atherosclerotic subjects (n=15) showed elevated levels of CD44 transcript and...

The recruitment of monocyte-derived macrophages (MDMs) and arterial smooth muscle cells (ASMCs) contributes to inflammation and development of intimal hyperplasia during atherosclerosis. Platelet-derived growth factor (PDGF) is a potent mitogen for SMC, signalling through PDGF-receptor subunits alpha (Ralpha) and beta (Rbeta). We have previously fo...

In the present study, the associations between the plasma concentration of soluble CD44 (sCD44), sex, cardiovascular risk factors, and ultrasound-assessed measures of carotid atherosclerosis were examined in 2 groups of 61- and 64-year-old men and women from population-based samples. Women had higher levels of circulating sCD44 than men. There were...

This study tested the hypothesis that human macrophages have the ability to modify oxidation products in LDL and oxidized LDL (oxLDL) via a cellular antioxidant defence system. While many studies have focused on macrophage LDL oxidation in atherosclerosis development, less attention has been given to the cellular antioxidant capacity of these cells...

CD44, a polymorphic hyaluronate receptor, may participate in chronic inflammation. We hypothesized that CD44 variants contribute to the development of arterial diseases. CD44 levels vary in normal and diseased arterial tissues in the following order: unaffected arteries < fibrous plaques < or = abdominal aortic aneurysm < atheromatous plaques; and...