Objectives. Unnatural deaths among Indigenous populations, including the Swedish Sami, occur more often than among the general population. To find prevention strategies, we explored the circumstances of the unnatural deaths of members of reindeer-herding Sami families. Study design. The number of deaths from among a cohort of 7,482 members of reindeer-herding Sami families were retrieved from the National Board of Health and Welfare for the years 1961- 2001. Methods. An evaluation of the information from autopsy records at the National Board of Forensic Medicine, police reports, and available medical records identified 158 unnatural deaths. These were then analysed in detail. Results. Transport-related deaths and suicides were the most common unnatural deaths among Swedish reindeer-herding Sami family members. Suicides contributed to 23% of all deaths, road traffic accidents to 16%, and snowmobile fatalities to 11%. The accidents generally reflected an "outdoor lifestyle" and the working conditions were characterized by the use of off-road vehicles such as snowmobiles. Half of the number of victims tested positive for alcohol and alcohol abuse was documented in 15% of all victims. Conclusions. The results indicate that alcohol is an important factor in preventing unnatural deaths among reindeer-herding Sami, together with increased safety of both on-road and off-road transportation.

Background: Educational environments are considered important in strengthening students’ health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach – namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work. Methods: This cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ). Results: Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC. Conclusions: Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach. © 2022, The Author(s).

Recovery from a myocardial infarction (MI) can be a very difficult process and some patients are also stricken by fatigue. The aim of the study was to describe the difficulties experienced by men with fatigue during the first year following their MI. The study was conducted using qualitative content analysis of semi-structured interviews with nine men in working age (mean age: 55 years) with verified fatigue (≥12 of 20 on the Multidimensional Fatigue Scale with a mean of 17) one year after their MI. During the first year after the MI the men suffering from fatigue experienced various difficulties in terms of both themselves and the care received. The analysis generated three themes with difficulties described by the interviewed men. 1) Going through involuntary change: not recognizing their body and the inability to recognize themselves. 2) Lacking individualized care: To be denied satisfactory health care treatment and to be denied respectful treatment. 3) Not being seen in the light of the social context: The MI affects the whole family and caregivers do not pay attention to the family. In order to make both the patient and relatives feel secure and cared for, it is essential that caregivers be aware of the importance of providing individualized care over time with particular attention for the patient’s social context.

The purpose with our qualitative study is to investigate the vision of leadership but how does one perfect visionary leadership in an everyday activity? To help us find out the purpose of this we have conducted semi structured interviews involving leadership in occupations. These interviews have provided phenomenal inspiration since our main focus is the experiences of leadership. In our analysis we have used the method of phenomenal analysis and as well as the process of the data. Our empiricist consists of ten interviews, eight of which are conducted with co-workers and two of which are conducted with team leaders.

Our result shows that the activity doesn't have an outspoken vision between co-workers and leaders. However both the leaders have a vision about their leadership which doesn't appear literally. Our study shows that if a leaders visions appears in practice, it therefore doesn't have to be official since it is already clearly expressed. We find that through our case study that occupation can evolve their leadership as well as their employeeship with the help of our results

Aims: The purpose of this thesis is to describe peer educators’ experiences from the training given to them by The Leadership South Programme. The aim is also to describe the participants’ perceived self-empowerment and perceptions about their own learning and experiences of being a peer educator. The study also aims to explore how peer educators share their skills with others.

Methods: Grounded Theory is the method used for the research presented in this thesis. The data collection was done by open-ended questionnaires followed by qualitative interviews.

Results: The results show that the peer educators who participated in our study show increased self-esteem and motivation. The training has also given them increased knowledge in communicating, listening and facilitating others. Furthermore peer educators experienced increased self-awareness and learned how to motivate and support their peers and share information.

Immigrants from the Middle East have higher prevalence and incidence of type 2 diabetes (T2D) compared with native Swedes. The aim of the study was to describe and understand health beliefs in relation to T2D as well as attitudes regarding participation in a screening process in a local group of Assyrian immigrants living in Sweden. A qualitative and quantitative method was chosen in which 43 individuals participated in a health check-up and 13 agreed to be interviewed. Interviews were conducted, anthropometric measurements and blood tests were collected, and an oral glucose tolerance test was performed. In total, 13 of the 43 participants were diagnosed with impaired glucose metabolism, 4 of these 13 had TD2. The interviewed participants perceived that screening was an opportunity to discover more about their health and to care for themselves and their families. Nevertheless, they were not necessarily committed to taking action as a consequence of the screening. Instead, they professed that their health was not solely in their own hands and that they felt safe that God would provide for them. Assyrians’ background and religion affect their health beliefs and willingness to participate in screening for TD2.

Overweight and obesity have been increasing problems among children in Sweden since the 1980s. These children’s health is at risk and the problems can become extensive if the youths remain overweight until adulthood. Diabetes type 2, low self confidence and cardiovascular diseases are but a few examples of health troubles caused by overweight and obesity. Obesity and its related diseases cost society three billion crowns per year in Sweden for health care and treatment, plus the cost for medicine, sick leaves and early retirement. Seen from a cultural point of view, the society ideal linked with health is to be slim. Since overweight and obesity have increased among children, we have investigated the obesity problem in a Swedish municipality. The demographics of the municipality suggests a socio-economic context of students' weight problems when the schools are in residential areas only have a few students who are overweight or obese compared to those schools that are in flat areas, where the problem of overweight and obesity is considerably larger. We have chosen school nurses as target group to examine the problem since they have contact with children and their health from the beginning of elementary school until the end of high school.

Our purpose was to examine the school nurses’ and other school and children related personnel’s conception and experience of obesity among children and young people, as well as their working methods with this problem. We were inspired by the phenomenographical approach and carried out fifteen semi-structured interviews with fifteen school nurses, one school physician and a physiotherapist, a total of seventeen people. The result reveals a demographic difference in overweight problems where culture and social economy emerged as primary factors. It appeared also that the parents must take responsibility for their children’s health by creating themselves healthy lifestyles at home, with support and help from the municipality. However, we could distinguish a lack of efforts to prevent obesity. The school nurses had a varied approach on which knowledge was needed and how one can work with overweight children and their families. We found also a need to review and revise the school nurses’ and municipality’s responsibilities.

Objective Stomach cancer is a leading cause of cancer death, especially in developing countries. Incidence has been associated with poverty and is also reported to disproportionately affect indigenous peoples, many of whom live in poor socioeconomic circumstances and experience lower standards of health. In this comprehensive assessment, we explore the burden of stomach cancer among indigenous peoples globally.Design The literature was searched systematically for studies on stomach cancer incidence, mortality and survival in indigenous populations, including Indigenous Australians, Maori in New Zealand, indigenous peoples from the circumpolar region, native Americans and Alaska natives in the USA, and the Mapuche peoples in Chile. Data from the New Zealand Health Information Service and the Surveillance Epidemiology and End Results (SEER) Program were used to estimate trends in incidence.Results Elevated rates of stomach cancer incidence and mortality were found in almost all indigenous peoples relative to corresponding non-indigenous populations in the same regions or countries. This was particularly evident among Inuit residing in the circumpolar region (standardised incidence ratios (SIR) males: 3.9, females: 3.6) and in Maori (SIR males: 2.2, females: 3.2). Increasing trends in incidence were found for some groups.Conclusions We found a higher burden of stomach cancer in indigenous populations globally, and rising incidence in some indigenous groups, in stark contrast to the decreasing global trends. This is of major public health concern requiring close surveillance and further research of potential risk factors. Given evidence that improving nutrition and housing sanitation, and Helicobacter pylori eradication programmes could reduce stomach cancer rates, policies which address these initiatives could reduce inequalities in stomach cancer burden for indigenous peoples.

Background/Objectives

Previous research shows that the stronger the sense of coherence (SOC) the healthier behaviour. A strong SOC seems to be related to lower consumption of drugs and smoking, more frequent physical exercises and healthier food choices. Further it is established by previous research that there is a difference in health behaviour between socioeconomic groups. Individuals with lower socioeconomic status (SES) smoke to greater extent, have more sedentary lifestyle and make unhealthier food choices than individual with higher SES. The evidence regarding the interactive relations of SOC and SES to health behaviour or the potential mediating role of SOC in the relationship between SES and health behaviour is more unclear. In order to explore this, there is a need of systematic reviews of the evidence concerning SOC and health behaviour and interactions with SES.

Thus, the objective of this study is to explore and synthesize empirical findings on the relationship between SOC and health behaviour among adults. Further the aim is to explore to what extent interactions with SES is considered in the studies of SOC and health behaviour.

 Methods

The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research focusing on the relationship between sense of coherence and health behaviour among adults and interrelations with socioeconomic status. The review covers scientific publications as well as doctoral theses published 2008–2018. The review is systematic in the sense that all the included papers will be critically examined and analyzed according to (1) the study objective, (2) the study designs and methods for analysis and, (3) the applicability and practical use of the results.

 Results

Expected outcomes of this study will be established state of the art regarding the relationship between sense of coherence and health behavior and interrelations with socioeconomic status. Further the results will identify knowledge gaps important to address in future research.

Discussion

The potential contribution of the synthesized knowledge to achieve a sustainable and equal development of health will be discussed as well as to what extent health inequalities can be explained or understood by SOC.

Denna studie berör friskvårdsförmåner och dess utnyttjande, som anställda kan få betalda av sin arbetsgivare samt hur detta utnyttjande kan påverka arbetsmotivationen. Detta sker inledningsvis genom en beskrivning av friskvård mer generellt, därefter följer en skildring kring skapandet av arbetsmotivation samt dess utformande. Vårt syfte med denna studie var först att undersöka utnyttjandet av betald friskvård och den upplevda arbetsmotivationen hos de anställda i Trollhättans Stad. Efter denna kartläggning var syftet att identifiera hur det differentierade utnyttjandet kunde samvariera med den upplevda arbetsmotivationen.

 Studien grundar sig på en kvantitativ undersökning i enkätform, vilken har utförts inom den offentliga verksamheten i Trollhättans Stad. Av de 440 stycken utskickade enkäterna fick vi totalt in 282 stycken, vilket gav undersökningen en svarsfrekvens på 64 procent. Könsfördelningen hos respondenterna i undersökningen var 78 procent kvinnor och 22 procent män. Bland våra respondenter kan det utläsas att det generellt existerar en positiv upplevelse kring att Trollhättan Stad som arbetsgivare väljer att erbjuda någon form av friskvård till sina anställda. Dock är inte utnyttjandet av dessa lika stort i relation till respondenternas positiva attityder till friskvård. Dessutom uppvisas en generell tillfredsställelse i upplevd arbetsmotivation, vilket delvis exemplifieras genom en hög meningsfullhet och motivationsnivå bland respondenterna. Resultatet påvisar genomgående att det existerar tendenser, som uppvisar att regelbundet friskvårdsutnyttjande är en faktor som kan samvariera med den upplevda motivationen hos de anställda på en arbetsplats. Däremot får dessa tendenser ses som relativt svaga då det är komplicerat att identifiera kausaliteten mellan dessa ämnesområden.

 Vi menar att eventuella insatser för att förbättra de kommunanställdas utnyttjande av betald friskvård, främst bör inriktas på de som mer sällan eller aldrig väljer att utnyttja någon form av betald friskvård. Detta då det troligen hade gett störst effekt på organisationens verksamhet, då ett brett utnyttjande av samt positiva attityder till friskvårdsförmånerna, är en god förutsättning för en främjande arbetssituation. Dessutom menar vi att det krävs ett långsiktigt strategiskt arbete för att uppnå denna främjande arbetssituation, vilket i sig skulle kunna bidra till en ökad arbetsmotivation för den enskilde individen.

Breast-feeding is to be encouraged during the first six months of life. Iron deficiency is extremely rare in exclusively breast-fed infants during this period. Any cow-milk based formula used should be iron-fortified. During the second half of infancy, the iron content of weaning foods is important in preventing iron deficiency. Indeed, owing to the low iron content of dairy products, it is hard to compose a weaning diet sufficiently rich in iron to meet the demands of rapidly growing infants, if it is to include substantial amounts of cow milk, sour milk or yoghurt. Accordingly, the Paediatric Committee on Nutrition and Health, of the Swedish Paediatric Association and the National Food Administration, recommend delaying the introduction of cow's milk and cow-milk products until the infant is 10-12 months of age. Until then, breast-feeding, and the use of iron-fortified formula or gruel with modified protein and sodium content are encouraged; iron-fortified porridges of softer consistency can be prepared to circumvent the need of extra fluids, or porridge can be served with breast milk or iron-fortified formula; small amounts of milk may be used for cooking purposes.

Since 1932, when vitamin A and D supplementation, in the form of cod liver oil, was introduced in Sweden, rickets has been a rare diagnosis among Swedish infants. In 1978, the National Board of Health and Welfare issued recommendations of daily supplementation with 300 micrograms (1000 IU) of vitamin A and 10 micrograms (400 IU) of vitamin D. This has recently been under review by the Paediatric Committee on Nutrition and Health, of the Swedish Paediatric Association and the National Food Administration, who concluded that there is no reason to retain vitamin A supplementation, but that vitamin D supplementation should continue to be recommended at the same daily dose (400 IU).

Objectives: to describe topics (1) presented by midwives' during antenatal classes and the amount of time spent on these topics and (2) raised and discussed by first-time parents and the amount of time spent on these topics. Design: qualitative; data were gathered using video or tape recordings and analysed using a three-pronged content analysis approach, i.e., conventional, summative, and directed analyses. Setting and participants: 3 antenatal courses in 2 antenatal units in a large Swedish city; 3 midwives; and 34 course participants. Findings: class content focused on childbirth preparation (67% of the entire antenatal course) and on parenting preparation (33%). Childbirth preparation facilitated parents' understanding of the childbirth process, birthing milieu, the partner's role, what could go wrong during delivery, and pain relief advantages and disadvantages. Parenting preparation enabled parents to (i) plan for those first moments with the newborn; (ii) care for/physically handle the infant; (iii) manage breastfeeding; (iv) manage the period at home immediately after childbirth; and (v) maintain their relationship. During the classes, parents expressed concerns about what could happened to newborns. Parents' questions to midwives and discussion topics among parents were evenly distributed between childbirth preparation (52%) and parenting preparation (48%). Key conclusions: childbirth preparation and pain relief consumed 67% of course time. Parents particularly reflected on child issues, relationship, sex, and anxiety. Female and male participants actively listened to the midwives, appeared receptive to complex issues, and needed more time to ask questions. Parents appreciated the classes yet needed to more information for managing various post-childbirth situations. Implications for practice: while midwifery services vary among hospitals, regions, and countries, midwives might equalise content focus, offer classes in the second trimester, provide more time for parents to talk to each other, allow time in the course plan for parents to bring up new topics, and investigate: (i) ways in which antenatal course development and planning can improve; (ii) measures for evaluating courses; (iii) facilitator training; and (iv) parent satisfaction surveys.

Background: The transition to parenthood is an overwhelming life event. From a theoretical perspective, tran- sition to parenthood is a developmental transition that contains certain phases and patterns.

Aim: This study aim was twofold (i) discover, describe and comprehend transitional conditions that parents per- ceive as facilitating and inhibiting during transition to parenthood and to (ii) use that knowledge to develop recommendations for professional interventions that sup- port and facilitate transition to parenthood.

Design: Meleis transition theory framed the study’s deduc- tive qualitative approach – from planning to analysis. Methods: In a secondary analysis, data were analysed (as per Meleis transition theory) from two studies that implemented interviews with 60 parents in Sweden between 2013 and 2014. Interview questions dealt with parents’ experiences of the transition to parenthood – in relation to experiences with parent-education groups, professional support and continuity after childbirth. Ethical issues: A university research ethics board has approved the research.

Results: These factors facilitated transition to parenthood: perceiving parenthood as a normal part of life; enjoying the child’s growth; being prepared and having knowledge; experiencing social support; receiving professional support, receiving information about resources within the health care; participating in well-functioning parent-education groups; and hearing professionals comment on gender dif- ferences as being complementary. These factors inhibited transition to parenthood: having unrealistic expectations; feeling stress and loss of control; experiencing breastfeed- ing demands and lack of sleep; facing a judgmental attitude about breastfeeding; being unprepared for reality; lacking information about reality; lacking professional support and information; lacking healthcare resources; participating in parent-education groups that did not function optimally; and hearing professionals accentuate gender differences in a problematic way.

Conclusion: Transition theory is appropriate for helping professionals understand and identify practices that might support parents during transition to parenthood. The study led to certain recommendations that are important for professionals to consider. 

Aaron Antonovsky advanced the concept of salutogenesis almost four decades ago (Antonovsky, Health, Stress and Coping. Jossey-Bass, San Francisco, CA, 1979; Unravelling the Mystery of Health. Jossey-Bass,San Francisco, CA, 1987). Salutogenesis posits that life experiences shape the sense of coherence (SOC)VC that helps to mobilize resources to cope with stressors and manage tension successfully (determiningone's movement on the health Ease/Dis-ease continuum). Antonovsky considered the three-dimensionalSOC (i.e. comprehensibility, manageability, meaningfulness) as the key answer to his question about theorigin of health. The field of health promotion has adopted the concept of salutogenesis as reflected in theinternational Handbook of Salutogenesis (Mittelmark et al., The Handbook of Salutogenesis. Springer,New York, 2016). However, health promotion mostly builds on the more vague, general salutogenic orientation that implies the need to foster resources and capacities to promote health and wellbeing. Tostrengthen the knowledge base of salutogenesis, the Global Working Group on Salutogenesis (GWG-Sal)of the International Union of Health Promotion and Education produced the Handbook of Salutogenesis.During the creation of the handbook and the regular meetings of the GWG-Sal, the working group identified four key conceptual issues to be advanced: (i) the overall salutogenic model of health; (ii) the SOC concept; (iii) the design of salutogenic interventions and change processes in complex systems; (iv) the application of salutogenesis beyond health sector. For each of these areas, we first highlight Antonovsky'soriginal contribution and then present suggestions for future development. These ideas will help guideGWG-Sal's work to strengthen salutogenesis as a theory base for health promotion.

Proteininnehållet i svenskkost är relativt högt i förhållande till internationella rekommendationer. Höga proteinintaghos barn har satts i samband med ökad risk för övervikt. Hos vuxna har ett högt proteinintag,och därmed förhöjda homocysteinnivåer i serum, samtidigt med ett lågt intag av folacin förts fram som riskfaktorer förhjärt–kärlsjukdom. Det finns inga fördelar – men eventuellt nackdelar – med ett proteinintag över 15 energiprocent, eller1,5 g/kg kroppsvikt.

The aim of this paper was to evaluate whether primary health care staff's referral of patients to perform an electronic screening and brief intervention (e-SBI) for alcohol use had a greater impact on change in alcohol consumption after 3 month, compared to patients who performed the test on their own initiative. Staff-referred responders reported reduced weekly alcohol consumption with an average decrease of 8.4 grams. In contrast, self-referred responders reported an average increase in weekly alcohol consumption of 2.4 grams. Staff-referred responders reported a 49 reduction of average number of heavy episodic drinking (HED) occasions per month. The corresponding reduction for self-referred responders was 62. The differences between staff- and self-referred patient groups in the number who moved from risky drinking to nonrisky drinking at the followup were not statistically significant. Our results indicate that standalone computers with touchscreens that provide e-SBIs for risky drinking have the same effect on drinking behaviour in both staff-referred patients and self-referred patients. Copyright © 2011 Preben Bendtsen et al.

Expectant and new parents are offered parental education groups as a way to support their transition to parenthood. Group leadership in these groups has been found to be challenging. Using a qualitative and summative design, the aim of the present study was to investigate how health professionals describe their role in parental education groups compared to their actual behavior. Thirteen health professional leaders in antenatal and child health services were interviewed. These descriptions were compared with the leaders' actual behavior in video and audio-recordings of 16 different group sessions. The results revealed that regardless of how the leaders described their role, they acted as experts and left little time to parents for discussions and active participation. In particular, leaders who described themselves as discussion leaders did not "walk the talk"; that is, they did not do what they said they do when leading groups. That could be explained by lack of professional awareness, group leadership, and pedagogical skills. In order to provide high-quality parental support, leaders need training in group leadership and pedagogy combined with supervision and support on a regular basis.

Abstract Rationale, aims and objectives  In this article, ideal conceptions about teamwork are tested. The research question posed is: How are teams in psychiatry formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while the parallel work mode is a transitional form between group and team. Methods  Three psychiatric outpatient teams at a university hospital specialist clinic were studied. Data were collected through 25 personal interviews and 82 hours of observations. The data collection was carried out over 18 months (2008–2009). Results  Results show: (1) that the three theoretical distinctions between group and team need to be supplemented with two intermediate forms, semiparallel and semisynchronous teamwork; and (2) that teamwork is not characterized by striving towards a synchronous ideal but instead is marked by an adaptive interaction between sequential, parallel and synchronous working modes. Conclusions  The article points to a new intermediate stage between group and team. This intermediate stage is called semiparallel teamwork. The study shows that practical teamwork is not characterized by a synchronous ideal, but rather is about how to adaptively find acceptable solutions to a series of practical problems. The study emphasizes the importance of the team varying between different working modes, so-called semisystematics.

Etiska aspekter vid screening av bukaortaaneurysm - en delutvärdering vid införandet i Västra Götaland

Regionstyrelsen har beslutat om införande av screening av 65-åriga män för buk-aortaaneurysm (fortsättningsvis benämnt AAA) i Västra Götalandsregionen. Syftet är, i likhet med andra screeningundersökningar, att ställa diagnos i ett tidigt skede, redan innan sjukdomen har börjat ge symtom. Utvärderarna, liksom den helt övervägande delen av de kallade och intervjuade medarbetarna, anser att detta är en riktig satsning. Utvärderingsgruppen ställer sig således bakom införandet och huvuddragen i genomförandet av AAA screening i Västra Götalandsregionen. De kunskaper vi har om screening i allmänhet och AAA i synnerhet indikerar helt enkelt att det vore oetiskt att inte screena denna grupp personer. Det finns dock en risk för oro och ångest i samband med förfarandet. Det är därför viktigt att minimera negativa upplevelser hos de kallade. Utvärderingen är gjord med detta som utgångspunkt och har således ansatsen att finna förbättringsmöjligheter i det framväxande förfarandet.

Under 2009 kallades 10 361 män och av dessa avstod 14,5 % . Till SU/Östra och SU/Mölndal avstod ca 20 % att komma medan de som kallades till SÄS, SKAS och NU avstod i mindre utsträckning (ca 11 %).

Förbättringsförslagen i rapporten bygger på enkätsvar, telefonintervjuer från såväl de som kom som de som uteblev. Det genomfördes också fokusgruppsintervjuer med den personalen som undersökte de kallade (ST-läkare, sjuksköterskor och biomedicinska analytiker) på de kliniskt fysiologiska mottagningarna vid Sahlgrenska universitetssjukhuset Mölndal och Östra, Kungälvs sjukhus (röntgen), Södra Älvsborgs sjukhus (SÄS), Norra Älvsborgs sjukhus (NÄL) och Skaraborgs sjukhus (SkaS).

Kort om resultaten

De kallade och personalen var i allmänhet positiva till att sjukvården gjorde screeningundersökning av 65-åriga män. Kallelse och informationsbrev upplevdes av de flesta som bra. Avståndet till screeningorten påverkade inte deltagandet i screeningen negativt trots kommentarer om lång resväg. De som hade längst resväg undersöktes på NÄL och SkaS. Att få ett påminnelsebrev gjorde att flera som glömt eller var bortresta kunde undersökas. Egenavgiften (100 kr) hade inte betydelse för deltagandet. Undersökningen medförde inga obehag och gick snabbt (5 min). Undersökningens korta tid kunde dock vara ett besvär för den som behövde mer omfattande information eller omhändertagande. Informationen om undersökningen var bra men besked om hur vanligt tillståndet var och normalgränserna saknades av de undersökta.

Av dem som avstod från undersökning förekom fysisk psykisk sjukdom eller handikapp som orsak till att det var svårt eller omöjligt att undersökas. Flera hade negativa attityder till massundersökningar och som exempel angavs svininfluensa-vaccinationen för inställningen. Andra orsaker till att man avstod var inställningen ”det drabbar inte mig”. Några hade dålig erfarenhet av sjukvård eller läkarskräck. Det förekom också transportproblem, som att man inte hade egen bil. Den största andel som avstod bodde i Göteborgsregionen (22 %).

Screeningpersonalen upplevde att de flesta var positiva och nöjda med informationen i kallelsen, förutom att man trodde att hela bukaortaavsnittet skulle undersökas. Personalen fick påpekanden från män att egenavgiften (100 kr) utgjorde ett problem för dem som inte hade internet då en betalningsavgift tillkommer. Speciell tid var avsatt för undersökningarna, på två ställen på kvällstid för att det skulle vara lättare med parkering. Ofta räckte undersökningstiden till (5 min) men ibland, om undersökningen var mer komplicerad eller om någon hade svårt att röra sig eller behövde prata, upplevdes tiden för kort.  Principen var att det skulle ges besked om bukaorta var normal eller förstorad, men beskedet gavs på olika sätt, en del fick muntligt besked, andra också skriftligt. Några fick reda på måttet när det var normalt men inte om det var förstorat. Vid upptäckt av vidgad aorta skulle personalen faxa uppgifter till kärlkirurgen i Göteborg. Personalen upplevde att de inte hade klara besked på hur informationen till patienten skulle ges om vidgad aorta upptäcktes. Det var även osäkert om och när patienten skulle bli omhändertagen både beroende på tillgång till mottagningstid till kärlkirurg och beroende på hur stor vidgning aorta hade.

Utvärderingsgruppen har reflekterat över de etiska aspekterna av screeningen. Gruppen anser att tillvägagångssättet visat sig vara hållbart och föreslår endast förbättringar av förfarandet och rekommendationer om alternativa förhållningssätt.

Sammanfattning av etiska reflektioner vid bukaortascreeningen i Västra    Götaland

• Information och undersökning byggde på ett rationalistiskt perspektiv där 65-åriga män ansågs vara friska, svensktalande och utan hjälpbehov.
• Vid komplicerad undersökning eller vidgad aorta var det brist på tidsmarginal vilket innebar att kravet på ett fullgott omhändertagande riskerade att inte kunna uppfyllas.
• Förfarandet vid beskedet av mätresultat, både skriftligt och muntligt, var inte samstämmiga mellan screeningorterna.
• Yrkeskategori som inte var utbildad för eller hade erfarenhet av omhändertagande vid besked kunde skapa oro och ångest.
• Beskeden till männen om och när läkarkontakt skulle fås varierade.
• Osäkerhet och frustration över att inte ha tillgång till läkare/psykolog fanns bland screeningpersonalen.

Studien i denna uppsats är explorativ och förståelseinriktad. Syftet med undersökningen är att undersöka om respondenterna uppfattar att man med hjälp av Web 2.0-verktyg kan stödja lärande utifrån tankebokens koncept.Undersökningen har genomförts på en grupp studenter på Digitala Medieprogrammet vid Högskolan Väst. Studenterna läste vid tillfället en kurs som heter Digitala Distributionsformer, en kurs kring hur man använder olika former av digitala distributionsformer både via internet och mobil. Undersökningen består av en fokusgrupp av dessa studenter, samt observationer kring studenternas användning av de digitala verktygen.Resultatet visar att bloggar ger fördelar och uppmuntrar studenter till ett reflekterat lärande genom t.ex. tankebok som form. Tankebok i blogg kan därigenom bli ett stöd i lärandet.

The purpose of this study was to examine if there were any differences between students’ dietary and exercise habits depending on sex and affiliated institution at University West. The study was based on 323 questionnaires, relevant literature and scientific works as theses, reports and articles. The results were analyzed from a sociological perspective. Dependent on sex or institution affiliation differences were found of dietary and exercise habits. Female students at University West in many respects indicate somewhat better dietary and exercise habits than male students did. In addition, small differences between the frequency of male and female students’ exercise were found. According to the Swedish guidelines for dietary and exercise students from the Department of Nursing, Health and Culture reported more healthy habits than students in average. Opposite to this finding, students from the Department of Economics & Informatics, showed the least compliance to the Swedish guidelines. Students from the Department of Engineering exercised least frequently compared to students from the other examined institutions at University West.

Adolescents in Western society often expose themselves to high levels of sound at gyms, rock concerts, discotheques etc. These behaviours are as threatening to young people’s health as more traditional risk behaviours. Testing boundaries and risk taking are fundamental aspects of young people’s lives and the processes of developing their identities. There is, however, a need to balance reasonable risk taking and risks that can damage health. The aim of Study I was to analyze the relationship between self-exposure to noise, risk behaviours and risk judgements among 310 Swedish adolescents aged 15-20 (167 men/143 women). The adolescents’ behaviour in different traditional risk situations correlated with behaviour in noisy environments, and judgements about traditional risks correlated with judgement regarding noise exposure. Another finding was that young women judge risk situations as generally more dangerous than young men, although they behave in the same way as the men. We suggest that this difference is a social and culture based phenomenon which underlines the importance of adopting a gender perspective in the analysis of risk factors. Adolescents reporting permanent tinnitus judged loud music as more risky than adolescents with no symptoms and they did not listen to loud music as often as those with occasional tinnitus. The aims of study II were to illuminate  the complexity of risk behaviour, the meaning and purpose of adolescent risk-taking in both a traditional sense (e.g. smoking and drug use) and in noisy environments (e.g. discotheques and rock concerts), in relation to norms and gender roles in contemporary society. In total, 16 adolescents (8 men/8 women, aged 15-19) were interviewed individually and in focus groups. The interviewees’ responses revealed social reproduction of gender and class. Main themes of the phenomena for both genders emerged: Social identity and Existential identity of risk taking. The descriptive sub themes, however, which together formed the general structure, were rather diverse for men and women. The incorporation of social and existential theories on gender as basic factors in the analysis of attitudes towards risk-taking behaviours is considered to be of utmost importance. Likewise, research on hearing prevention for young people needs to acknowledge and make use of theories on risk behaviour and similarly, the theories on risk behaviour should acknowledge noise as a risk factor.

             Study III aims to increase the knowledge about young women’s and men’s risk judgement and behaviour by investigating patterns in adolescent risk activities among 310 adolescents aged 15-20 (143 women; 167 men). The Australian instrument ARQ, developed by Gullone et al, was used with additional questions on hearing risks ^[1] and a factor analysis was conducted. The main results showed that the factor structure in the judgement and behaviour scale for Swedish adolescents was rather different from the factor structure in the Australian sample. The factor structure was not similar to the Australian sample split on gender and there were differences in factor structures between genders among Swedish adolescents. The results are discussed from a gender and existential perspective on risk taking, and it is emphasized that research on risk behaviour needs to reconceptualize stereotypical ideas about gender and the existential period in adolescence. The aim of Study IV was to investigate possible gender differences regarding psychometric scales measuring risk perception in noisy situations, attitudes towards loud music, perceived susceptibility to noise, and individual norms and ideals related to activities where loud music is played. In addition, the purpose was to analyze whether these variables are associated with protective behaviour, e.g. the use of hearing protection. A questionnaire was administered to a Swedish sample including 543 adolescents aged 16 to 20. The result revealed significant gender differences for all the psychometric scales. Furthermore, all psychometric measures were associated with hearing protection use in musical settings. Contrary to previous studies, gender did not solely contribute to any explanation of protective behaviour in the analysis. One conclusion is that although gender does not contribute solely to the explanation of protective behaviour, gender may affect psychological variables such as risk perception, attitudes and perceived susceptibility and these variables may in turn be valuable for decision-making and protective behaviour in noisy situations. Although women tend to be more ’careful’ psychologically, they nevertheless tend to behave in the same way as men regarding actual noise-related risk-taking.

The World Health Organization (WHO) states that working intersectorally and internationally with health issues is crucial in creating a change towards healthy public policy at a local level. Healthy Cities is one of the programmes where WHO uses a health governance approach (governing through networks) to try to reach this objective. The aim of this bachelor thesis is to identify the factors that make member cities of the WHO European Healthy Cities Network successful in reorienting local public policy towards healthy public policy. An analysis of nine documents corresponding to the selection criteria set up by the authors was conducted. These documents consisted of reports published by WHO on the Healthy Cities programme, but also of independent research articles and one thesis published on other networks similar to Healthy Cities. Also, further data was collected through telephone interviews with contact persons in four member cities. The interviews were transcribed word by word. Both data (documents and interviews) were analysed using a qualitative content analysis.

The results show that the four key “elements for action” (political commitment, leadership, readiness for institutional change and intersectoral collaboration) crystallized by WHO for creating healthy public policy were mainly confirmed in this research study. Therefore, the authors draw the conclusion that WHO has succeeded in making the member cities commit to the Healthy Cities philosophy and in spreading the idea of health governance in Europe. However, additional factors were found both in the document analysis and in the interviews. When looking at the top four frequently occurring factors in the documents, community participation and status were highlighted. The two additional factors found in the interview data was holistic thinking and systematic, goal-oriented work. Also, the importance of political commitment was questioned by a minority of the respondents. This might indicate that the four key “elements for action” crystallized by WHO might not have as big of an effect in creating change at a local level as has been made out by WHO. Furthermore, respondents stated that difficulties existed in translating theory into practice at a local level. This might indicate that potential changes made in the member cities after joining the Healthy Cities programme are mainly ideological. Despite this, the attitudes among the respondents towards membership in the WHO European Healthy Cities Network were overall positive, and even though difficulties still exist, the respondents maintained that Healthy Cities enables them in taking the next step towards healthy public policy at a local level.

Background:

Type I diabetes is a chronic disease that places great demands on the child and family. Parental involvement has been found to be essential for disease outcome. However, fathers’ involvement has been less studied, even though high paternal involvement has been correlated with less disease impact on the family and higher quality of life among adolescents.

Aim: The overall aim of the study was to explore and analyze constructions of fathers’ involvement in their child’s everyday life with type 1 diabetes from an ecological and health promotion perspective. Four specific aims were applied: 1) explore and describe discourses in health care guidelines for children with type 1 diabetes in Nordic countries, focusing on parents' positioning (I), 2) analyze how Swedish pediatric diabetes teams perceived and discussed fathers’ involvement in the care of their child with type 1 diabetes, and to discuss how the teams’ attitudes toward the fathers’ involvement developed during a focus group process (II), 3) explore and discuss how fathers involved in caring for their child with type 1 diabetes experience support from their pediatric diabetes team in everyday life with their child (III), and 4) analyze how involved fathers to children with type 1 diabetes understand their involvement in their child’s daily life and to discuss their perceptions from a health promotion perspective (IV).

Material and methods: A qualitative and inductive approach was applied. Data were collected and analyzed during 2010-2012. The sample consisted of three pediatric guidelines originating from Norway, Denmark and Sweden (I), three Swedish pediatric diabetes teams (PDTs) (II), and 11 (III) and 16 (IV) fathers of children with type 1 diabetes who scored high involvement on the Parental Responsibility Questionnaire. Data were collected through repeated focus group discussions with the PDTs (II), online focus group discussions (III) and individual interviews (III, IV) with the fathers. Three analysis methods were applied: analysis of discourses (I), Constructivist Grounded Theory (II, III) and content analysis (IV).

Findings: The findings illuminated the complex interaction between the pediatric guidelines, the PDTs and the fathers. Fathers highly involved in their child’s daily life experienced different levels of tension between the general recommendations and their personal experiences of living with a child with type 1 diabetes (III). The fathers regarded their involvement in their child’s diabetes care as additional to their general parenting, and a fine balance was identified between a health promotion perspective and a controlling involvement. The common denominator between the highly involved fathers was their use of parental leave (IV). The PDTs initially perceived fathers’ involvement as gendered and balanced on the mother’s agement, but as focus was set on fathers’ engagement the PDTs increased their awareness of this and started to identify and encourage their engagement II). At the macro-level, parents’ voices were diminished in Nordic pediatric diabetes guidelines in favor of an expert discourse (I).

Conclusions: Fathers’ involvement concerning a child with type 1diabetes is constructed in a complex way, based on an interaction between the fathers’ perceptions of their additional involvement and the support provided by the PDTs; the PDTs’ perceptions of the fathers’ involvement; and how parents/fathers are constructed in pediatric diabetes guidelines. In order to promote the health and well-being of children with type 1 diabetes, fathers’ involvement needs to be taken into account in the pediatric guidelines as well as in clinical practice. 

The purpose of this study was to analyze how Swedish pediatric diabetes teams perceived and discussed fathers' involvement in the care of their child with type 1 diabetes. It also aimed to discuss how the teams' attitudes towards the fathers' involvement developed during the data collection process. The Constructivist Grounded Theory design was used and data were collected during three repeated focus group discussions with three Swedish pediatric diabetes teams. The core category of the teams' perception of fathers' involvement emerged as: If dad attends, we are happy – if mom doesn't, we become concerned. Initially the teams balanced their perception of fathers' involvement on the mother's role as the primary caregiver. In connection with the teams' directed attention on fathers, in the focus group discussions, the teams' awareness of the importance of fathers increased. As a consequence, the team members began to encourage fathers' engagement in their child's care. We conclude that by increasing the teams' awareness of fathers as a health resource, an active health promotion perspective could be implemented in pediatric diabetes care.

Background: Since parental involvement is essential to the outcome of diabetes type 1 treatment in childhood and high paternal engagement in everyday life promote the child's health, it is of value to explore how professionals, the diabetes teams (DT), perceive fathers' involvement in their child with diabetes type 1.

Method: The study design was Constructivist Grounded Theory and data was collected by Repeated Focus Groups discussions with three Swedish pediatric diabetes teams, between May 2010 and January 2011.

Results: The core category for the diabetes teams' perception of fathers' involvement was If dad comes, we are happy – if mom fails to appear, we become desperate. The core category relied on three subcategories. Societal and cultural context where DTs perceived fathers involvement as having specific properties and specific areas of responsibility, Balancing where the DTs balanced the father's involvement against the mother's engagement and Becoming aware where the DTs raised awareness of the fathers from being a indistinct parents-unit till to identify and appreciate the father's engagement.

Conclusions: Perceiving fathers as equal caregivers, and becoming aware of fathers as a health resource, could support an active health promotion perspective in pediatric diabetes care. 

AIM: To provide reference data for bone mineral variables in 15- and 17-y-old adolescents and to analyse the relationships between these variables and measures of bone and body size, gender, puberty, growth, various lifestyle and environmental factors and socioeconomic background.

METHODS: In the same 321 randomly selected adolescents (147 boys and 174 girls) living in two different regions of Sweden, the total bone mineral content (TBMC), bone area (BA) and total bone mineral density (TBMD) were assessed by dual-energy X-ray absorptiometry at ages 15 and 17 y. The effects of bone and body size, gender, growth, sexual maturity, physical activity, region of domicile, social conditions, food habits, smoking and alcohol intake on TBMC and TBMD were examined in multivariate analyses.

RESULTS: In the 15-y-old adolescents, BA, height, gender, physical activity, maturity and weight explained 91% and 48%, of the variance in TBMC and TBMD, respectively. In similar analyses in the 17-y-olds, the corresponding figures were 92% and 62%, respectively, when BA, height, growth, physical activity, gender and region emerged as significant in the model. In all these analyses, BA explained most of the variance in TBMC and TBMD. No significant reduction of variance was found when different measures of social conditions, smoking, food habits, alcohol or dietary intakes of energy, calcium or vitamin D were included in the models. The reason why region of domicile had a significant impact on TBMC in the 17-y-olds is not known. The fact that the normal fluoride concentration in drinking water (1.1 mg/L) is 10 times higher in the region where TBMC was higher than in the other region is an interesting observation.

CONCLUSION: Almost 90% of the variance in TBMC and 50% of that in TBMD was explained by measures of bone and body size and only a few percent by gender, physical activity, Tanner stage, growth and region of domicile.

Food is the main source of trace elements for the general population. The gastrointestinal absorption of certain trace elements, e.g., cadmium, is strongly influenced by iron (Fe) status. This factor may also be relevant for the bioavailability of other trace elements. Therefore, we investigated relationships between Fe status indicators and trace element concentrations in blood and serum of 234 boys and girls at ages 15 and 17 years. Fe status was measured using serum ferritin (S-Ft), soluble transferrin receptor in serum (sTfR), and the ratio sTfR/S-Ft. The trace elements we investigated were, in blood, cadmium, cobalt, copper, zinc, selenium, rubidium, mercury, and lead, and, in serum, cobalt, copper, zinc, selenium, rubidium, tungsten, mercury, and lead. We found inverse correlations between Fe status and blood cadmium, blood or serum cobalt, or blood copper. There were positive correlations between Fe status and mercury concentrations. Selenium was positively correlated with sTfR. The relationships between Fe status and lead were equivocal. There were fewer correlations for serum than for blood, but the inverse relationships between Fe status and cobalt were equally strong in serum and blood. We found only occasional, and perhaps spurious, correlations with zinc, rubidium, and tungsten. In conclusion, previous indications that cadmium, cobalt, and copper are absorbed by transport mechanisms similar to that of Fe are supported by this study. Strong positive correlations between Fe status and mercury concentrations remain to be explained.

Blood and serum samples from 372 15-year-old adolescents were collected in two cities in Sweden and analyzed by inductively coupled plasma mass spectrometry (ICP-MS). The objective was to (1) determine the levels of 13 elements in blood and serum from the teenagers; and (2) for each element, investigate the correlation between the concentrations in blood and serum. The concentrations in blood and serum were generally in line with that usually reported for the essential elements Co, Cu, Zn and Se, and generally low for the 'non-essential' elements Cd, Hg, Pb. The median concentrations were in blood and serum, respectively: of Co 0.31 and 0.48 microg/l, Cu 0.92 and 1.0 mg/l, Zn 6.1 and 0.99 mg/l, Se 110 and 100 microg/l, Rb 2.8 and 0.24 mg/l, Hg 1.1 and 0.44 microg/l, Pb 16 and 0.33 microg/l. The median concentration of W in blood was <0.2 microg/l (below the detection limit) and in serum 0.087 microg/l. The median concentrations of Cd, Rh, Pd, Pt and Tl were below the detection limits. Statistically significant correlations were found between the concentrations in blood and serum for Co, Cu, Zn, Se, Rb, W, Hg and Pb. The levels presented in this study constitute baseline levels or levels generally not exceeded in adolescents for 13 elements, including essential, ubiquitous toxic, and rare elements.