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  • 101.
    Daniels, Karen
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Health Systems Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa .
    Nor, Barni
    Jackson, Debra
    Department of Women's and Children's Health, Uppsala University, Sweden .
    Ekström, Eva-Charlotte
    Doherty, Tanya
    Department of Women's and Children's Health, Uppsala University, Sweden .
    Supervision of community peer counsellors for infant feeding in South Africa: an exploratory qualitative study.2010In: Human resources for health, ISSN 1478-4491, Vol. 8, p. 6-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recent years have seen a re-emergence of community health worker (CHW) interventions, especially in relation to HIV care, and in increasing coverage of child health interventions. Such programmes can be particularly appealing in the face of human resource shortages and fragmented health systems. However, do we know enough about how these interventions function in order to support the investment? While research based on strong quantitative study designs such as randomised controlled trials increasingly document their impact, there has been less empirical analysis of the internal mechanisms through which CHW interventions succeed or fail. Qualitative process evaluations can help fill this gap.

    METHODS: This qualitative paper reports on the experience of three CHW supervisors who were responsible for supporting infant feeding peer counsellors. The intervention took place in three diverse settings in South Africa. Each setting employed one CHW supervisor, each of whom was individually interviewed for this study. The study forms part of the process evaluation of a large-scale randomized controlled trial of infant feeding peer counselling support.

    RESULTS: Our findings highlight the complexities of supervising and supporting CHWs. In order to facilitate effective infant feeding peer counselling, supervisors in this study had to move beyond mere technical management of the intervention to broader people management. While their capacity to achieve this was based on their own prior experience, it was enhanced through being supported themselves. In turn, resource limitations and concerns over safety and being in a rural setting were raised as some of the challenges to supervision. Adding to the complexity was the issue of HIV. Supervisors not only had to support CHWs in their attempts to offer peer counselling to mothers who were potentially HIV positive, but they also had to deal with supporting HIV-positive peer counsellors.

    CONCLUSIONS: This study highlights the need to pay attention to the experiences of supervisors so as to better understand the components of supervision in the field. Such understanding can enhance future policy making, planning and implementation of peer community health worker programmes.

  • 102.
    Daniels, Karen
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Health Systems Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa .
    Van Zyl H, Hendrien
    Boland District Municipality, Stellenbosch, South Africa.
    Clarke, Marina
    Nursing Division, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, 7505, South Africa .
    Dick, Judy
    Health Systems Unit, Medical Research Council, Cape Town, South Africa.
    Johansson, Eva
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institute, Stockholm, Sweden.
    Ear to the ground: listening to farm dwellers talk about the experience of becoming lay health workers.2005In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 73, no 1, p. 92-103Article in journal (Refereed)
    Abstract [en]

    Ranking ninth in the world for its contribution to the global burden of tuberculosis (TB), South Africa continues to battle the disease. Within the framework of the World Health Organisation's Directly Observed Treatment Short Course (DOTS) strategy, attempts have been made to utilize lay health workers (LHWs) as TB treatment supporters. Previous research has highlighted the benefits and difficulties associated with such an approach, but little attention has been paid to the perceptions of LHWs themselves. A randomised control trial of a LHW intervention in TB treatment in the farming areas of the Western Cape, South Africa has shown a 19% improvement in TB treatment outcomes. This paper describes the experiences of those LHWs drawing on data collected through focus groups with incumbents. The data has shown that once trained, respondents were engaged in a wide range of activities, well beyond simple health care. In the majority LHWs were women. Becoming LHWs opened up their worlds, creating opportunities they would otherwise not have had. But while doing so, it also added extra responsibilities and stresses, which were not easy to manage. Respondents sustained themselves through support from each other, the intervention team, their employers and contact with the public health system. The question this study raises is given the obvious need for LHWs, how can they be motivated to participate in primary health care in such a way that maximises their access to resources while minimising their experience of the role as burdensome?

  • 103.
    Darulis, Zilvinas
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Use and Perceptions of Lithuanian Computerized Health Information System2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The study was user survey method based, performed to get the overview of use and perceptions of health caremanagers towards Lithuanian computerized health information system as a tool for decision – making.

    Aims of the study were to describe LCHIS, its inputs and potential use; to account for a surveyofpotential users, health care administrators; to discuss the need for improvement of the system and itsuse.

    Methods. User survey method was applied. Literature search was performed and the questionnaire was constructed after interview with four respondents and clarification of questions. Totally 100 ofrespondents from different health care institutions were interviewed. Data was analysed using normal statistical methods, using MS Excel 2000 and statistical package SPSS 10.0 as tools.

    Main results. Concerning the awareness about the existing of LCHIS, 68% of the respondents saidtheyhave heard about it and 15% said theyhave been using this system daily. As many as 68% of respondents didn’t really take care about the existence of LCHIS, while the size of respondents being satisfied and not was pretty the same. The number of satisfied with the structure was rather small ifcomparing with those partially satisfied. As many as 76% of the respondents said they haven’t been using the system at all. 24% of the respondents were satisfied with the certain groups of healthindicators within the system. Group of morbidity indicators and group of hospital activity indicatorswere among the mostly used (17% together). Almost 20% of the respondents said it was easy for them to use LCHIS; the same number of health care administrators trusted the information comingfrom LCHISand they have experienced the situation, where they have used LCHIS for planning ormanagement in current situation. As many as 82% of health care managers agreed heads or administrative staff of hospitals supposed to be the key members, who must encourage them to use the system.

    Conclusions. About two thirds of health care administrators interviewed knew about LCHIS and the rest had been or were users. In the comments this group claimed they were supporting their decisions by using the systemand indicators in it. As many as 96% of the respondents stated there was a needfor statistical information and skills for dailydecision - making and managerial activities. The respondents, who used LCHIS, trusted the information in the system and found it useful in their dailywork as health managers. The main comments, why respondents didn’t use the system or didn’tknow about it, was lack of information technologies in work place, lack of computer skills and lackof support from hospital authorities

  • 104.
    Edgren, Lars
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Thorpenberg, Stefan
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Åhgren, Bengt
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Utvärdering med lärande ansats av pandemiplaneringinklusive vaccinationsprogram i Västra Götalandsregionen2010Report (Other academic)
    Abstract [sv]

    Pandemiplaneringen inklusive vaccinationsprogrammet för att möta den nya influ-ensan var unikt till sin omfattning genom att den avsåg hela befolkningen. Något sådant har inte tidigare genomförts i Sverige. Det ger möjlighet att lära för framti-den. Hälso- och sjukvårdsutskottet i Västra Götalandsregionen (VGR) har beställt en utvärdering. En viktig tanke bakom denna utvärdering var att genomföra data-insamlingen medan vaccinationsprogrammet fortfarande var i färskt minne och således dokumentera viktiga skeenden i nära anslutning till att de ägt rum. Den huvudsakliga datainsamlingen skedde under januari 2010. Pandemiorganisationen i sin helhet har vaccinerat drygt 923 000 individer i Västra Götaland. Totalt har mer än 1 080 000 doser registrerats i journalsystemet Svevac. Sjukhusen har vaccinerat cirka 5 procent, primärvården 55 procent, kommunerna 30 procent (skolhälsovården står för 22 procent), företagshälsovården 7 procent samt övriga 3 procent. Antalet personer med rätt att registrera vaccinationer i Svevac har beräknats till 12 000 personer, de flesta av dem är vaccinatörer. Totala antalet vaccinatörer har beräknats till mellan 10 000 – 12 000. De kommer från drygt 600 enheter (Svevac 28 maj 2010).

    Utvärderingen har två fokusar – organisering samt epidemiologiskt utfall. Det för-sta handlar om hur den samlade pandemiorganisationen i VGR förbereder sig för att möta den nya influensan inklusive genomförandet av vaccinationsprogrammet. Den andra handlar om att försöka beräkna samhällsnyttan av vaccinationen. Här redovisas den första delen av uppdraget. Den andra redovisas separat. Uppdraget är forskarstyrt och har genomförts av Nordic Centre for Health and Social Assess-ment vid Nordiska högskolan för folkhälsovetenskap i Göteborg. Föreliggande rap-port bygger på en dokumentstudie (cirka 800 sidor planer, riktlinjer, rekommenda-tioner samt minnesanteckningar från möten). Vidare har information hämtats från vetenskaplig litteratur, informationsbroschyrer, artiklar i dagspress och relevanta webbplatser. Den empiriska studien omfattar 44 individuella intervjuer (450 A4-sidor intervjuprotokoll) samt en direkt observation. Utvärderingen lyfter fram både kvalitativa och kvantitativa aspekter. Det ger en rikare bild av händelseförlop-pet och en möjlighet att uttala sig om helheten.

    Den fråga forskarna umgåtts med är hur en modell, ett logiskt sammanhängande system för att möta en influensapandemi kan se ut med utgångspunkt i nuvarande kunskap och vägledande policydokument. Här bortser forskarna från hur systemet fungerar idag för att istället försöka skapa en måttstock eller referenspunkt mot vilken verksamheten kan bedömas – en referenspunkt i form av den ”optimala praktiken”. Gapet mellan optimal praktik och det händelseförlopp som dokumen-teras och granskas i utvärderingen bildar forskarnas helhetsbedömning.

    I redovisningen granskas bl.a. epidemiplan, systemets aktörer, ansvarsfördelning, arbetets uppläggning och styrning på regional nivå och fältnivå. Organisationen för pandemiledning och Smittskyddsenhetens (SME) centrala roll gås igenom. Här ingår bl.a. logistik för inköp, lagerhållning och transporter. Extern och intern in-formation samt kommunikationen med massmedia granskas. Slutligen granskas belastningen på den reguljära vården.

    Slutsatser

    Utvärderingen har bedömt pandemiledningens arbete i nio dimensioner som gene-rerats från den idealbild eller ”optimala praktik” som presenteras i de teoretiska utgångspunkterna. 1)Att prioritera- Utvärderingen visar att hälso- och sjukvården i VGR planerat väl för att möta ett scenario innebärande en första pandemivåg utan vaccin. - Utvärderingen visar att pandemiledningen snabbt växlade över till att för-bereda för massvaccination.- Utvärderingen visar att det fanns oklarheter i anvisningarna beträffande risk-grupper vilket gjort dem svåra att avgränsa. 2)Att agera under osäkerhet- Utvärderingen visar att framför allt SME som hållit i trådarna behållit initiativ-et under planering och genomförande och gjort detta väl.3)Att agera under stress- Utvärderingen visar att systemet som helhet levererat trots de oklara påfrestande omständigheterna. 4)Att kommunicera under osäkerhet- Utvärderingen visar att den valda kommunikationsstrategin, baserad på öppen kommunikation, varit lyckad även om den varit tidskrävande för ledningen på SME.- Utvärderingen visar att den regionala informationen varit för detaljerad beträffande annonskampanjen gentemot allmänheten. 5)Att styra viktiga flöden- Utvärderingen visar på tydliga svårigheter att få till ett fungerande arbetsflöde för vaccinering beroende på försenade vaccinleveranser. 6)Att anpassa den reguljära vården- Utvärderingen visar att den strategi man valt för att anpassa den reguljära vården har varit att försöka minska den totala arbetsmängden under pandemin. Strategin fungerade denna gång.7)Att visa prov på flexibilitet- Utvärderingen visar att där man planerat väl och i tid, där var man redo att ställa om den ursprungliga planeringen. 8)Att balansera regional styrning med lokalt handlingsutrymme- Utvärderingen visar att styrningen har fungerat – det tog initialt lite tid innan den hann hitta sina praktiska former lokalt. 9)Att ha koll på kostnaderna- Utvärderingen visar att flera kostnadsposter ännu inte är tillgängliga varför forskarna saknar underlag för att bedöma pandemiledningens kostnadskontroll.Några lärdomar- De privata utförarna i primärvården behöver involveras i pandemiarbetet via en gemensam representation. - Ett välfungerande 1177 (Sjukvårdsrådgivningen) är viktigt för att avlasta sjuk-husens/primärvårdens akutmottagningar.- De informatörer som engageras på regionnivå i VGR behöver arbeta mer själv-ständigt som experter mot media samtidigt som de koordinerar sitt budskap med den lokala nivån. - Vården överöstes initialt med icke selekterad information. Samma information spreds från nationell, regional och lokal nivå. Varför inte marknadsföra vaccina-tionsmanualen som vaccinationsenheternas primära informationskälla.- Undvik andra organisatoriska påfrestningar under en vaccinationskampanj, t.ex. vårdvalsreform eller större organisationsförändringar.- Hälso- och sjukvården har ingen personal att tillgå för extraordinära händelser. Det har varit svårt att utnyttja personalstrategiska funktionen på ett gott sätt. Ett bra instrument för att mäta aktuell sjuklighet bland personalen saknas vilket försvårar personalplaneringen. För att stärka SME föreslås en regional resurs-grupp hos HSA (Hälso- och sjukvårdens adressregister) som vid behov kan diri-geras till funktioner som behöver resurstillskott. - Pandemiplanen behöver revideras, vilket påbörjats. - Den valda strategin för massvaccination föreslås bli omprövad. Jämförelser med strategier i andra landsting är viktig men svår då förutsättningarna är olika samt att man registrerar sina vaccinationer på olika sätt. - Pandemiledningen har tagits på sängen av de oregelbundna vaccinleverans-erna. Att vaccinet inte levererades som planerat är den enskilt mest betydelse-fulla frågan att lära för framtiden.- Samarbetet med kommunerna var avgörande för att genomföra vaccinations-uppdraget.SlutordPandemiarbetet blev en allas angelägenhet. Häri ligger magin att i det osäkra och i den upplevda stressen var alla funktioner i samhället som hade med pandemin att göra inriktade på att bidra. Därför har systemet levererat.

  • 105.
    Ege, Bente
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Regionsdannelsens betydning for sundhedsområdet i Danmark: med specielt fokus på sygehusenes finansiering2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: On 1 January 2007 the Local Government Reform came into force. The formation of regions is the biggest change of the public sector since the Local Government Reform in 1970. The regions’ main task will be the responsibility for health service.

    Purpose: To describe, analyse and discuss the structural changes taking place in the Danish health service, with emphasis on hospitals.

    Method: The starting point of the essay is official sources and explanations as well as scientific literature.

    Results: The structural reform is a centralisation is inspired by the New Public Management philosophy. The financial system in the health care area has been changed significantly through the Local Government Reform. It is dubious to assume that local government measures are cheaper than the regional health services, and that the net saving is sufficient to drive the substitution process.

    A reduction of the treatment guarantee from two to one month must be expected to stimulate the private health service market, thereby causing undermining of the integrated model with public ownership and operation of health service.

    Conclusion: The new financing model will affect the financial incentives in the system as the individual players are only rewarded for the services they deliver to the patient with no relation to the remaining treatment. The increasing activity depending financing presents a significant management challenge. With the reduction from two months to one the waiting time guarantee will assume the character of being a service goal instead of a guarantee of treatment of high professional quality.

  • 106.
    Egge, Hilde
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Du er ikke alene”: Samtalegrupper som helsefremmende tiltak for skilsmissebarn. En Grounded Theory studie.2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background

    Peer groups for children of divorced parents have been shown to have a positive effect. Participants experience increased self-esteem, become happier, and report better well-being and a more positive family experience.

     

    Aim

    This study aimed to identify and increase understanding of the positive consequences of participating in peer groups for children of divorced parents.

     

    Method

    Twenty-eight pupils, 14–16 years of age, from three various communities in Norway participated in seven focus group discussions. Grounded Theory was applied in the analysis.

     

    Results

    Peer groups create a sense of community that provides health promotive effects for children experiencing divorce. Group members who share similar experiences gain a feeling of openness and support, providing increased confidence and self-confidence as well as better influence and control over their own lives. Peer groups also increase understanding of divorce, parents/step-parents, and ability to see the positive aspects of divorce.

     

    Conclusion

    This study shows that peer groups for children of divorced parents may provide an important public health measure.

  • 107.
    Einemo, Ing - Marie
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Värdet av screening för Enterohemorragisk Escherichia coli hos barn under tio år med diarré, i Jönköpings län, Sverige2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background:Enterohemorrhagic Escherichia coli(EHEC) is a toxin-producing bacterium responsible for sporadic cases of infection as well as serious outbreaks. Symptoms rangefrom uncomplicated or bloody diarrhea to hemolytic uremic syndrome (HUS). In Sweden, most EHEC casesoccurin 1-4-year-old children.

    Aims:This study aimed at investigate the value of EHEC screening in children younger than 10 years of age by evaluatingthe prevalence of EHEC and the distribution of serotypes and stxtypes. We also aimed t ocorrelate clinical symptoms with EHEC serotypes and stxtypes. Furthermore the duration of faecal shedding of stxwas investigated.

    Methods: The study examined stool samples collected fromall children younger than 10 years of age between1 May 2003 and April 2013 in the County of Jönköping. We divided the children into a physician-requested EHEC analysis group and ascreening group. Children who tested positive for stxwere sampled weekly after initial EHEC diagnosis. We used a questionnaire and reviewed medical records to collect clinical data.

    Results: Among 191 children (87 girls and 104 boys) with confirmed EHEC, 162 specimens were index cases and 29 were found by contact tracing. The EHEC prevalence was 1.8 % in the EHEC requested group and 1.5 % in the screening group (p=0.5). The median duration of stxdetection in faeces was 20 days (1-256 days). Symptoms were more severe in children with Stx2-producing EHEC, and seven children developed HUS, all infected in Sweden. We were able to determine the source of infection in five cases.

    Conclusions: This study showed that the EHEC prevalence and severity of symptoms where equal between the requested and screening group. HighEHEC prevalence and a high proportion of non-O157 isolates were found. Our results emphasize the need for serotype-independent methods for EHEC detection. The long duration of stxdetection in stools indicates a risk for transmission. Most children with Stx2 were infected in Sweden, suggesting a higher risk forsevere symptoms. Our results confirm the value of EHEC screening in children.

  • 108.
    Ek, Amanda
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Promoting public health by Physical activity on Prescription, with focus on organized exercise2011Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Insufficient physical activity is a public health problem. Nordic healthcare professionals use physical activity on prescription (PaP) to increase physical activity.

    Purpose: This study aimed to evaluate the effectiveness of PaP that includes organized exercise.

    Method: Prospective data was obtained from four Swedish counties during fall 2009 and spring 2010. The study population comprised 98 patients whose healthcare professional prescribed PaP to prevent or treat disease. Questionnaires administered at baseline, three and six months after initiating PaP evaluated self-reported physical activity levels, adherence, factors influencing adherence, and experience of PaP.

    Results: Although the majority of patients receiving PaP including organized exercise are middle-age women, there are a wide distribution regarding e.g., age, socioeconomic status and reason of receiving PaP. Most participants received initial support from healthcare providers and activity organizers, and most were satisfied with the support they got. Approximately 70% participated in several activities at all measuring points. Although PaP including organized exercise increased activity levels only marginally, sedentary behavior decreased significantly. Six months after initiating PaP including organized exercise, 68% adhered to the prescribed physical activity level. Most participants deemed PaP including organized exercise a good method for becoming physically active. However, there is a need for regularly and longer support. Importantly, individualized instruction, adjusted exercise regimens, and support from other participants provide positive reinforcement. On the other hand, PaP with organized exercise imposes additional costs and decreases flexibility including both time commitment and scheduling constraints.

    Conclusion: Adherence levels to PaP with organized exercise are similar to those achieved by other chronic disease treatments. PaP including organized exercise can decrease sedentary behavior, an important factor in promoting public health in the Nordic countries.

  • 109.
    Ekbäck, Gunnar
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Livshändelser, hälsa och munhälsa: en studie av skilsmässa, make/makas död och dess relation till hälsa och munhälsa, baserad på en enkätstudie av 65-åringar i två landsting.2008Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    BACKGROUND: Individuals who have experienced difficult life events, limited here todivorce or death of a spouse, show elevated risk regarding general and oral health.

    AIM: This study investigated how and to what extent difficult life events, i.e., divorce ordeath of a spouse, affect general and oral health. I also sought to determine whether a globalquestion can identify different aspects of oral health.

    MATERIALS AND METHOD: This cross-sectional quantitative study used an existingquestionnaire already distributed to all (8,313) 65-year-old citizens in two Swedish counties.Within the questionnaire, a global question measured general as well as oral health, and sixadditional questions assessed oral health. Descriptive analysis sought to determinedifferences between groups, and logistic regressions were used to compare them further.

    RESULTS: The questionnaire response rate was 73.1%. The results showed statisticallysignificant differences in general and oral health among individuals who experienceddivorce or death of a spouse compared with individuals without such experiences. Thedifferences among groups, i.e., better general and oral health among individuals withoutdivorce or death of a spouse, were significant and systemic, p<0.05. Further, differencesremained statistically significant even when using a global question on oral health. However,this global question focused mainly on chewing capacity and appearance.

    CONCLUSIONS: This study shows the importance of accurate anamnesis, includingquestions on civil status. A global question about self-perceived oral health providesimportant information for judging patients’ oral health and determining preventive actions.The study also suggests that risk for deteriorating oral health lingers long after difficult lifeevents have occurred.

  • 110.
    Elo, Sirkka L
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hälso- och sjukvårdens roll som informationskälla för hälsoläget i befolkningen och uppföljning av dess folkhälsoinriktade insatser2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Information about health in the population and interventions to improve public health can be assembled directly through the National Public Health Survey and indirectly from health care. However, there are no generally applied routines for collection, analysis, and reporting of information from health care for public health interventions. In addition there are no routines for collection and feed-back of public health measures in health care.

    Aims: To analyse the role of health care and its methods of information about population health, and to support the development of health informatics and methods on follow up on public health interventions in health care.

    Methods: This project started by implementation and assessment of the Minimum Data Set instrument for public health nurses (PHN-MDS) in Örebro County (I). Next, clinical notes from public health nurses were analysed by a triangulation process and core elements identified, to be used in the information model (II). The Hospital Discharge Register is often used as a proxy for disease and disability in the population. In order to test its validity, data were collected for each individual who used an official care provider in a well defined geographical area (III). The final work (IV) uses data from a Public Health Survey in order to assess how and to whom health care professionals present questions and advice on health related life style and what factors influence this.

    Results: The PHN-MDS makes it possible to assess health problems in the population (I). Analyses of clinical notes from public health nurses showed a broad spectrum of interventions ranging from health promotion to diagnostic, therapeutic, rehabilitation and palliative actions (II). The comparisons of data on ischemic heart disease and its risk factors on an individual level indicated that less than half of the cases were identified in the Hospital Discharge Register (III). Smoking and physical activity are the most common themes for questions and counselling by professionals in health care. The probability to be asked decreases with age, and women are less often given questions and advice. Persons with obvious needs of counselling e.g. with diabetes, obesity and high blood pressure were more likely to receive counselling (IV).

    Conclusions: Development of health informatics makes it possible to collect and analyse data from health care in order to broaden the knowledge on health in the population, as well as on individual counselling within health care. Unfortunately, routines based on developed health informatics systems are insufficient

  • 111.
    Elo, Sirkka L
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    The public health nursing minimum data set: Development, application and use2009In: OmvårdnandsforskningArticle in journal (Refereed)
  • 112.
    Elo, Sirkka L
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Calltorp, Johan B
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Health promotive action and preventive action model (HPA model) for the classification of health care services in public health nursing.2002In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 30, no 3, p. 200-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a need for an expanded approach to develop knowledge of public health nursing as a sphere of public health. The aim of this paper was to construct a theoretical model for healthcare services in the area of public health nursing based on the analysis and classification of healthcare services used in public health nursing practice.

    METHODS: Patient records were examined using a qualitative research approach. The categorization and classification of the actions followed certain criteria. Three methods were used for verifying and modifying the concept.

    RESULTS: Of the identified categories 34 dealt with healthcare services, three with administrative services, and five with coordination. The six recognized domains of the healthcare services are health promotive services, health protective services, diagnostic services, therapeutic services, rehabilitation services, and terminal healthcare services. Using the public health approach, the Health promotive action and preventive action model (HPA model) was constructed in order to visualize where in the course of the process of health-ill health and developmental stages the public health nurses provide healthcare services. Health promotion and the levels of prevention are described on the operational and conceptual levels in this paper.

    CONCLUSIONS: The result is expected to have an important effect on how public health nurses conceptualize their field of knowledge. The classification reflects current public health policy by focusing on health promotion and illness prevention. The developed HPA model will support health service research.

  • 113.
    Elo, Sirkka L
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Karlberg, Ingvar
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Validity and utilization of epidemiological data: A study of ischaemic heart disease and coronary risk factors in a local population2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 123, no 1, p. 52-57Article in journal (Refereed)
    Abstract [en]

    Objectives

    To calculate the burden of ischaemic heart disease (IHD) and coronary risk factors in a defined population using data from all public providers of health care, i.e. inpatient and outpatient care in all settings.

    Study design

    Cross-sectional, 1-year retrospective study.

    Methods

    The main outcome measures were the number of individuals by diagnosis and by care setting, and gender- and age-specific event rates by diagnosis.

    Results

    Less than half of the individuals who visited any care provider for IHD or coronary risk factors were identified in the hospital discharge register. Calculation of the actual burden of disease in the population showed that when hospital discharge data were combined with outpatient data, there were no or slight differences in the age-specific rates of acute myocardial infarction (AMI), while the rates of angina were between two-fold and four-fold higher, and unspecified IHD was between three-fold and ten-fold higher in individuals aged ≥50 years compared with using hospital discharge data alone. The rates of hypertension, diabetes and lipid disorders increased in all age groups when outpatient data were added to hospital discharge data. The differences in the rates were more pronounced in women aged 50–79 years. However, the age-specific rates were higher in men except for hypertension which was higher in older women.

    Conclusion

    Data for epidemiological analyses of diseases are often based on hospital discharge data. This study found that hospital discharge data provide limited information on patients treated for IHD and coronary risk factors, except for AMI. These findings suggest that hospital discharge data should be combined with outpatient care data to provide a more comprehensive estimate of the burden of IHD and its risk factors.

  • 114.
    Elstrøm, Petter
    Nordic Council of Ministers, Nordic School of Public Health NHV. Nasjonalt folkehelseinstitutt, Avdeling for infeksjonsovervåking Postboks 4404 Nydalen, 0403 Oslo, Norge.
    Å isolere beboere er ikke nødvendig for å forebygge smitte av MRSA på sykehjem2013Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Methicillin-resistant Staphylococcus aureus(MRSA) associates with increased risk of morbidity and mortality. In Norway,public health officials recommend comprehensive infection control measures to prevent the spread of MRSA in healthcare institutions, includingnursing homes. Previous recommendations advisedsingle-room isolation for MRSA-positive nursing home residents. National MRSA-guidelines (2009)recommended avoidinglong-time isolation.

    Aim: Thisstudy aimed to determine whether the new MRSAregime,which no longer requires isolation ofresidents with MRSA,was equally effective as the former regime,which required isolation ofMRSA-positive patients,in preventing the spread of MRSA among residents in nursing homes.

    Method: This noninferioritycohort study used historical data on registered MRSA-cases in Norwegian nursing homes, information aboutinfection control measures in each nursing home,and statistics regarding the use of resources in primary health care.

    Results: The incidence rate for secondary cases of the same MRSA spa-type in the same nursing home was 6.3 per 1,000 person-years in nursing homes thatdid not isolateMRSA-infected residentsversus 18.5 per 1,000 person-years in nursing homes that did isolate such residents. The incidence rate ratio for new versus former MRSAregime was 0.34 (95% CI: 0.17–0.63).

    Conclusions: Thenonisolating MRSA regimeis equally effective as the isolatingregime in preventing the spread of MRSA. Our results suggest that allNorwegian nursing homes should implement the current national guidelines regarding MRSA

  • 115.
    Eriksson, Andrea
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Development of health promoting leadership – experiences of a training programme2010In: Health Education, ISSN 0965-4283, E-ISSN 1758-714X, Vol. 11, no 2, p. 506-515Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to describe and analyse the experiences of an intervention programme for development of health promoting leadership in Gothenburg in Sweden. The more specific purpose is to identify critical aspects of such a programme as part of the development of a health promoting workplace.Design/methodology/approach – A programme supporting managers in health promoting leadership was studied. The study was performed as a holistic case study design. In total, 17 semi‐structured interviews were conducted, supplemented with data from a leadership survey. The material was coded according to the principles of content analysis, resulting in the three main categories: comprehensiveness, integration and participation.Findings – The results show the importance of regarding the development of health promoting leadership as a contribution to the building of organisational capacity for health promoting workplaces. This requires a comprehensive approach, including both individual and structural aspects, as well as an integration of programme ideas into the practice of management. Moreover, a wide participation in the planning and design of the programme is desirable. The concrete outcomes of this programme were action plans for workplace health promotion developed during the programme. For the participating managers a positive part of the programme was also the possibilities for reflecting and sharing experiences.Originality/value – This study contributes knowledge and experiences that can be applied in the development of health promoting leadership. There is, however, a need for clearer health promoting goals and sub‐goals in order to assess the health outcomes of such a leadership programme.

  • 116.
    Eriksson, Andrea
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Health-Promoting Leadership: A Study of the Concept and Critical Conditions forImplementation and Evaluatio2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: This thesis aims to describe and analyse the concept of health-promoting leadership, including criticalconditions for implementation and evaluation of such leadership.

    Methods: Three case studies and one conceptual analysis were conducted using qualitative methods, including interviews, observations and document analysis. The qualitative data material in study III was supplementedwith quantitative material from a leadership survey. Study I was a qualitative case study of a Swedish industrial company characterized by a low sickness rate, a structure of self-managed teams and an organisational culturethat aimed to develop employee skills and influence. Study II was a phenomenograpic study of health-promoting leadership, as described by 20 individuals employed in Swedish municipalities. Study III was a case study of anintervention programme for the development of health-promoting leadership conducted in four city districts of Gothenburg, Sweden. Study IV was a case study on collaboration in workplace health promotion between municipalities in a Swedish region.

    Results: Study I illustrates how a company leader developed and influenced organisational culture, including the employees’ control over their work situation, participation and personal development. The results of this study emphasise the importance of considering contextual factors when evaluating the role of leadership in promotinghealth at work. Study II describes health-promoting leadership in three different ways: organising health promoting activities, supportive leadership style, and developing a health-promoting workplace. Interviewees frequently linked good leadership in general with good employee health. Study III shows the importance ofregarding the development of health-promoting leadership as a contribution to building organisational capacityfor a health-promoting workplace. The intervention programme was implemented in an existing managementgroup already producing action plans for workplace health promotion. Such integration is an important part ofbuilding organisational capacity for creating and sustaining a health-promoting workplace. Study IV shows thatcollaborative health-promoting leadership is viewed as a strategy to reduce the sickness rate amongmunicipalities in a region. The study implies that collaborative workplace health promotion should be organisedinitially on a small scale, giving participants the time and opportunities to develop mutual trust. Moreover, StudyIV demonstrates the importance of including participants with differing levels of knowledge and experienceabout workplace health promotion.

    Conclusions: Health-promoting leadership can be defined as leadership that works to create a culture for healthpromotingworkplaces and values, to inspire and motivate employee participation in such a development. Healthpromotingleadership can also be viewed as a critical part of organisational capacity for health promotion,including managerial knowledge and skills as well as organisational policies and structures that support a healthpromotingworkplace. Therefore, leadership involvement in the systematic development of both the physical andpsychosocial work environment is important.

  • 117.
    Eriksson, Andrea
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Axlesson, Runo
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Bihari-Axelsson, Susanna
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Health promoting leadership - different views of the concept.2011In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 40, no 1, p. 75-84Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe and analyse different views of health promoting leadership among actors involved in workplace health promotion in eight Swedish municipalities.

    METHODS: Twenty individuals were interviewed and their views were analysed according to the methodology of phenomenograpic research, exploring how health promoting leadership was described, what motives were expressed, and what critical conditions were perceived for developing such leadership.

    RESULTS: The informants described health promoting leadership in three ways: organising health promoting activities, having a supportive leadership style, and developing a health promoting workplace. The motives mentioned for developing health promoting leadership were instrumental motives and improved health. The critical conditions for health promoting leadership were organisational conditions, characteristics of individual managers, and support to managers.

    CONCLUSIONS: It seems that the concept of health promoting leadership was often used to link ideas about good leadership to the health of employees. Organisational goals and management trends may also have influenced the motives as well as the conditions for development of health promoting leadership.

  • 118.
    Eriksson, Andrea
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Bihari-Axelsson, Susanna
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Axlesson, Runo
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Collaboration in workplace health promotion: – a case study2012In: International Journal of Workplace Health Management, ISSN 1753-8351, E-ISSN 1753-836X, Vol. 5, no 3, p. 181-193Article in journal (Refereed)
    Abstract [en]

    Purpose– The aim of this article is to describe and analyze a case of interorganizational andintersectoral collaboration on workplace health promotion involving nine municipalities in a Swedishregion.Design/methodology/approach– A holistic case study design was chosen. The work of a projectgroup responsible for developing plans for collaboration in the target area of health promotingleadership was studied. Observations at project meetings, interviews with project members, andwritten project documents were analyzed by qualitative methods.Findings– Collaboration on health promoting leadership was seen as a strategy to reduce thesickness rate among the employees in the municipalities. The best way to develop such leadership wasconsidered to be through supporting good leadership in general and improving the general workingconditions of managers in the municipalities. Moreover, it was regarded as a critical condition to havestructural arrangements and resources to continue this collaboration.Practical implications– An implication of the study is that collaboration on workplace healthpromotion should be organized initially on a small scale, giving time and opportunities for theparticipants to develop mutual trust with one another. It is also important to involve participants withdifferent knowledge and experiences in the field. Thus, it may be possible to develop strategies forhealth-promoting leadership contributing to the overall aim of a decreased sickness rate.Originality/value– There is limited research on barriers and facilitating factors forinterorganizational and intersectoral collaboration on workplace health promotion. This study contributesan analysis of important conditions for this kind of collaboration.

  • 119.
    Eriksson, Andrea
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Jansson, Bjarne
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, SE-171 76 Stockholm, Sweden .
    Haglund, Bo J A
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, SE-171 76 Stockholm, Sweden .
    Axlesson, Runo
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Leadership, organization and health at work: a case study of a Swedish industrial company.2008In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 23, no 2, p. 127-33Article in journal (Refereed)
    Abstract [en]

    The application of knowledge on organization and leadership is important for the promotion of health at workplace. The purpose of this article is to analyse the leadership and organization, including the organizational culture, of a Swedish industrial company in relation to the health of the employees. The leadership in this company has been oriented towards developing and actively promoting a culture and a structure of organization where the employees have a high degree of control over their work situation. According to the employees, this means extensive possibilities for personal development and responsibility, as well as good companionship, which makes them feel well at work. This is also supported by the low sickness rate of the company. The results indicate that the leadership and organization of this company may have been conducive to the health of the employees interviewed. However, the culture of personal responsibility and the structure of self-managed teams seemed to suit only those who were able to manage the demands of the company and adapt to that kind of organization. Therefore, the findings indicate that the specific context of the technology, the environment and the professional level of the employees need to be taken into consideration when analysing the relation between leadership, organization and health at work.

  • 120.
    Fjeldstad, Gullborg
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Intrauterin fosterdød hos innvandrerkvinner og svenske kvinner – en svensk registerstudie2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background:

    Stillbirths or intrauterine fetal death have wide effects on families. This is  about women’s and children’s health as well as equity in health for all. As Sweden becomes more multicultural, new challenges in equity on women’s and children’s health develope related to culture, communication, women –and family matters, lifestyle and medical issues.

    Aim:

    The aim of this study was to assess the occurence of stillbirths in immigrant women compared to Swedish women and investigate factors related to stillbirths.

    Method:

    Data from 904 646 newborns and their mothers during the period 1992-2001 was analysed using bivariat analyses. A literature study was undertaken with a systematic appraisal of relevant national and international research in the field.

    Results:

    The analyses showed that stillbirth was more common in non-European immigrant women. OR: 1,45 (95% CI 1,28-1,63). Non-European immigrant women in Sweden had higher odds of stillbirths compared to the background population.

    The litterature showed that non-European immigrant women have 2-3 times the risk of stillbirths, and the risk of stillbirths is also increased in women of lower socioeconomic status (SES). Other risk factors indicated to be important are age, consanguinity, smoking and the quality of perinatal care.

    Conclusions:

    Non-European immigrant women in Sweden have higher odds of stillbirths compared to the background population. These women also have an increased risk of low SES, which is itself a riskfactor of stillbirth. Appropriate knowledge of difference in health needs in different groups in the community is important for filling the health care needs and improving the medical treatments. Further research is needed from different sectors to assess the importance of lifestyle, language limitations and how these women are treated by the health care system.

  • 121.
    Fjellingsdal, Anne - Gro
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Insidensregistrering av blodbaneinfeksjoner på en intensivavdeling i et lokalsykehus i Norge2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: BSIs is areof the most serious hospital infections patients are exposed to, and in the intensive care unit (ICU) it affects the most vulnerable patients.

    Aim: To find the incidence of BSI in an ICU in a local hospital in Norway, as well as examine the various risk factors related to Central venous catheters (CVK), as well as patients with general infection at point of admission.

    Method: Incidence registration of BSIs within 12 months, where the definitions of BSI is based upon the 2001 Sepsis Definition Conference. Data is collected prospectively as patients were admitted to the ICU. The study population is the number of patients who had been hospitalized for more than 48 hours in the ICU, and the study population is divided into three open cohorts.Patients with diagnosed BSI during their stay, patients with CVK during stay and patients with infection at admission.

    Results: 615 patients were in the ICU within 12 months, and 116 of those patients had been hospitalized for more than 48 hours in the ICU and were included in the study. Average length of stay ranged from 2 to 40 days (median 4 days). 73 of the 116 patients had CVK in place during their stay, andof these 11 had a laboratory confirmed BSI. Three patients without any central CVK in place during their stay in the ICU had a laboratory confirmed BSI, 14 in total. Of these 14, 6 weredefined nosocomial, i.e.5.2% (6 of 116) or 7.8 BSI/1,000 patient days. One patient was diagnosed with catheter-related BSI (CR-BSI), which corresponds to 1.7 CR-BSI/1, 000 catheter days. A total of 69 blood cultures were performed, of which 54 patients with CVK. Patients with CVK has a significantly higher risk of developing clinical BSI than those without CVK (OR = 5.3, 95% CI 2.32 to 12.0, p < 0.0001).

    Conclusion: This study shows a relatively low incidence of BSI, NBSI and CR-BSI. CVK is significantly related to the development of clinical BSI, but the study shows no link between CVK and laboratory confirmed BSI. This study may encourage health care  workers to focus more on the risk factors associated with the use of CVK to critically ill patients. It should also encourage researchers to focus more on the importance of consensus regarding definitions of BSI and clinical BSI, since this have been proven to have as high lethality rates as laboratory confirmed BSI

  • 122.
    Fleetwood, Christina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Brukarsamverkan inom hälso- och sjukvård i Sverige och Storbritannien: Handikapporganisationernas delaktighet i planering och utveckling av vård2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The concept of “user involvement”/collaboration in Sweden was described at WHO:s conference in Sundsvall 1991 as “the essense of a democratic health promotion approach”. User involvement in the form of handicap or patients ́ organizations participating in the planning of health care has been of interest for more than 35 years. Work had begun with user groups in Sweden as early as 1970, but there is very little empirical research in the area.The purpose of this dissertation is to further knowledge in the area of user involvement/ patient collaboration and to gain a wider perspective by comparing developments in Sweden with the United Kingdom. What are the motives behind user involvement? What factors influence user involvement? What forms exist and how do they compare with existing theory on collaboration? The dissertation is in 3 parts: A literature study based on material from the United Kingdom, an analysis of official documents from the Stockholm County Council and an interview study from 1999 with representatives from health care administration and patient organizations. Motives for user involvement/collaboration are improved democracy as well as improved quality by making use of the knowledge and experience of health care users. User involvement may also be a method for legitimizing reductions of resources and prioritizations, a practice which the handicap movement doesn ́t wish to be part of. Despite the extensive Swedish tradition of participation in organizations and interest groups, effective collaboration is hindered by unclear definitions, diffuse goals and unrealistic demands on the organizations ́ representatives. The resulting activity can most often be characterized as “consultation” rather than “collaboration

  • 123.
    Fleitscher, Hilde
    Nordic Council of Ministers, Nordic School of Public Health NHV. Alderspsykiatrisk enhet, Sørlandet sykehus, 4604 Kristiansand.
    Kognitiv svikt og sikkerhet i trafikken: vurdering av helsekrav og ergoterapeutens rolle2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: The aim of thestudy was dual. First, itsought to determine whether individuals with cognitive impairments meet health requirements fordrivingsafety. Second, itexaminedthe role of occupational therapists and their knowledge of driver assessments.

    Method:For part 1, across-sectional study was applied, based partly on data from 99 patient records,focusing on two neuropsychological tests (NorSDSA and UFOV) and on-roaddriver performancetest(P-Drive). The second part wasbased on data from an online survey sent to 1.857 Norwegian occupational therapists.

    Result:UFOV had significant correlation with outcome in P-Drive, high sensitivity, and high PPV. A failed UFOV indicates a reason to continue with an on-roadtest. NorSDSA had low sensitivity but high specificity and high PPV. Passing NorSDSA indicates a reason to continue with an on-road test. The items in P-Drive that had the highest correlation with the result of the driving assessment were problem solving,reaction, and attention to the left.Few occupational therapists in Norway were involved in driving assessment. Survey participants felt that they might play a central role in assessing the health requirements for driving but lacked the knowledge, valid and reliable methods, and national guidelines for driving assessments.

    Conclusion: From a public health perspective, the challenge is to identify at-risk drivers as early as possible, without unnecessarily restricting other drivers. This study shows a need for conducting neuropsychological tests and for a practical driving test to assess people with cognitive impairment. This area requires further study, just as there is a need for national guidelines.Occupational therapists perceived a central role for them in driving assessment. They believed they could contribute most effectively through a driving test.

  • 124.
    Forsman, Anna
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. THL National Institute for Health and Welfare, Mental Health Promotion Unit, Vaasa, Finland.
    Herberts, C
    THL National Institute for Health and Welfare, Mental Health Promotion Unit, Vaasa, Finland.
    Nyquist, F
    THL National Institute for Health and Welfare, Mental Health Promotion Unit, Vaasa, Finland.
    Wahlbeck, K
    THL National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland..
    Scheirenbeck, I
    Nordic Council of Ministers, Nordic School of Public Health NHV. School of Global Studies, University of Gothenburg, Gothenburg, Sweden..
    Understanding the role of social capital for mental wellbeing among older adults2013In: Ageing and Society, ISSN 0144-686X, Vol. 33, no 5, p. 804-825Article in journal (Refereed)
    Abstract [en]

    Previous research applying quantifiable measurements has established significant positive associations between social capital and mental health in older adults. This study aimed to obtain a deeper understanding of the causal mechanisms of social capital affecting mental wellbeing among older people. The study is based on two independent qualitative data materials collected through two focus group interviews and an open-ended question included in a Finnish population-based postal survey. The findings indicate that informal social contacts such as family members and life-long relationships between friends impact the experienced mental wellbeing among older adults due to shared life events, social support, mutual appreciation and trust, as well as a sense of belonging through common social activities. Hence, this study challenges Putnam's idea of social capital as a collective concept focusing on formal contacts and the benefits on a collective level. In addition, the findings highlight the obstacles specific to older adults in maintaining social networks and participation, which should be considered in order to promote mental health in later life.

  • 125.
    Forsman, Anna K
    Nordic Council of Ministers, Nordic School of Public Health NHV. THL National Institute for Health and Welfare, Mental Health Promotion Unit, Vaasa, Finland.
    The Importance of Social Capital in Later Life: Mental Health Promotion and Mental Disorder Prevention among Older Adults2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background Mental health problems among older adults are a central public health problem. Depressive disorders are among the most prevalent mental disorders in later life. Maintaining good health and experiencing well-being in later life are important for the growing population of older adults, enabling them to enjoy life and participate in society for longer.

    Aims The overall aim of the thesis is to examine how mental health and mental well-being can be promoted and how the incidence and prevalence of depressive symptoms and disorders can be prevented among older adults. The specific aims of the included studies are to examine the associations between mental ill-health (depression and psychological distress) and social capital among older adults, as well as to collect and evaluate the effect of psychosocial interventions for the primary prevention of depressive disorders. Another specific aim is to provide a better understanding of how social capital influences the experienced mental well-being among older adults.

    Methods Population-based survey data collected in Finland and Sweden in 2008 and 2010 were used and logistic regression analyses were conducted to examine the associations between depression and psychological distress among older adults (65+) and various social capital components. A systematic review and meta-analysis were conducted to evaluate the effect of psychosocial interventions on depressive symptoms, functional level and quality of life. Furthermore, two independent sets of qualitative data material – collected through two focus group interviews and an open-ended question included in a Finnish population-based survey from 2008 – were used in order to identify views on the causal mechanisms between mental well-being and social capital in later life (60+).

    Results Restricted social networks with regard to both quantity and quality aspects were found to associate with depression and psychological distress in later life as defined in this thesis. Low structural and cognitive social capital are both significant depression covariates in older adults, although the findings were somewhat inconclusive from the association studies. Low frequency of social contacts with friends and neighbours and experienced mistrust in friends were all significantly related to depression, while no statistically significant connection was found between depression and experienced mistrust in neighbours. Further, restricted access to instrumental social support was statistically significantly associated with depression, while other cognitive components of social capital, such as experienced general mistrust, as well as having a limited number of people to count on or who are concerned about you were significantly associated with psychological distress. In addition, based on both quantitative and qualitative data the findings of this thesis highlight the effectiveness and subjective importance of social activities for the maintenance of mental health and well-being among older adults. The social activities are an important mental health resource among older adults because of the accompanied sense of belonging to a social group, as well as feelings of purpose with regard to everyday life and hope for the future. The social activities evaluated in the systematic review and meta-analysis significantly reduced depressive symptoms when compared to no-intervention controls. However, the systematic review also revealed the scarce research base of psychosocial interventions, as only a small number of studies were included and many were characterised by a small or no effect.

    Conclusions The findings illustrate the need to actively maintain the social networks and interactions of older people in order to promote mental health and prevent mental ill-health. Older people experiencing low-level social capital are more likely to suffer from mental ill-health and this risk group should have access to initiatives that empower social networking and a maintained rich social life. In addition, the findings highlight the significant potential of psychosocial interventions as they support active and healthy ageing when appropriately implemented

  • 126.
    Forsman, Anna K
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. THL National Institute for Health and Welfare, Mental Health Promotion Unit, Vaasa, Finland.
    Nyqvist, F
    Schierenbeck, I
    Nordic Council of Ministers, Nordic School of Public Health NHV. School of Global Studies, University of Gothenburg, Gothenburg, Sweden..
    Gustafson, Y
    Wahlbeck, Kristian
    Nordic Council of Ministers, Nordic School of Public Health NHV. THL National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland.
    Structural and cognitive social capital and depression among older adults in two Nordic regions.2012In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 16, no 6, p. 771-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the association between structural and cognitive aspects of social capital and depression among older adults in two Nordic regions.

    METHOD: Data were retrieved from a postal survey targeting older adults aged 65, 70, 75 and 80 years (N=6 838, response rate=64%) residing in the Västerbotten region (Sweden), and the Österbotten region (Finland) in 2010. The associations between structural (measured by frequency of social contact with friends and neighbours) and cognitive (measured by experienced trust in friends and neighbours) aspects of social capital and depression (measured by Geriatric Depression Scale, GDS-4) were tested by logistic regression analyses.

    RESULTS: Both low structural and cognitive social capital as defined in the study showed statistically significant associations with depression in older adults. Only experienced trust in neighbours failed to show significant association with depression. In addition, being single and being 80 years of age indicated a higher risk of depression as defined by GDS-4.

    CONCLUSION: The findings underline the connection between adequate levels of both structural and cognitive individual social capital and mental health in later life. They also suggest that the connection differs depending on various network types; the cognitive aspect of relationships between friends was connected to depression, while the connection was not found for neighbours. Further, the oldest age group in the sample (80 years of age) is pointed out as a population especially vulnerable for depression that should not be overlooked in mental health promotion and depression prevention.

  • 127.
    Forsman, Anna K
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. THL National Institute for Health and Welfare, Mental Health Promotion Unit, Vaasa, Finland.
    Nyqvist, Fredrica
    Wahlbeck, Kristian
    Nordic Council of Ministers, Nordic School of Public Health NHV. THL National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland.
    Cognitive components of social capital and mental health status among older adults: a population-based cross-sectional study.2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 7, p. 757-65Article in journal (Refereed)
    Abstract [en]

    AIMS: To determine the associations between the cognitive aspects of social capital and mental health status in older adults.

    METHODS: Data on older people (65 years of age or older, n = 1,102) were retrieved from a general population mental health survey conducted in Finland in 2008. The response rate was 61%. The associations between self-reported depression (measured by the Composite International Diagnostic Interview Short Form, CIDI-SF) or psychological distress (measured by the General Health Questionnaire, GHQ-12) and perceived social support, sense of belonging, and trust were tested by logistic regression analyses.

    RESULTS: For the cognitive social capital indicators, difficult access to help from neighbours showed a significant association with depression. Furthermore, not having people to count on, experiencing a lack of concern from other people, and feeling mistrust towards other people were all significantly associated with psychological distress.

    CONCLUSIONS: Links between mental health and cognitive social capital indicate that social support and trust may be important factors to consider when developing interventions to promote mental health and prevent mental disorders among older adults.

  • 128.
    Forsman, Anna K
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. THL National Institute for Health and Welfare, Mental Health Promotion Unit, Vaasa, Finland.
    Schierenbeck, I
    Nordic Council of Ministers, Nordic School of Public Health NHV. School of Global Studies, University of Gothenburg, Gothenburg, Sweden..
    Wahlbeck, Kristian
    Nordic Council of Ministers, Nordic School of Public Health NHV. THL National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland.
    Psychosocial interventions for the prevention of depression in older adults: systematic review and meta-analysis.2011In: Journal of Aging and Health, ISSN 0898-2643, E-ISSN 1552-6887, Vol. 23, no 3, p. 387-416Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the effectiveness of psychosocial interventions for the prevention of depression in older people.

    METHOD: Systematic review and meta-analysis of prospective controlled trials.

    RESULTS: Thirty studies were included. Overall, psychosocial interventions had a small but statistically significant effect on depressive symptoms (17 trials, standardized mean difference = -0.17, 95% CI = -0.31 to -0.03). In comparison with no-intervention controls, social activities were effective in reducing depressive symptoms, but results should be interpreted with caution due to the small number of trials. No statistically significant effect on depressive symptoms was found for physical exercise, skill training, reminiscence, or for multicomponent interventions.

    DISCUSSION: Psychosocial interventions have a small but statistically significant effect in reducing depressive symptoms among older adults. The current evidence base for psychosocial interventions for primary prevention of depression in older people is weak, and further trials warranted especially for the most promising type of interventions evaluated, that is, social activities.

  • 129.
    Fredriksen, Sven-Tore D.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Intensivpasientens gåtefulle kunnskap: om erfart kunnskap og kunnskapsformidling i enintensivkonteks2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and purpose: Acute/critically ill patients have had their life-conditions severely altered from awell-functioning everyday situation to a situation in which they struggle to survive. Traditionally the knowledgeparadigmfrom natural sciences together with medical expertise constitutes the framework for treatment. To beacute/critically ill involves experiences and events and phenomena typical to the situation. The patients’embodied knowledge is not limited to the personal and private sphere, it refers to highly relevant preconditionsfor visibility and reception, also on an existential level; it represents knowledge which needs to be researchedand discussed openly within the public health and nursing sciences. This knowledge represents a differentontology and epistemology from the natural sciences and thus a different perspective, also with regards toclinical tutoring. The dissertation’s primary target is to increase the knowledge about how critical illness isexperienced and how experience based knowledge is significant to teaching in an intensive care context.

    Data and methods: The dissertation is based on qualitative methods. Sub-study I includes reviews ofarticles on stress in a perspective of body, space and relationship. Sub-study II contains interviews with formerICU patients relating to their experience of body, strength and movement during critical illness. Sub-study III isbased on former ICU patients’ experience of the physical presence of their significant others during criticalillness. Sub-study IV contains observations and interviews of ICU nurses on how they teach experience basedand interpretation based knowledge in clinical tutoring. Phenomenological-hermeneutic analysis method isapplied to all four sub-studies.

    Findings: Sub-study I describes how patients experience stress in a perspective of body, space andrelation. The body is influenced by sleep deprivation, pain and anxiety. Patients experience loss of control withtheir bodies as well as with the situation. The room mirrors the situation patients are in, creating stress by itsrepresentation of life as well as fear of dying. The patient’s horizontal position reflects disproportionate powerinducing a sense of disempowerment. Relational stress situations usually appear in contexts involvingobservation, care or treatment. The organizational structure and activity on the ward affects stress levels. In substudyII the ICU patients experience how power and movement is affected by a sense of loss of body, how theymanage to respond to the situation and how they eventually reclaim the body, power and movement. Theyexperience disempowerment and limitations to movement. This causes dependency and creates conflicts withtheir significant others, especially with regards to proximity and distance. The patients address their loss of bodyby drawing on resources from their significant others, yet refrain from allowing themselves involvement infamily matters. The struggle for survival is characterised by gallows humour and the cry for help as their finalcry. Reclaiming the body happens stepwise with the aid of staff combined with a need to achieve. Sub-study IIIdescribes problems related to proximity to, and distance from, the significant others. A sense of exclusion iscontradicted by being showered with gifts. It is unsettling for patients to have their situation compared to theirsignificant others’. They fear the loss of community with loved ones, yet they need to limit visits fromsignificant others. The lack of ability to communicate when others are physically present is unsettling. Sub-studyIV describes how ICU nurses tutor students in practise by demonstrating knowledge in meaningful actions. Theyconvey their impressions of situations to provide an overview, convey knowledge of observable phenomena, andteach skills to assist the body’s own processes. They also assess and evaluate physical expressions in the patientand how these can be read and addressed. Nurses are also concerned with conveying embodied knowledge totheir students.

    Conclusion: In four sub-studies this dissertation highlights a form of knowledge which clearly contraststhat of the natural sciences. During acute critical illness patients experience severe stress and disempowermentcaused by a lack of response and action from nurses who are unable to interpret the body’s own knowledge inthe situation. Patients are often facing life and death questions characterised by marginality and existentiality.Patients demonstrate ability to cope with the situation, but are rarely assisted with coping. Intensive care nursesdisseminate a variety of professional skills and knowledge to their students in order to provide comprehensionand understanding of situations. Experience based knowledge from an intensive care context thus becomes asignificant supplementary factor in the public health perspective

  • 130.
    Fredriksen, Sven-Tore D.
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Living the situation stress-experiences among intensive care patients.2007In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 23, no 3, p. 124-31Article in journal (Refereed)
    Abstract [en]

    The study is about the types of stress that patients in intensive care units experience. Ten reviewed articles selected from Cinahl and Pubmed between 1994 and 2003 constitute the data. The paper is a literature review, and the data is analysed from the phenomenological-hermeneutical point of view. Stress related to the body, room and relationships is discussed. Experiences of stress that are related to the body include bodily stress reactions, deprivation of control, emotions related to technical equipment, procedures and loss of meaning. Stress related to the room highlights the environment and the situation in which the patient finds him/herself. The ethical relations of professionals and separation of patients from their significant others constitute stress related to relationships.

  • 131.
    Fredriksen, Sven-Tore D.
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Svensson, Tommy
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden .
    The bodily presence of significant others: Intensive care patients' experiences in a situation of critical illness.2010In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 4Article in journal (Refereed)
    Abstract [en]

    This study is about intensive care patients and the bodily presence of significant others. The aim of the study is to inquire and understand the patients experience of the body in relation to their significant others during critical illness. Open, unstructured, in-depth interviews with six former intensive care patients provide the data for the study. The phenomenological-hermeneutical analysis points to a theme among ICU patients' experience of conflict between proximity and distance during the bodily presence of their relations. Patients experience different and conflicting forms of responses to the presence of their significant others. Patients experience significant positive confirmation but also negation through this presence. In the ICU situation, the reactions of significant others appear difficult to deal with, yet the physical presence is significant for establishing a sense of affinity. Patients seek to take some responsibility for themselves as well as for their relatives, and are met with a whole spectrum of reactions. Intensive care patients experience the need to be actively, physically present, which often creates sharp opposition between their personal needs and the needs of their significant others for active participation.

  • 132.
    Fredriksen, Sven-Tore D.
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Talseth, Anne Grethe
    Tromsø University College, 9293, Tromsø, Norway.
    Svensson, Tommy
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden .
    Body, strength and movement*intensive care patients’ experienceof body2008In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 3, p. 77-88Article in journal (Refereed)
    Abstract [en]

    This study is about intensive care patients’ experience of strength, body and movement during critical illness in an intensivecare unit. The aim of the study is to inquire and understand the ways the body and its experience appear when thephenomena of strength and movement are altered. The data were collected through in-depth interviews with seven patientsand analysed from a phenomenological-hermeneutical point of view. The findings showed a body that refuses to cooperateand is often marginally able to cope with the situation at all. It showed relational bonding between the patients and healthpersonnel and/or significant others where the patients were overlooked and at the same time dependent on the same persons.They were waving between life and death through dimension of existence, which is contrasted to earlier experiences. Theyshowed feeling responsible for the family through a role in to reduce their fears. At the same time, they are in a continuousstruggle for life in which they balance between vague hope and a situation so challenging that the only thing left is grimhumour. They showed progressing and expectations where the slightest changes in the situation in a positive direction createa hope in them.

  • 133.
    Furenbäck, Ingela
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Utveckling av samverkan: Ett deltagarorienterat aktionsforskningsprojekt inom hälso-och sjukvård2012Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Objective: The general scientific objective of this thesis is to reach a greater understanding of processes of collaboration.

    Design and methods: The study was conducted through participatory action research within the health services of Hässleholm, Sweden. The people involved, who were participants of different activities related to health care, aimed at developing their collaboration in a collective attempt to facilitate the development of an integrated local health care. Based on local circumstances and perspectives, the research has generated knowledge on which future decisions on how to implement practical changes can be made. A combination of various methods was used to generate empirical material, where the main method was participant observation withdialogue. In addition, interviews and document reviews were conducted as well as the use of collaborative inquiry,which is a specific method within participatory action research. The study was conducted according to a hermeneutic approach and interpretations were supported by various theoretical perspectives and models. Kurt Lewin's field theory constituted a general theoretical frame of reference for the study.

    Results: By describing and interpreting the course of events that were presumed to have an impact on the development of collaboration, a greater understanding of the observed collaboration process was achieved. The process was described in terms of vertical as well as horizontal integration within and between organisations. This description included components that were present in work processes as well as social processes. The observed collaboration process was divided into sub-processes, each of them containing a certain type of activity that was performed in support of the development of collaboration. Strategies for development of collaboration were identified and illustrated by different models: the linear hierarchical model and the dynamic model. The latter was developed through action research.

    Conclusions: At an initial stage, collaborationamong the participants in the field was supported by a linear hierarchical model, which constitutes a mind map where collaboration is developed in a linear hierarchical process. Politicians make decisions, managers make plans and professionals implement activities. The model emanates from a consensus theoretical perspective, where conflicts are regarded as disruptive elements. In this case, participants from various domains and organisations avoided the different conceptual worlds of one another, which ledto impediments in the developments of the collaboration process. The action research made it possible to intervene in the process by arranging communication arenas with and for participants from the different domains and organisations. Thus, collaborationcame to evolve from a dynamic model, which includes the assumption that collaboration processes are dynamic and is based on a conflict theoretical perspective, where conflicts are regarded as natural aspects of the processes

  • 134.
    Føreland, Nina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Internt pasienthotell, et alternativ til sengepost ved innleggelse i sengepost?2009Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Medical advances and demands for improved cost-effectiveness in Norway have contributed to a major focus on how to reduce costs while maintaining/improving the quality of treatment. A patient hotel is described as a way of achieving both increased flexibility and cost-effectiveness by offering more or less self-reliant patients an alternative to traditional hospitalization. Treatment in a patient hotel is based on a salutogenetic approach, while traditional hospital wards usually approach treatment pathogenetically. There is little research on whether converting traditional ward beds  to the patient hotel model is indeed cost-effective, especially when patient hotel beds are considered an alternative to traditional ward beds. This study sought to determine which patients in traditional wards were suitable for admittance to an internal patient hotel. The study used a cross-sectional survey/questionnaire to collect data and focused on (i) the criteria for admission to a patient hotel, (ii) supplementary treatment, (iii) the patient’s need for special observation, and (iv) the employee’s perception of the patient suitability for the patient hotel. Our survey included 951 patients and was conducted at Sørlandet Sykehus, Kristiansand, Norway, during a two-week period in the autumn of 2007. The survey included all patients admitted to traditional wards and to the patient hotel, except patients in the palliative, maternity, and observation wards. Because we evaluated the patients according to their functional level, we intentionally recorded several patients over a span of several days. We determined that about 18% of patients admitted to traditional wards met the admission criteria for the patient hotel. Patient distribution between the Medical and Surgical Clinic was even, but there were variations per unit. A large proportion of the patients received supplementary treatment, including many from the Surgical Clinic. Many patients who fulfilled the criteria for admission to the patient hotel required special observation. The survey revealed a variation in the employees’ evaluation of which patients were suitable for the patient hotel. However, there was little variation between the actual results and the employees' perception of the proportion of patients who met the criteria when adjusted for supplementary treatment and the need for special observation. Based on the results of the study, it is reasonable to transfer patients from traditional wards to a patient hotel. Furthermore, this option is cost-effective and will not reduce the overall quality of patient care.

  • 135.
    Garver, Else
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Gåture som sundhedsfremmende aktivitet hos ældre.: Ældre menneskers oplevelse af at have gennemført et otte-ugers interventions gå-tur projekt.2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The aim of this MPH thesis is to describe the experience of elderly people who have completed an eight-week intervention walking project. The insight and knowledge acquired in this study have been very useful with regard to the planning of walking for the elderly people who would not otherwise have ventured outside. A qualitative method has been used. The population consists of the eleven projectparticipants who completed the eight-week intervention period. The theme-based interviews have been transcribed in full and analyzed in accordance with a qualitative thematic analysis inspired by Giorgi’s guidelines and Husserl ́s philosophy. The project participants` comments demonstrate that walking as intervention gave them the experience of doing something, especially for their own wellbeing. Other important results were a sense of increasing mastery of their situation ,improved physical fitness, moreenergy, higher spirits a sense of fellowship, and some knowledge of the surroundings and nature. The project includes a new dimension: People who would not otherwise have ventured outside now do so because they get support either by walking alone and experiencing the "obligation" of walking or by walking with a companion. Offering walks to elderly people who would not otherwise have ventured outside seems to be a good decision in a public health care perspective because these elderly peoplepresumably live longer with a better health.

  • 136.
    Gaudernack, Lise C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Keisersnittønske hos andregangsfødende: utløsende faktorer og effekten av kjent jordmor2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study primarily aimed to determine how many second-time mothers hoping for a caesarean section changed their mind and requested a vaginal delivery when they had the opportunity to know their midwife in advance. Second it wasdetermined which delivery method was experienced by mothers in the known midwife group. The study also compares the rate of delivery complications experienced during first-time delivery for the whole study population compared to the mean population of Norwegian first time mothers. Finally the differences between the women choosing “known midwife” and those who choose caesarean section are explored regarding delivery complications and experience during first pregnancy

    Method:This quantitative study was conducted at Rikshospitalet in Oslo. All second-time mothers wanting a cesarean delivery without medical indication in 2006 to 2010 and having been offered to participate in the in “the known midwife project” were identified. The study used data from the Norwegian medical birth registry, delivery ward databases, and the patients’ personal journals.

    Among129 second time mothers desiring a caesarean delivery, 48 joined the “known midwife team” and planned a vaginal birth;the remaining 81 women choseto have a planned caesarean section and were called the “caesarean section group”. In the “known midwife group” 81.2% had a vaginal delivery. The 129 women had experienced significantly more complications than the mean population of Norwegian first time mothers during their first delivery. The women in the “caesarean section group” were four times more likely to have a health problem compared to women in the “known midwife group”. They were also more likely to have experienced birth anxiety during their first pregnancy.

    Conclusion: The consequences of caesarean section were discussed using terms such as health locus of control, sense of coherence, coping, empowerment, and public health.The major increase in caesarean sections worldwide has resulted in more health problems than they solve. Caesarian section has a negative short-and long-term impact on both mental and physical health. Therefore, it is vitally important to optimize vaginal delivery and prevent bad delivery experiences. Projects such as “the known midwife” help women who are afraid of having a vaginal delivery. Such projects should be encouraged

  • 137.
    Gausdal, Margit
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Depresjon blandt hjemmeboende eldre som utredes for demens i Norge2011Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background Depression and dementia are two of the most prevalent mental disorders among elderly individuals worldwide. Depression and dementia may occur simultaneously, and the disorders are often underdiagnosed. Relatives may experience great stress as caregivers.

    Aim This study aimed to a) examine whether depression in home-dwelling elderly assessed for dementia is associated with variables such as gender, marital status, age, cognitive function and need for assistance before and after a dementia assessment, and b) to examine if there is a association between depression in elderly undergoing dementia assessment and burden of their caregivers.

    Method The study is based on information about the patients treated in clinical practice for dementia assessment in 33 municipalities in Norway over the course of one year (n=474). Anonymised information was obtained from patients and their caregivers. The study included only patients who were assessed for depression as part of the dementia assessment (n=165).

    Results Depression assessments are conducted in 34.8 % of all dementia assessments, and 46.1 % of these patients have symptoms of depression (n=74). Patients with depression do not differ from patients without depression regarding gender, age, marital status and cognitive function.  Services from the community healthcare system do not differ, regardless of whether the patient has signs of depression. Depression is associated with caregiver burden (r = 0.44). In 31.6% of cases the patients had a severe degree of depression and their relatives reported a burden of care that ranged from easy/moderate to severe (n=24).

    Conclusion Half of the patients who participated in this study had symptoms of depression. Patients with depression do not differ from patients without depression. Depression is associated with caregiver burden. Dementia assessments in municipalities should place greater emphasis on assessments of depression.

  • 138.
    Gees, Lis
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Naturens betydning for ældres velvære2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Demographic development points to a significant increase in elderly and old people, which according to WHO is creating challenges for governments to make policies, that increase the opportunities for people to stay active as they age. The point is that there should be more emphasis on health promotion. This is a qualitative study on what impact nature has on elderly (60+) peoples experience of well-being, and what kind of nearby environment they prefer. Analysing 12 semi-structured interviews, the findings are, that the value of nature is very high amongst the informants and that nature tributes to their well-being. To them, their nearby environment is part of nature, and they particularly prefer garden and terraces. New findings in this study are, that the informants emphasis especially how much nature’s light means to them. The perspectives of this study suggest that health policies consider nature as a resource in health promotion

  • 139.
    Gjengedal Knudsen, Åse
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Foreldrekraft – en kvalitativ intervjuundersøkelse av foreldre til barn med Downs syndrom, multifunksjonshemning og autisme om deres opplevelser i møte med helse- og sosialkontorene og helsestasjonene2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The Purpose of the study was to gain knowledgeabout how parents with children that have Downs syndrome, are multi disabled and with autism experience the health care centres and the social services. How did the parents experience the effort they had to do to claim their rights and to make sure that their child received the care she/he was entitled on. The study took place in a middle sized city located in the west of Norway

    Method: In the study Grounded theory was applied as the main research method. A qualitative interview method has been used where 14 parents were interviewed. The interview guide was semistructured. Information about the research was done through contact persons from the healthcare centers or the social service office. The interviews took place either at the parent’s home or at the health care centres.

    The results: The findings showed that many parents experienced that the health and social professionals influenced the parent’s ability, care,and nursing, positive or negative depending on how involved in their work the health professional was. The core category of the study became The power of parents. This emerged from the five main categories: The helplessness of the child, The resources and abilities of the parents, The level of involvement from the professionals, The political actions and Network. Positive support and attitude from health and social professionals have supportive and helping affect on the parents, while negative attitude and lack of involvement weaken The power of parents. Political actions had influence on how the professionals acted. The parents’ network was also a component that influenced the level of the power of parents.

    Conclusion: Professionals working at the health care centres or at the social services affect the power of parents positive or negative. The parents experienced that they had to search for answers, fight for their rights and ask for help. The power of the parents were the continuously in the work with the children. The findings in the study show a need for increased competence among the professionals in their work with these children and their families. In addition, collaborate with the parents about new resolutions

  • 140.
    Gjøra, Linda
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Svart på hvitt - Norske avisers fremstilling av personer med demens2011Independent thesis Advanced level (degree of Master (One Year))Student thesis
    Abstract [en]

    Background: Dementia is a disease that will affect many of us during our lives. Our knowledge about a disease often reflects our response to it. Mass media is one resource that many people will use as they seek more information about dementia. In Nordic countries, newspapers are among the important mass media resources that create and spread information to the population.  

     

    Aim: This study aimed to gain deeper knowledge about how Norwegian newspapers present people with dementia.

     

    Method: Modified grounded theory was used to analyze Norwegian newspaper articles published during 2010.

     

    Results: Norwegian newspapers present people with dementia as a homogeneous group.

     

    Conclusion: Articles in Norwegian newspapers label people with dementia as stereotypes, thus sustaining the stigma already related to this group. There is a need for a broader presentation of people with dementia, one that describes individual differences and the different phases of the disease to achieve a more dementia-friendly society.

  • 141.
    Gram, Kristine
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Skolehelsetjenestens arbeid med kosthold og fysisk aktivitet for å forebygge overvekt hos barn og unge2010Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Since overweight currently affects 15-20% of all children in Nordic countries, overweight represents a growing public health problem among children and adolescents. Physical activity and healthy diet are important target areas for reversing this developing trend. Although school health services are uniquely positioned to address overweight within the school environment, time and availability present important barriers between schools and school health services. The purpose of this study was to explore how school health nurses in the Oslo area experience their roles, possibilities and limitations in preventing overweight by encouraging physical activity and healthy diet in children and adolescents. The present study is based on theories about health promotion, empowerment, salutogenesis and cooperation.We conducted qualitative interviews with nine school health nurses in different districts in the Oslo area and analyzed their response using the Graneheim method of content analysis. The results show that personal experience correlated with the level of the problem at the corresponding school. Both factors also related to socio-demographical factors. All participants viewed weight as a sensitive issue, and several encountered difficulty in identifying an approach toward overweight pupils. Different districts placed different priorities on preventing overweight. A year-plan that includes mutual goals and target areas figures importantly in adding these issues to the agenda of individual school health nurses. Lack of time was the foremost reason for sacrificing this work for other tasks specified in the “Recommended Program for School Health Services 5-20 yrs”. Since sharing tasks from different competencies strengthens work quality and since the opportunity to distribute tasks gives the individual more time, an interdisciplinary cooperation is particularly important with physiotherapists. We determined that adequate cooperation with the among school management and school based activities, among others with sufficient availability of health services and a coordinated year-planning, was necessary for shaping action-programs at a system level. Focus on weight and height was perceived as a sensitive topic and more informants in this study had difficulties finding an appropriate approach to overweight pupils. New national guidelines for weight

  • 142.
    Gran Bruun, Anne-Marie
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Grell Ulrik, Anne-Marie
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Udviskede professionsgrænseri: interprofessionelt samarbejde mellem læger og sygeplejersker inden for klinisk anæstes2008Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The study has had the purpose of examining how the self-perception of two professions affects their work and mutual relation in the area of clinical anaesthesia. A qualitative starting point with a salutogenetic perspective has been chosen with emphasis on creating a clear picture of expectations about what is good professionally and what is good teamwork. Concurrently, different potential areas of conflict are uncovered. The perception of roles appears as an ideal about how to act, which has common features independently of professional background. There appears to be good accordance between the different professions and their expectations of roles and mandate. This can create a basis for good co-operation, but at the same be a cause of conflict. Acknowledgement of the value of both professions’ core competences in dealing with patients is uncovered. The type of teamwork between the professions is dependent on the character of the assignment as well as the participants’ personality and experience. Transferral of assignments to the other profession can be seen as provocation against the integrity of both professions. Hierarchy and turf-protection appears to give rise to certain rigidity in the organisation of the work. Knowledge and skills are exchanged across the professions. This strain of empowerment seems to result in a unique collegiate spirit and binding. Neither of the two professions want to work in a mono professional context. But the pronounced overlap can give rise to inter-human challenges in connection to giving each other space while also demanding room for one’s own competencies and values.

  • 143.
    Granath, Aina B.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Antenatal Care, Southern Bohuslän County, Sweden.
    Pain from the pelvic area in relation to pregnancy: Prevention and explanation - two different approaches2007Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    From a public health perspective pain from low back and/or pelvis was studied in relation to pregnancy. Two interventions, water gymnastics or Friskis and Svettis ́ gymnastics for pregnant women, were evaluated regarding effects on symptoms and need for sick leave due to low back or pelvic pain. In an intervention study with 390 randomised women, 266 participated in physical activity during 60 minutes once a week during just about half their pregnancies. No one was sick-listed due to low back pain in the water gymnastic group compared to 6 women in the land-based exercise group (p=0.03). Some doubts may be raised regarding recommendations to pregnant women with a history of low back pain to participate in gymnastics. On the contrary, water gymnastics seems to be beneficial regarding low back pain. Methods to prevent pelvic pain in relation to pregnancy are not known. Furthermore, a possible relation between longstanding pelvic pain after pregnancy was investigated. Such a relation has never been described before. Fifteen subjects, women with defined posterior pelvic pain during and after pregnancy and as many controls without anamnesis of such pain were tested for lactose intolerance, using the BH2-test. A correlation was found, p=0.05 but results need to be confirmed in larger studies. The possible link towards explaining such a relation goes through the fact that lactose intolerance and “irritable bowel syndrome”, IBS, often overlap and lactose intolerance test is recommended to be included in investigation of IBS. Can low back/pelvic pain in relation to pregnancy sometimes be correlated to lactose intolerance?

  • 144.
    Granath, Aina B.
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Antenatal Care, Southern Bohuslän County, Sweden.
    Hellgren, Margareta
    Department of Antenatal Care, Southern Bohuslän County, Sweden .
    Gunnarsson, Ronny K.
    Department of Primary Health Care, Göteborg University, Sweden, and Research and Development Unit, Primary Health Care, Southern Älvsborg County, Sweden.
    Lactose intolerance and long-standing pelvic pain after pregnancystudy.: a case control2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 10, p. 1273-1276Article in journal (Refereed)
    Abstract [en]

    Background.Long-standing pelvic pain during pregnancy and after delivery (PPP) is common. Its causes are not fullyunderstood. A scientifically, undocumented, clinical observation is PPP patients often reporting unspecific abdominal painand adverse reactions to milk. The main objective in this pilot study was to investigate if lactose intolerance, celiac diseaseor allergic propensity are risk factors for developing pelvic pain after delivery.Methods.A matched, case control study,where consecutive patients consulting a registered physiotherapist specialised in treating women with postpartum pelvicpain were compared to matched controls.Results.Lactose intolerance was found in 10 of 15 patients, and in 3 of 15matched, healthy controls (p0.05). No difference was seen between groups in the prevalence of celiac disease or allergicpropensity.Conclusion.This study suggests that lactose intolerance might be a possible risk factor for pelvic pain afterdelivery.

  • 145.
    Granath, Aina B.
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Research and Development Unit, Primary Health Care in Southern Bohuslän County, Krokslätts vårdcentral, Mölndal, Sweden.
    Hellgren, Margareta S.E.
    Department of Antenatal Care, Primary Health Care in Southern Bohuslän County, and Department of Obsterics and Gynecology, Göteborg University, Sweden..
    Gunnarsson, Ronny K.
    Research and Development Unit in Southern Älvsborg County, Primary Health Care, Borås, Sweden.
    Water aerobics reduces sick leave due to low back pain during pregnancy.2006In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 35, no 4, p. 465-471Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To compare the effect of a land-based, physical exercise program versus water aerobics on low back or pelvic pain and sick leave during pregnancy.

    DESIGN:

    Randomized controlled clinical trial.

    SETTING:

    Three antenatal care centers.

    PARTICIPANTS:

    390 healthy pregnant women.

    INTERVENTIONS:

    A land-based physical exercise program or water aerobic once a week during pregnancy.

    MAIN OUTCOME MEASURES:

    Sick leave, pregnancy-related low back pain or pregnancy-related pelvic girdle pain, or both.

    RESULTS:

    Water aerobics diminished pregnancy-related low back pain (p=.04) and sick leave due to pregnancy-related low back pain (p=.03) more than a land-based physical exercise program.

    CONCLUSIONS:

    Water aerobics can be recommended for the treatment of low back pain during pregnancy. The benefits of a land-based physical exercise program are questionable and further evaluation is needed.

  • 146.
    Granerud, Arild
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Social integration for people with mental health problems: Experiences, perspectives and practical changes2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The goal of social integration is part of the ideological motivation behind the transition from institutionalised to decentralised psychiatric care. Modern community mental health care considers social integration vital for improving mental health. However, reports suggest that efforts to socially integrate people who suffer from mental health problems have not been as successful as anticipated.Aim: The overall aim of the study was to achieve a deeper understanding of the phenomenon of social integration of people with mental health problems in the community. An additional aim was to develop the healthcare professionals’ insight into this phenomenon by means of co-operative inquiry. The specific research questions were: How have people with mental health problems affected their neighbourhood after re-establishing in the community? How do people with mental health problems experience social integration in the community? How does knowledge of social integration promote practical changes in mental health professionals’ practice?Methods: This study, which comprises four papers, has a hermeneutic design. The data collection methods took the form of interviews with 19 neighbours of group homes for people with mental health problems (Paper I) and focus groups in two separate studies of people with mental health problems, one of which comprised 12 participants in three groups (Paper II) and the other 17 participants in three different multistage focus groups (Paper III), i.e. a total of 14 focus groups. Paper IV utilises findings from Papers I-III by means of a co-operative approach. There were two areas of knowledge development in the research process: dialogue-based teaching and focus groups. The main emphasis of the dialogue-based teaching was to facilitate the articulation of practical and tacit knowledge. Twenty-two healthcare professionals and social workers participated in two different multistage focus groups, a total of 6 focus groups (Paper IV). Data-analysis methods included both the constant comparative process and qualitative content analysis.Findings: The first paper begins with the experiences of neighbours of people who suffer from mental health problems. The neighbours reported frightening behaviours as well as complications in their contact with people who had long-term mental health problems, which led to increased insecurity and fear. The reaction of the neighbourhood was exclusion and segregation in the form of distancing or watching. The next two papers employed a user perspective and revealed that, when meeting people, the participants experienced shame and fear of exclusion due to lack of acceptance and loss of autonomy. Integrity proved a necessary quality for the possibility to be treated as an equal. Lack of work or a meaningful occupation and a low income contributed to a sense of worthlessness and loneliness. Those who had a job or took part in club activities seemed to achieve social companionship, which gave them a sense of being more socially integrated. The co-operative research project enabled co-researchers to gain increased professional knowledge and awareness, as well as providing potential for improvements in clinical practice. Systematic reflection on practice leads to an increased awareness of one’s own attitudes and intervention methods, societal conditions and the community’s attitude to the increased social integration of people with mental health problems. The experiential knowledge gained may contribute to health-promotion strategies such as social integration.Conclusions: Integration difficulties are experienced by both individuals with mental health problems and their neighbouring community. In order to achieve social integration, a person with long-term mental health problems needs to develop adequate social competence. Those working in community mental health care must ensure that people suffering from mental health problems experience a sense of belonging in the community, which can enable them to develop a network and achieve social integration in the planning and development of day-time activities and work, thus promoting social integration. The neighbourhood requires, at the very least, general information when a group home is established. Co-operative inquiry can be beneficial in the public sector, although in order to achieve the best possible result, the whole team must be involved and play an active role in all areas of the research project. If the groups are too large, the participants’ level of engagement may suffer. Multistage focus groups proved to be a powerful method for knowledge acquisition and should be further developed as a means of expanding new knowledg

  • 147.
    Granerud, Arild
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Severinsson, Elisabeth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Knowledge about social networks and integration: a co-operative research project.2007In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 58, no 4, p. 348-57Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study investigating how knowledge of social network and integration influenced mental health professionals' understanding and practice.

    BACKGROUND: Community mental health work focuses on people suffering from mental health problems as well as the consequences for the person involved and their family or network. There is a need to expand community mental health workers' knowledge about social networks and their functions.

    METHOD: A qualitative study using a co-operative research approach was used to develop participants' knowledge of social network and social integration theory. Action research has the potential to facilitate changes in the field. Data were collected using focus groups. Qualitative content analysis was employed to develop the theme and categories. The data were collected in 2004-2005.

    FINDINGS: The main theme identified was the potential of experiential knowledge-based competence, which was characterized by the following categories: (1) increased knowledge, (2) awareness of social interactions, (3) cross-disciplinary professionalism and (4) potential for changes in practice. Participants' knowledge and awareness of the potential of social integration as a tool for social network interventions were considerably strengthened. However, this knowledge needs to be implemented in practice.

    CONCLUSION: Co-operative research is an approach that can be beneficial in the public sector. To achieve the best possible results, the whole team must be involved and play an active part in all areas of the research project. If the groups involved are too large, participants' level of engagement may suffer.

  • 148.
    Granerud, Arild
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Severinsson, Elisabeth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Preserving integrity: experiences of people with mental health problems living in their own home in a new neighbourhood.2003In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 10, no 6, p. 602-13Article in journal (Refereed)
    Abstract [en]

    For patients with mental health problems, de-institutionalization has meant a shift from institutional care to living in the community. However, several studies show that problems of stigmatization, loneliness and negative attitudes devalue the dignity and autonomy of these patients. The aim of this study was to gain a deeper understanding of how people with mental health problems experience living in an apartment of their own. The data collection method was focus group interviews. The constant comparative method revealed the main category 'preserving integrity'. The subcategories were: the need for control over information, similar relationships with both friends and neighbours (symmetrical contact), and 'My home is my castle'. Participants who lived in a group home had little or no contact with their neighbours. The participants experienced lack of acceptance and loss of autonomy when meeting people. Integrity was a necessary condition in order for them to become equal citizens, experience autonomy and dignity, and have the opportunity to develop social contacts.

  • 149.
    Granerud, Arild
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Severinsson, Elisabeth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    The new neighbor: experiences of living next door to people suffering from long-term mental illness.2003In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 12, no 1, p. 3-10Article in journal (Refereed)
    Abstract [en]

    The transition from hospital to community care for people with long-term mental illness is of growing concern. The aim of the present study was to illuminate if and how people with long-term mental illness have affected their neighbourhood after re-establishing themselves in apartments of their own. Nineteen neighbours of group homes for people with long-term mental illness, in seven different communities in eastern Norway, have been interviewed. The grounded theory procedures as well as the constant comparative method were employed to analyse the findings. From the data, one main category was identified: the need for information.

  • 150.
    Granerud, Arild
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Severinsson, Elisabeth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    The struggle for social integration in the community--the experiences of people with mental health problems.2006In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 13, no 3, p. 288-93Article in journal (Refereed)
    Abstract [en]

    The goal of social integration is part of the ideological motivation behind the transition from institutionalized to decentralized psychiatry. Modern community mental health care considers social integration as vital for improving mental health. However, reports suggest that efforts to socially integrate people who suffer from mental health problems have not been as successful as anticipated. The aim of this study was to explore how people with mental health problems experience their ability to integrate socially into a community in central Norway. Three multistage focus groups, consisting of 17 people with mental health problems, were set up in two counties of different sizes. In this explorative study, data were analysed using a qualitative content analysis method. The participants experienced shame and fear of exclusion in their struggle to become integrated in the community. They had a sense of loneliness, had to struggle for equality and experienced being neglected. The days passed very slowly and they reported a lack of financial resources. They wanted to work or take part in other daytime activities and sought reciprocal relationships. In conclusion, those working in community mental health care need to ensure that people suffering from mental health problems experience a sense of belonging in the community, thus enabling them to develop a network and achieve social integration.

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