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  • 151.
    Grimsrud, Elisabeth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Fødselsopplevelser – hva synes å bidra til at de blir en negativ erfaring?2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study aimed to explore the aspects women describe as contributing to their negative experience of childbirth.

    Methods: We used qualitative thematic analysis to analyze 103 free-text comments in a questionnaire from the Norwegian cohort of the Bidens study. The comments were provided by women who had a negative childbirth experience.

    Main findings: The majority of respondents reported experiencing unexpected and dramatic complications during childbirth. We identified three major themes: “(i) complications in mother, baby or both”, “(ii) not being seen or heard”; and (iii) “experience of pain and loss of control”. Further, the majority of respondents had felt ignored, had not been treated with respect, and did not feel included in decisions about their childbirth. A minority described pain and loss of control as the main reason for their negative birth experience.

    Conclusions: The women’s comments show that they did not expect to experience negative things during childbirth. Further, they were unprepared for complications and improper care. Alarmingly, many respondents experienced what must be characterized as abuse in the health-care system (i.e. neglect, verbal abuse or rudeness). The present study shows that caregivers’ attitudes and presentation contribute importantly to a positive childbirth experience. Midwives can use the information gained from this study to prevent negative birth experiences.

  • 152.
    Griskonis, Sigitas
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Patients' perceived satisfaction with hospital services2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    ackground. There are a number studies related to patients’ satisfaction with health care. Since the Baltic States regained independence in 1990, a reform of the health care system took place in which a serious consideration is paid to health care quality. Patients' views are becoming increasingly important in the current health system. They provide information on effectiveness of healthcare and how it may be improved.The main objective of this study was to investigate inpatients experiences with the care and treatment given in Klaipeda hospitals in order to improve the quality of care and patients’ satisfaction. Material and methods. A cross-sectional survey with questionnaires was made. The subjects of the investigation were patients (from 18 years old), hospitalized in internal and surgery departments in different Klaipeda city hospitals. The survey questions were divided into sections that broadly followed the patient's experience in the hospital. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multiple logistic regression to estimate Odds for each of the independent variables in the model.Results. The study shows that 60-80 % of the respondents were satisfied with different parts and aspects of health care services. Satisfaction with getting enough time for discussion with the doctor was higher for younger, male and employed patients. Those from the city needed more understandable explanation from doctor about health condition or treatment plan. Doctors listened more to male patients compare to female. Those results were statistically significant. Conclusions. Majority of the patients were satisfied with hospitalization order in Klaipeda hospitals. Better physician communication skills can improve patient satisfaction and clinical outcomes. Physicians could more effectively facilitate patient involvement by more frequently using partnership-building and supportive communication. Hospital cleanliness is quite important factor to overall satisfaction with hospital care. Waiting time is a significant component of patient satisfaction and depends from patients’ characteristics and their behavior. Different aspects of reception can influence patients’ satisfaction and must be considered. Information about continuity of the treatment were needed more for patients with an increased need for follow up, younger and living alone patients. It is important to provide the setting customers expect and create an environment that meets or exceeds customer needs for safety, security, support, competence, physical comfort, and psychological comfort.

  • 153.
    Grytli, Ingvil
    Nordic Council of Ministers, Nordic School of Public Health NHV. Helsetjenesten, Molde kommune, N - 6413 Molde, Norge.
    Ansattes syn på friluftsliv i barnehagen: En kvalitativ studie2013Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Purpose This study aimed to increase knowledge about the stance, opinion, and valuesof kindergarten employees regarding the use ofnature in playand general activity. We also investigated the role of kindergarten, and factors that promote or inhibit how kindergartens use nature.

    Method Twenty-one kindergarten employees from four municipalities in Central Norway participated in six focus group interviews. Study participants came from kindergartens that provided aspecificfocus on outdoor and nature in the name of the kindergarten, or on their homepages, as well as kindergartens that lacked such focus. We used qualitative contentanalysis to analyzethe data.

    Results Our analysis identified three categories: (i) nature as an arena for physical and psychosocial development and learning, (ii) kindergarten as a promoter of outdoor activities, and (iii) factors that influence the use of nature. We found that such influencesoccur within the kindergarten, in arenas outsidethe kindergarten,and from central authorities.

    Conclusion The use of nature can contribute to learning and the overall development and health of kindergartners. Moreover, nature may help reducesocial health inequalities. To enhance the facilitation of regular activity and playing in nature, several internal and external factorsshould be considered

  • 154.
    Grønning Stølen, Svanhild Bjørg
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Inntakav vanlig brusog lettbrus og insidens av diabetes type 2 blant adventister i Nord-Amerika2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Diabetes is increasing globally,presenting a growing public health problem. The rapid rise of obesity, physical inactivity, and an increasinglyelderly populationcontribute to this epidemic. The increase in obesity and diabetes coincide with increased intake of sugary and artificially sweetened drinks.

    Aim: This study aimed to investigate whether the consumption of regularor diet soft drinks predicts the incidence of type2 diabetes.

    Method: We used data collected from the Adventist Health Study-2, a prospective cohort study. The data was based on a baseline questionnaire, as well as a follow-up form (i.e., hospital history form-3) distributed to previous respondents up to 6 years later. Both questionnaire and follow-upformasked about a possible diabetes diagnosis and date of diagnosis. Importantly, Adventist Health Study-2 excluded individiuals who presented with diabetes at baseline. Among 45,777 subjects, the study detected 1,277 new cases of diabetes. Analyses were conducted both with and without body mass index. Complementary log-log Cox analysis was used to calculate hazard ratios(HR)and corresponding 95% confidence intervals.

    Results: Adjusted for demographic variables, body mass index, type of diet, physical activity, and fiber and magnesiumintake, multvariateanalysis showed that consumptionof ≥1 can (355 ml) of diet soda/day was associated with the incidence of type 2 diabetes (HR=1.46, 95% CI, 1.19 to 1.73;p<0.001). In comparison,consumptionof ≥ 1 can of regular soda/daydid not increaserisk of diabetes (HR = 1.20, 95% CI, 0.95 to 1.50). The associations were strengthened and statistically significant for both types of soda when not adjusted for BMI. Other risk factors for developing diabetes included age, male gender, non-white ethnicity, and body mass index. High intake of magnesiumandfiber, higher education,and a vegetarian diet were protective against the disease.

    Conclusion:  Consumption of diet soda was significantly associated with the development of type 2 diabetes.

  • 155.
    Gunnarsdóttir, Hrafnhildur
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ambivalent men naturlig del av våra liv: Kvalitativ studie om ungdomars inställning till Internets roll i främjandet av hälsa och välbefinnande.2010Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Adolescents and young people of the 21st century represent the first generation togrow up with the new digital technology and view it as an integrated part of their lives. Previousstudies show that young people value the potential of the Internet for acquiring information thatotherwise might be difficult to obtain. They also recognize the potential of the Internet for meetingand developing relationships with other people. Young people face diverse challenges during theirtransition from childhood to adulthood and need to have easy access to health information and socialsupport. Developing the potential of the Internet as a source of health information and social supportrequires increased information about young people's own views and preferences.

    The aim of thestudy was to deepen the knowledge about young people’s views on the role of the Internet inpromoting health and wellbeing.

    Method: Focusgroupdiscussions were conducted and included 26youths between 16 and 20 years of age, divided into six groups. Collected data was analyzed usingmodified grounded theory. The results show ambivalence among young people regarding the role ofthe Internet in promoting health and well-being. Although young people report a positive view of theInternet and their experience with it, they were very aware of its negative aspects and tried to findstrategies to minimize those aspects. Despite this ambivalence, the young people in this studyconsidered the Internet as an essential part of their lives and a natural source of health informationand social interaction.

    Conclusions: Efforts should be made to minimize the negative aspects of theInternet in order offer young people access to health information and social support in ways that suitsthem.

  • 156.
    Gunnarsdóttir, Oddný
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Users of a hospital emergency department: Diagnoses and mortality of those discharged home from the emergency department2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Objectives – To ascertain the annual number of users who were discharged home after visits to the emergency department, grouped by age, gender and number of visits during the calendar year, and to assess whether an increasing number of visits to the department predicted a higher mortality.

    Methods – This is a retrospective cohort study, at the emergency department of Landspitali University Hospital, Reykjavik capital city area, Iceland. During the years of 1995 to 2001 19259 users visited the emergency department, and were discharged home and they were follow-up for cause specific mortality through a national registry. Standardised mortality ratio, with expected number based on national mortality rates was calculated and hazard ratios according to number of visits per calendar year using time dependent multivariate regression analysis were computed.

    Results – The annual increase of visits to the emergency department among the patients discharged home was seven to 14 per cent per age group during the period 1995 to 2001, with a highest increase among older men. The most common discharge diagnosis was the category Symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified. When emergency department users were compared with the general population, the standardised mortality ratio was 1.81 for men and 1.93 for women. Among those attending the emergency department two times, and three or more times in a calendar year, the mortality rate was higher than among those coming only once in a year. The causes of death which led to the highest mortality among frequent users of the emergency department were neoplasm, ischemic heart diseases, and the category external causes, particularly drug intoxication, suicides and probable suicides.

    Conclusions – The mortality of users of the emergency department who had been discharged home turned out to be higher than that of the general population. Frequent users of the emergency department had a higher mortality than those visiting the department no more than once in a year. Since the emergency department serves general medicine and surgery patients, not injuries, the high mortality due to drug intoxication, suicide and probable suicide is notable. Further studies are needed into the diagnosis at discharge of those frequently using emergency departments, in an attempt to understand and possibly prevent this mortality

  • 157.
    Gunnarshaug, Bente
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Fall blant pasienter i hjemmet og i sykehjem og betydning av tverrfaglighet og mestring2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Falls and fear of falling is a major and increasing problem for older males and females in the Western world. The effectiveness of falls prevention programmes is well documented and the multidisciplinary approach has been proven to be the most effective. For this reason the municipality of Stavanger has given priority to falls prevention programmes in the care for the elderly. The implementation of new models of care is challenging, it is therefore important to determine whether new techniques achieve good outcomes which in turn can influence how we deliver our service. The theory of this study is based upon understanding the concepts of a multidisciplinary approach, salutogenesis and coping, and how they impact on the implementation of falls prevention interventions.

    The objectives of this study were to obtain data about falls amongst patients in nursing homes and those patients receiving home care. To explore how the health professional documents and evaluates the patients’ and relatives’ experience after a fall, and to find out which falls prevention interventions are currently being utilised.

    A two part evaluation was chosen for this study. Part one outlines the fall description and the types of patients who fell. Part two reviews the interventions utilised after a fall and benchmarks them against recognised standards and procedures. Data gathered from 12 nursing homes and 5 home care units, using the fall registration form, over a period of four months, was analysed. Further information was obtained by conducting focus group interviews with the staff of nursing homes and home care units.

    During the period 798 falls were registered of which 170 falls resulted in injuries. A total of 365 patients fell, 45% of all patients in nursing homes and 6% of all patients receiving home care. All staff expressed the importance of reducing risk of falling, and providing multidisciplinary interventions. They gave the impression that it was easy to register falls, but difficult to follow up with interventions. This was supported with the results from the quantitative study, 50% of falls had no documentation of follow up. For patients living at home environmental changes were the most used intervention, for patients in nursing homes being looked after were most important. Individual assessment and multidisciplinary interventions were rarely carried out.

    For successful implementation of evidence based practice in falls prevention it is important to identify the target group. Other areas to be improved include the utilisation of patient assessments and ongoing evaluations with the focus on patients’ resources and individual coping strategies. Managers should ensure the adoption of the multidisciplinary team approach to interventions and implement regular assessments and evaluation of the target group

  • 158.
    Gunnersen, Morten
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Disability Adjusted Life Years in a Regional and Cultural Perspective.: Who Should weight the disabilities?2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The concept of disability adjusted life years (DALY) came forward in the early 1990’s to be used as a measurement of the burden of disease. The DALY combines the burden with regard to premature death and years lived with a disease. Much criticism has been raised since then with regard to e.g. ethics. This thesis focuses on the lack of contextual aspects of the DALY-concept because the measurement has a universal standard for all diseases in all countries. One aim of the study is to describe how regional and cultural context influence the view of disability and therefore contradicts with the underlying approaches of the DALY-concept. The regional and cultural differences are illustrated by examples like paraple-gia. Published burden of disease studies are examined for contextual considerations. The conclusion of the analysis is that regional and cultural issues are not taken into ac-count when using the DALY-approach of health assessments in public health. The second aim of the study is to discuss who should value the life of disabled. Follow-ing the transition of health, different views of fair health have developed and the need of health care. Underlying this assessment is an implicit valuation of disabilities among lay-people and health care professionals. If one uses DALY as a general measurement for the burden of disease and prioritising resources for disabled it is discussed who should be involved in the calculation of disability weights and a model for the collabo-ration is described. The conclusion is that lay people must be involved in a facilitated process. Overall the thesis show that the development of DALY is a serious attempt to give a simple tool for understanding and prioritise the complex challenges in public health. At present, an agenda for development of contextual DALY’s is needed.

  • 159.
    Gyldenhof, Susanne
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sundhed som en del af skolens hverdag: hvordan kan lærere bidrage som sundhedskoordinatorer?2013Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Purpose: This study aimed to increase understanding by management, teachers and healthcoordinators regarding the role of health coordinators in schools and to investigate schools’responsibility in promoting student health and well-being. The aim was also to identify thestrengths and barriers of health coordinators regarding implementation of a program ofaction.

    Methods: Based on semi-structured interview guides, three qualitative focus groupinterviews and four individual interviews were conducted with managers, teachers andhealth coordinators at a total of four schools. The method of analysis wasphenomenography.

    Results: 4 categories and 12 subcategories were developed. Categoriesincluded (i) the school has a task, (ii) an important key person, (iii) management matters,and (iv) it makes a difference. All informants agreed that school plays a meaningful role inpromoting children’s health and well-being. The informants use the broad and positivehealth concept exemplified by the World Health Organization. The measure must bemultifaceted, demand a clear priority, and provide an extensive implementation period. Theteachers as health coordinators must have the right qualifications and operate within a fixedstructure. Management predominantly viewed health coordinators as supportive, andteachers expected health coordinators to maintain focus and support them in their jobs.When describing their experiences and knowledge, health coordinators frequently usedhealth promotion and education terminology. They also viewed leaders’ support as essential.The results show a positive change in attitude toward the health coordinator function anddescribe different initiatives implemented by health coordinators.

    Conclusion: Promoting health and well-being in schools is a meaningful job that requiresschools to provide clear political and managerial priorities and sufficient time forimplementation. All informants recognized the usefulness of the health coordinator’s role.Informants recognized that the setting approach includes many elements that provide asuitable frame for continued effort.

  • 160.
    Hallberg, Lillemor R-M
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ett pionjärarbete för ensamvargar: Enkät- och intervjuundersöknng av nordiska folkhälsodoktorander examinerade vid nordiska hälsovårdshögskolan under åren 1987 - 2000.2001Report (Other (popular science, discussion, etc.))
    Abstract [sv]

    Forskarutbildning bör kontinuerligt utvärderas för att anpassas till de krav som olika intressenter ställer. Syftet med denna undersökning var att be-skriva hur folkhälsodoktorer, som examinerats från Nordiska hälsovårds-högskolan (NHV) mellan åren 1987 – 2000, upplevt sin forskarutbildning och sin fortsatta akademiska karriär. Data samlades in dels genom en post-enkät med 17 frågor och dels genom en bandinspelad intervju med öppna frågor. Elva av 17 examinerade folkhälsodoktorer besvarade den utsända enkäten. Samtliga ställde sig positiva till att delta i den uppföljande inter-vjun. Fyra av folkhälsodoktorerna tycktes vid tidpunkten för studien vara docentkompetenta och flertalet hade anställningar inom universitet och hög-skolor. Flertalet var forskningsaktiva och hade i genomsnitt publicerat fyra artiklar efter disputationen. Av undersökningen framgår att de examinerade folkhälsodoktorerna i stort sett var nöjda med sin forskarutbildning. De har minnen av suveräna föreläsningar, intressanta tvärfackliga diskussioner och en stimulerande stu-diemiljö. De upplevde dock att de haft få möjligheter att diskutera sina av-handlingsarbeten med andra doktorander och övriga forskare/lärare på NHV. De menade också att de inte tillräckligt utvecklade ett kritiskt förhållnings-sätt under sin forskarutbildning. Flertalet hade genomgått få ämnes- och metodkurser utöver de kurser som ingick i MPH-examen. Forskarutbild-ningen, som i genomsnitt tog 4 år, innebar i princip att ytterligare 3 – 4 em-piriska studier skulle planeras, genomföras och dokumenteras. Jämfört med dagens kursplan för forskarutbildning på NHV (1999), är det tydligt att kra-ven på ämnes- och metodkunskaper har ökat betydligt. Folkhälsodoktorerna hade både positiva och negativa synpunkter på den handledning de fått. När extern och intern handledning vägdes samman, ansåg sig dock flertalet nöjda med den handledning de fått. Några var dock otillfredsställda med handledningen och ansåg sig ha klarat av avhandlings-arbetet genom insatser från andra lärare vid och utanför NHV. Avhandlings-arbetet upplevdes som ett pionjärarbete, som till stora delar utfördes i en-samhet. Flera av de svagheter i forskarutbildningen som angavs i under-sökningen, har tillgodosetts genom den nya kursplanen för forskarutbild-ningen, som antogs av NHVs styrelse 1999.

  • 161.
    Hallberg, Ulrika
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Klingberg, Gunilla
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Oral ohälsa hos personer med kognitiva och/eller fysiska funktionsnedsättningar: ett dolt folkhälsoproblem?2008Report (Other academic)
    Abstract [sv]

    Antalet individer med funktionsnedsättning ökar, dels beroende på att numera kan sjukdomar botas som tidigare inte kunde botas och dels beroende på att allt fler för tidigt födda barn kan räddas. Den orala hälsan är ofta negativt påverkad hos personer med funktionsnedsättning och det föreligger risk att dessa personer, trots ett större tandvårdsbehov än andra, erhåller mindre tandvård. Anledningen till detta är inte helt känd. Syftet med våra studier var därför att fördjupa kunskapen om hur personer med funktionsnedsättning och deras anhöriga prioriterar och tänker om oral hälsa. Syftet med studierna var också att fördjupa kunskapen om hur hälso- och sjukvårdspersonal samt tandvårdspersonal tänker om behov avseende bemötande och oral hälsa hos personer med funktionsnedsättning. Den kvalitativa forskningsmetoden grounded theory har valts då den är speciellt lämplig på områden där teorier är sparsamt förekommande eller saknas. Öppna kvalitativa intervjuer har genomförts med 65 informanter. Studierna visade att föräldrar till barn med funktionsnedsättning samt vuxna personer med kognitiva och/eller fysiska funktionsnedsättningar inte prioriterade den orala hälsan på grund av att andra mer akuta problem upplevdes som viktigare. Många personer med funktionsnedsättning vårdas kortare eller längre tid på vårdinrättningar, men kunskapen om oral hälsa var låg och inte prioriterad av personal inom hälso- och sjukvården. Personer med funktionsnedsättning återfinns inom såväl allmäntandvård som specialisttandvård och kunskapen om dessa patienters vårdbehov och bemötande av dem varierade mycket mellan olika kliniker, allmän- och specialisttandvård och mellan olika tandvårdspersonal. Sammantaget utgör dessa resultat en möjlig förklaring till varför personer med funktionsnedsättning löper ökad risk för oral ohälsa. Detta innebär också att en prioriterad, god oral hälsa och ett adekvat bemötande av personermed funktionsnedsättningar snarare kan handla om tur än om en jämlik rättighet.

  • 162.
    Hallman, Göran
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Nyttjandet av resurser inom hälso- och sjukvård samt social sektor: En ny modell för utvärdering byggd på sammanförda individdata från utförare2008Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The Swedish welfare system is complex and includes a range of health and social services, varying providers, and numerous financial methods. Such complexity makes it difficult to evaluate the components and study their interactions. Although the system combines a professional problem solving approach with a service concept, it currently lacks evaluative analyses to offer perspective on how individuals might benefit from the different components of the system.

    During the 1980s and 1990s, many county councils in Sweden established special units to elicit new knowledge , using the community diagnostic model (CDM) to collect and analyze medical and administrative data about welfare recipients. The system intended to use such data in policy discussions, especially to improve the health system, and also in planning processes between component providers who sometimes respond as individual participants. Others have discussed the use and impact of such data in managing health and social services. Further, intersectoral studies, e.g. how disabled individuals use services, have raised questions regarding the effectiveness and efficiency of the welfare system that might relate to differing internal and external expectations regarding supplied services.

     

    This thesis proposes a new methodology for collecting information from the different components of the welfare system. The evaluation model, D5, described here was developed and tested during a “community diagnosis” in the small municipality of Oxelösund, which is located south of Stockholm. The model produced valuable information on service utilization predictors for and also added new data that will enhance the identification of appropriate services during the application process for disability pensions.

  • 163.
    Hannestad, Anette
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Empowerment gjennom læring: Hvordan opplever utøvere å bli involvert i en empowermentprosess, når de lærer å forbedre egne arbeidsoppgaver?2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Experiences in my work as a nurse made me interested in the correlation between the inclination of health care professionals to learn and their status as empowered people.

    Purpose: The aims of this study is to gain more knowledge about how health care professionals perceive the experience of being involved in conscious learning processes and to get a better understanding of factors that are critical in this empowerment process.  

    Method and material: Phenomenography was used as the research method. 17 health care professionals, who are working in the primary health care system in two different Norwegian municipalities, participated in focus group interviews. They were divided into five quality management groups. All informants had previously learned from an external supervisor how to improve the quality of their work by using flow charts.

    Results: The data were categorized into one core category and three main categories. Critical factors are: the organisation’s focus on quality improvement, sufficient human and economical resources for learning, time for reflection and learning, an external supervisor teaching and supporting the groups, and leadership supporting change. Other important factors are how the professionals accept the extra work involved in being learners, group dynamics, and efficient use of flow charts.

    Conclusion: The findings suggest that a structure which gives the health care professional a feeling of legitimacy for giving priority to learning, is more likely to enter the process of empowerment

  • 164.
    Hansen, Hans Henrik Erland
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Seksuel orienteringsdiskrimination i Danmark: et studie af seks homoseksuelle mænds oplevelser og erfaringer i det danske forsvar2009Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study aimed to improve knowledge about and illuminate the phenomenon of sexual orientation discrimination (SOD), particularly as perceived by homosexual men in a male-dominated workplace such as the Danish Armed Forces. We also sought to increase understanding of how such discrimination affects those individuals. Moreover, wesought to increase knowledge about and highlight the challenges and problems regarding SOD in the context of coping strategies.

    Method: We used transcribed semi-structured in-depth interviews as our survey tool. To analyze our results, we used open, axial, and selective coding, as described in grounded theory.

    Results: Data analysis allowed us to identify minority power (MP) as a core variable. Further, MP is sourced in the four main categories: stressors, coping, environment, and identity, which are elements of the core process. The MP model that emerged from our results illustrates the core process.

    Conclusion: The study shows that homosexual men use a complex range of coping strategies in different situations where SOD occurs. Despite the negative minority stressors experienced by homosexual men in the Danish Armed Forces, the subjects showed a unique sense of coherence—meaningfulness, comprehension, and manageability—that leads to MP. To benefit the entire population, this study emphasized the need to include questions about sexual orientation in public health research. The study shows that training about the special social conditions for the LGBT population, a diversity policy, and recruitment campaigns aimed at homosexuals result in greater competence among all individuals in the workplace. Preventing discrimination based on sexual orientation requires a salutogen perspective and multifactorial strategy on an intersectorial and interdisciplinary level without placing all responsibility on the individual

  • 165.
    Hansse, Sjur Bjørnar
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    LINDRING AV LIDELSE MOT LIVETS SLUTT: ET PÅRØRENDEPERSPEKTIV Pårørendes opplevelser av hvordan omsorg i hjemmet var med på å lindre lidelse hos deres nærmeste2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Many cancer patients prefer to be cared for at home the last period of their lives. The next-of kin has a key role in the care for their loved ones. The society has a responsibility to organise health care services to make this possible. The aim of the study is to explore the next of kin experiences in how their loved ones’ illness and suffering were met by professional health care workers in their home. Further through the relatives’ perspective and experiences to get knowledge about how the care for the ill person and the family should be performed to meet their needs in the terminal phase. A qualitative approach has been performed. The study was based upon principles of Grounded Theory. Data were collected by in-depth interviews, mainly performed in the deceased's home. Eight persons were interviewed. They had had close relationships lasting 12 to 77 years. The findings show that the seriously ill home living cancer patient considers many fields as sufferings in the last period of his life. Also for the next-of-kin there are many challenges of physical, social and spiritual/existential nature. The core category ”A strive towards restoration of every days rhythm and to cope with changes” describes that both the patient and the next-of-kin wants stability and to live as normal as possible. Secondly, the strategy is to manage the changes the illness leads to when the patients no longer can obtain their functional level and activities. The next-of-kin has little experience in this type of care, and the ill person has a need for professional assistance with “the complicated care”. Adjustments and care must be built upon the life the families have lived, in order to help them to cope with the changes in the perspective of their own wishes, resources and possibilities. Even though all of the next of kin felt it had been a challenging task, none of them regretted that they had decided to take care of their loved ones at home. Conclusion: Homecare for seriously ill and dying patients with cancer requires a great effort from the next-of-kin and the health personnel in order to meet the challenges in the home. The health personnel must meet the changes with strategies to promote a situation as normal as possible for the patient and the family, and help them to cope with the changes in life.

  • 166.
    Haro, Josep Maria
    et al.
    Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain, Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de LLobregat, Barcelona, Spain, Universitat de Barcelona, Barcelona, Spain.
    Ayuso-Mateos, José Luis
    Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain, Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid, Spain.
    Bitte, Istvan
    Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
    Demotes-Mainard, Jacques
    Institut National de la Santé et de la Recherche Médicale (INSERM U955), Creteil, France, ECRIN Coordination Office, Paris, France.
    Leboyer, Marion
    Fondation FondaMental, Créteil, France, Institut National de la Santé et de la Recherche Médicale (INSERM U955), Creteil, France, URC Eco Ile-de-France (AP-HP), Paris, France.
    Lewis, Shôn W.
    School of Community Based Medicine, The University of Manchester, Manchester, UK.
    Linszen, Donald
    Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Centre, Maastricht, The Netherlands.
    Maj, Mario
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    McDaid, David
    PSSRU, LSE Health and Social Care and European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK.
    Meyer-Lindenberg, Andreas
    Zentralinstitut Fuer Seelische Gesundheit (CIMH), Mannheim, Germany.
    Robbins, Trevor W.
    Department of Psychology, and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.
    Schumann, Gunter
    Institute of Psychiatry, King's College London, London, UK, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.
    Thornicroft, Graham
    Institute of Psychiatry, King's College London, London, UK, Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
    Van Der Feltz-Cornelis, Christina
    Trimbos Instituut, Utrecht, Tilburg University, and GGz Breburg, Tilburg, The Netherlands.
    Van Os, Jim
    Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Centre, Maastricht, The Netherlands.
    Wahlbeck, Kristian
    Nordic Council of Ministers, Nordic School of Public Health NHV. Finnish Association for Mental Health, Helsinki, Finland, National Institute for Health and Welfare (THL), Vaasa, Finland.
    Wittchen, Hans-Ulrich
    Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Germany.
    Wykes, Til
    Institute of Psychiatry, King's College London, London, UK, Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
    Arango, Celso
    Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
    Jerome Bickenbach, Jerome
    Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain, Swiss Paraplegic Research Centre, Nottwil, Switzerland.
    Brunn, Matthias
    Fondation FondaMental, Créteil, France, URC Eco Ile-de-France (AP-HP), Paris, France.
    Cammarata, Pamela
    CF Consulting, Milan, Italy.
    Chevreul, Karine
    Fondation FondaMental, Créteil, France, nstitut National de la Santé et de la Recherche Médicale (INSERM U955), Creteil, France, URC Eco Ile-de-France (AP-HP), Paris, France.
    Evans-Lacko, Sara
    Institute of Psychiatry, King's College London, London, UK, Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
    Finocchiaro, Carla
    CF Consulting, Milan, Italy.
    Fiorill, Andrea
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Forsman, Anna
    Nordic Council of Ministers, Nordic School of Public Health NHV. National Institute for Health and Welfare (THL), Vaasa, Finland.
    Hazo, Jean-Baptiste
    Fondation FondaMental, Créteil, France, URC Eco Ile-de-France (AP-HP), Paris, France.
    Knappe, Susanne
    Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Germany.
    Kuepper, Rebecca
    Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Euron, Maastricht University Medical Centre, Maastricht, The Netherland.
    Luciano, Mario
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Miret, Marta
    Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain, Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid, Spain.
    Obradors-Tarragó, Carla
    Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain, Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de LLobregat, Barcelona, Spain.
    Pagano, Grazia
    CF Consulting, Milan, Italy.
    Papp, Szilvia
    Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
    Walker-Tilley, Tom
    Institute of Psychiatry, King's College London, London, UK, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK.
    ROAMER: roadmap for mental health research in Europe2014In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, ISSN 1049-8931, Vol. Suppl.1, p. 1-14Article in journal (Refereed)
    Abstract [en]

    Despite the high impact of mental disorders in society, European mental health research is at a critical situation with a relatively low level of funding, and few advances been achieved during the last decade. The development of coordinated research policies and integrated research networks in mental health is lagging behind other disciplines in Europe, resulting in lower degree of cooperation and scientific impact. To reduce more efficiently the burden of mental disorders in Europe, a concerted new research agenda is necessary. The ROAMER (Roadmap for Mental Health Research in Europe) project, funded under the European Commission's Seventh Framework Programme, aims to develop a comprehensive and integrated mental health research agenda within the perspective of the European Union (EU) Horizon 2020 programme, with a translational goal, covering basic, clinical and public health research. ROAMER covers six major domains: infrastructures and capacity building, biomedicine, psychological research and treatments, social and economic issues, public health and well-being. Within each of them, state-of-the-art and strength, weakness and gap analyses were conducted before building consensus on future research priorities. The process is inclusive and participatory, incorporating a wide diversity of European expert researchers as well as the views of service users, carers, professionals and policy and funding institutions

  • 167.
    Heikkila, Katriina
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland,.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark,.
    Nyberg, Solja T
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Fransson, Eleonor I.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, School of Health Sciences, Jönköping University, Jönköping, Sweden, Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Ahola, Kirsi
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alfredsson, Lars
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Bjorner, Jakob B.
    National Research Centre for the Working Environment, Copenhagen, Denmark,.
    Borritz, Marianne
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany,.
    Dragano, Nico
    Institute for Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany,.
    Ferrie, Jane E.
    School of Community and Social Medicine, University of Bristol, Bristol, United Kingdom, Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Koskenvuo, Markku
    Department of Public Health, University of Helsinki, Helsinki, Finland,.
    Koskinen, Aki
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Nielsen, Martin L.
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Nordin, Maria
    Department of Psychology, Umeå University, Umeå, Sweden.
    Pejtersen, Jan H.
    The Danish National Centre for Social Research, Copenhagen, Denmark,.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark, Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark,.
    Oksanen, Tuula
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Suominen, Sakari B.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Folkhälsan Research Center, Helsinki, Finland, Department of Public Health, University of Turku, Turku, Finland.
    Theorell, Töres
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Väänänen, Ari
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Vathera, Jussi
    Finnish Institute of Occupational Health, Helsinki, Tampere and Turku, Finland, Department of Public Health, University of Turku, Turku, Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health, Helsinki, Finland,.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Westerholm, Peter J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, London, United Kingdom, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edingurgh, United Kingdom,.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health, University College London, London, United Kingdom,, Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
    Kivimäki, Mika
    Finnish Institute of Occupational Health, Helsinki, Finland, , Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Job Strain and the Risk of Inflammatory Bowel Diseases: Individual-Participant Meta-Analysis of 95 000 Men andWomen2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, ISSN 1932-6203, Vol. 9, no 2, p. e88711-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS:

    Many clinicians, patients and patient advocacy groups believe stress to have a causal role in inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. However, this is not corroborated by clear epidemiological research evidence. We investigated the association between work-related stress and incident Crohn's disease and ulcerative colitis using individual-level data from 95 000 European adults.

    METHODS:

    We conducted individual-participant data meta-analyses in a set of pooled data from 11 prospective European studies. All studies are a part of the IPD-Work Consortium. Work-related psychosocial stress was operationalised as job strain (a combination of high demands and low control at work) and was self-reported at baseline. Crohn's disease and ulcerative colitis were ascertained from national hospitalisation and drug reimbursement registers. The associations between job strain and inflammatory bowel disease outcomes were modelled using Cox proportional hazards regression. The study-specific results were combined in random effects meta-analyses.

    RESULTS:

    Of the 95 379 participants who were free of inflammatory bowel disease at baseline, 111 men and women developed Crohn's disease and 414 developed ulcerative colitis during follow-up. Job strain at baseline was not associated with incident Crohn's disease (multivariable-adjusted random effects hazard ratio: 0.83, 95% confidence interval: 0.48, 1.43) or ulcerative colitis (hazard ratio: 1.06, 95% CI: 0.76, 1.48). There was negligible heterogeneity among the study-specific associations.

    CONCLUSIONS: Our findings suggest that job strain, an indicator of work-related stress, is not a major risk factor for Crohn's disease or ulcerative colitis

  • 168.
    Hellström, Ulla W
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Äldres upplevelse av självbestämmande på särskilda boende2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Self-determination and quality of life are closely connected to one another and at the same time an important indicator on how the long-stay care functions. The aim of this study was to focus on the thoughts of the elderly people and their experiences on self determination and value in their long-stay care. In this qualitative study, eleven elderly people from five different long-stay cares in a medium big city in the south of Sweden have been interviewed. Data has been analysed according to manifest and latent qualitative content analysis. In the study the following five main categories have manifested themselves during the analysis; To face an accomplished fact, To do something for the satisfaction of others, To be dependant, To feel hopelessness, Not to be appreciated. The result shows that self determination within the long-stay cares need to be focused on, the elderly people didn’t feel as though they had any influence on their situation. It was also evident that the elderly people felt they were not appreciated in society or in the long-stay care. The general theme expressing the latent contents in the interviews turned out to be disempowerment of the elderly people, creating an environment which neither empowers nor strengthens the self determination of the individual.

  • 169.
    Henriksen, Kari
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Å leve i en flyktig tilstand – og ønske seg et annet liv.: Hvordan kvinner med rusproblemer forstår sine rusproblemer og hvordan de opplever å fortelle om det. Hvordan opplever kvinnene at ansatte i helse- og sosialtjenesten møter dem og det de forteller2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    How women experience their drug dependency influence why they seek help and how they experience the help they are receiving. Use of drugs affects their human qualities (will or abilities, normality and appearance), it influence their experience of belonging (being normal, ordinary, abnormal and different, as part of a normal family with an ordinary social network but yet isolated and lonesome) and their condition (sickness and nearly dying, well-being and healthy). They move along these axis. Where they are depend on the situations they are in and the feelings they have or get in the situation. This influence on how they experience communication with helpers. They experience inclusion and exclusion, understanding and misunderstanding. They experience ownership of their problems and becoming aliensto them. They are either treated as equals or degrated as human beings. They experience hope and trust or mistrust and hopelessness. The professionals used confrontation, dialogue over time or delimitation of the problem.Dialogue and confrontation was useful strategies if the the professionels showed understanding for the compexity of the womens problems. Their experiences in the meetings influenced whether they were working along with their drug/alcohol problems or whether they continued to use drugs and alcohol. Their recognition of their problems with drugs/alcohol reveals over time. It is not conscious and concrete in their minds. Focus on drugs/alcohol must therefore be persistant over time

  • 170.
    Henriksen, Lena
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hva betyr helhet og kontinuitet i svangerskap, fødsel og barselomsorg for kvinner?: En evaluering av Barsel hjemme, et prosjekt fra Oslo.2010Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: This study is based on a project known as “Barsel hjemme” (“postnatal careat home”), whose main goal has been to develop a model for prenatal, birth, and postnatalcare, focusing particularly on continuity. Participants had prenatal check-ups with projectmidwives, delivered their babies at Ullevål University Hospital, and were discharged fromthe hospital early in the postnatal period. Project midwives visited all participants at home.

    Aim: This study aimed to evaluate Barsel hjemme by examining patient satisfaction andassessing their experiences and desires through the prism of continuity.

    Methods: A triangulation of methods was used. This included a patient satisfaction survey;an anonymous survey that was then compared with a similar survey from a standardpostnatal department; and content analysis of focus group discussions.

    Findings: Women who participated in Barsel hjemme were very satisfied, generally moresatisfied than women from a standard postnatal department. They would participate again ifpossible. They did not define continuity of care as being cared for by the same person.Expectations played an important role in how they experienced the project. Midwives’ability to create a personal connection and treat participants as individuals were paramount.Participants wanted greater continuity in the information given during pregnancy, birth, andthe postnatal period.

    Conclusions: Women recommend the Barsel hjemme project and want it to continue.Continuity of care hinges on individual expectations. Personal relationships and recognitionof individuality are of primary importance.

  • 171.
    Hjälte, Lena
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Suserud, Björn-Ove
    Herlitz, Johan
    Karlberg, Ingvar
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Initial emergency medical dispatching and prehospital needs assessment: a prospective study of the Swedish ambulance service.2007In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 14, no 3, p. 134-41Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the setting of priorities and patients' need for the ambulance service.

    METHODS: A prospective, consecutive study was conducted during a 6-week period. The ambulance staff completed a questionnaire assessing each patient's need for prehospital care. In addition to the questionnaire, data were extracted from the ambulance medical records for each case.

    RESULTS: The study included 1977 ambulance assignments. The results show that there is a substantial safety margin in the priority assessments made by the emergency medical dispatch operators, where the ambulance staff support the safety margin for initial priorities, despite the lack of at-the-scene confirmation. At-the-scene assessments indicated that 10% of all patients had potentially life-threatening conditions or no signs of life, but the advanced life support units were not systematically involved in these serious cases. The results even showed that one-third of the patients for whom an ambulance was assigned did not need the ambulance service according to the assessment made by the ambulance staff.

    CONCLUSION: Using the criteria-based dispatch protocol, the personnel at the emergency medical dispatch centres work with a safety margin in their priority assessments for ambulance response. Generally, this 'overtriage' and safety margin for initial priority settings were supported as appropriate by the ambulance staff. According to the judgement of the ambulance staff, one-third of all the patients who were assigned an ambulance response did not require ambulance transport.

  • 172.
    Hjälte, Lena
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Suserud, Björn-Ove
    Herlitz, Johan
    Karlberg, Ingvar
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Why are people without medical needs transported by ambulance? A study of indications for pre-hospital care.2007In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 14, no 3, p. 151-6Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose of this report was to describe the characteristics of patients transported by ambulance, in spite of being evaluated by the ambulance staff at the scene as not requiring prehospital care. A second aim was to compare these patients with those judged as being in need of this care.

    METHODS: Three ambulance service districts located in different rural and metropolitan geographical areas were included in the study and all three were covered by a single emergency dispatch centre. Following the dispatch of ambulances, the staff assessed and recorded the medical needs of the patients at the scene, according to a questionnaire developed for the study. In addition to the questionnaire, data were extracted from the ambulance medical records database for each patient. If the patients were just transported by ambulance without receiving any other prehospital intervention, they were assessed as not being in need of the emergency service. The evaluation included events at the scene and during transportation. The ambulance staff making the needs assessments were emergency medical technicians and registered nurses. In this report, 604 patients who did not require prehospital care are described and compared with the remaining group of patients who required this care (1373). For analysis, descriptive statistics were used to analyse the data.

    RESULTS: The ambulance staff assessed that, among patients reported by the emergency medical dispatch centre as having abdominal or urinary problems, 42% did not need the ambulance service. Even among intrahospital transports (patients for whom medical personnel made the request for an ambulance), 45% did not require ambulance transport, as judged by the ambulance staff. Among patients reported by the emergency medical dispatch centre as having chest pain or other heart symptoms or trauma/accidents, respectively, only small percentages (18%) and (17%) did not require the ambulance service, as assessed by the ambulance staff. Most of the patients without obvious medical needs had been allocated an ambulance response for nonurgent conditions, that is priority level 2 or 3, but patients without medical needs were even found at the highest priority level 1. Of the patients who did not require an ambulance, more than half (55%) would have been able to get to a hospital in their own car or by taxi, whereas the remainder of the patients needed a transport vehicle in which they could lie down, but which was not equipped and staffed like an ambulance.

    CONCLUSION: Among the patients transported by the emergency medical service system in the study areas, a significant percentage were judged by the ambulance staff as not being in need of prehospital interventions. The majority were transported by a fully equipped emergency medical ambulance to an emergency medical department at a hospital, without requiring any prehospital interventions either at the scene or during transportation. The emergency medical service organization has to develop clear criteria for the utilization of ambulance services that can be accepted and implemented by the dispatch centres and by healthcare personnel. These criteria need to include safety margins and at the same time enable the appropriate use of resources.

  • 173.
    Hoelgaard, Jens
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Tidlig Opsporing af borgere i primærsektor med begyndende sygdomstegnog sygdomsforebyggende indsatser2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background.New methods and interventions in the primary sector can increase early disease detection and avoid unnecessary hospitalization.

    Aim:This study aimed to test a powerful set of early detection methods for vulnerable citizens who exhibit signs of incipient disease or preventable deterioration, including (i) an IT system customized to perform triage, (ii) Timely Observation of Beginning Sickness (TOBS) to measure at-risk citizens, and (iii) a questionaire that assesses change in healthcare practice.

    Methods. The mixed methods in this study included clinical testing, a triaged changing table, TOBS, risk scoring, and a new IT platform. We also pilot-tested a new questionnaire to investigate change in the healthcare practice.

    Main Results: After testing the triaged changing table in three healthcare groups (n=105), we registered citizens according to risk. Information boards allowed care groups to identify patients who experienced less loss of function and fewer signs of disease (12.4%); others experienced several major changes and were at risk of deterioration or hospitalization (8.6%). We initiated follow up and preventive measures to care for these citizens. TOBS included measurement of vital signs (i.e., heart and breathing rate, temperature, level of consciousness and systolic blood pressure) in selected risk patients, providing systematic risk scoring and suggestions for actions. Finally, we developed and pilot-tested (in two care groups, n = 45) a simple questionnaire that can prospectively examine change in healthcare practices. There are no signs of systematic errors on single items but in the last test group there was too large a general lapse of answers to achieve a full representation in relation to their responses.

    Conclusion: Early detection of preventable diseases in the primary sector requires methods that are adapted to the clinical setting and professional groups. Our results suggest that combining TOBS with the changing table may enable systematic measurement in vulnerable citizens detected and a quick follow up with preventive measures to care for these citizens. A well-customized IT platform will help healthcare providers detect early signs of disease. Using data entered during patient visits, the system can perform an online triage, create summaries of categorized citizens, and provide reminders of important follow up

  • 174.
    Holch Skalkam, Grete
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hygiejnesygeplejerskers udfordringer med de infektionshygiejniske retningslinjer i forhold til forebyggelse af smitte med antibiotikaresistente bakterier2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Objectives:This study aimed to understandwhetherinfection control nurses in Denmark considerthe national guidelines on infection control asuseful and relevant regarding multi-drug resistant microorganisms. We also aimedto identify potential needs and wishes to optimizeor reconsider the general and supplementary guidelines on infection controlas applied to preventing multi-drug resistant microorganisms.

    Methods: This qualitative study collected data from 24 Danish infection control nursesin 5 focus group discussions. Data was analyzedusing systematic text condensation. The theoretical and conceptual frame included Antonovsky’s theory of salutogenesis, communication, and health literacy.

    Results: Participants experienced varying levels of support from the guidelines,but mainly perceived them as a theoretical foundation and framework. They saw a great challenge in making the guidelines understandable in practice. Due to language difficulties and lake of helth literacy, some health care professionals lacked elementary knowledge of hygiene because they were unable to read and understand the text. Accordingly, the guidelines required translation and follow up in practice. The health care professionals’ knowledge and ability to access the guidelines also varied. Combined these challenges with hospitals’ arrangements and economic priorities,the guidelines’practicability was problematic. Furthermore, participants distrusted the guidelines’development processand called a new perspective that focuses less focus on making more supplementary guidelines and instead focus more on the general guidelines.

    Conclusions: Denmark should reconsider its level of focus on preventing multi-drug resistant microorganisms. A national collaboration could optimizethe contents, layout, and communication of the guidelines to make them understandable, useful,and relevant in preventing infections caused by multi-drug resistant microorganisms

  • 175.
    Holmberg, Vigdis
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Norske ergoterapeuter som aktører på helsefremmende arbeid og helsefremmende arbeidsplasser: en kvalitativ studie2010Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background. Occupational therapists are trained to use their general competence in health promotion to initiate healthy workplaces. However very few therapists specialize in areas that combine occupational health and public health. By using their competence regarding healthy workplaces, therapists could positively impact employee health and work environments and likely reduce sick leaves that result from working conditions.

    The purpose of this study was to clarify the therapists’ opinion of their own competence in health promotion, and also determine how they use that competence in their daily work, focusing especially on:

    -          self-evaluation of their own competence regarding healty workplaces;

    -          their opinions on what competence they lack in this area;

    -          their personal experience with healthy promotive workplaces; and

    -          their thoughts and opinion on the potential for health promotion in occupational therapy

    Method. We chose a qualitative approach using focus groups and prosessed collected data  using thematic content analysis.

    The findings suggest that although study participants maintain a salutogenetic focus and a health promotional way of working, they currently work mainly at an individual level. Focus on the individual is deeply rooted in their practice and seems to influence their work such that they hardly use their health promotion competence on a system or a societal level. They also described their competencies as unknown by citizens, collaborating partners and authorities, possibly explaining why their competence is not in demand.

    Conclusions. While their statements indicate much knowledge and experience about healthy workplaces, our findings show that they don’t appreciate the importance of using that competance to

    initiate healthy workplaces. We further determined that study participants should be able to use their general competence in health promotion to initiate healthy workplaces. Allthough this is a qualitative study, our results may be valid for all the occupational therapists in Norway, an aera that requires further investigation.

  • 176.
    Holmberg, Vigdis
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Occupational Therapy Programme, Oslo University College, Norwa.
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Occupational therapists as contributors to health promotion2014In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 21, no 2, p. 82-89Article in journal (Refereed)
    Abstract [en]

    This study was undertaken to explore the views of occupational therapists concerning their competences in healthpromotion, and their perceptions of how they apply these competences in their daily work. The study also elicited their views onthe contributions that occupational therapists could make to health promotion if given the opportunity.Methods:Data werecollected infive focus-group discussions with 24 occupational therapists. These discussions were tape recorded andtranscribed verbatim; data were analysed using qualitative content analysis.Results:The mainfindings are that the informantstook an individualized salutogenic approach in their work and rarely engaged in health promotion on a systemic or societallevel. They believed that their patients and collaborating partners, as well as public officials, remained unaware of theircompetences in health promotion.Conclusions:Thefindings of this study could enrich the discussion among occupationaltherapists on how they could make a more significant contribution to health promotion on a broader level.

  • 177.
    Holt, Marianne
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Patientinddragelse -beskrivelse af kvalme og copingstrategier under kemoterapibehandling: et led i en sundhedsfremmende strategi2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background and Aim: Several studies have reported low quality of life among cancer patients with chemotherapy-induced nausea.This study aimed to describe cancer patients’ perception of chemotherapy-induced nausea and the coping strategies used to ease nausea during chemotherapy.

    Method: Fourteenfemale cancer patients undergoing chemotherapy in a Danish university hospital participated in this study.Data were extracted from diaries, followed byqualitative content analysis.

    Result: Data analysis comprised both manifest and latent content and revealed the patients’ own experiences of and reflection about perceived chemotherapy-induced nausea.Five categories,appetite, localization, character, intensity, and durationemerged. The latent content of these categories is described by the theme: nausea is a physical experience of complex and contradictory sensations. The results also identified six subcategories and comprised two main categories, which described the women ́s coping strategies: structuring everyday life with nausea and shifting focus. To manage nausea, patients’ employed coping strategies from both categories.

    Conclusion: This study used patients’ own assessments to understand both the complexity of nausea and the patients’ description of coping with nausea. A strategy involving patient participation might helpto create health promotion activities that increase quality of life among patients with chemotherapy-induced nausea

  • 178.
    Hotvedt, Kirsti
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Yrkesaktive pårørende til personer med demens: hvordan kan omsorgen påvirke fungeringi arbeidslivet?2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Dementia is a major cause of illness in old age. Family carers for persons with dementia are at risk of experiencing burden of care. Many carers continue to work while providing care. Studies show that "time squeeze" induced by caring for an elderly family member might have negative consequences for the carers’employment.

    Aim: This study aimed to examine and describe whether caring for persons with dementia affects family carers’ ability to function at work. Furthermore,the aim of the study was to examine the relationship between various characteristics of the carer’s situation and functioning at work. It also describes how they cope with obligations both as carers and employees.

    Methods: The study is based on data from questionnaires completed by 594 of 614 employed family carers who responded to a question about how caring for a person with dementia affected ability to function at work. Data were collected in connection with two former Norwegian cross-sectional studies, conducted in 2002-2004 and 2008-2009.The present study includes both quantitative and qualitative data.

    Results: Among all respondents 37.5% reported that caring for a family member with dementia affects their ability to function at work. Mean age was 51 years and significantly more women and daughters formed the largest group (69.2%). The residence to the person with dementia (own home or nursing home)revealed no significant difference regarding the carers impact at work, whereas living together with the family member with dementia did. Impact factors included phone calls from the person with dementia, practical caring tasks, followingup on healthcare services, and different types of absence from work.The family carers experienced stress and lack of time. Satisfaction with health care services, as well as help and support from family and friends seemed to have a positive effect.

    Conclusion: This study shows that balancing caring for a person with dementiain combination with being profewssionally active may negatively affect the ability to function at work. The dilemma family carers experience between work and care giving obligations maybe difficult to manage while maintaining an optimal active working life.

  • 179.
    Hultman, Barbro
    Nordic Council of Ministers, Nordic School of Public Health NHV. Mid-Sweden University, Östersund, Sweden.
    Self-rated quality of life among unemployed people and people in work in northern Sweden2007Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Self-assessed quality of life (QoL) is analysed using a QoL questionnaire (Hörnquist’s QLcs) covering the life spheres: somatic health, mental well-being, cognitive ability, social and family life, activity, financial situation, meaning in life and a global score for ‘entire life’. In all, 487 unemployed and 2917 employed subjects aged 25-64; and 651 unemployed subjects and 2802 in work (including employment, studying and military service) in the 18-24 age group, were investigated in a population-based cross-sectional study on life and health in northern Sweden in 1997. In line with previous findings, results showed that unemployed people exhibited poorer QoL.The greatest difference between unemployed people and those in work was in the financial domain (18-24, 25-64). Unemployed women (aged 25-64) rated the final values of QoL – ‘entire life’ and meaning in life – higher than unemployed men did. In the young group (aged 18-24), unemployed women did not rate any of the domains higher. The young unemployed men rated somatic health and mental well-being higher. Interaction effects were interpreted in the following way: a) unemployed men (aged 25-64) were worst off in the global domain ‘entire life’; b) employed respondents, having a university/college education was beneficial for QoL, while for unemployed respondents (25-64) it was not; c) in the young group (aged 18-24), people in work rated their activity higher than unemployed people, and the effect was strengthened when they were regularly active during leisure. Close friends and cash reserve were important for all participants, no matter whether they were employed or not. The risk of being young and unemployed was greater if the person had a shorter education, worse economy (according to their own ratings) and was in the upper half of the age group (aged 21-24). Finally, the conclusion that QoL is poorer when in unemployment – both for the young and those who are older (aged 25-64) – is in line with earlier findings; however, in contrast to three previous studies, we conclude that psychological well-being is even poorer for young people than for those who are older. Intervention, in terms of steadily improved labour market conditions to counteract the negative effects of exclusion from the labour market, is of great importance from a public health perspective.

  • 180.
    Hultman, Barbro
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Mid-Sweden University, Östersund, Sweden.
    Hemlin, Sven
    bGothenburg Research Institute (GRI) School of Business, Economics and Law, Gothenburg University, Göteborg, Sweden.
    Self-rated quality of life among the young unemployed and the young in work in northern Sweden2008In: Work, ISSN 1051-9815, Vol. 30, no 4, p. 461-472Article in journal (Refereed)
    Abstract [en]

    This study analysed self-assessed quality of life (QoL), using a QoL questionnaire (Hörnquist's QLcs) covering life spheres, somatic health, mental well-being, cognitive ability, social and family life, activity, financial situation, meaning in life and a global score "entire life", for young people aged 18–24 in a population-based cross-sectional study in northern Sweden. Of these, 651 were unemployed and 2802 were in work (employed, students and in military service). Results showed that the young unemployed exhibited poorer QoL than the young in work and the greatest difference was found regarding their financial situation. Young men rated somatic health and mental well-being higher than young women. However, QoL in other essential domains was rated higher by young women in work. Close friends and money reserve were important for all participants, no matter whether they were employed or not. The risk of being young and unemployed was greater if the person had a worse financial situation, shorter education, and fewer leisure activities with other people. Finally, it was concluded that while QoL is poorer when in unemployment – both for the young and those who are older (aged 25–64) – psychological well-being, in contrast to several previous studies, is even poorer for young people than for those who are older. This is worrying in a public health perspective and could have implications for unemployment policies for younger and less well-educated age groups.

  • 181.
    Hultman, Barbro
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Mid-Sweden University, Östersund, Sweden.
    Hemlin, Sven
    Centre for Research Ethics, The Sahlgrenska Academy at Göteborg University, Sweden.
    Hörnquist, Jan Olof
    Department for Health Sciences, University of Örebro, S-701 82 Örebro, Sweden.
    Quality of life among unemployed and employed people in northern Sweden: Are there any differences?2006In: Work, ISSN 1051-9815, Vol. 26, no 1, p. 47-56Article in journal (Refereed)
    Abstract [en]

    This study analysed self-assessed quality of life (QoL), using a QoL questionnaire (Hörnquist's QLcs) covering life spheres, somatic health, mental well-being, cognitive ability, social and family life, activity, financial situation, meaning in life and a global score "entire life", for young people aged 18–24 in a population-based cross-sectional study in northern Sweden. Of these, 651 were unemployed and 2802 were in work (employed, students and in military service). Results showed that the young unemployed exhibited poorer QoL than the young in work and the greatest difference was found regarding their financial situation. Young men rated somatic health and mental well-being higher than young women. However, QoL in other essential domains was rated higher by young women in work. Close friends and money reserve were important for all participants, no matter whether they were employed or not. The risk of being young and unemployed was greater if the person had a worse financial situation, shorter education, and fewer leisure activities with other people. Finally, it was concluded that while QoL is poorer when in unemployment – both for the young and those who are older (aged 25–64) – psychological well-being, in contrast to several previous studies, is even poorer for young people than for those who are older. This is worrying in a public health perspective and could have implications for unemployment policies for younger and less well-educated age groups

  • 182.
    Hunstad, Ellen Julie
    Nordic Council of Ministers, Nordic School of Public Health NHV. Norsk senter for cystisk fibrose, Oslo Universitetssykehus HF, Ullevål sykehus, Postboks 4956 Nydalen, 0424 Oslo.
    Awareness of Infection Control within Cystic Fibrosis Health Care: a Scandinavian study2013Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study aimedto illuminateawareness of hygiene regimens andinfection control guidelines for cystic fibrosis (CF) care at Scandinavian cystic fibrosis centers (SCFCs)and Norwegian cystic fibrosis satellite teams (NCFSTs).Method: We modified a knowledge, attitudes and practices (KAP) surveyused earlier for CF and infection control care teams in the United States. Our modified questionnaire sought responses regarding sputum cultures, hand hygiene, education and infection control measures in hospital/at home. We distributed individual questionnaires to 8SCFCs and 10 NCFSTs. Awareness exceeding 75% per item was considered sufficient for clinical practice. Results: Respondents represented different disciplines atSCFCs with 61 (37%) and 30 (58%) at NCFSTs core team professionals (mainly doctors, nurses and physiotherapists).SCFC respondents demonstrated higher KAP (range 49-100%) than NCFST (range 23-100%). Both groups showed a high awareness of outcome expectancy for selected guideline components (80-100%), but only moderate awareness regarding familiarity. Additionally, both SCFC and NCFST respondents demonstrated greater awareness of items connected closely to practical care and medical treatment(73% and 80% versus 93% and 74% respectively). As opposed, SCFC and NCFST respondentsshowed lower awareness of guideline content(49% and 23% respectively).Conclusion: Becauseinfection control is a cornerstone in CF care, reducing the risk of cross infection among CF patients in health-and non-health caresettings requireshealth care professionals to maintain increased awareness of CF guidelines. This study revealed generally good knowledge of infection control measures. Importantly, bestcarerequires continious collaboration and educationfor health care professionals and patients regardingthe written guidelines for CF infection control.

  • 183.
    Husby, Sofie
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Økologiomlægning i et medarbejderperspektiv – vilje, viden og værktøjer2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: In this study,we aimed to learn how kitchen professionals perceiveand experience the transition to organic food. We also aimed to understand how employees view training in relation to collaboration and the transition process.

    Method: Participants attended a six-daycourse (two time three days) in organic food transition. The course was funded by governmental funds to promote organic food in public kitchens through training. After finished course the course participants (n=327) and leaders (n=50) completed evaluationforms comprising openended answers. All data was examined using qualitative content analysis.

    Result: Our participants described organic transition as a complex process that requires changesin habits and practice. Participants also mentioned the necessity of perceiving the organic food transition as a commongoal. Our data also shows that employees must be able to link the purpose of transitioning to organic food with their work and how it relates to the larger goal. Although most participants were motivated by sustainability and health issues, they reported that knowledge and instruments contribute importantly to making the process manageable. Participants expressed a need for their action competence and perceived action competency tobe strengthened. This was also mentioned in relation to structural framework, including economy, which were experienced as challenging in relation to the transition. If employees perceive transition as challenging or as opportunity for development likely will depend on the individual. Overall, the course seemed to prepare employees and increase awareness in relation to the process, but employees also expressed a need for a distinct and supportive leadership.

    Conclusion: We show here that training strengthens employees’ incentive, knowledge, and transitional instruments about the transition. Organic food must provide aclear and common goal that fits in to the overarching goal of the organization. This ongoing process requires continuous learning and distinct leadership support, as well as willingness to challenge the existing structural framework and gain increased latitude in the kitchens.

  • 184.
    Hustad, Jørn
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hva opplever anestesisykepleiere som stressfylt i sitt arbeid, og hvordan påvirker dette dem?: En kvalitativ undersøkelse om arbeidsrelatert stress blant anestesisykepleiere2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The aim of this study is to explore work-related stress among nurse anaesthetists. This qualitative study is conducted as described by Kvale. Two research questions were posed: What do nurse anaesthetists experience as stressful in their work, and how does this affect them? A semi-structured interview-guide was used to find answers to these questions.

    Ten nurse anaesthetists from three different hospitals participated in the study.

    The results show that nurse anaesthetists experienced stress in five areas: stress in situations of patient care, stress related to co-workers, stress related to leadership and administration, stress as a senior nurse anaesthetist and stress-factors in the environment.

    Stress related to situations in patient care and to co-workers seems to be of a temporary nature if the nurse anaesthetists are able to find time and opportunity to accommodate their experiences.

    Social support is important to reduce stress.

    Lack of time and reduced professional update together with increased personal responsibility and increasing demands from the surroundings creates an experience of being under ever increasing pressure. Nurse anaesthetists experience little influence on the political, economical and administrative frames of their work situation. 

  • 185.
    Hviding, Krystyna
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Tverrsektoriell samhandling om pasienter med lett til moderat depresjon.: Virker det?2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Objectives: To identify different models of collaborative care for mild to moderate depression in primary care settings and to evaluate their effectiveness.

    Method: Meta-review/ Overview of systematic reviews. Search: Medline, Cochrane Library, SWEMED, EMBASE and Cinahl database. Selection criteria: systematic reviews of controlled clinical trials of collaborative care in primary practice versus usual care for patients with mild to moderate depression. Exclusion criteria: Systematic reviews with majority of studies with patients with serious depression or other mental disorders or pure treatment studies. Data collection and analysis: All relevant studies published between 1995 and 2006 were systematically assessed for relevance and methodological quality. Primary outcomes were level of depression, psycho-social functioning and quality of care. The results are presented as a narrative synthesis.

    Results: Eight systematic reviews were included. Much of the evidence is based on studies performed in USA or UK. Patients with minor to moderate or even major depression were included. Interventions: educational tasks, counselling, disease management programmes, guidelines, managed care, case management, on-site specialist, shared care, active follow-up. It appears that complex interventions which include educative tasks towards guideline – based care combined with on-site specialist at primary care level improve both the quality of care and clinical outcomes compare to usual treatment. The evidence may not be directly applicable to a Nordic health care setting.There is a need for Nordic studies. Future studies would benefit from the addition of qualitative research about the conditions that facilitate or prevent collaboration in health care.

    Conclusion: • Collaborative service delivery in primary health care of patients with depression appears to be more effective intervention compare to usual care in terms of symptoms reduction, better adherence to treatment and psycho-social functioning and enhance quality of care.

    • Educative interventions combined with on-site specialist in primary care setting and active follow-up were the most frequent components of effective interventions.

    • The evidence is insufficient to provide a definitive answer to clinical effectiveness and cost-effectiveness of individual models or to make a comparison between models.

    • It is unclear which patients gain most profit from collaborative service delivery or which elements of complex interventions are most effective. We need more research.

  • 186.
    Häggblom, A M E
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hallberg, L R-M
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Möller, Anders R
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Nurses' attitudes and practices towards abused women.2005In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 7, no 4, p. 235-42Article in journal (Refereed)
    Abstract [en]

    The present article is a descriptive survey assessing nurses' knowledge, training, and practices regarding the care of abused women. A self-administered questionnaire was sent to all nurses working within the government health organization on the Aland Islands, Finland. The response rate was 57%. Most nurses had no formal training in domestic violence and were less likely than the in-service-trained nurses to intervene with abused women. Nurses' knowledge, beliefs, and practices were found to be unsystematic and had drawbacks. Nurses were not familiar with the formal structure provided by the health administration. The results suggest that in order to meet the urgent need for training among nurses, an in-service training program needs to be set up. This program would help the nurses in identifying survivors of abuse and make them prepared to intervene more effectively to promote the health of these women.

  • 187.
    Häggblom, Anette
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Fighting for survival and escape from violence: Interviews with battered womenRead More2007In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 2, no 3, p. 169-178Article in journal (Refereed)
    Abstract [en]

    The present study is a qualitative study aiming at explaining and understanding the experience of being battered. It explores the act of searching for help, from the health service and others, and the ending of abusive relationships. In-depth interviews were conducted with nine battered women. The study adopted a grounded theory method and produced an emerging core category fighting for survival and escape, and three key categories: having a personal construct of violence, struggling to cope with the violence, and feeling a need for support. The women with deep internal scars struggled to understand and to recover from the violence. They struggled between feeling guilty and feeling innocent. In the process of leaving, an important other, often a friend, played a supportive role in creating an inner strength within the woman, which enabled her to break up. Supportive professionals found relevant solutions and helped the women to maintain their new situation, while other professionals re-victimized the women. We conclude that battered women with enhanced support include affirmation, information, and safety leading to increased survival and recover

  • 188.
    Häggblom, Anette
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Love that turns into terror: Intimate partner violence in Åland: nurses’ encounters with battered women in the context of a government-initiated policy programme2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Violence against women is a problem in all countries in the world, including the small autonomy of the Åland Islands. The violence ranges from psychological threats to femicide. In the Åland Islands the issue has been placed on the agenda of politicians and the authorities, while reports about severe violence against women have been brought to the public. In Åland no scientific research on violence against women has been performed. The overall aim of this dissertation is to gain a deeper insight into how battered women in Åland are cared for by nurses, and how the official organizations have responded to the government policy directives. In this thesis, the first study, a descriptive survey, describes how nurses identify and support battered women. In the second and third studies, the method of grounded theory was used to explore the experiences and perceptions of nurses and battered women of violence against women. In the fourth study a case study approach was used to explore government policies for intimate partner violence. The main findings in this thesis are that battered women used health services to receive help. We found that nurses identified and supported abused women, even though services for these women were inadequate. Nurses were willing to help the women, but they often lacked support. Battered women reported that they received ad hoc help. They were often left alone, dependent on a nearby person to escape, survive, and recover. Another finding was that the Government of the Åland Islands demanded that the official organizations should allocate services to battered women, but the organizations’ response to the directives had some limitations. From a public health perspective, the phenomenon presents an urgent challenge. Overall, the public health community can and should contribute greatly towards the understanding, prevention, and control of violence by applying and adapting already constructed principles, and by implementing strategies.

  • 189.
    Häggblom, Anette M E
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Möller, Anders R
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Implementation of a government policy programme on Operation Kvinnofrid.2009In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 16, no 1, p. 43-52Article in journal (Refereed)
    Abstract [en]

    Today, intimate partner violence is addressed by most government authorities, including the government of Aland. In Aland the government required the official organizations to implement an Operation Kvinnofrid Programme. In this study, a descriptive case study design was used to explore the impact of the government's recommendations to the organizations to implement the programme. The organizations responses were limited. They used a top-down approach and almost no resources were allocated to the issue.

  • 190.
    Häggblom, Anette M E
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Möller, Anders R
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    On a life-saving mission: Nurses' willingness to encounter with intimate partner abuse.2006In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 16, no 8, p. 1075-90Article in journal (Refereed)
    Abstract [en]

    The main purpose of this qualitative study was to explore in depth selected expert nurses' experiences of the phenomenon of violence against women and the nurses' roles as health care providers to those women. The authors adopted a grounded theory method and produced an emerging theory comprising two key themes: nurses' personal perceptions toward intimate partner violence and nurses' feeling equipped to intervene. The findings showed that violence against women existed in a small local community and raised pitfalls caused by nurses' knowing the inhabitants. Furthermore, the findings indicate the devotion of nurses and the importance of their role in the care of battered women and the sharing of knowledge. Thus, the nurses compensate for a lack of training through personal maturity and security within the social context.

  • 191.
    Häggman, Carina
    Nordic Council of Ministers, Nordic School of Public Health NHV. Valnesfjord Helsesportssenter, Østerkløft, 8215 Valnesfjord, Norge.
    Pasienterfaringer med stavgang: en kvalitativ studie av stavgangi spesialisert medisinsk rehabilitering2013Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Insufficient physical activity is a public health problem. Rehabilitative healthcareprofessionals playan important role in encouraging patients to increase their physical activity.

    Purpose This study aimedto explorehow patients experience Nordic walking (pole walking)in specialized medical rehabilitation.

    Method This qualitativestudy gathered data from three focus group. The total number of patients interviewed was 19, eight women and 11 men. I conducted follow-up interviews with seven studymembers.

    Results The resultsshowed that Nordic walking provided positive experiences for patientsduring the rehabilitation process which included learning Nordic walking, experiencingNordic walking as an activity, social as pects toward Nordic walking and plans to continue with Nordic walking. The follow-up interviews also elicited reasons or hopes for continuing with Nordic walking.

    Conclusion Learning, experiencing and mastering the skill of Nordic walking as an activity during rehabilitation gave patients some positive experiences. Patients perceived Nordic walking as a safe, meaningful,and easily accessible activity that helped alleviate balance or joint problems, and also resulted in higher fitness levels than normal walking

  • 192.
    Högberg, Hjördis
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hjälper det att samtala med blivande föräldrar om alkohol?: Barnmorskans dialogsamtal omalkoholvanor och psykosocialt stöd för alkoholfri graviditet2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Introduction:In Sweden, midwives as a routine encourage pregnant women to refrain from alcohol use but theydo not discuss the habits of the father. The registration at the ACC provides a unique opportunity for both the mother and the father to reflect over alcohol habits during pregnancy and parenthood and possible alcohol problems among relatives.

    Purpose: The objective was to study if conversationswith both parents-to-be leads to reduced consumption of alcohol during the pregnancy and if psychosocial support primarily from the father is of importance for the mother ́s choice of pregnancy without alcohol and if the father receives corresponding support to decrease drinking.

    Method: The study was quasi-experimental within regular ACC-activities. The intervention group comprised of 238 couples. Two control groups with together 413 couples participated. The intervention group received written and oral information before registration and the couple filled questionnaires at registration. The couples were given opportunity to reflect about their habits and attitudes concerning alcohol in pregnancy and parenthood. They were also encouraged to think about how it in some cases was to be brought up with alcoholism. In the control groups, the midwife conducted a routine alcoholinformation. The intervention group and the first control group filled premeasuring after registration and filled postmeasuring in pregnancy week 33. The second control group only filled postmeasuring in pregnancy week 33.

    Results and conclusions:Most parents-to-be, used alcohol the year before the pregnancybut the majority of the women stopped when they got to know they were pregnant. Most fathers-to-be continued drinking but many of them reduced their consumption. One quarter drank for relaxation and about as many drank to become drunk. Few men (2-3%) did ever worry about the alcoholconsumption of the women but 12% of the women did ever worry about the alcohol consumption of the men. Fathers-to-be receive less support for reduced drinking than the pregnant women. In 6-13% of all answers there is a notion of alcohol problems among own father or mother and 64-68% of all answers stated absence of alcoholismamong relatives. The differences between groups were generally small. However, the persons in the intervention group reported that they thought ACC to give the most important information about alcohol. They also perceived that theyto a higher extent got support from each other more often than in the control groups

  • 193.
    Høst, Dorte
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ældres opfattelse og håndtering af at falde samt motivation for faldforebyggende tiltag2009Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study aimed to describe variations in elderly people’s perceptions of falling, and how they coped with falls. To target future initiatives to needs of the elderly, we also sought to determine what motivated them to participate in fall-prevention initiatives.

    Method: We collected data using semi-structured interviews with 14 elderly individuals (65 years +) who had contacted the emergency ward at a university hospital in Denmark. We analyzed the data using a phenomenographic approach that focused on describing varying perceptions by the elderly on the phenomenon of “falling.”

    Results: Five categories and 15 subcategories emerged from the interviews. The five main categories included emotional perceptions of falling; falling has consequences; handling the situation; support from the social network; motivation and demotivation. The study showed that older people’s perceptions of falling vary. Individuals accepted falling because they had become older. Falls were embarrassing and could be explained. The fear of falling was the foremost concern of some individuals. The elderly did consider falls a meaningful risk factor, but coped by restricting movements or dropping activities to prevent falls in the future. If demands exceeded resources, they asked their relatives or the GP for help. The elderly gained support, approval, and acceptance from their social network when deciding which coping strategies to use. The elderly were motivated by autonomy, competence, and relatedness and they preferred activities that increased happiness and enjoyment, preferably in a social atmosphere. The elderly protected their identity self-determining their activities, but they often encountered factors in their surroundings that restricted motivation.

    Conclusion: Future fall-prevention initiatives must target the needs of the elderly and consider that there are not one but many ways of perceiving falling. Further, the coping strategies that elderly individuals develop are not necessarily convenient. Social networks and the GP can play active roles in encouraging the elderly to participate in fall-prevention initiatives. When planning fall-prevention interventions, one should consider the extent to which such programs support the elderly individual’s need for autonomy, competence, and relatedness, because these factors affect motivation.

  • 194.
    Ingimundardóttir, Sigþrúður
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    The influence of light and nature on health and well-being: A phenomenological study among a group of elderly in Iceland2013Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Elderly people’s experiences of what embodies a rewarding old age and vitality form a vital premise for developing comprehensive age-related services.This study sought to increase knowledge and deepen understanding of elderly people ́s life.

    The objective: This study aimed to investigate how lightand nature influence elderly people ́s experience of health and well-beingin Iceland.

    Method: We applied the Vancouver School phenomenological method to data accumulated from,interviews with 10people(6women and 4men) with anaverage age of 80.9 years. Participants were residents of Reykjavík, Hafnarfjörður,and Mosfellsbær.

    Findings: Participants reported that light and nature were important. Although individual definitions varied, they loved nature and described it as akin to life itself. Twilight had a special place, bringing a sense of romance. All participants felt physically and mentally healthy during the interview process. Nevertheless, each of them had experienceda variety of health-related difficulties in the past. They felt that vitality and mental and physical equilibrium form the basis of are warding old age.

    Conclusion: From birth,an individual is part of his environment, which shapes him. This process is always active(i.e., anindividual re-analyses and values his health and well-being as conditions change). Although the values forming that basis vary, an individual must establish a balance between body and soul to feel healthy and achievewell-being. The findings reported here throw light on those factors which elderly people feel promote health and well-being, and are of value for those who study, teach and provide services for them.

  • 195.
    Jacobsen, Sissel
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Evaluering av læringsutbytte av etterutdanning for helsesøstre og jordmødre i samliv, seksualitet og prevensjon2009Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Purpose: To examine whether the qualifying postgraduate course, which authorizes public health nurses and midwives to prescribe oral contraceptives to teenage girls 16–19 years of age has increased the students’ knowledge of oral contraceptives, contributed to changing their attitude to adolescence and sexuality, and increased their motivation for offering teenage girls counselling in sexuality and sexual relationships.Method: The data set used for this study is a previously existing survey collected among public health nurses and midwives through questionnaires administered before and after they completed the course.Results: The response rate was 94 %. The students significantly increased their knowledge about effects and physical and psychological side effects of using oral contraceptives, but did not about the risk of serious diseases that accompanies oral contraceptive use. After the course, 58% and 50 % of the students found it necessary to inform teenage girls about the risk of blood clots in legs and lungs, respectively, when using oral contraceptives. The students’ attitudes towards youth and sexuality were quite liberal before the course and the course did not significantly change those attitudes. Moreover, students were significantly more positive about offering teenage girls counselling regarding sexual relationships and sexuality.Conclusion: The results demonstrate that the purpose of the course, i.e. upgrading students’ qualifications, is only partly successful. Although the students are significantly better qualified to inform teenage girls about oral contraceptives effects and their side effects, their knowledge about the risk of serious diseases did not increase significantly. The students show significantly more interest in offering counselling about sexual relationships and sexuality after completing the course.

  • 196.
    Jagmann, Kirsten
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Tsjetsjenske foreldres synspunkter på hjelp til barn og unge med psykiske vansker etter krig og flukt2009Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Many refugee children struggle with mental problems. This presents a challenge for the Norwegian health service.

    Purpose: This thesis aims to describe Chechenian parents’ experience of parenting in Chechnya and Norway respectively, and which initiatives they perceive to be best for their children’s mental health.

    Method: This descriptive study used a qualitative approach to interview ten parents who had immigrated to Norway from Chechnya. The themes in the interview guide were:  Parenting role in the homeland; the children’s psychological situation; the wishes, viewpoints and thoughts of the parents concerning what might improve the possible poor mental health of the child; how the rigours of participation in the qualification programme demanded by immigration laws affect the parenting role. Data were analysed by content analysis.

    Findings: The parents reported that, after many years in Norway, their children and teenagers experience both mental and social difficulties including loneliness, difficulty fitting in with friends and adjusting to leisure activities.  Some are behaviourally disturbed, and functioning socially is difficult. The children’s poor mental health and social challenges place great demands on the parents. Informants explained that they lack experience in having responsibility for raising children. Moving to Norway, they have left behind the child-rearing skills found in their family and social network. At the same time, they describe considerable differences in the parental goals and values of their homeland and Norway. Mothers especially, described a very exhausting daily life whilst participating in the qualification programme, balancing parental responsibilities whilst having their own mental difficulties. Having little or no free time increased their stress levels. Parents want help with health-promoting initiatives such as leisure activities, network building, cultural activities, and teaching of parenting skills, but their experience of child-therapy has been negative. Most of all, they want time to be parents for their children.

    Conclusions: The reception of large families where both parents and children have endured traumatic experiences is complicated, and demands a coordinated effort from the local council, where the child’s perspective must be as central as the parents’ circumstances, preferably with a separate qualification programme for children. In particular, programmes must be organised with good parenting function in mind.

  • 197.
    Jahnsen, Bente
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Bemanningsenhet som en ressurs i sykehus.: En kvalitativ studie.2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: In healthcare manyc aregivers work part-time involuntarily, resulting in unpredictable income and work schedule. A staffing unit could providean efficient tool for reducingthe scope of involuntary work.

    Purpose: This study aimed to determine the important factors in supporting a good staffing unit and full-time work for caregivers while simultaneously providing quality services.

    Method: We recruited 14 caregivers,who had worked ina staffing unit for 7-18 months, to participate inthree focus-group interviews. We reviewed all data using qualitative content analysis.

    Result: We identified and describedthree categories: organization and culture, health promoting work places, and the qualifications of the employees.

    Conclusion: Our results show that a full-timeposition is a basic requirement for recruitment to staffing units. Retaining employees requires systematic and structured training as well as skill development and maintenance. Management should promote a healthy workplace by facilitating coping skills and recognizing achievement, ambition, and affiliation. Such promotion ensures careg ivers’ ability to provide quality care. The employees’ coping resources and personal skills appear to be significant.

  • 198.
    Javtokas, Zenonas
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sense of coherence and awakening: evidence from the population survey in Lithuania2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Lithuania has one of the highest suicide rates for men in the world (81.7 per 100,000 men). 21.7% of the population feels depressed. A salutogenic model of health developed by Antonovsky provides new knowledge for betterunderstanding of the behaviour of individuals and explains why some individuals fall ill under stress and why some do not. The study is focussed on the analysis of sense of coherence (SOC) on the population sample of Lithuania (n=3390) using a simplified way of measuring SOC developed by Lundberg and Nyström Peck at the Swedish Institute for Social Research of Stockholm University. The data of the study showed that people with low SOC (60.1%) predominate among the Lithuanian population. A strong correlation between low SOC, depression and stress was found. Additional studies, preferably longitudinal, are needed to identify possible relationshipsbetween cognitive processes (SOC) and biological mechanisms, causing adverse effects on mental health

  • 199.
    Jensen, Anette
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sundhedspersonales opfattelser og håndtering af smitterisiko: et kvalitativt studie2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim:This study aimed to explore and describe how healthcare workers (HCWs) perceive and handle the risk of infection in isolated and non-isolated patients.The study also sought to determinewhetherany specialperceived risk of infection in isolated patients affects how HCWsperceive the importance of general infection control measures.

    Method:This was a qualitative study. Data was collected from eight HCW focus groups and analyzed using a systematic textcondensation method. The conceptual framework includes antibiotic resistance in a public health perspective, adescription of the context of infection controland prevention in Denmark, a theoretical framework consisting of the concept of risk, health education and a perspective on cooperation.

    Results: The study showed that HCWsassessed risk differently inisolated and in non-isolated patients. HCWs perceivedthat they prevented infection more effectively in isolated patients, due to greater attentiveness and a more structured approach.Cooperation was an important motivation in isolation rooms. HCWsperceived special risk situations among non-isolated patients who shared rooms and toilets. The HCWs experienced flaws in their own infection control measures andin the behaviour of patients and their relatives. HCWs read and interpreted infection control protocols differently leading to confusion and misunderstandings. It was a challenge keeping up the changing of knowledge and practice over time as well as new development caused new infection control challenges.

    Conclusion:HCWsperceive the risk of infection differently in isolated and non-isolated patients. Further, HCWs often associatethe work of caring for and treating isolated patients with fear of spreading infection. Differences in knowledge base, experience level and individualrisk assessments contribute to the explanation of differing perceptions and approaches to handle infection control

  • 200.
    Jensen, Marianne
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Evaluering af en geriatrisk funktion på et mellemstort dansk hospital2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Introduction:  The Nordic Hospitals have these years seem a lot of organizational changes.

    They are traditionally quantitatively evaluated. There is no tradition to use qualitative evaluation methods. The perspective of the patients is examined quantitatively by a patient satisfaction survey each year, but it is not possible to see the results of these surveys in coherence to a given activity in a given ward in the hospital. The perspective of the employees is not included in evaluations of organizational changes.

    Purpose: The purpose of this evaluation is to examine coherence between the indicators that have been fulfilled, and the employees’ experience of their daily work, together with the patients – and their relatives’ experience of the admittance at the ward. 

    It is the intention to show a picture as varied as possible of the geriatric ward and both reasonable and not reasonable conditions in the employees work life and in the patients’ experiences.

     Method: The clinical indicators of quality are examined by an audit reading of 50 consecutively chosen patient files from the geriatric ward. The patients – and the relatives perspective is illuminated by four interviews with patients and relatives directly following their admittance to the ward and the perspective of the employees is illuminated by two interviews with the managers of the ward and a focus group interview with eight staff members of the ward.

    Results: The employees express frustration and lack of management. It is not easy for them to see coherence in the daily activities and they experience absence of peace and meaning in their daily work. In their opinion, the clinical indicators of quality are not relevant for their work.

    Only a low part of the indicators of clinical quality fulfil the expected goals. This find is in concordance with the experiences of the patients and the relatives and to some extent, can be explained, by the employees’ way of understanding the quality indicators. The most probable explanation to the low fulfilment of the goals is the employees’ experience of lack of management, coherence, and meaningfulness in their daily activities.

    Conclusion: There is a consistent connection between the three perspectives. The perspective of the employees describes possible causes to the low part of clinical indicators of quality, which fulfil the goals. The perspective of patients and relatives points at the consequences of this.

    The triangulation of the methods in an evaluation of organizational changes has shown a successful way, to understand conditions and coherence in the results of an organizational change, than the traditional method of evaluation.

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