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  • 251.
    Laur, Piret
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    EXTERNAL CAUSES OF DEATH IN ESTONIA 1970-2002: a special reference to suicide, traffic accidents and alcohol poisoning2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The study aims to describe the external causes of death (ECD) mortality, specifically suicide and traffic death in Estonia 1970-2002 in relation to the political and economic development with a special focus on the unemployment and alcohol use impact. This analyse bases on the Statistical Office of Estonia and other governmental institutions published information. The highest mortality rates occurred for traffic accidents 1990-91 and for suicides 1994-95. Middle-age man excess ECD mortalityoccurred in early 1990s with the greatest politico-economic changes accompanied by high psychosocial stress before the population could acquire appropriate coping strategies. Impact of the first main reforms on the population health has been ascertained. Price liberalisation was followed by immense inflation and real wage fall in early 1990s. Privatisation and monetary reform influenced on the basic living security of the population. People faced unexpected living difficulties as work and dwelling insecurity, decreased real income, insufficiency to meetessential expenditures, declined living standard, social status loss, population stratification and inadequate social protection. Unemployment was just introduced and did not play a significant role for the high mortality. Traffic accidents’ fatal consequences decreased with growing GDP as cars and roads became safer however accidents’ number did not decrease. Western cars appearance euphoria could influence more than alcohol consumption. It could plausibly increase accidents but the reason and role of alcohol consumption in the intentional actions needs more information. Suicide could have been influenced mainly by social and traffic accidents mortality mainly by environmental factors. Earlier findings about the unemployment and alcohol consumption impact on the transition’s high injurymortality have not been confirmed by the current study. Current paper provides framework within population worsening health factors during politico-economic changes could be better understood. The strongest impact on Estonia’s population health could come from transition’s political and economic reforms influencing dwelling and incomesecurity. Low salary and low purchasing power could hurt a human dignity even more than possible unemployment

  • 252.
    Leitz, Christine
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Forsigtig antibiotikabrug i Norden. Hvordan kan den fremmes? Fokus er antibiotikas påvirkning af tarmfloraen2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    BACKGROUND:Drug resistance resulting from the overuse of antibiotics poses a threat to public health. Consequently, antibiotics must be used more cautiously.Intestinal flora is important to health and antibiotics can disrupt intestinal flora. Salutogenic theory is a well-established concept in public health. Sense of coherence (SOC), which is a key concept insalutogenic theory, reflects a person ́s lifeviewand capacity to respond to stressful situations, includes three components: comprehensibility, manageability and meaningfulness. SOC is a valuable tool for problems that target “compliant” behavior. Lack of SOC in both physicians and the general public may contribute to poor compliance to current guidelines that recommend restricting the use of antibiotics.

    AIM: The study aimed to formulate proposals for promoting the prudent use of antibiotics by optimizing SOCbased on literature that illustrates(i) the attitudes of the general public and doctors regarding antibiotics and antibiotic resistance in Scandinavia and (ii) the influence and possible health consequences of antibiotics on intestinal flora. It is discussed whether there are reasons for looking at antibiotics in a different way, which factors that facilitate or hinder prudent antibiotic use and how SOC could be optimized.

    METHODS: A literature study aftera structured search of the PubMed and Psych INFOdatabases.

    RESULTS: Although antibiotics are generally considered protective, their effect on intestinal flora may have adverse health consequences. Knowledge, habits and communication affect how antibiotics are used and whether prudent antibiotic use is experienced comprehensible and manageable. Doctors may experience conflict when prescribing antibiotics between treating the patient in the best possible manner and the need to limit such treatment to protect the community from increased resistance to antibiotics. Doctors ́wish to guarantee that their patients receive the best possible treatment might be one reason why they do not adhere to guidelines that recommend more restrictive use of antibiotics. Doctors do not consider the cautious use of antibiotics as meaningful.

    CONCLUSION: Careful antibiotic use could be promoted by using the influence of antibiotics on intestinal flora as motivational strategy;promoting effective communication and supporting appropriate and unlearn undesirable habits related to antibiotic use. A possible approach would be teaming physicians with a microbiologist for a day

  • 253.
    Lerum, Arve
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Barnevern og beslutninger, stress og mestring: En komparativ studie av barnevernsarbeid i en dansk og en norskkommune2011Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study aimed to compare the practice of the child protection services in a Danish and a Norwegian municipality. We sought to increase understanding about (i) the decision making processes of child protection services, (ii) the stressors encountered by child protection workers, and (iii) the coping mechanisms such workers use.Methodology: Child protection workers with 10 or more years of work experience participated in two focus group discussions, one held in a Norwegian municipality with four participants and the other in a Danish municipality with three participants. Discussion transcriptions were analysed using quality content analysis.Results: The data showed that the child protection service in Norway used only limited collaboration with other municipal services. Moreover, Norwegian child protection workers were more likely to rely on their colleagues and make group decisions. In contrast, the child protection service in the Danish municipality collaborated structurally and sustainably with other municipality services. Both groups experienced stress when they (i) were unable to achieve good outcomes and (ii) could not easily assess the situation and available information for a child in need. Child protection workers in both municipalities reported difficulty in making appropriate decisions regarding children. Important coping strategies for workers during the decision-making process involved support from colleagues and management.Conclusion: The decision-making process of Danish child protection workers relies on both individual assessments and collaboration with other municipal services. Conversely, Norwegian child protection workers are more self-reliant. Both services struggle to make appropriate decisions regarding the care of children in need, and all workers seek support from colleagues and management.

  • 254.
    Lesén, Eva
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Psychotropic drugs among the elderly: Population-based studies on indicators of inappropriate utilisationin relation to socioeconomic determinants and mental disordersEva LesénGothenburg,2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Drug utilisation among the elderly is complex due to multiplemorbidities, extensive drug utilisation and an increased sensitivity to drugs. One of the most common drug groups utilised in this population is psychotropic drugs, which include antipsychotics, anxiolytics, hypnotics, and antidepressants. In appropriat eutilisation of drugs among the elderly is an issue of great public health importance.

    Aims: The overall aim of this thesis is to assess and analyse potentially in appropriat eutilisation of psychotropic drugs among the elderly in Sweden. The specific aims are to assess to what extent the indicator “concurrent use of three or more psychotropic drugs”captures the utilisation of Potentially Inappropriate Psychotropics (PIP) among theelderly, and to analyse potentially inappropriate utilisation of psychotropic drugs inrelation to time, mental disorders, institutionalisation, and socioeconomic determinants among the elderly in Sweden.

    Methods: Data from individual-based registers on dispensed drugs and socioeconomic determinants in 2006, the Gothenburg 95+ Study (1996-1998), and aggregated drug sales statistics from 2000-2008 were used. The agreement between the two indicators“concurrent use of three or more psychotropic drugs” and PIP was assessed. Utilisationof psychotropic drugs and PIP was assessed in relation to mental disorders and institutionalisation among the 95-year olds, and in relation to socioeconomic determinants among individuals aged 75 years and older. Further, trends over time inutilisation of PIP and recommended drugs were analysed.

    Results: During 2006, about half of the elderly aged 75 years and older utilised psychotropic drugs and one fifth of all elderly utilised PIP. One fourth of individualsutilising PIP were captured by the indicator “concurrent use of three or morepsychotropic drugs”. In 1996-1998, less than one tenth of the 95-year olds with depression utilised antidepressants, while hypnotics and anxiolytics were more common. Individuals with low income and the non-married were more likely to utilise PIP compared to those with high income and the married, respectively. During 2000-2008, utilisation of PIP decreased and utilisation of recommended psychotropic drugs increased.

    Conclusions: There are substantial problems in the utilisation of psychotropic drugsamong the elderly. This thesis found that the agreement between two indicators of inappropriate psychotropic drug utilisation was poor, which emphasises the importance of choosing relevant indicators. The findings also show socioeconomic inequities inpsychotropic drug utilisation among the elderly, a low utilisation of antidepressants among 95-year olds diagnosed with depression, and a trend towards the utilisation of recommended rather than inappropriate psychotropic drugs among the elderly

  • 255.
    Lesén, Eva
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Andersson, Karolina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Petzold, Max
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Carlsten, Anders
    Department of Research and Development, The National Corporation of Swedish Pharmacies (Apoteket AB), Gothenburg, Sweden.
    Socioeconomic determinants of psychotropic drug utilisation among elderly: a national population-based cross-sectional study.2010In: BMC public health, ISSN 1471-2458, Vol. 10, p. 118-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychotropic drugs are commonly utilised among the elderly. This study aimed to analyse whether two socioeconomic determinants - income and marital status - are associated with differences in utilisation of psychotropic drugs and potentially inappropriate psychotropic drugs among elderly in Sweden.

    METHODS: All individuals aged 75 years and older who had purchased a psychotropic drug in Sweden during 2006 were included (68.7% women, n = 384712). Data was collected from national individual-based registers. Outcome measures were utilisation of three or more psychotropic drugs and utilisation of potentially inappropriate psychotropic drugs, as classified by the Swedish National Board of Health and Welfare.

    RESULTS: Individuals with low income were more likely to utilise three or more psychotropic drugs compared to those with high income; adjusted odds ratio (aOR) 1.12 (95% confidence interval [CI] 1.10-1.14). The non-married had a higher probability for utilising three or more psychotropic drugs compared to the married (aOR 1.22; CI 1.20-1.25). The highest probability was observed among the divorced and the never married. Potentially inappropriate psychotropic drugs were more common among individuals with low compared to high income (aOR 1.14; CI 1.13-1.16). Compared to the married, potentially inappropriate psychotropic drug utilisation occurred more commonly among the non-married (aOR 1.08; CI 1.06-1.10). The never married and the divorced had the highest probability.

    CONCLUSIONS: There was an association between socioeconomic determinants and psychotropic drug utilisation. The probability for utilising potentially inappropriate psychotropics was higher among individuals with low income and among the non-married.

  • 256.
    Lesén, Eva
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Carlsten, Anders
    Department of Research and Development, The National Corporation of Swedish Pharmacies (Apoteket AB), Gothenburg, Sweden.
    There is a trend in the utilization of psychotropics among elderly towards recommended drugs.2010In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 19, no 10, p. 1095-9Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To analyse trends in sales of potentially inappropriate psychotropic substances (PIPS) in relation to drugs recommended by Drug and Therapeutics Committees (DTC drugs) among 75-year olds and among individuals born 1925 in Sweden.

    METHODS: Trends in sales of PIPS and DTC drugs among 75-year olds and among individuals born 1925 in Sweden during 2000-2008 were analysed with linear regression models. Sales were measured as defined daily doses per 1000 inhabitants and day. PIPS were defined according to a proposal from the Swedish National Board of Health and Welfare. The selection of DTC drugs was based on a review of recommendations from local DTCs.

    RESULTS: Among 75-year olds, PIPS sales decreased 38% and DTC drugs sales increased 31% from 2000 to 2008. The hypnotic PIPS decreased 45%, while the DTC hypnotics increased 36%. The total sales of PIPS to individuals born in 1925 decreased 12% from 2000 to 2008. The DTC drugs increased 115%. Sales of hypnotic PIPS decreased 12%, and the hypnotic DTC drugs increased 120%.

    CONCLUSIONS: The findings indicate a trend towards the utilization of DTC drugs rather than PIPS.

  • 257.
    Lesén, Eva
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Carlsten, Anders
    Department of Research and Development, The National Corporation of Swedish Pharmacies (Apoteket AB), Gothenburg, Sweden.
    Skoog, Ingmar
    Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Waern, Margda
    Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Petzold, Max
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Börjesson-Hanson, Anne
    Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Psychotropic drug use in relation to mental disorders and institutionalization among 95-year-olds: a population-based study.2011In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, no 8, p. 1270-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The prevalence of psychotropic drug use is high among the elderly, but research on how psychotropic drugs are used among individuals aged 90 years and older is limited. An increased knowledge on this topic may contribute to improved prescribing patterns in this vulnerable population. The aim of this study was to assess the use of psychotropic drugs in relation to mental disorders and institutionalization among 95-year-olds and to identify use of potentially inappropriate psychotropic drugs.

    METHODS: All 95-year-olds born in 1901-1903 living in nursing homes or community settings in Gothenburg, Sweden were invited to participate. The response rate was 65% and 338 95-year-olds were examined (263 women, 75 men). Psychotropic drug use in relation to mental disorders and institutionalization was assessed. Information on drug use was collected primarily from multi-dose drug dispensing lists. Participants were examined by trained psychiatrists using the Comprehensive Psychopathological Rating Scale and a battery of cognitive tests. Dementia, depression, anxiety and psychotic disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R).

    RESULTS: Sixty percent of the 95-year-old participants used psychotropic drugs; hypnotics were most common (44%). Potentially inappropriate psychotropics were observed in one third (33%). Antidepressants were used by 7% of the participants without dementia who fulfilled criteria for a depressive disorder, while 56% used hypnotics and 30% used anxiolytics.

    CONCLUSIONS: The high prevalence of psychotropic drug use and the nonspecific nature of these treatments among 95-year-olds indicate a need for improvement in prescribing patterns.

  • 258.
    Lesén, Eva
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Petzold, Max
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Andersson, Karolina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Carlsten, Anders
    Department of Research and Development, The National Corporation of Swedish Pharmacies (Apoteket AB), Gothenburg, Sweden.
    To what extent does the indicator "concurrent use of three or more psychotropic drugs" capture use of potentially inappropriate psychotropics among the elderly?2009In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 65, no 6, p. 635-42Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The indicator "concurrent use of three or more psychotropic drugs" has been used as a measure of quality in drug use among the elderly. The aim of our study was to assess to what extent the indicator captures the use of specific psychotropics associated with an increased risk of adverse events among the elderly, i.e., potentially inappropriate psychotropic drugs (PIP).

    METHODS: All individuals aged 75 years and older in Sweden purchasing prescribed psychotropic drugs in 2006 constituted the study population (n = 384,904). Data on purchased psychotropic drugs from the Swedish Prescribed Drug Register were used. The overlap between individuals with the indicator and individuals using PIP was assessed with sensitivity, specificity, positive and negative predictive values and likelihood ratio as outcome measures.

    RESULTS: Among the psychotropic drug users, 15% had the indicator and 39% used PIP. The proportion of individuals with the indicator among all individuals using PIP was 27% (sensitivity). The proportion of individuals without the indicator among all individuals not using PIP was 93% (specificity). The positive predictive value was 72%, and the negative predictive value was 67%. Differences in outcome measures were observed between different categories of PIP.

    CONCLUSIONS: The indicator "concurrent use of three or more psychotropics" can be technically easy to use, but PIP is more specific. Three quarters of all individuals who used PIP in this study were not captured by the indicator. However, two thirds of all individuals with the indicator used PIP. When selecting instruments to assess appropriateness in drug therapy in the elderly, clinical relevance should be balanced against convenience of use.

  • 259.
    Lewin, Simon
    et al.
    Norwegian Knowledge Centre for the Health Services, Preventive and International Health Care Unit, Oslo, Norwa.
    Munabi-Babigumira, Susan
    Norwegian Knowledge Centre for the Health Services, Preventive and International Health Care Unit, Oslo, Norwa.
    Glenton, Claire
    SINTEF Health Research, Department of Global Health and Welfare, Oslo, Norwa.
    Daniels, Karen
    Nordic Council of Ministers, Nordic School of Public Health NHV. Health Systems Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa .
    Bosch-Capblanch, Xavier
    van Wyk, Brian E
    Swiss Tropical and Public Health Institute, Swiss Centre for International Health, Basel, Switzerland.
    Odgaard-Jensen, Jan
    Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
    Johansen, Marit
    Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
    Aja, Godwin N
    Babcock University, Department of Health Sciences, Ikeja-Lagos, South West, Nigeria.
    Zwarenstein, Merrick
    Sunnybrook Health Sciences Centre, Combined Health Services Sciences, Toronto, ON, Canada.
    Scheel, Inger B
    SINTEF Health Research, Department of Global Health and Welfare, Oslo, Norway.
    Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases.2010In: The Cochrane database of systematic reviews, ISSN 1469-493X, no 3, p. CD004015-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. Little is known, however, about the effectiveness of LHW interventions.

    OBJECTIVES: To assess the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases.

    SEARCH STRATEGY: For the current version of this review we searched The Cochrane Central Register of Controlled Trials (including citations uploaded from the EPOC and the CCRG registers) (The Cochrane Library 2009, Issue 1 Online) (searched 18 February 2009); MEDLINE, Ovid (1950 to February Week 1 2009) (searched 17 February 2009); MEDLINE In-Process & Other Non-Indexed Citations, Ovid (February 13 2009) (searched 17 February 2009); EMBASE, Ovid (1980 to 2009 Week 05) (searched 18 February 2009); AMED, Ovid (1985 to February 2009) (searched 19 February 2009); British Nursing Index and Archive, Ovid (1985 to February 2009) (searched 17 February 2009); CINAHL, Ebsco 1981 to present (searched 07 February 2010); POPLINE (searched 25 February 2009); WHOLIS (searched 16 April 2009); Science Citation Index and Social Sciences Citation Index (ISI Web of Science) (1975 to present) (searched 10 August 2006 and 10 February 2010). We also searched the reference lists of all included papers and relevant reviews, and contacted study authors and researchers in the field for additional papers.

    SELECTION CRITERIA: Randomised controlled trials of any intervention delivered by LHWs (paid or voluntary) in primary or community health care and intended to improve maternal or child health or the management of infectious diseases. A 'lay health worker' was defined as any health worker carrying out functions related to healthcare delivery, trained in some way in the context of the intervention, and having no formal professional or paraprofessional certificate or tertiary education degree. There were no restrictions on care recipients.

    DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and assessed risk of bias. Studies that compared broadly similar types of interventions were grouped together. Where feasible, the study results were combined and an overall estimate of effect obtained.

    MAIN RESULTS: Eighty-two studies met the inclusion criteria. These showed considerable diversity in the targeted health issue and the aims, content, and outcomes of interventions. The majority were conducted in high income countries (n = 55) but many of these focused on low income and minority populations. The diversity of included studies limited meta-analysis to outcomes for four study groups. These analyses found evidence of moderate quality of the effectiveness of LHWs in promoting immunisation childhood uptake (RR 1.22, 95% CI 1.10 to 1.37; P = 0.0004); promoting initiation of breastfeeding (RR = 1.36, 95% CI 1.14 to 1.61; P < 0.00001), any breastfeeding (RR 1.24, 95% CI 1.10 to 1.39; P = 0.0004), and exclusive breastfeeding (RR 2.78, 95% CI 1.74 to 4.44; P <0.0001); and improving pulmonary TB cure rates (RR 1.22 (95% CI 1.13 to 1.31) P <0.0001), when compared to usual care. There was moderate quality evidence that LHW support had little or no effect on TB preventive treatment completion (RR 1.00, 95% CI 0.92 to 1.09; P = 0.99). There was also low quality evidence that LHWs may reduce child morbidity (RR 0.86, 95% CI 0.75 to 0.99; P = 0.03) and child (RR 0.75, 95% CI 0.55 to 1.03; P = 0.07) and neonatal (RR 0.76, 95% CI 0.57 to 1.02; P = 0.07) mortality, and increase the likelihood of seeking care for childhood illness (RR 1.33, 95% CI 0.86 to 2.05; P = 0.20). For other health issues, the evidence is insufficient to draw conclusions regarding effectiveness, or to enable the identification of specific LHW training or intervention strategies likely to be most effective.

    AUTHORS' CONCLUSIONS: LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care. For other health issues, evidence is insufficient to draw conclusions about the effects of LHWs.

  • 260.
    Lien Smedsrød, Mirjam
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Vellykket livsstilsendring handler om utvikling av motivasjon, ferdigheter og evne til selvregulering.2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The incidence of overweight and obesity is steadily increasing in the Nordic countries and the entire world. This trend is a cause for concern because obesity links directly to many several illnesses, some life-threatening. Various methods have been developed in an effort to manage problems associated with obesity and inactivity. These methods also try to initiate positive lifestyle changes. However, it is necessary to broaden the knowledge base regarding the effectiveness of these strategies.

    Aim: This study aimed to use qualitative methodology to assess people who have succeeded in making positive lifestyle changes, documenting their experiences and learning how they adapted during the change process.

    Methodology: A group of 14 people consisting of eight men and six women, all between the ages of 23 and 68 years, were individually interviewed using a modified version of Grounded Theory to collect and analyze the data.

    Results: The study shows that the participants' positive lifestyle changes have gone through a variety of social processes. These processes comprised three main categories: motivation to change, development of new habits, and self-management. A defining factor in the change process of each candidate was how well that individual developed a greater degree of self-control and management of their own lives.

    Conclusion: Successful lifestyle change is a psychological empowerment process that emphasizes self-regulation, motivation, mental disorders, and the development of new habits.

  • 261.
    Lillesveen, Birger
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sammenheng mellom enkeltvedtak og hjelp til hjemmeboende personer med demens Sammenheng mellom enkeltvedtak og pasientens tap av funksjonsevner2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    he purpose of this study was to look more closely at a previously neglected area namely: Do administrative decisions for provisions of care correspond to the actual care given to persons with dementia living at home, and does the loss of skills effect the decision and care provided?The method used was collection of data, which was than categorised by a qualitative analysis of content. Although individual administrative decisions are governed by law, and most local authorities have passed guidelines on how these decisions should be formulated, and how the care should be provided, our study showed a large variation in the quality of provisions and professional practice. Four hundred and sixty persons with dementia, from all health regions, were included in the study. Inclusion criteria were patients with known dementia, diagnosed by a doctor and/or assumed to be demented by the community nurse. In total, 489 patients were recruited, 249 with a confirmed diagnosis of dementia, and 240 without. Of these 240 patients, with assumed dementia, 211 had a KDV score of one or greater. These were included, whilst the 29 with lower scores were excluded from the study. Data for the study was thus collected from 460 patients. The results show little relationship between the administrative decisions for care, the need for care, and actual care provided. Eighty-six percent of administrative decisions were followed up by the home services, but many receive help without formal decisions. The study also found many in need of help who did not receive it. Routines for arriving at and formalising administrative decisions were incomplete. The study shows a failure of implementation of existing laws, regulations and patient rights, rather than a failure of the laws and regulations themselves

  • 262.
    Lindahl Norberg, Annika
    et al.
    Department of Women’s and Children’s Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden, 2 U-CARE/Psychosocial Oncology and Supportive Care, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Mellgren, Karin
    Department of Pediatrics, Institution for Clinical Sciences, University of Gothenburg, Gothenburg, Sweden,.
    Winiarski, Jacek
    Department of Clinical Science, Intervention and Technology, Astrid Lindgren Children’s Hospital, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Forinder, Ulla
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Social Work, Stockholm University, Stockholm, Sweden.
    Relationship between problems related to child late effects and parent burnout after pediatric hematopoietic stem cell transplantation2014In: Pediatric Transplantation, ISSN 1397-3142, E-ISSN 1399-3046Article in journal (Refereed)
    Abstract [en]

    A few studies have indicated that parents’ reactions to achild’s serious disease may entail long-term stress for the parents.However, further knowledge of its consequences is valuable. The aim ofthe study was to investigate the occurrence of burnout in a Swedishnational sample of parents of children who had undergone HSCT andsurvived. Burnout (Shirom–Melamed Burnout Questionnaire) andestimations of the child’s health status (Lansky/Karnofsky estimationsand study-specific questions) were self-reported by 159 mothers and 123fathers. In addition, physicians made estimations of the child’s healthstatus (Lansky/Karnofsky estimations). Nonparametric tests revealedthat burnout symptoms occurred more often among fathers of childrenwho had undergone transplantation within the last five yr compared tofathers of children with no history of serious disease (34.4% vs. 19.9%).Burnout among mothers and fathers was associated with the child’snumber and severity of health impairments up to five yr after the childunderwent HSCT (Spearman’s rho for mothers 0.26–0.36 and forfathers 0.36–0.61). In conclusion, chronic stress in parents after achild’s HSCT seems to abate eventually. However, parents should bemonitored and offered adequate support when needed. Moreover, thesituation of fathers in the often mother-dominated pediatric settingshould receive more attention in research as well as in the clinic.

  • 263.
    Lindqvist, Rafael
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Bengtsson, Steen
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Fredén, Lars
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Larsen, Frode
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Rosenberg, David
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ruud, Torleif
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Wahlbeck, Kristian
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Från reformintention till praxis: Hur reformer inom psykiatri och socialtjänst översatts till konkret stöd i Norden2011Report (Other academic)
    Abstract [sv]

    Den här forskningsrapporten, som finansierats av Nordiska Ministerrådet, är en komparativ studie av hur reformer inom psykiatri och socialtjänsten översatts till konkreta vård- och stödinsatser i fyra nordiska länder: Danmark, Finland, Norge och Sverige. Att Island utelämnats beror på att vi inte funnit någon intresserad forskarkollega som haft möjlighet att anta utmaningen. Arbetet med projektet ingår i den s.k. Handlingsplanen för Psykisk hälsa där ytterligare ett antalprojekt har genomförts. Samtliga dessa projekt har organiserats av Nordiska Akademin för forskning om psykisk hälsa vid NHV och med docent Lars Fredén som huvudansvarig.Rapporten innehåller dels en inledande komparativ analys och därefter följer en beskrivning av reformutvecklingen i varje enskilt land. Rapporten ger en bild av hur policyintentioner, servicesystem, arbetsformer och samverkansformer gestaltar sig i de fyra nordiska länderna och i vilka avseenden likheter och skillnader finns. Trots att det finns stora kulturella likheter mellan länderna finns också olikheter som bl.a. innebär skillnader i hur begrepp och terminologi används. I ett par av länderna, Danmark och Finland, är det tveksamt om man överhuvudtaget kan tala om specifika psykiatrireformer eftersom det handlar om en utveckling med ett tämligen långt utdraget förlopp där olika politikområden berörs. I Norge och Sverige kan vi däremot iaktta relativt specifika och avgränsade reformer. En annan aspekt som rör begrepp och terminologi är att man i Finland och Norge använder begreppet psykiatri när man mer entydigt refererar till den aktuella medicinska disciplinen, medan man använder sig av begreppen mentalvårdsarbete respektive psykisk helsearbeid när vill inkludera socialtjänstens och andra organisationers insatser för personer med psykisk ohälsa. I Danmark och till viss del även i Sverige använder man sig av begreppet socialpsykiatri för motsvarande verksamhet. Vi har valt att inkludera länderrapporterna skrivna med den i landet gängse terminologin eftersom den återspeglar de diskussioner och ställningstaganden man gjort vad gäller policyinriktning och servicestruktur. I den komparativa analysen har videlvis frångått detta språkbruk till förmån för en mer enhetlig begreppsapparat. Vi kan bara hoppas att läsaren gör sina egna reflektioner om hur utvecklingen av policy och servicestruktur återspeglas i vår analys.

  • 264.
    Ling - Roos, Monica
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hur arbetar chefer med att förbättra hygienrutiner?: En kvalitativ studiepå ett sjukhus i Stockholm2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Introduction: Every year, millionsof patients world wide contract healthcare-associated infections, which posea public health problem and threaten patient safety. According to the World Health Organization, all countries must reduce the prevalence of healthcare-associated infections by improving hygiene procedures by health professionals.

    Aim: This thesis aims to increase insight, understanding,and knowledge about how managers at an emergency hospital in Stockholm work to improve patient safety through hygiene procedures, clothing,and hand hygiene routines.This thesis also aims to provide suggestions and inspiration for optimizing adherence to hygiene procedures and possibly inspire other caregivers.

    Method: Forty-one managers at various levels were interviewed using aqualitative research approach.Manifest qualitative content analysis was used for data analysis.

    Results: Managers perceived that adherence to hygiene procedures is generally good, but reported that adherence may differ between professions. Despite correction, some ndividuals repeatedly demonstrated non-adherence. Managers worked o increase adherence in their own units, but reported little coordination between units. Because the hospital had no joint strategy, each manager organized work assignments for their own staff. Mid-level managers expressed a desire to discuss their unit’s adherence to hygiene procedures with senior managers.They also voiced the need for improvement in health professionals with low adherence.

    Conclusion: The evidence presented here suggests that adherence to hygiene procedures would increase if managers interact, coordinate,and have more unifiedstrategies.A hospital-wide focus on hygiene procedures would aid adherence.

  • 265.
    Löf, Hans
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Liv med kvalité vid 75+: En intervjuundersökning av äldres uppfattning om livskvalitet och boende2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: The rapidly ageing population in the Nordic countries warrants research on factors that older adults self-report as contributing to healthy ageing and enhanced quality of life. In Sweden,previous research focused mainly on structural factors related to living conditions. Housing is important because almost 50 % of all people 80 years or older live in homes that lack adequate accessibility.

    Aim:This study aimed to nvestigate how older adults experience quality of life and identify related key factors.We also aimed to increase understanding of what older adults consider important to quality of life, and how home accessibility contributes to such quality and how they view their living situation.

    Methods: We interviewed 16 adults aged 75 years or older,residing in a larger city in southern Sweden. All informants were in “the third age”(i.e., the period of active and healthy ageing that usually follows retirement).The informants, ten females and six males, volunteered to an interview after an inquiry was directed to three local pensioners associations.

    Results: Our results demonstrate that perception outweighs structure for quality of life among active and healthy older people. We identified three key factors that influence quality of life, (i) experienced health status (i.e., mobility and ability to cope with everyday life); (ii) residential comfort; and (iii) meaningful social relationships and activity. Interviewees reported that factors related to residential accessibility are not as important, at least as long as the consequences of limited access do not interfere with everyday life.

    Conclusions: For the near future, older people in the third age need better understanding and awareness of the benefits that result from taking responsibility for and planning their living arrangements before disabilities affect quality of life. Because remainingin one'sown home is so essential to quality of life, Sweden ́s housing stock must become more accessible.Long-termplanning(i.e.,national and local government building regulations)should ensureav ailability of accessible homes for the elderly, to avoid forcing them to move when disability occurs. Achieving these goals will require stronger links between housing and public health policies regarding the elderly

  • 266.
    Løvendahl Sørensen, Alice
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Oplevelse af sammenhæng hos bærere af Meticillin Resistente Staphylococcus aureus(MRSA): Et kvalitativt studie.2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: More and more citizens are carrying MRSA. Consequently, they mustcope with the knowledge of being a potential health risk for their families and close relations. For society,the carrierembodiesa reservoir and a risk of spreading resistant bacteriafrom the community into hospitals, resulting in problems with the treatment of patients in intensive and acute care wards.

    Purpose: This qualitative study aimed to deepenknowledge of the impactof MRSAon the Sense of Coherenceand Healthfor carriers living at home.

    Method: Thisqualitative study used Grounded Theory to analyze interviews with twelve carriers and four relatives.

    Results: The carriers describedthe experience of colonization with MRSA as a strange,unclear,and confusing state between sickness and wellness. The studyidentifiesacore category(i.e., “Inadequate information”)that causes emotional reactions among carriers and family members, including anxiety, insecurity, confusion, inadequate compliance, worries aboutthe future,and stigmatization. Increased stress negatively influences carriers’ and family members’sense of coherence. This was especially true infemale carriers and relatives who work in health and social carebecause they risk becominga health risk to their patients or clients.

    Conclusion: Thisstudy reveals inadequacy in the Primary Health Care System regarding the quality of information provided to MRSA-carriers and their relatives. Such inadequacynegatively affects carriers’Sense of Coherenceand health. Lack of knowledge in the network and local area can stigmatize MRSA carriers, making them susceptible tosevere bullying

  • 267.
    Lüdemann, Bente
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Å være faglig leder for anestesisykepleiere i norske helseforetak: balansekunst eller spagatøvelse?2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study aimed to investigate the conditions being a professional leader of nurse anesthetists in Norwegian public hospitals today.

    Method: Thestudy used a combination of quantitative and qualitative methods, including a survey questionnaire constructed by the author and distributed to all first-line managers of nurse anesthetists in 77 Norwegian public hospitals, with a response rate of 80.5 %. The questionnaires were analyzed by quantitative methods. The author also conducted semi-structured individual interviews with seven strategically chosen leaders, both women and men, at hospitals in Norway’s four health regions. The interviews were analyzed using qualitative content analysis.

    Result: The results showed that leaders give less priority to professional leadership, largely due to many other urgent tasks, and frequently delegate this part of their leadership role to others (e.g., nurse anesthetists working with professional development). In leadership roles, nurse anesthetists focus on health promotion. They describe their managerial role as burdensome, at times even affecting their health. There is not much interest in and hardly any competition for managemen tpositions. Among the leaders, there is a relative dominance of men.

    Conclusion: Due to altered framework conditions, such as unitary management and health enterprises, the managerial role has changed, moving in responsibility from something more like a traditional foreman to becoming a first-line manager, who increasingly deals with personnel management and administration. Leaders have mostly adapted to the new demands.In many ways, they functionas hybrid leaders whofocus on health promoting leadership.Nurse anesthetistsperceive the management position as burdensome and not particularly attractive

  • 268.
    Madsen, Ann Filippa
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Oplevelseaf isolation under indlæggelse: Et kvalitativt studie2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study explored and describedthe factors that may influence how patients react to source isolation from others during hospitalization. The study also sought to determine how background variables such as gender, age, and previous hospitalization affect source isolation. Based on individuals’ risk assessment, this study also focusedon how hospitalsplan and the organization of care and treatment.

    Method: This qualitative study used content analysisto reviewd ata collected from interviews with five patients. The conceptual framework describes antibiotic resistance and infection control from a public health perspective and exploredits prevention in Denmark. Thetheoretical framework describe show patients experiencean infection acquired by exposure to drug-resistant bacteria, as well assubsequent source isolation.

    Results: Thelimited space of an isolation room, including closed doors, lack of contact with people, and few sensory stimuli, resulted in patient boredom, monotony,and anxiety. Moreover, the data showed that background variables affected how patients experience source isolation. Compared with men, women showed greater concern about precautions against infection and greater awareness of staff behavior. Women also worried more about the risk of transmitting bacteria/disease to visitors and familymembers, and display more emotion during isolation. In contrast, men outwardly resigned themselves to the situation and didnot speculate about infection precautions. Men had more rational approach, and tended to cope better when isolated in a single room. Younger patients seemed to have a better coping strategy during isolation, and considered a single room an advantage compared to the ward. Elderly patients felt sad and lonely during source isolation. In addition, previous negative experiences from earlier hospitalization seemedto influence current isolation. Patients developed their own strategies for coping with source isolation and found themselves balanced between being stressed and coping.

    Conclusion: Hospitals need more alternatives (e.g., better training and improved treatment culture) to prevent negative psychological affects due to isolation without compromising infection prevention. Hospitals should update their personnel at all organizational levels, and focus on room facilities in the ward, contact time,and improved information and communication. Riskassessment should be individualizedfor each patient.

  • 269.
    Mahler, Marianne
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    At holde balance Betingelser for og perspektiver i forhold tilforebyggelse af fald blandt gamle mennesker2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. Falls among older persons are a public health problem in Denmark, the Nordic countries and the rest of the Western world. In a population perspective fall-prevention has been characterised by an individual behavioural modificationand a regulating mode. This kind of fall-prevention discourseis nowbreaking up.

    Aim. To describe how community-dwelling older adults experience and handle falls, falling and loss ofbalance. The focus is also on examination offalls as contextual phenomena with the older adults’ experiences. This study will contribute to develop health promotion and fall-prevention to individuals and to the fall-prevention as so.

    Methodology. This thesis consists offour studies/articles (I-IV). Interpretative phenomenology as philosophical and analytical method was used. In one study (III) case study methodwas used as a framework,complemented bycritical discourse-analytic interpretation of documents. Within thefour studies nine women and four men (75-94 years old) were interviewed in narrative in-depth interviews about falling. In article III,five health and social workers and a nurse were interviewed.

    Results. In coping withfalling accidents, vulnerability, frailty and death imminence the participants developed various methods ofmanagingeveryday lifeat home. They describedadaptive resourcesused to achieve an adequate quality oflife andexperiencea feeling of well-being (I). Fear of fallingwas always present and was met in differentways. On one handwas worry aboutungraceful situationsnot able to manage on your own; on the other hand was the willto live with the fear.(II). The two protagonists, dependent onhome-care developed their own strategies for preventingfalls. The health professionals created a supportive network; a platform of continuity where the efforts of the older persons and the staff complemented each other. The staff had no clear approachto addressing issues raised by accidental falls or the prevention of falls (III).Eating and appetite on foodwerenot trivial everyday routines. The participants showed no particular interest in eating but ateto stay alive. Even if they had little appetite forfood, the participants showed great appetite forestablishing social relationships withfamily, neighbours and health care staff,as well as appetite forestablishing an influence in these relations and in local communities and society.

    Conclusion. In the future,fall-prevention must takea health promotion approach and contextualise falling accidents withexperiences and meanings as point of reference. Fall-prevention will be not only multifactorial,but also multidimenssional and existential

  • 270.
    Mahler, Marianne
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Appetite and falls: Old age and lived experiences.2012In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 7Article in journal (Refereed)
    Abstract [en]

    Falling among older adults is a well-known public health problem but the association between falling and appetite is seldom studied although poor nutritional status is accepted as a risk factor for falls. On this background the aim of this study was to understand how older adults, who have fallen several times within a year, related their experiences of appetite as a phenomenon in everyday life. In narrative in-depth interviews, eight women and four men contributed with their stories. Using interpretative phenomenology the thematic analysis resulted in three main themes: appetite for food; appetite for social relations and appetite for influence. Eating was not trivial everyday routine and required self-regimentation. Meals were not an object of desire, but of discipline out of the wish to survive. Feelings, reflections and ambivalence were bound to the lack of appetite on food. The participants were oriented towards the forbidden, the delicious and to everyday food as a strengthener and as medicine. In their dependency on help, home was the framework for establishing social relations as means of social support. As well as family and neighbours, the significant others were persons on whom the participants were dependent. Personal relationships and mutual dependencies may ensure social security in lives characterised by contingency and maintain influence in daily life. Falling is both a dramatic and a trivial incident where life and death could be at stake. From this perspective, connectedness was prominent in all fall stories. The quest for influence and a sense of social connectedness was the incentive to re-enter local community arenas and to express solidarity. In health-care practice multi-factorial fall-prevention should be complemented with a multi-dimensional approach in order to balance the medical approach with humanistic and societal approaches towards fall-prevention.

  • 271.
    Mahler, Marianne
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Fear of falling from a daily life perspective;: narratives from later life2012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 1, p. 38-44Article in journal (Refereed)
    Abstract [en]

    Fear of falling is a well-known condition in later life. The aim of this study was to illuminate the experiences and the meaning of fear of falling in a daily-life context. The method used was a qualitative study inspired by interpretive phenomenology. In narrative interviews, five community-dwelling women over 80 years of age told about their fear of falling from a daily-life perspective. The overall thematic analysis resulted in three main themes: the meaning of managing daily life necessities; keeping in contact with the outside; living with fear. The findings showed that to live with fear of falling was to discipline daily life, and to learn to live with the challenge of a vulnerable bodily condition and of losing control at different levels: from falling, from incontinence, from dirt and from the stigma of being in a humiliating situation. The women created a perception of independence while they were dependent on help and community care and on news from the outside. At an existential level, they coped with their fear by strengthening their will. The conclusion was that the older women studied accepted the condition of fear of falling. They shared the ability to cope in various ways with the limitations of their bodily capacity and their imbalance.

  • 272.
    Mahler, Marianne
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Indispensable chairs and comforting cushions: — Falls and the meaning of falls in six older persons lives2010In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 24, no 2, p. 88-95Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to illuminate the meaning of falls for older adults in an everyday perspective. In narrative in-depth interviews, four women and two men, 80–94 years old, told their stories from a daily-life perspective; they had experienced falling several times. The methodological approach used was interpretive phenomenology, in order to grasp the meaning of the participants' situations and everyday practices. The women had learned and used a special technique; they had disciplined their bodies with exercises and training activities, although they suffered from several chronic illnesses. In order to cope with the falling episodes, the women had equipped sofas and chairs with cushions to soften the process of getting up again, whereas the two men sat in a chair moving as little as possible. In handling the falls, each participant showed individual coping strategies and adaptive resources to achieve a life, experiencing a feeling of being well

  • 273.
    Mahler, Marianne
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Svensson, Tommy
    Nordic Council of Ministers, Nordic School of Public Health NHV. Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden .
    Sarvimäki, Anneli
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    The balance of life : Two case studies on falls and fall-prevention in older persons2011Article in journal (Refereed)
  • 274.
    Mangerud, Gunhild
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Dietary Mercury Exposure in selected Norwegian Municipalities: The Norwegian Fish and Game Study, part C.2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Improved and detailed knowledge regarding dietary mercury exposure in the Norwegian population is considered important as part of a national monitoring of exposure to hazardous environmental contaminants. Mercury is still regarded an important pollutant in Norway, reflected in the priority list for the Norwegian Pollution Control Authority (Norwegian: Statens forurensningstilsyn, SFT) from 1996. This priority list, defined politically by the Norwegian Parliament, includes about 30 different chemical pollutants and is aimed at ending, or substantially decreasing, emissions of the chemicals listed. Mercury is also found on the “obs-list”, which is the environmental authorities` list of health and environment threatening chemicals that may represent a particular problem on a national level. The proclaimed goal by the Norwegian environmental authorities concerning mercury is that emissions should be “substantially decreased, at latest by the year 2010” (SFT 2004). Mercury is a metal that may be released from both natural and anthropogenic sources. It is estimated that less than half of the mercury pollution in Norway is released from national sources, the rest being depositions from atmospheric transportation from abroad (Berg et al. 2003). As mercury is able to circulate in the atmosphere probably as long as one year, it may be transported very long distances and is thus an issue of international concern. Even though many western countries (Norway included) have decreased their mercury releases during the last decade, countries in both Asia and Africa have had a substantial increase in their emissions (Fjeld & Rognerud 2003). This means that international agreements are necessary for an effective handling of the problem, and the United Nations are currently working on efforts to reach international agreements regarding the use of mercury (UNEP 2002). This does not negate, however, that local industrial emissions have been of great importance for local contamination in some parts of Norway. In the year 2000 it was estimated that about 290 kg of mercury were released from national sources in Norway, and about 50 % of this was discharged directly into sea and lakes (Berg et al. 2003). The most important sources in Norway is offshore industry (about 42 % of national releases in 2000), garbage disposals and renovation systems (21 %) and metal production (12 %) (Berg et al. 2003). One important implication of the long-distance atmospheric mercury transportation is that increased levels of mercury have been found in many lakes in the Scandinavian countries (Fjeld & Rognerud 2003). Studies have shown a north-south gradient of mercury levels in Norway, with higher levels in lake sediments and soils in the southern parts (Berg et al 2003). Internationally, the major concern regarding mercury in the environment is dietary exposure through the consumption of freshwater and marine fish (WHO 1996). Also in Norway, several studies have shown that mercury concentrations in pike, perch and trout in somelocations may be above the maximum level permitted on the commercial market (defined by the Norwegian Food Control Authority: 0.5 mg/kg generally and 1.0 mg/kg for pike) (Fjeld et al. 2001). However, although it is evident that especially freshwater fish may contain higher concentrations than what is considered safe for human consumption, no detailed monitoring of mercury concentrations exist for Norwegian lakes. Thus fish consumption restrictions for freshwater fish have been given on a general basis, and include avoiding consumption of pike, of perch above 25 cm, and trout and charr weighing more than 1 kg. These advises are primarily directed against pregnant and breast-feeding women, although the gener population is recommended not to eat these fishes more than once a month on a yearly basis (Matportalen 2004a) Some fjords have also been affected by local industrial pollution, and currently the Norwegian Food Safety Authority (Norwegian: Mattilsynet) recommend avoiding consumption of fish from Sørfjorden due to the high levels of mercury found in fish from this fjord (last evaluated in 2003) (Matportalen 2004b).

  • 275.
    Meljordshagen von Ubisch, Ann Kristin
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    BMI og sosiodemografiske faktorers påvirkning på operative forløsninger blant Norske og Pakistanske kvinner i Groruddalen, Norge2013Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Elevated body mass index(BMI) and increased immigration pose challenges that demand a new focus on health inequalities for mothers and children. Currently, Pakistani immigrants are among the largest minority groups in Norway.This study aimed to determine the prevalence of pre-pregnancy BMI and the impact of different sociodemographic factors on operative (caesarean section, vacuum and forceps) deliveries among Norwegian and Pakistani nulliparous women in Groruddalen, Norway.

    Methods: This population-based cohort study included 146 Norwegian and 39 Pakistani women attending Child Health Clinics in Groruddalen and delivering at Oslo University Hospital and Ullevål and Akershus University Hospital, Norway.

    Results: Compared to Norwegian women, pre-pregnancy BMI was lower in Pakistani women (24.6 and 22.1, respectively; p < .05). Further, education level was > 9 years lower in Pakistani versus Norwegian women (79.5 % and 96.6 %, respectively; p < .05) and fewer Pakistani women work outside the home (66.5 % and 95.2 %, respectively; p < .05). Compared to Norwegian women (M = 29.7 years, SD = 4.4 years, p <.05), Pakistani women were younger (M = 26.4 years, SD = 4.0 years) when they delivered their first child. Moreover, Pakistani infants weighed 339 g less (average birth-weight = 3181 g) compared to Norwegian infants (3520 g; p< 0.05). We observed no significant difference in operative delivery among the Pakistaniversus Norwegian women (31.6 % and 27.9 %, respectively; p = 0.805). Regardless of ethnicity, variable maternal age (OR=1.106 [CI 95: 1.017 to 1.203]) and gestational age (OR=0.951 [CI 95: 0.908 to 0.997]) associated with operative delivery in this study.Newborn weight (OR=1.001 [CI 95: 1.000 to 1.002]) was considered borderline.

    Conclusion: This study revealedsociodemographic differences between Norwegian and Pakistani women undergoing operative delivery in Groruddalen, Norway. Compared to Norwegian women, Pakistani women had lower BMI and lower educational attainment. Fewer Pakistani women worked outside the home and they were younger when they delivered theirfirst child. Additionally, the birth weight of Pakistani babies delivered was lower than Norwegian newborns. We observed no difference in the proportion of operative deliveries between Norwegian and Pakistani women. Regardless of ethnicity, women’s chronological and gestational age affect operative delivery.

  • 276. Meng, Qingyue
    et al.
    Li, Renzhong
    Cheng, Gang
    Blas, Erik
    Nordic Council of Ministers, Nordic School of Public Health NHV. UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), The World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
    Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, China.2004In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 19 Suppl 1, p. S45-62Article in journal (Refereed)
    Abstract [en]

    Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended.

  • 277.
    Mogensen, Dorthe
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hygiejne i medvind, –samarbejde om udvikling af kommunale hygiejneorganisationer: –et kvalitativt studie2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background:Infection control isa new focus areain the intersectoral health agreements 2011-2014,which statesthat municipalities need guidance regarding infection control.

    Aim:The present study aimed to investigate, describe and analyze, how municipalitiesin Denmark ́s Capital Region collaborate internally while building an infection control organization. The study also aimed to determinehow hygiene suggestions from the National Board of Health and networking with hospitals affected the development of the infection control organization.

    Method:The empirical material of this qualitative studyincludedsemi-structured interviews with network members.Data was analyzed with qualitative content analysis. Theories supporting the study were different perspectives on collaboration.

    Results:The study found that municipalities in the Capital Region collaborate in different ways while developing an infection control organization. Management participationplayeda crucial role.. The municipality was considered a large confusing organization. Motivation factors included the health agreements, hygiene suggestions from the National Board of Health and networking with hospitals. Access to an infection control nurse was considered a necessary element, basing collaboration on competencies, rather than personal interest.

    Conclusion:Different circumstances are crucial when developing an infection control organization. Management must participate, and also must approve settings and resources. The municipality must have directaccess to expert knowledge about infection control

  • 278.
    Mogensen, Karin
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hustruers oplevelse af det postoperative forløb efter ægtefællens prostataoperation2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The length of stay at hospital after surgery has shortened. Little is known about the immediate post-surgery period. The aim of this study is to assess whether spouses have to take active care of their husbands and to assess if the burden of other part of the health service increases as a result of early discharge after prostatic surgery. Furthermore, the study intends to increase the knowledge about how patients experience the first postoperative weeks. Initially qualitative interviews were conducted with ten spouses. The Phenomological method described by Giorgi and Karlsson was used for analysing the interviews. Based on the experience of this, a questionnaire was prepared and sent to all spouses of patients who had undergone prostatic surgery between November 2004 and May 2005. The results of the questionnaires were put into an access database. The principal finding is that many patients during the first postoperative period experience various urinary problems such as incontinence, frequency, haematuria, and urinary retention. Problems which negatively impacted on the spouses. Furthermore, the spouses were uncertain whether it was common to experience these problems, and they did not know whom to contact when in need of support

  • 279.
    Momen, NC
    et al.
    Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
    Olsen, J
    Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark , Department of Epidemiology, University of California, Los Angeles, CA, USA.
    Gissler, Mika
    Nordic Council of Ministers, Nordic School of Public Health NHV. THL National Institute for Health and Welfare, Helsinki, Finland.
    Cnattingius, S
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Li, J
    Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
    Delivery by caesarean section and childhood cancer: a nationwide follow-up study in three countries.2014In: BJOG : an international journal of obstetrics and gynaecology, ISSN 1470-0328Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To investigate the association between delivery by caesarean section and risk of childhood cancer.

    DESIGN:

    A population-based, follow-up study using register data from three countries.

    SETTING:

    Denmark, Sweden and Finland.

    POPULATION:

    Children born in Denmark (1973-2007), Sweden (1973-2006) and Finland (randomly selected sample of 90%, 1987-2007; n = 7 029 843).

    METHODS:

    Exposure was delivery by caesarean section and the outcome was childhood cancer diagnosis. Follow-up started from birth and ended at the first of the following dates: cancer diagnosis, death, emigration, day before 15th birthday or end of follow-up. Cox regression was used to obtain hazard ratios.

    MAIN OUTCOME MEASURES:

    Childhood cancer diagnosis.

    RESULTS:

    A total of 882 907 (12.6%) children were delivered by caesarean section. Of these, 30.3% were elective (n = 267 603), 35.9% unplanned (n = 316 536) and 33.8% had no information on planning (n = 298 768). Altogether, 11 181 children received a cancer diagnosis. No evidence of an increased risk of childhood cancer was found for children born by caesarean section (hazard ratio, 1.05; 95% confidence interval, 0.99, 1.11). No association was found for any major type of childhood cancer, or when split by the type of caesarean section (elective/unplanned).

    CONCLUSION:

    The evidence does not suggest that caesarean section is a risk factor for the overall risk of childhood cancer and possibly not for subtypes of childhood cancer either

  • 280.
    Monclair, Marianne
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Scaling up malaria interventions.: Integrating free distribution of long lasting insecticide treated mosquito nets during vaccination campaigns. A new strategy to meet the millennium development goal2008Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Objective: To look at the Red Cross and the Red Crescent societies integrated campaigns between 2002 and 2006 with free distribution of insecticide treated nets (ITN)that have taken place and its contribution to the Millennium Development Goals(MDG) and the Abuja target. 

    Method: Review of surveys, evaluations and reports from the International Federation of Red Cross and Red Crescent integrated campaigns. Published articles up to 2007 have been accessed from electronic databases Medline, PubMed, the Cochrane Library and website`s from WHO, UNICEF, GFATM , and related articles available from international organisations web sites in addition to informal discussions and meetings with key stakeholders.

    Results: The integrated vaccination and free distribution of long lasting insecticidal nets (LLINs) achieved a rapid, high and equal LLIN coverage among all wealth quintiles. The MDG and Abuja target for ITN coverage at household level were reached within a week giving a unique opportunity for a significant reduction in malaria incidences, morbidity and mortality. The ITN possession remained higher than utilisation, but utilisation increased if a follow up visit, ensuring nets being hung and properly used, had taken place at household level post campaign.

    Conclusion: Large scale free distribution of LLINs  bridge the equity gap between poor and rich and increased the use rate among children under five and pregnant women. The low utilisation versus possession remains a challenge and thus a “minimum standard” of a two phased strategy is recommend to reach maximum impact and the MDG; Phase one preparing for pre campaign data, logistical planning and distribution while phase two should focus on a post campaign Keep Up program providing health education at household level to ensure proper net hanging and use.

  • 281.
    Montgomery-Andersen, Ruth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Faces of Childbirth: The Culture of Birth and the Health of the Greenlandic Perinatal Family2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    INTRODUCTION. This dissertation concerns childbirth and its position within the Greenlandic society. It takes a world relational view to health promotion during, focusing on the perinatal family and the importance of the mothers, the child, their families and the local community as equal pieces of a whole.

    AIM. The aim of the dissertation is to present new concepts and knowledge concerning the health of the perinatal family in Greenland. It looks holistically at the place of birth with focus on the issue of support of the perinatal family. It seeks to present the perinatal family and its position within the Greenlandic society. It links the changes in health policy with the concepts of family, attitude and community structure. It draws on statistical, historical, anthropological and cultural data within the context of the Greenlandic perinatal family.

    METHOD AND MATERIAL. The dissertation is comprised of four studies and uses multidisciplinary methods. Over an eight-year period from 2003 to 2011, narrative interviews and focus groups were collected at four sites in Greenland: Nuuk, Ilulissat, Sisimiut and Tasiilaq. Data included seven focus groups with 35 participants, supplemented with 18 individual interviews of mothers, fathers and Culture Bearers, as well as two literature studies. The mode of conducting focus groups and interviews was based on the principles in the Helsinki Declaration.

    RESULTS. The perinatal family’s concepts of safety are often connected directly to access to family and community. Family is perceived as security, and lack of family support and network as insecurity. The concept of family and community is culturally specific and connected to the immediate family, extended family and kin. There is a cultural room for birth in Greenland, where the health of the perinatal family lies in their ability to strengthen the bonds within family, kinship and community networks. The mothers of the study perceived themselves as the bearers of their children; the fathers considered themselves to be the artisans and caregivers for their family; the community, including the extended family, deemed an important support network for the families.

    CONCLUSION. It is important to understand the link that exists between traditional and cultural properties and the health of the child within the family. These are elements of the eco cultural pathways that are already integrated within the family interactions and could be a way to strengthen family interaction and health. Families and community support these traditions and in healthy eco cultural exchanges it enhances the child’s role as a health–promoting agent within the family. Greenlandic public health, health promotion programs and the national perinatal guidelines have a physical health focus, but do not address the mental, social and spiritual dimensions of perinatal health. This fragmented way of perceiving and implementing health does not support the relational worldview that is an integral part of the culture of Greenland, and thus many families struggle to exercise choice within the system

  • 282.
    Montgomery-Andersen, Ruth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Referral in Pregnancy: A challenge for Greenlandic women2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Referral practices within healthcare systems are seen as a means of heightening the quality of perinatal care and lessening perinatal mortality and morbidity. Perinatal death or the birth of child with a handicap can be debilitating for a family. Since January 2002 a new referral system has been instituted within Greenland sending all at risk pregnancy to the referral hospital in Nuuk. The aim of the study was to describe the women’s experience of referral by drawing on their experiences and using their voices to present referral from the women’s point of view. Interviews were conducted within arrival at the referral hospital and during fieldwork over a one-year period. Interviews were conducted, recorded and transcribed. The analysis of interview data was conducted within the narrative framework, using Coping theory and resiliency tools as the theoretical base for structuring the narratives. Through their narratives the women presented their identities as mothers, community members and caretakers. Acceptance of referral was described as a tool for protecting their unborn child. With acceptance of the referral the women found an inner source of strength to deal with their own anger joy anxiety and loneliness. Their ability to accept referral was directly connected to their family and community and the support that they found therein

  • 283.
    Montgomery-Andersen, Ruth
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Borup, Ina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Family support and the child as health promoting agent in the Arctic - "the Inuit way".2012In: Rural and remote health, ISSN 1445-6354, Vol. 12, no 2, p. 1977-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: In the context of the UN's 1990 'Convention on the Right's of the Child' 1990, and the associated definition of health promotion as a community's ability to recognise, define and make decisions on how to create a healthy society, this article describes and analyses how family support networks are conceived and present themselves in perinatal Inuit families.

    METHODS: This literature review conducted an initial and secondary search using the keywords and combinations of the keywords: healthy families, health promoting families, resiliency, Arctic, Inuit, Family support, was executed in PubMed, Popline, CSA and CINAHL. The tertiary literature search was then combined with literature gleaned from literature lists, and other relevant articles were selected.

    RESULTS: Individual members of the family contribute to the health of the family, but the child is often the catalyst for health promotion within the family, not only the siblings to the unborn child, but also the unborn child. Perinatal entities create their own networks that support and develop concepts of family and support systems. Resiliency, kinship and ecocultural process within the family are concomitant to the health of perinatal family and of the children.

    CONCLUSION: More research is needed that moves children from being viewed as the receivers of health towards being seen as the promoters of health and an important actor as health promoting agent within the family.

  • 284.
    Montgomery-Andersen, Ruth
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Borup, Ina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Songlines and touchstones:: A study of perinatal health and culture in Greenland2013In: AlterNative: An International Journal of Indigenous Peoples, ISSN 1177-1801, Vol. 9, no 1, p. 87-101Article in journal (Refereed)
    Abstract [en]

    Abstract: This paper aims to focus on how family and community in Greenland perceive support- giving during the perinatal period. It explores Greenlanders use of storytelling as a health- promoting tool in the perinatal period. It is research set in Greenland, but analysed in a larger context. Using an ethnographic approach to subject matter, the paper is based on a series of qualitative interviews and focus groups conducted between 2003 and 2011 with mothers and fathers. Ethnographic content analysis, interviews and dialogues with Culture Bearers were used to analyse and set the stories into a cultural perspective. The child was described as the centre of the family and the family as the bedrock of life. The mothers, fathers and Culture Bearers presented three main concepts in their stories: 1) my family ... a safe harbour, 2) the child as the centre of the family, and 3) the equal sharing of burden and joy

  • 285.
    Montgomery-Andersen, Ruth
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Douglas, Vasiliki
    Borup, Ina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Literature review: The ‘logics’ of birth settings in Arctic Greenland2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 11, p. 79-88Article in journal (Refereed)
    Abstract [en]

    Objective

    to review literature on the physical place of childbirth in Greenland between 1953 and 2001, using a narrative review theory and a content analysis framework, the paper seeks to describe and analyse the change in perinatal health care structure in Greenland.

    Design

    findings were discussed within the framework of Daviss' Logics bringing into account scientific, clinical, personal, cultural and intuitive logics as well as economic, legal and political ‘logics’ concerning perinatal health care policies.

    Setting

    the literature study concerns the place of birth in Greenland, a self-governing constituency of 57,000 people, the world's largest island and with a predominately Inuit population with its own language and culture. Inuit population with its own language and culture.

    Findings

    the place of birth in Greenland has changed and focus has moved from birth as a personal and community act to birth within the private and political arena. New policies and guidelines for pregnancy and childbearing decisions are seldom negotiated with the women, families and their communities.

    Conclusionspolicy changes have an influence on the social and cultural development of Greenland and it poses a challenge and a counter weight to the political and economic limitations that the government works within. Women and children are vulnerable groups and are directly affected by the changing perinatal health care and policy. It is important that when changing policy, the women and their families are part of the dialogue around chang

  • 286.
    Montgomery-Andersen, Ruth
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Willen, Helena
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Borup, Ina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    'There was no other way things could have been.' Greenlandic women's experiences of referral and transfer during pregnancy.2010In: Anthropology & Medicine, ISSN 1364-8470, E-ISSN 1469-2910, Vol. 17, no 3, p. 301-13Article in journal (Refereed)
    Abstract [en]

    The World Health Organization (WHO) has stated that referral practices along with midwifery care are a means of heightening the quality of perinatal care and lessening perinatal mortality and morbidity. In 2002, in response to high perinatal mortality and morbidity, a referral system was instituted nationally in Greenland, transferring all at-risk pregnancies to its national referral hospital. Little or no current research has focused on evaluation of the perinatal referral system or on the thoughts, beliefs, opinions and challenges faced by women and Greenlandic families themselves. The aim of this paper is to document how women referred to Nuuk because of at-risk pregnancies narratively constructed self-understanding and defined meaning during their period of separation from family and community; and how they dealt with the challenges they were presented with. Interviews were conducted with women upon their arrival at the national referral hospital and during fieldwork over a one-year period. Narrative framework was used for analysis. Coping theory and narrative theories were the theoretical base for structuring the narratives. Through their narratives, women presented their identities as mothers, community members and caretakers. Acceptance of referral was described as a means of protecting their unborn child and was where women found an inner source of strength to deal with their own anger, joy, anxiety and loneliness. The ability to accept referral was directly connected to their family and community and the support they found therein.

  • 287. Mubyazi, Godfrey
    et al.
    Kamugisha, Mathias
    Mushi, Adiel
    Blas, Erik
    Nordic Council of Ministers, Nordic School of Public Health NHV. UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), The World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
    Implications of decentralization for the control of tropical diseases in Tanzania: a case study of four districts.2004In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 19 Suppl 1, p. S167-85Article in journal (Refereed)
    Abstract [en]

    Decentralization has been and is still high on the agenda in contemporary health sector reforms. However, despite extensive literature on the topic, little is known about the processes and results of decentralization, including the relationship with the control of major public health problems caused by communicable diseases. This paper reports from a study of decentralization and control of tropical diseases in districts implementing health sector and local government reforms in Tanzania. The study was undertaken in four districts, involving interviews and discussions with key stakeholders from individual household members to the district commissioner, and a review of official health policy, planning and management documents. The study findings reveal devolution of financial, planning and managerial authority being theoretical rather than practical, as district health plans are largely directed by national and international priorities rather than by local priorities. Vertical programmes still exist, focusing narrowly on single diseases. The local mechanisms for multisectoral collaboration, as well as community participation functions, are far from optimal. Further, inappropriate and weak information systems prevent adequate local responsiveness in setting priorities. In conclusion, decentralization might have a large potential for improving health system performance, but problems of implementation pose serious challenges to releasing this potential.

  • 288.
    Munk Laursen, Thomas
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Nordentoft, Merete
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Gissler, Mika
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Westman, Jeanette
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Wahlbäck, Kristian
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Psykiatrisk registerforskning i Norden: En beskrivelse af forskningsmuligheder i psykiatri-relevante registre i Danmark, Sverige og Finland2010Report (Other academic)
    Abstract [da]

    Dette er slutrapporten udarbejdet i den fælles Nordisk forskningsgruppe. Gruppen har fokuseret på at undersøge psykisk sygdom, ved hjælp af de Nordiske populations registre. Projektet er finansieret af Nordisk Ministerråd under handlingsplanen för psykisk hälsa, med en bevilling som er tildelt ”Nordiska akademin för forskning om psykisk hälsa, Nordiska högskolan för folkhälsovetenskap”.Vi har fra de nationale patientregistre udtrukket oplysninger om indlæggelser med psykisk sygdom, samt fundet dødsdag og dødsårsag i dødsårsagsregistrene. Ud fra disse oplysninger har vi lavet en række undersøgelser omkring dødelighed og forventet livslængde blandt personer med registreret psykisk sygdom. Vores overordnede mål har været at undersøge overdødeligheden blandt psykisk syge personer i forhold til den generelle befolkning. Herunder at se på udviklingen over tid, forventede levetider, forskelle på undergrupper af psykisk sygdom, samt undersøge eventuelle forskelle imellem de tre lande. Resultaterne er beskrevet i fem artikler som i øjeblikket er indsendt til peer-review hos internationale tidsskrifter, eller under udarbejdelse og klargøring til indsendelse. En kort beskrivelse af disse artikler er at finde til sidst i rapporten. Det er på grund af ophavsrettigheder desværre ikke muligt at vedhæfte artiklerne i denne rapport. Resultaterne vil desuden blive fremlagt på en konference den 22.11.2010 i København. Her vil repræsentanter for alle de nordiske lande være til stede. Projektgruppen har udover produktion af artikler afholdt nordiske forsknings seminarer om psykiatrisk registerforskning.

  • 289.
    Muus, Ingrid
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Helbredsrelateret livskvalitet efter apopleks: Validering og anvendelse af SSQOL-DK, et diagnosespecifikt instrument til måling af helbredsrelateret livskvalitet blandt danske apopleksipatienter2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Abstract Background and aim: Stroke is most frequently the cause of adult disability. In Denmark more than 50.000 people suffer from the sequels of stroke. One of them may be aphasia, i.e. reduced ability to communicate. Primary and secondary prevention may reduce the incidence and the severity of stroke. The interest in quality of life with a chronic disease is increasing. Rehabilitation efforts are targeted for physical, mental and social function but the impact on health related quality of life after stroke has not been studied with stroke specific instruments. Aphasic patients are normally excluded from studies where communicative skills are required. The aim of this thesis is to develop an instrument suitable for measuring health related quality of life after stroke. Methods and material: The design of the thesis is quantitative. In study I Stroke Specific Quality of Life Scale, version 2.0, SSQOL © (copyright Linda S. Williams), an American instrument recently developed, was translated and culturally adapted to Danish according to established guidelines. With 49 items SSQOL covers 12 domains comprising physical and mental issues. Thirteen items covers an appraisal of each domain compared to pre stroke status and overall quality of life. Psychometric properties was examined by studying three samples of stroke survivors. Study II and III examined reliability, validity and responsiveness. Established generic scales were used as external criteria. Study IV tested a proxy-version meant for stroke patients with language impairment or patients who are unable to fill in a questionnaire. The patients chose the proxies. Study V provided health related quality of life in a group of mildly affected patients after stroke or transient ischemic attack, TIA. Significant covariates with deteriorated health related quality of life were studied. Data were analyzed with mean and standard deviations, median and range, proportions correlations and logistic regression. Results: The Danish version of SSQOL, SSQOL-DK, showed good face- and content validity. It can be completed in less than 25 minutes. Test-retest showed correlations rs 0.65-0.99. Internal consistency showed Cronbach’s alpha from 0.81-0.94 in study II, 0.75-0.96 in study III and 0.64-0.87 in study V. Ceiling effect was 24-52%, floor-effect was modest. Construct validity showed shared variance with external criteria, r2 0.03-0.62. Convergent validity showed (r) >0.40 for 48 out of 49 items. SSQOL-DK classified direction of change in over all quality of life concordantly from 43-58% with external criteria. The agreement between patient- and proxy data was good. Fifty seven (57) percent of mildly affected patients after stroke or TIA rated their overall quality of life unchanged one year after stroke compared to pre stroke status. In the regression model male sex OR 3.77), working outside home (OR 2.84), and less than 5.00 (maximum score) on the domains Mood and Work/productivity at three months were significant predictors for rating over all quality of life deteriorated at 12 months. Conclusion: The SSQOL-DK has demonstrated satisfactory reliability and validity and can be used on group level measuring health related quality of life among Danish survivors after mild to moderate stroke and TIA. Stroke survivors with severe communication problems are still limited as validity of the proxy data should be further tested

  • 290.
    Muus, Ingrid
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Christensen, Doris
    Petzold, Max
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Harder, Ingegerd
    Johnsen, Søren Paaske
    Kirkevold, Marit
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Responsiveness and sensitivity of the Stroke Specific Quality of Life Scale Danish version.2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 25-26, p. 2425-33Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To test responsiveness and sensitivity to change of the Stroke Specific Quality of Life Scale Danish version (SSQOL-DK) scores in patients following stroke.

    METHODS: A follow-up study of 150 patients with first-ever stroke was used. Questionnaires on quality of life, fatigue, depression, and functional level were completed. Direction of change was categorised as deterioration, no change or improvement. Proportion of concordant classification with external criteria was assessed. Associations between differences in SSQOL-DK domains and the other instruments were estimated using Spearman's rank order correlation coefficients. Paired t-test was used to assess change in the SSQOL-DK domains in patients affected in that domain. Effect size and standardised response mean (SRM) were used to express domain responsiveness.

    RESULTS: SSQOL-DK classified concordantly in 42.2 to 58.1%, and misclassified from zero to 31.3%. Changes in SSQOL-DK and in the corresponding measures correlated from (r(s)) 0.08 to -0.58. Fatigue and domain energy in SSQOL-DK were negatively correlated. Effect size ranged from -0.03 to -0.53, SRM from -0.02 to -0.56 reflecting mild-to-moderate responsiveness in eight out of 12 domains.

    CONCLUSION: SSQOL-DK is mildly to moderately responsive and sensitive and can be used for descriptive purposes over time in groups of patients with mild stroke.

  • 291.
    Muus, Ingrid
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Petzold, Max
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Health-related quality of life after stroke: reliability of proxy responses.2009In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 18, no 2, p. 103-18Article in journal (Refereed)
    Abstract [en]

    A Danish version of the Stroke-Specific Quality of Life Scale (SSQOL-DK) has been developed for self-reporting; it contains 12 physical and psychosocial domains. The purpose of this study was (a) to assess the reliability of the proxy version of the SSQOL-DK and (b) to evaluate the influence of frequency of proxy contact on agreement. In all, 143 patients completed the SSQOL-DK 1 to 5 years post-stroke. A patient chosen proxy completed a proxy version of the same questionnaire. The proxy version showed satisfactory internal consistency (Cronbach's alpha = .85-.95). Agreement was generally high. Proxies rated the amount of trouble significantly smaller (higher score) than the patients only in the domain Social Roles. The amount of trouble in the domain Family Roles received significantly higher ratings from noncohabitant proxies when compared with patients (lower score). The proxy version of the SSQOL-DK appears to be reliable for use with stroke patients up to a few years following a stroke.

  • 292.
    Muus, Ingrid
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Petzold, Max
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Health-related quality of life among Danish patients 3 and 12 months after TIA or mild stroke.2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, p. 211-8Article in journal (Refereed)
    Abstract [en]

    AIM: This paper aimed to describe health related quality of life three and 12 months after mild stroke or transient ischemic attack, TIA, to describe the perceived changes from pre to post stroke status and to examine sociodemographic determinants for health related quality of life.

    METHODS: 105 patients with mild stroke or TIA delivered self reported data on health related quality of life using the Stroke Specific Quality of Life Scale Danish Version, SSQOL-DK. The main outcome was perceived change in over all quality of life from pre to post stroke status. Non-parametric tests were used to examine change over time and differences between groupings of gender, age and life conditions. Logistic regression was used to model the change of all over quality of life changed at 12 months compared to pre stroke status.

    RESULTS: Fifty seven percent (57%) of the patients felt that their pre stroke status concerning quality of life was regained. Those that rated all over quality of life deteriorated 12 months post stroke were more often working (48.9% vs. 31.7%), fewer had a diagnosis of TIA (13.3% vs. 30%), functional level was lower and the consumption of antidepressive medication was more frequent. In the regression model male sex (OR 3.77), working outside home (OR 2.84) and less than 5.00 (maximum score) on the domains Mood and Work/productivity at three months were significant predictors for rating health related quality of life deteriorated after stroke.

    CONCLUSION: Rehabilitation efforts should include employment alternatives of a less demanding nature for male patients.

  • 293.
    Muus, Ingrid
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Stroke Specific Quality of Life Scale: Danish adaptation and a pilot study for testing psychometric properties.2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 2, p. 140-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Stroke has an effect on many aspects of quality of life (QoL) and therefore it is important to measure the magnitude of the impact. Items in the American version of the Stroke Specific Quality of Life (SS-QoL) Scale are developed with help from patients with stroke and include even language impairments.

    AIMS: To translate and culturally adapt the American SS-QoL Scale, version 2.0, a stroke-specific instrument measuring health-related QoL, into a Danish version, and to perform a pilot testing of the psychometric properties of the instrument.

    METHODS: The guidelines recommended by Guillemin et al. (J Clin Epidemiol, 46, 1993, 1417) were followed including two independent forward and one back translation, inclusion of laymen, here patients with stroke and their spouses, pretest, and examining selected items with a probing technique. Four couples were included in the pretest, 14 in the pilot study. The patients for pretest and pilot study were selected strategically with regard to interest for participation, experience as stroke survivors, sufficient capacity of language perception and cohabitant status.

    RESULTS: In the Danish version instructions were made more distinct and formal than in the original American version. Explanatory examples within the items were excluded. One new item adjusted for Danish conditions replaced one in the original version, and the response categories concerning personality were adjusted for cultural differences. The pilot study resulted in a more explicit formulation of the instructions to mark each item only once and on the same line as the item.

    CONCLUSIONS: A Danish version of SS-QoL version 2.0 has been developed and content as well as format has proved relevant and acceptable to patients with stroke including those with impaired language production. The next step is testing the psychometric properties of the instrument.

  • 294.
    Muus, Ingrid
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Williams, Linda S
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Validation of the Stroke Specific Quality of Life Scale (SS-QOL): test of reliability and validity of the Danish version (SS-QOL-DK).2007In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 21, no 7, p. 620-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the reliability and validity of the Danish version of the Stroke Specific Quality of Life Scale version 2.0 (SS-QOL-DK), an instrument for evaluation of health-related quality of life.

    DESIGN: A correlational study.

    SETTING: A stroke unit that provides acute care and rehabilitation for stroke patients in Frederiksborg County, Denmark.

    SUBJECTS: One hundred and fifty-two stroke survivors participated; 24 of these performed test-retest.

    INTERVENTION: Questionnaires were sent out and returned by mail. A subsequent telephone interview assessed functional level and missing items.

    MAIN OUTCOME MEASURES: Test-retest was measured using Spearman's r, internal consistency was estimated using Cronbach's alpha, and evaluation of floor and ceiling values in proportion of minimum and maximum scores. Construct validity was assessed by comparing patients' scores on the SS-QOL-DK with those obtained by other test methods: Beck's Depression Index, the General Health Survey Short Form 36 (SF-36), the Barthel Index and the National Institutes of Health Stroke Scale, evaluating shared variance using coefficient of determination, r2. Comparing groups with known scores assessed known-group validity. Convergent and discriminant validity were assessed.

    RESULTS: Test-retest of SS-QOL-DK showed excellent stability, Spearman's r = 0.65-0.99. Internal consistency for all domains showed Cronbach's alpha = 0.81-0.94. Missing items rate was 1.0%. Most SS-QOL-DK domains showed moderately shared variance with similar domains of other test methods, r2 = 0.03-0.62. Groups with known differences showed statistically significant difference in scores. Item-to-scale correlation coefficients of 0.37-0.88 supported convergent validity.

    CONCLUSIONS: SS-QOL-DK is a reliable and valid instrument for measuring self-reported health-related quality of life on group level among people with mild to moderate stroke.

  • 295.
    Myntti, Asko
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Renoveringen av en lågstadieskola som en intervention i Vasa, Finland: Elevernas upplevelse av inomhusklimatet och besvär samt symtom i två lågstadieskolor2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The aim of the questionnaire study was to investigate what kind of changes a large renovation of the primaryschool Huutoniemen ala-aste had for the subjective experience of the environment as well as complaints and symptoms of the pupils. The reference school was the primary school Palosaaren ala-aste in which a major renovation was made earlier. The opinions of the pupils and other information were collected with a standardized and verified questionnaire produced byClinic of Occupational Medicine in the City ofÖrebro, Sweden. The questionnaire was sent to over 470 pupils in both schools before and after the renovation at the same time of the year in 1997 and 2000. Technical measurements of CO2, relative humidity and temperature in the indoor air were made before and after the renovation and at the same time of the year in 6-8 classrooms/school. The answers of the pupils in Huutoniemen ala-aste from the time before the renovation 1997 were compared to the answers after the renovation in 2000. In a similar way answers of the pupils in Huutoniemen ala-aste were compared to the answers from the reference school in 1997. The results were tested by the SPSS with Chi Square test for independence (p<0,05 or p<0,01). The subjective evaluation of the pupils of the environment as air quality, rooms, temperature, cleaning, lighting and noise were significantly worse in the object school than inthe reference school but became significantly better after the renovation. The prevalence of hay fever and long periods of cough duringthe previous yearwere significantly higher in the object school than in the reference school but were reduced significantly in the object school after the renovation. The prevalence of the present symptoms with headache and eye irritation was higher in the object school than in the reference school but was reduced in the object school significantlyafter the renovation. The subjective view whether the school was the cause of the present symptoms as tiredness, head-ache, eye irritation, symptoms of the nose, cough and the skin of the face and itch/tickle on the hair scalp/ears and symptomsof the skin of the hands were higher in the object school than in the reference school but were reduced significantly after the renovation. The medium level of the CO2 decreased dramatically in the object school during the lectures froma level of about 2220 ppm to about 870 ppmafter the renovation and was approximately at the same level as in the reference school. The renovation of the primary school Huutoniemen ala-aste gave a much better environment in the school for the pupils and teachers.

  • 296.
    Måsøval - Jensen, Arnold
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    MRSA-spredning i Norge – en epidemiologisk kartlegging2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: The World Health Organization describes antimicrobial resistance within a wide range of infectious agents, including methicillin-resistant Staphylococcus aureus (MRSA), as a growing threatto public health. MRSA associates with increased risk of morbidity and mortality. In Norway, nationalguidelines (2009) aimed to minimize the incidence of MRSA, especially in hospitals and nursing homes. Beginning in 2008, all MRSA-samples have been typed according to Staphylococcusprotein A (spa). This information is included in the Norwegian Surveillance System for Communicable Diseases.

    Aim: This study aimed to show the spread pattern of MRSA in Norway during 2008–2010, and to examinethe potential for recommending changes to the national MRSA guidelines.

    Method: To identify disease clusters, this registry-based retrospective cohort study reviewed the Norwegian Surveillance System for Communicable Diseases for all reported MRSA-cases (n=2,384), including spa-type MRSA, during 2008–2010.

    Results: There is a statistically significant increase in total MRSA cases from 2008 (IR 13.9/100,000) to 2010 (IR 18.7/100,000). Registered outbreaks of MRSA (44 outbreaks, 227cases, 98 % reported from healthcare services), have a statistical significant decrease during the study (from IR 1.9/100,000 to IR 1.3/100,000). We connected660 MRSA cases (27 % of all cases) to clusters;1,497 cases (62.8 %) were “single cases”.The statistically significant increase in MRSA cases resulted mainly from contact with high incidence countries (e.g.,traveling abroad, adoptions, refugees, immigration).

    Conclusions: Norway has a low incidence of MRSA. Concurring with the goal of national MRSA guidelines, this study shows that healthcare services reported a decline in MRSAcases and outbreaks. The increasing incidence of community-acquired MRSA raises a question about recommending stronger infection control measures in the national MRSA guidelines to prevent the spread of MRSA in the community.

  • 297.
    Mæhlum, Synøve
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Krenket jeg deg?: Den økede sårbarheten hos personer med begynnende demens og omsorgspersoners mulighet til å respektere deres integritet2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The aim of this MPH thesis is partly to show the increased vulnerability at early stages of dementia related to their caretakers, and partly to investigate what the caretakers think should be changed when it comes to development of knowledge and competence necessary for promoting a care based on the respect for the integrity of this group of patients. The study is part of a research collaboration between Hedmark University College and two municipalities, one urban and one rural municipality: Promotive and preventive mental health work in the local community. Data is created on the basis of eight focus group interviews with home care workers and family carers (spouses and children) from two municipalities during October-03 through March-04. Data was analysed by means of qualitative content analyses. The results show that the persons interviewed had experienced that persons suffering from dementia experienced vulnerability and different kinds of threats against their integrity in their daily life. The home care workers wanted continuance in the service and “time enough” in the caring situations with the patients suffering from dementia to be able to give security and confidence. The family carers wanted collaboration- and communication routines to be able to take better care of the patient. They also felt very much left alone in the care of the patient.

  • 298.
    Möller (red), Anders
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Funktionshinder ur ett folkhälsoperspektiv2012Report (Other academic)
    Abstract [sv]

    De 13 essäer som presenteras i denna rapport representerar ungefär lika många olika sätt att närma sig temat. Samtliga studenter hade erfarenhet av olika slags arbete med personer med funktionshinder och de använde sina egna erfarenheter tillsammans med litteraturstudier i sina skrivningar. En kategorisering av de ämnen som behandlas visar ett brett spektrum. Här finns essäer som tar sin utgångspunkt i diagnoser eller tillstånd: utvecklingsstörning, Usher syndrom, cystisk fibros, muskelsjukdom, demens i ung ålder och tekniska hjälpmedel till personer med demens. En essä diskuterar barn- och föräldrainflytande vid samverkan med habiliteringen och en hälsofrämjande sjukhus som ett sätt att föra in ett folkhälsoperspektiv på specialiserad sjukvård. Etnicitet och funktionshinder är temat för ett arbete. Rehabilitering är utgångspunkt för tre essäer. En av dessa beskriver den s.k. Sassam-metodiken, dvs. Strukturerad Arbetsmetodik för Sjukfallsutrdening och Samordnad rehabilitering. I den andra diskuteras anpassad fysisk aktivitet för personer med funktionshinder. I den tredje tas rehabilitering efter ryggmärgsskada upp ur Danskt perspektiv. Den sista av de 13 essäerna belyser frågan om äldres mobilitet versus trafiksäkerhet. Antalet tänkbara infallsvinklar på temat funktionshinder ur folkhälsoperspektiv är i det närmaste oändligt. Föreliggande 13 perspektiv ska naturligtvis ses som exempel.

    Lena Widerlund tar i sin essä, Delaktighet som hälsofrämjande faktor, med fokus på personer med utvecklingsstörning, utgångspunkt i de politiska ambitioner som formulerats i Sverige och övriga nordiska länder. I essän lyfts också ICF (International Classification of Functioning, Disability and Health) upp som en viktig del i modern habilitering och rehabilitering. ICF är centralt i flera av de presenterade essäerna. Moa Wahlqvist går i sin essä, Funktionshinder och folkhälsa. Diskussion kring relationen mellan funktionshinder och folkhälsa med exemplet dövblindhet och Usher syndrom typ II, i närkamp med just det som titeln på essän lovar. Ellen Julie Hunstad lyfter fram hur det är att leva med cystisk fibros och de komplikationer sjukdomen kan ha. Speciellt fokuserar hon den nödvändiga och besvärliga infektionskontrollen då människor med cystisk fibros är extremt infektionskänsliga också för s.k. kryssmitta. Irene Lund närmar sig relationen mellan folkhälsa och funktionshinder med hjälp av personer med muskelsjukdom. Hon formulerar också några idéer om vad som bör göras för att förbättra livet också för personer med funktionsnedsättning. I Margit Gausdals arbete om yngre personer med demens lyfts personer med förvärvade kognitiva svårigheter fram. Gausdal diskuterar de svårigheter som möter personer som drabbas av demens i relativt unga år (under 65 år) och hon visar hur vårt samhälle är byggt för personer med god kognitiv förmåga. Hon poängterar också vikten av att identifiera och ta hänsyn till personer med demens egna upplevelser och perceptioner. Linda Gjöra diskuterar användning av tekniska hjälpmedel vid demens. Traditionellt har möjligheter till hjälpmedel inte förknippats med demens. Gjöra visar att det finns en utveckling av tekniska hjälpmedel som kan vara mycket användbara för att underlätta situationen för personer med demens. Framförallt gäller det att försöka kompensera för brister i orienteringsförmåga och minne. Ändamålet med hjälpmedlen är att hjälpa personen behålla så många funktioner som möjligt så länge som möjligt. Anita Nyqvist tar sig an den svåra uppgiften att diskutera barns och föräldrars inflytande vid s.k. gränsöverskridande samverkan med utgångspunkt från habiliteringsinsatser. I analysen använder hon bl.a. FN’s konvention om barns rättigeher. Hon tar också upp centrala begrepp som barn, funktionedsättning, habilitering och samverkan till diskussion. I Elisabeth Brodins arbete finns en ny vinkling, nämligen ”hälsofrämjande sjukhus”. Hon berättar vad det begreppet står för och beskriver hemofiliteamets arbete på ett sådant sjukhus för att illustrera ett hälsobrämjande perspektiv i inom den specialiserade sjukvården. Marijeh Mehdiyar analyserar situaionen för personer med funktionsnedsättning som kommer från annan etnisk bakgrund än nordisk. I analysen använder hon begreppet intersektionalitet för att beskriva att det kan vara mångdubbelt problematiskt att befinna sig i skärningspunkten av två eller fler utsatta positioner. Samuel Luneno beskriver i sin essä den s.k. Sassam-modellen. Metoden går ut på dels att få högsta möjliga grad av medverkan från rehabiliteringspatienter och dels att samordna hela rehabiliteringsteamets insatser. Carina Häggman diskuterar behovet av s.k. ”tilpasset fysisk aktivitet” för personer med funktionsnedsättning. Det har ju visats att personer med funktionsnedsättning är mindre fysiskt aktiva men att de kanske har ännu större behov av fysisk aktivitet än andra. I essän beskrivs viktiga komponenter för att få den anpassade fysiska aktiviteten att fungera. Hanne Vest Hansen fokuserar rehabilitering av personer med ryggmärgsskada. Den forskningsgenomgång som hon gör visar på behovet av patientmedverkan men också på vikten av en sant humanistisk inriktning hos de personer som arbetar med rehabilitering. Hilde Fleitscher tar i sin essä upp ett problem som också har stor folkhälsovetenskaplig relevans, nämligen äldre som bilförare i relation till trafiksäkerhet. I essän belyses äldres med åldern, tilltagande funktionsförluster och konsekvenser av för förmågan att köra bil. Den forskning som presenteras visar att sambanden mellan ålder och trafiksäkerhet dock inte är kristallklara. Genom den frihet varje författare har haft är det naturligt att det förekommer en del upprepningar i essäerna. Exempelvis är det flera författare som använder tankarna i ICF som utgångspunkt i texten. Även Antonovskys idéer har påverkat många.

  • 299.
    Ness Hansen, Mette
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Endring av rutiner som fremmer amming ved fødeenheteri Norge i perioden 1973-20092014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: In concurrence with the World Health Organization and UNICEF, Norwegian health authorities recommend exclusive breastfeeding for infants during the first six months of life. Thereafter, recommendations suggest the continuance of breastfeeding for the first year of life, while introducing complementary food. Routines in maternity wards have a huge impact on the establishment and duration of breastfeeding. Consequently, supplemental nutrition that lacks medical justification may reduce exclusive breastfeeding, and associates with early termination of breastfeeding.

    Objective: This study aimed to examine changes in maternity ward routines with regard to breastfeeding, focusing particularly on the period between 1991 and 2009, immediately before and after Norway launched the Baby-Friendly Hospital Initiative. In addition we examined the continuous registration of breastfeeding and the provision of breast-milk substitutes in the maternity units.

    Methods: Norway conducts a descriptive and cross-sectional National Breastfeeding Survey (Ammeundersøkelsen) every 9th year. The 53 head midwifes responded retrospectively to a questionnaire about their units’ breastfeeding practices the preceding year. In addition each unit registered breastfeeding and the use of breast milk substitutes for 20 healthy term infants, a total of 984 infants, prospectively.

    Results: Except for non-medical use of breast-milk substitutes, changes in breastfeeding routines mostly adhered to health authority recommendations. The registration of breastfeeding and breast-milk substitutes confirms our findings. Thirty percent of registered babies received breast-milk substitutes at least once during their stay in the maternity ward, and most received a substitute due to a non-medical reason.

    Conclusion: The use of breast-milk substitutes for non-medical reasons indicates that hospitals’ breastfeeding routines are not satisfactory.

  • 300.
    Nessæther, Anne Lise
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Kvinnelige ledere av omsorgstjenestene.: En kvalitativ studie.2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    There have been great readjustments and modernizations within the Norwegian public sector. Many Norwegian local authorities have implemented a flat organizational structure with 2 levels of authority. Decentralization of responsibility to level of execution, empowerment, and a strong management are key features. The increased efficiency of health- and care services, combined with increased demands for results and rationalization, have had a negative effect on the work environment. The health and care services are large female workplaces, and the need for attention around the female contribution to the Norwegian welfare sector is great.

    The purpose of this study is to gain knowledge about how female leaders within the welfare sector perceive and handle the pressure that arises between the lack of funds and the increase in demand for public welfare services. Furthermore, it explores the significance gender, the services’ content and structure, and professional backgrounds of the leaders affect the management.

    There has been done qualitative interviews with ten female leaders of caring services and institutions for elderly in a larger city municipal in Norway.

    Conclusion: The main findings in this study is that management in the two-level model, is contextually conditioned, and the directors and zone leaders carry out their management in different ways. The decentralization of responsibility seemingly gives power and authority over resources and the budget. Directors feel they have the opportunity to succeed and experience mastering in their work. Zone leaders perform “powerless leadership” and have a distant relationship with the higher system. Family is an important support and also sets boundaries for both of the managerial groups

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