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  • 251.
    Johannessen, Aud
    Nordiska ministerrådet, Nordic School of Public Health NHV. Ageing and Health Norwegian Centre for Research, Education and Service Development Tønsberg, Norway.
    Public Health and Dementia - with focus on access to society2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Aim: The overall aim of this thesis is to learn more about how to contribute to improving the daily lives of persons with dementia and those of their carers, and to increase these people’s participation in society.

    Methods: The thesis comprises four studies carried out between2003and2011. Study Iwas based on qualitative interviews with 20 persons with early-onset dementia living in the Southern Norway. Study II was a qualitative study with interviews of 19 support contacts,from the Southern Norway. Study III was also based on interviews, in this study with 35 administrators in local authorities, from 32 Norwegian rural and urban local authorities.Study IV was an evaluation study of an intervention for carers of people with dementia and datawere obtained in three steps; (1) a self-derived questionnaires with space for comments, completed by 45 carers after the intervention and 12 months after the starting point of the intervention; (2) interviews with 13 carers 12 months after the starting point of the intervention and analysed together with the comments from the evaluation questionnaires; and (3) a new intervention for carers of younger persons with dementia was developed based onthe findings from the two first steps. The new intervention was evaluated with a self-report questionnaire completed by the carers with space for comments based on the findings from the two first steps. The questionnaire was completed by 48 carers after the new intervention and 12 months after the starting point of this intervention.

    Main findings: StudyI describes how people with dementia experience living with dementia, their experiences of the process towards a dementia diagnosisand their descriptions of how they try to maintain their “quality of life”. Study II describes how support contacts perceive their work in dementia care. The study also shows the support contacts’motives for becoming a support contact and their encouraging and discouraging experiences while being a support contact. Furthermore, Study III describes the variation in the process that leads or does not lead to the use of support contacts as a service offered to families with dementia. The administrators’ skills, the accessibilityand management of the service are factorsthat influence this process of offering families with dementia a support contact.Study IV showsthat carers rated the original intervention as beingbeneficial for them,a benefit that remained. These findingscorrespondwith the findings from the interviews. Study IV also shows that the carers of younger persons with dementia benefited from the new intervention aimed at carers of younger people with dementia, a benefit that remained. The carershad valuable proposals for further interventions.

    Conclusion: This thesis shows us that the opinions of these families, their supporters and those of other health personnel should not be overlooked when developing services in order to facilitate the provision of the chance to participate in society to families with dementia

  • 252.
    Johannessen, Aud
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Pårørende til personer med demens: Evaluering av en psykoedukativ intervensjon rettet mot pårørende2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Bakgrunn: ”Demens i familien” er en intervensjonsstudie hvor psykoedukativ metode ble benyttet for å redusere stress hos pårørende, og for å redusere psykiatriske tilleggssymptomer hos personer med demens. Studien pågikk i Norge fra 2001-2004. Denne MPH- oppgaven er en delstudie av”Demens i familien”.

    Mål: Undersøke om pårørende opplevde at de hadde hatt nytte av den psykoedukative intervensjonen, og om effekten ble opprettholdt over tid, dette ble målt med et evalueringsskjema. Delmål var å beskrive pårørendes vurdering av eget stress, egen byrde og egen opplevelse av helse, samt sammenligne om det forelå noen forskjell mellom de som hadde fått en kortvarig intervensjon og en kontrollgruppe som hadde fått vanlig behandling.

    Metode: Evalueringsskjema med 8 spørsmål og en rubrikk for kommentarer var utarbeidet. Skjemaet ble fylt ut av pårørende etter intervensjonen og 7,5 måneder senere (n=45). Spørreskjemaer sommåler stress (RSS), byrde (NPI- byrde) og opplevelse av egen helse (GHQ-30), ble målt hos pårørende, ved baseline, etter intervensjonen og 7,5 måneder senere. Andre fra intervensjonsgruppen (n=47) og kontrollgruppen (n=86), skåret på de samme spørreskjemaene. Grad av demens (MMS), varighet av sykdom, pårørendes alder og kjønn forelå på alle.

    Resultater: Skårene fra spørreskjemaene RSS, NPI- byrde og GHQ-30 viste ingen signifikant forskjell etter intervensjonen i gruppene eller mellom gruppene. Forskjeller i varighet av sykdommen, pårørendes kjønn og alder var små. Alle opplevde nytte av intervensjonen også over tid. I den åpne rubrikken var det kommentarer fra 36 personer.

    Konklusjon: Spørreskjemaene viste at pårørende var stresset, belastet og at dette gikk ut overhelsen. Psykoedukative intervensjonsgrupper var nyttige, og pårørende ønsket differensierte grupper med oppfølgingsmøter og egne grupper for personer med demens

  • 253.
    Johannessen, Aud
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV. Ageing and Health Norwegian Centre for Research, Education and Service Development Tønsberg, Norway.
    Hallberg, Ulrika
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Möller, Anders
    Nordiska ministerrådet, Nordic School of Public Health NHV. Ersta Sk ö ndal , University Collage , Sweden.
    Motivating and discouraging factors with being a support contact in the dementia care sector:: a grounded theory study2012Ingår i: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 15, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: People with dementia need different forms of assistance as the disorder progresses. In Norway, support contacts work as ‘paid friends’ and their role can be compared with respite carers or voluntary workers' in other Western countries. Support contacts may be helpful within the dementia sector, especially in the early stages of the disorder, though they are rarely used.

    Aim: The aim of this study was to find out how the support contacts perceive their work.

    Method: Grounded theory, a qualitative method, with interviews of 19 participants (14 women and five men aged 40–75 years) during 2009–2010, from 12 local authorities.

    Findings: This study describes the participants' motives for becoming a support contact and their encouraging and discouraging experiences while being a support contact, expressed as four sets of opposites; flexibility vs rigidity; being compensated vs feeling used; affiliation vs abandonment; and satisfaction vs lack of satisfaction.

    Conclusion: Greater flexibility, adequate compensation, a sense of affiliation and satisfaction, together with potential for building relationship with families, are factors that will encourage dementia care supporters to continue with their work.

  • 254.
    Johannessen, Aud
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV. Ageing and Health Norwegian Centre for Research, Education and Service Development Tønsberg, Norway.
    Möller, Anders
    Nordiska ministerrådet, Nordic School of Public Health NHV. Ersta Sk ö ndal , University Collage , Sweden.
    Experiences of persons with early-onset dementia in everyday life: a qualitative study.2013Ingår i: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 12, nr 4, s. 410-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The small number of existing studies confirms that people with early-onset dementia (EOD) need special assistance from the beginning and as the disease progresses. There is a need to develop services to respond to the specific needs of persons with EOD.

    AIM: To find out how people experience living with early-onset dementia, and to assess the implications for practice and the development of further services.

    METHOD: Grounded theory, a qualitative method, with interviews of 20 informants (aged 54-67 years; 12 of them men) during 2010-2011.

    FINDINGS: One category, the process toward a dementia diagnosis, covered two subcategories; describing changes and being diagnosed. Another category fighting for dignity describes how the informants try to maintain their quality of life, covering two subcategories; intrapsychic challenges and social challenges.

    CONCLUSION: Health services should give persons with EOD the ability to maintain contact with society and their voices should not be overlooked.

  • 255.
    Johannessen, Aud
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV. Ageing and Health Norwegian Centre for Research, Education and Service Development Tønsberg, Norway.
    Möller, Anders
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Why do administrators employ or not employsupport contacts?: A Norwegian qualitative study2012Ingår i: Nordic Journal of Social Research, ISSN 1892-2783, E-ISSN 1892-2783, Vol. 3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This is a qualitative study based on statements by administrators in thedementia sector in Norwegian local authorities. The aim of the present study isto investigate the arguments for and barriers to the allocation and organizationof support contacts for people with dementia and their families. Variousservices are needed to help these families from being isolated. ‘Supportcontacts’ can be one such service, yet the local authorities rarely use them inthe Norwegian dementia-care sector and little is known about why that is so.Support contacts are ‘paid friends’ and their tasks can be compared to respitecarers or volunteers in other Western countries. The data was gathered frominterviews with 35 informants (34 women and one man, aged 35-66 years)during 2011, from 32 local authorities in Norway. The analysis of data involveda qualitative content analysis. Three main categories emerged: ‘knowledge’,‘accessibility’, and ‘management’. ‘Knowledge’ describes the range of anadministrator's familiarity both with dementia and with the legislationconcerning the offering of a support contact to families with dementia, and ithas two subcategories: ‘formal knowledge’ and ‘experiential knowledge’. Thecategory of ‘reaching out’ describes the circumstances that lead families withdementia to apply for help and contains the subcategories of ‘supplyinginformation’ about the service and ‘characteristics of target group’ receiving asupport contact. The category of ‘management of services’ describes thevarious ways in which a supporter service may work satisfactorily and containsthe subcategories ‘recruitment’ and ‘organization’. In conclusion, theadministrators consider support contacts to be a valuable service. The authorsconclude that managers of local authorities need to organize theirdepartments in a way that administrators will have sufficient knowledge aboutmaking the service available and supporter contacts will receive the necessaryguidance and knowledge to maintain the service effectively.

  • 256.
    Johansson, Lars Age
    et al.
    Nordiska ministerrådet, NOMESKO-NOSOSKO.
    Korpi, Helena
    Nordiska ministerrådet, NOMESKO-NOSOSKO.
    Pedersen, Anne Gro
    Nordiska ministerrådet, NOMESKO-NOSOSKO.
    Nomesco Report on Mortality Statistics for the Nordic/Baltic Countries - Theme section 20102010Rapport (Övrig (populärvetenskap, debatt, mm))
    Abstract [en]

    NOMESCO decided in 2008 to produce a new report on the production of mortality statistics in the region. The task was assigned to a subgroup of the BNG, Lars Age Johansson (Sweden, chair), Helena Korpi (Finland) and Anne Gro Pedersen (Norway).

    The major part of the present report is based on replies to a questionnaire. A first draft of the questionnaire was designed by the report team and then reviewed by the entire BNG members in early 2009. Anne Gro Pedersen summarized the replies- Lars Age Johansson compiled a draft report that was circulated to the BNG in April 2010, and also edited the final version. Experiences from the annual meetings with the BNG have also been included in the report, where relevant. 

  • 257.
    Johnsen, Børre
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Barnevaksinering i Montsjegorsk og Kirovsk kommuner på Kola – følges Nasjonal Vaksinasjonskalender?2014Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Hensikt: Hensikten med studien var å undersøke om Nasjonal vaksinasjonskalender for Russland følges i de to kommunene Montsjegorsk og Kirovsk på Kola når det gjelder vaksinering av barn i alderen 0-2 år

    Metode: Studien er en retrospektiv kohortstudie av vaksinerte barn i alderen 0-2 århenholdsvis Montsjegorsk kommune (2007 og 2008) samt Kirovsk kommune (2006, 2007,2008 og 2009).

    Resultat: Denne studien viser ingen signifikant forskjell på antall vaksinerte barn i Montsjegorsk og Kirovsk, der vi har fått tilgang til vaksinasjonskortene, og dekningsgrad forøvrig barnevaksinering i Russland. Det har ikke vært mulig å få fatt i populasjonsdata foraldersgruppen 0-2 år verken i Montsjegorsk eller Kirovsk for de årskullene undersøkelsenomfatter. Resultatene baserer seg derfor på vaksinasjonskortene vi har fått tilgang til.

    Konklusjon: Barn født i Montsjegorsk i 2007 og 2008, samt barn født i Kirovsk i 2006,2007, 2008 og 2009, og som det var vaksinasjonskort tilgjengelige for, ble vaksinert sombestemt i den nasjonale vaksinasjonskalenderen for Den Russiske Føderasjon

  • 258. Jonsson, Caroline
    Health Equity in the Nordic Region2019Rapport (Övrig (populärvetenskap, debatt, mm))
    Abstract [en]

    There are no simple solutions for achieving greater health equality; the road forward must be based on a genuine understanding of how the various elements of society and the welfare system affect inequality.

    To this end, the Nordic Welfare Centre invited the most renowned experts in the Nordic region to share their knowledge in the field.

    In this report, you can read summaries of the presentations given at the Health Equity in the Nordic Region Conference, which was held in Stockholm on 22-23 November 2018. The conference is part of the Nordic Arena for Public Health Issues’ initiative for health equity, a prioritised area of Nordic public health cooperation

    The conference was organized in cooperation between the Nordic Welfare Centre and the Ministry of Health and Social Affairs in Sweden.

  • 259. Jonsson, Caroline
    Jämlik hälsa i Norden: En rapport från konferensen Health Equity in the Nordic Region, Stockholm 20182019Rapport (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Det finns inga enkla lösningar för ökad jämlikhet och vägen framåt måste bygga på en genuin förståelse för hur olika delar av samhället och välfärdssystemet påverkar ojämlikheten. Nordens välfärdscenter bjöd därför in några av de mest namnkunniga experterna i Norden för att förmedla sin kunskap inom området.

    I den här rapporten kan du läsa referat från presentationerna på konferensen Health Equity in the Nordic Region som vi arrangerade i Stockholm 22-23 november 2018. Konferensen är en del av den nordiska folkhälsoarenans satsning på jämlik hälsa, ett område som är prioriterat i det nordiska folkhälsosamarbetet.

  • 260.
    Jonzon, Robert
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Violence against women in intimate relationships:: Explanations and suggestions for interventions as perceived by health care workers, local leaders and trusted community members in a northern district in Vietnam2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    Objectives: The objectives of the study was to describe how people who face partner violence against women, either as volunteers or as professionals in their everyday work, explain violence against women in intimate relationships and their suggestions for preventive activities.

    Methods: Twenty men and twenty women were strategically selected for five focus-group discussions. The interviews were analysed following the procedure for qualitative thematic content analysis.

    Findings: The study shows that the participants acknowledged violence against women as a multifaceted phenomenon grounded in the interplay betweenindividual, family-related factors and local community and socio-cultural factors. Men’s level of education, ‘social evils’, women challenging gender role expectations and women’s extensive work load were discussed as factors at individual and family level. Poverty in the local community and ‘feudal ideologies’ were referred to as explanatory factors at structural level. The informants suggested two main ways of preventing violence against women; improved gender equality through information, education and communication, and enforcing policies and law. Examples pertaining to different levels of society were given.

    Conclusions: This study shows that behind all of the explanations to intimate partner violence laid the culturally constructed messages about the proper roles of men and women mirroring gender inequality and women’s power disadvantage. A hesitation to intervene was found among some of the informants, the medical doctors, while all the others were eager to discuss activities but mainly those they were already undertaking and it seems the local level require further support to better handle this problem.

  • 261.
    Julin, Bodil
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Äldre deltagares upplevelser av Må Bra TVsom resursförstärkande metod: En grundad teoriav ett hälsofrämjandetelevård projekt i Åbolands skärgård 2007-20102012Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Syftet med den aktuella kvalitativa studienär att utifrån av empiriska datafördjupa förståelsen för äldre deltagares upplevelser av Må Bra TV(MBT).

    Metod: Sammanlagt sju äldre från Åboland skärgård som har använt sig av MBT har intervjuats. Data har analyserats enligt Corbin och Strauss modifierade version av grundad teori.Huvudresultat:Det centrala i MBT visade sig vara samvaron i de virtuella möten där deltagarna träffade varandra och studerandevid högskolan.”Att få och ge stöd genom interaktiva möten”framstod där med som en kärnkategori i analysen av data. I analysen av intervjuerna kunde ytterligare fyra kategorier identifieras som alla var relaterade till kärnkategorin. Dessa kategorier beskriver deltagarnas upplevelser av konsekvenserna av att delta i virtuella möten. De upplevde att trots att tekniken kunde vara en utmaning, så vidgades både deras vyer och deras aktivitetsnivå och dessutom ökade deras självförtroende av att de klarade av deltagandet. De kategorier som genererades i analysen benämndes ”Att lärasig använda ny teknik”, ”Att få möjlighet till vidgade vyer”, ”Att bli aktiv i vardagen” och”Att erhålla stärkt självförtroende”

    Slutsats: Kärnkategorin i den resursförstärkande metoden är social samvaro. Studien bidrar med kunskap om hur socialt stöd kan användas i utveckling av hälsofrämjande televård för äldre. Mer forskning behövs för att kunna utveckla ett multiprofessionellt resursförstärkande vårdarbete som kan förverkligas virtuellt

  • 262.
    Kaarna, Marina
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    The importance of job satisfaction in hospital quality processes2007Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    Purpose. The purpose of the study was to evaluate the level of job satisfaction among the staff of Pärnu County Hospital and to describe variables related to their job satisfaction.

    Methods. The study was carried out in December 1998. The opinions of staff regarding satisfaction with their jobs were studied using an Estonian translation of the Norwegian Medical Association Job Satisfaction questionnaire, which was distributed to all 673 staff members of the hospital. Three levels of analyses were carried out. Stepwise regression analysis was used to determine which single item factors were most important in job satisfaction for the various groups of hospital staff. Further, global job satisfaction item and a four items construct called nature of job satisfaction (α=60) were selected as dependent variables. The independent variables consisted of constructs measuring: knowledge in planning (3 items α=70), relationship with superior (5 items α=89), strategic knowledge of workplace (5 items α=84), work stress (6 items α=77), unrealistic expectations (5 items α=72), collegial relationships (2 items α=75), discussions with colleagues (3 items α=80), recognition (3 items α=67) and sense of belonging (single item). Pearson correlations were used to determine whether the independent variables were significantly correlated with job satisfaction. Scheffe’s F-test was used to conduct post-hoc analyses of variance for each independent variable between categories of hospital personnel. Results. The response rate was 77%.

    The key results were that overall job satisfaction was moderately high (3.86 on a scale of 5); however there are differences in satisfaction models between categories of personnel. In addition, there are significant differences in the correlations between job satisfaction and the independent variables among the groups of personnel.

    Conclusions. The findings of this study suggest that executives of a health care institution that are informed about the expectations and daily work-related problems of their employees are better able to understand the needs of their employees. Executives should: 1) build up effective relationships between managers and staff; 2) identifynegative working conditionswhich affect staff; 3) appropriately delegate authority to personnel, and hold them accountable for the work done in their organizational units; 4) keep staff informed about changes that will affect them; and 5) express appreciation and recognition for the efforts of staff members in accomplishing the work of the health care organization. In doing this, executives will create a favorable working environment for the hospital staff. The value of the study is that the results can be used as a set of reference levels and indicators for the human resources development component of the quality management system of Pärnu County Hospital

  • 263. Kalda, Rurth
    et al.
    Põlluste, Kaja
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Lember, Margus
    Patient satisfaction with care is associated with personal choice of physician.2003Ingår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 64, nr 1, s. 55-62Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate whether choosing one's own primary care doctor is associated with patient satisfaction with primary health care. To evaluate factors related to population's satisfaction with primary health care.

    POPULATION: A random sample of Estonian adult population (N=997).

    STUDY DESIGN: Cross-sectional study using a pre-categorized questionnaire which was compiled by the research group of the University of Tartu and the research provider EMOR.

    RESULTS: Altogether 68% of the respondents had been listed in their personal physician. Their overall satisfaction with the physician as well as satisfaction with several aspects of primary health care were significantly higher compared with those of unregistered respondents. Although some other factors (practice size, patient age, health status) also influenced patient satisfaction, presence of a personal physician appeared the most important predictor of high satisfaction with physician's punctuality and understanding, effectiveness of prescribed therapy, clarity of explanations given by the physician as well as with overall satisfaction with the physician.

    CONCLUSION: Personal doctor system is associated with patient satisfaction with different aspects of care.

  • 264. Kalda, Ruth
    et al.
    Polluste, Kaja
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Maaroos, Heidi-Ingrid
    Lember, Margus
    Patients' opinions on family doctor accessibility in Estonia.2004Ingår i: Croatian Medical Journal, ISSN 0353-9504, E-ISSN 1332-8166, Vol. 45, nr 5, s. 578-81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To investigate the accessibility of family doctors in Estonia from the patients' point of view.

    METHODS: Face to face interviews using structured questionnaires were performed. A random sample of the Estonian residents, aged 15-74 years, was studied (n=999).

    RESULTS: The number of visits provided by family doctors has been continuously increasing since 1998. Out of 999 respondents, 59% visited the family doctor during the previous 12 months. The average number of visits per Estonian resident in one year is 2.48. Out of 999 interviewed persons, 72% said that they had a possibility of contacting their family doctor by phone. The waiting time for an appointment was short in most cases. The family doctor admitted 60% of the respondents on the same day the patients had requested; 22% of the patients were admitted within 1-2 days and 9% of the patients were admitted within 3-4 days. Only 9% of them had to wait more than 5 days. The current home visit fee in Estonia would have affected the decision of the home call of 58% of people. There was a correlation between the acceptability of a visit fee and the people's income.

    CONCLUSION: The accessibility of family doctors can be considered good in Estonia.

  • 265.
    Kalibatas, Vytenis
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Evaluating Hospital Costs in Kaunas Medical University Hospital2005Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    The purpose of the study is to evaluate hospital costs in Kaunas Medical University Hospital (KMUH). KMUH is the largest hospital in Lithuania, having 1995 in-patient beds, 26 specialised in-patient departments, 5130 employees, and providing wide range of in-patient services.

    Methods. Methods, used in the study include assessment of inputs and outputs, evaluation of average cost per case, estimation of cost structure, estimation of case-mix dimensions in in-patient departments and clinical categories and assessment of impact of case-mix dimensions to cost per case, using multiple regressionanalysis. Cross-sectional study designwas used in the study, evaluating mainly cases and expenses of all 26 specialised in-patient departments of KMUH per year 2002. Five cost groups have been used and defined inmonetary terms in each in-patient department: labour costs; medication costs; laboratory, radiology and anaesthesiology costs; running costs of medical equipment supply andother costs (including in-patients’ mealcosts, transportation, laundry, communication, etc. costs). Case was defined as one treatment episode in particular in-patient department. Cases were analysed using following case-mix dimensions: sex, age, absenceor presence of surgical operation, patient separation status and in-patientservice group.

    Results. Average costs per case vary widely among in-patient departments, ranging from 126.01 Litas (36.52 Euro) to 3451.68 Litas (999.73 Euro) per case.During the study average cost per case were also estimated in clinical profiles – surgery – 1161.0 Litas (336.24 Euro), therapy – 1312.15 Litas (380.02 Euro),obstetrics and gynaecology –685.82 Litas (198.62 Euro), newborn and child care – 893.54 Litas (258.78 Euro) and intensive care – 1292.92 Litas (374.45 Euro). Using multiple regression analysis method, costper case ineach in-patient department and clinical category according case-mix dimensions were predicted. In all in-patient departments predicted values of average costs per case according case-mix dimensions, comparing with actual values, did not differ so much. Positive contributions to predictedvalue of cost per case, shows only one variable – IA in-patient service group. In any predicted case contributions of independent variables have notbeen observedas significant (p>0.05).

    Conclusions. Inputs (measured in the number of beds) and outputs (measured in the number of in-patientcases and the number of bed-days) are different across in-patient departments, as well as outputs (measured inthe number of treatment episodes according to case-mix dimensions). The average costs per case vary widely across in-patient departments and clinical categories. The analysis of the structure of average costs per case demonstrated striking differences in in-patient departments. In all in-patient departments the predicted values of the average costs per case according to case-mix dimensions, do not differ so much comparing with theactual observed costs per case. Positive contributions to the predicted value of the cost per case, shows only onevariable – IA in-patient service group. The results of the study have proved the evidence that clinical casestreated within the same in-patient department of the hospital are not similar. The results of studyhave showedthe failure of use of “in-patient service groups” as proxy of International Disease Classification due to numberof reasons

  • 266.
    Kalling, Lena V
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Fysisk aktivitet på recept i Norden: erfarenheter och rekommendationer.                                                                            På uppdrag av ”Nordisk nettverk for fysisk aktivitet, mat og sunnhet”2011Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    SammanfattningBakgrund Otillräcklig fysisk aktivitetsnivå i befolkningen är en gemensam utmaning i de nordiska länderna. För att utbyta erfarenheter och samarbeta för att öka kunskapen och utveckla området livsstil på recept bildades ”Nordisk nettverk for fysisk aktivitet, mat og sunnhet”. I Danmark, Finland, Norge och Sverige har man under det senaste decenniet utvecklat olika modeller av ordination av fysisk aktivitet inom hälso- och sjukvården. Syftet med denna rapport är att beskriva de olika modellerna. Genom att sammanfatta erfarenheter och analysera de olika modellernas för och nackdelar är avsikten att ge rekommendationer för det framtida arbetet i Norden – att finna en nordisk ”best practice” av skriftlig ordination av fysisk aktivitet, med lokala anpassningsmöjligheter. Metod Material har sammanställts utifrån rapporter, vetenskapliga studier, hemsidor och kontakter med experter inom området i respektive land. Då förutsättningarna skiljer sig mellan länderna beskrivs kontexten för det hälsofrämjande arbetet med fysisk aktivitet och en kort historisk tillbakablick ges på det utvecklingsarbete som gjorts kring ordination av fysisk aktivitet. Skillnader respektive likheter identifieras mellan ländernas upplägg av förskrivning av fysisk aktivitet och gemensamma utvecklingsfrågor identifieras. En sammantagen analys leder till rekommendationer för det framtida arbetet i Norden. Resultat Den gemensamma nämnaren i de olika modellerna för fysisk aktivitet på recept är att läkare eller annan legitimerad hälso- och sjukvårdspersonal har ett samtal med patienten och gör en skriftlig ordination på fysisk aktivitet. Gemensamt tankesätt är även att i respektive land finns en eller ett par modeller som sedan anpassas utifrån lokala förutsättningar i varje region, landsting eller kommun. Olikheter mellan modellerna gäller framför allt vem som förskriver, vem som har det motiverande samtalet och följer upp den ordinerade aktiviteten samt vilka patienter som kan komma ifråga. Det är stor variation i hur intensiva interventionerna är, vilka delar som utförs inom hälso- och sjukvården respektive i samverkan med andra aktörer i samhället, om man fokuserar på att främja fysisk aktivitet på egen hand eller gruppaktivitet. Vissa modeller utnyttjar befintliga strukturer i samhället medan andra har utvecklat nya. Alla modeller har sina för- och nackdelar och olika modeller passar under olika förutsättningar. De modeller som har studerats vetenskapligt, har i samtliga fall lett till en ökad fysisk aktivitetsnivå. Slutsats Det är viktigt med en individuell anpassning av såväl ordinerad aktivitet som vilket stöd patienten är i behov av. Grovt indelat bör hälso- och sjukvårdspersonal använda två nivåer av insatser till patienter som behöver öka sin fysiska aktivitet i förebyggande eller behandlande syfte. I första hand erbjuds motiverande samtal med en individanpassad skriftlig ordination av fysisk aktivitet som patientens bedriver på egen hand (vardagsaktivitet och/eller organiserad aktivitet). För de patienter som behöver utökat stöd för att komma igång med fysisk aktivitet, erbjuds träningsgrupper inom vården som ett första steg. En individanpassad skriftlig ordination kan därefter underlätta övergången från strukturerad träning inom vården, till att individen blir varaktigt fysiskt aktiv på egen hand. Det är dock inte möjligt att föreslå en enda modell för fysisk aktivitet på recept i Norden som passar alla patienter, förskrivare och olika lokala villkor. Arbetet måste därför anpassas utifrån de aktuella förutsättningarna.

  • 267.
    Kalmark, Morten
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Opsøgende Psykoseteam (ACT-model) - en tværfaglig teambaseret intervention: Om modeltrofasthed og oplevelsen af reduktion af kompleksitet2014Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [da]

    Formålet: Psykiatriens udvikling er konstant præget af ønsket om effektive behandlings-metoder. Etablering af ACT (Assertive Community Treatment) -er skabt i erkendelse af, at psykiatrien i hospitalerne ikke i tilstrækkelig grad har evnet at helbrede. Med afsæt i de kronisk psykisk syge, vil dette MPH arbejde fokusere på denne gruppes sundhedstilstand, ved at studere arbejdsmetoden ACT. En arbejdsmetode som sundheds-og socialvæsenet i stigende grad accepterer som organisation og funktion til forebyggelse og sundhedsfremme. Der er i de sindslidendes liv brug for en arbejdsmodel, hvor en kompetent hjælper kan støtte den sindslidende i at begribe hverdagen, så der dannes et meningsfuldt grundlag for at håndtere livet. Formålet med studiet er, at få mere viden om, hvordan de danske ACT teams fungerer i en hektisk hverdag. Modellen har i udlandet vist, at have god effekt på reduktion af kompleksitet og sikre en bedre sammenhæng i det psykiatriske arbejde. Studiet er ligeledes en efterprøvning af, om der arbejdes modeltrofast overfor ACT i Danmark.

    Metode: Studiet belyser ACT interventionen ved hjælp af en struktureret elektronisk spørgeundersøgelse og efterfølgende kvalitativ indholdsanalyse. Efterfølgende fravalg af størstedelen af den indsamlede kvantitative data, grundet lav svarprocent.

    Resultat: I undersøgelsen deltog 72 respondenter fordelt på 31 respondenter fra Region Hovedstaden (43 %),12 respondenter fra Region Sjælland (17%), 11 respondenter fra Region Syddanmark (15 %), 2 respondenter fra Region Midtjylland (3%) og endelig 16 respondenter fra Region Nordjylland (22%). Antal ACT teams i Danmark er fordelt med 33 teams i Region Hovedstaden, et team i Region Sjælland, otte teams i Region Syddanmark, 11 teams i Region Midtjylland og endelig fire teams i Region Nordjylland. Danske ACT teams arbejder anderledes og med en anden sammensætning / funktion end den oprindelige model fra USA. ACT har vist sin funktionsdygtighed gennem mere end de sidste 10 år i Danmark. ACT teams indtænker salutogenitet i sin arbejdsform og fokuserer på ressourcer og på at forbedre sundhedstilstanden. ACT er opsøgende og assertivt i sin kontakt til klienterne.

    Konklusion: ACT har med sit indtog i Danmark vist,at tilgodese et behov hos både klienter, den arbejdende psykiatri og samfundet. Psykiatrien skal behandle klienterne, der hvor de er – i deres eget liv. Med tilbud som er tilgængelige, sammenhængende og meningsfulde for den enkeltes vej mod et godt liv uden eller på trods af sygdom. Arbejdsmetoden er effektiv i reduktion af sundhedsfaglig og socialfaglig kompleksitet og teammedlemmerne udtrykker stor arbejdstilfredshed ved metoden. Teammedlemmerne i danske ACT-teams evner at arbejde i teams. Det tværfaglige samarbejde opleves meningsfuldt og håndterbart. ACT arbejdet er attraktivt og kan rekruttere kompetente medlemmer. Kvaliteten af de ydelser som ACT teams leverer, inkluderer forebyggelse, pleje, behandling, rehabilitering samt en øget oplevelse af tilgængelighed, koordination, kontinuitet og reduktion af kompleksitet. De danske ACT teams er ikke modeltro mod ACT –men tilpasset danske forhold og begrænsninger. ACT team har ikke fuldstændig myndighedsfunktion. ACT som model er under udvikling og tillempes mere og mere i en dansk kontekst

  • 268.
    Karlshøj Poulsen, Bodil
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Forebyggende og sundhedsfremmende arbejde i Kalaallit Nunaat 1996-20072010Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [da]

    Baggrund: Kalaallit Nunaat (Grønland) har opbygget en unik organisering af det forebyggende og sundhedsfremmende arbejde, hvor centralt og lokalt niveau er forbundet gennem et forebyggelsesudvalg og en forebyggelseskonsulent i hver kommune. Paarisa, Center for Folkesundhed, havde lederskabet og har udviklet en uddannelse for forebyggelseskonsulenterne.  

     

    Formål: At samle og analysere indhentede erfaringer fra arbejdet med organiseringen af det forebyggende og sundhedsfremmende arbejde i perioden 1996 til 2007.

     

    Metode: Officielle dokumenter blev analyseret ved et retrospektivt, deskriptivt og eksplorativt casestudie. Semistrukturerede interviews med udvalgte nøglepersoner og anbefalinger til det fremtidige forebyggende og sundhedsfremmende arbejde, som blev givet af forebyggelses-konsulenterne på et seminar i 2007, blev ligeledes inkluderet. Endelig blev der gennemført et litteraturstudie med henblik på at analysere partnerskaber som et redskab til at højne folkesundheden. Dette studie blev anvendt til triangulering af resultaterne.

     

    Resultater: For at fremme af folkesundheden lokalt skal der arbejdes tværsektorielt og være vilje til koordinering og samarbejde. Dette kan ske ved netværksarbejde, men formelle partnerskaber anbefales. For at opnå succes, skal der desuden være forbindelse mellem centralt og lokalt niveau

  • 269. Karlsson, Nina
    et al.
    Gustafsson, Jessica
    Äldre och alkohol: Om utmaningarna inom äldreomsorgen i Norden2018Bok (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Dagens 50-70-åringar dricker mer eller oftare än personer i 40-års åldern och också de äldsta åldersgrupperna dricker mer i jämförelse med tidigare generationer. Det visar flera nordiska dryckesvaneundersökningar.

    Den växande alkoholkonsumtionen förväntas resultera i ett större antal alkoholrelaterade skador och det i sin tur innebär utmaningar för äldreomsorgen, missbruksvården, social- och hälsovården och mentalvårdstjänsterna.

    Nordens välfärdscenters nya publikation Äldre och alkohol – Om utmaningarna inom äldreomsorgen i Norden granskar på vilket sätt den nordiska äldreomsorgen har förberett sig för dessa utmaningar. I publikationen lägger vi fokus på alkohol som en av de centrala utmaningarna för såväl förebyggning av problematiskt bruk som för våra vård- och omsorgssystem i Norden

  • 270.
    Kavli, Frode
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Eksternaliserende samtaler: et narrativt perspektiv på undersøkelsessaker i barnevernet.2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Studien tar utgangspunkt i et metodeutviklingsprosjekt ved et barnevernkontor i Oslo, kalt ”DuKanJo” – et forsøk på å anvende eksternaliserende samtaler som en form for empowermentstrategi allerede i undersøkelsesfasen i en barnevernsak. I alt fire familier ble invitert til å delta i såkalte ettersamtaler – en form for evaluering av et empowermentprosjekt – samtaler som også utgjorde de primære forskningsdata i studien. Studien bruker en narrativ tilnærming både som forskningsmetode og som metodisk tilnærming i ettersamtalene og kan derfor betraktes som både en evaluering av en empowermentsrategi og som et forskningsprosjekt. Hensikten med studien er å belyse om hvorvidt en narrativ metodikk i undersøkelsessaker kan bidra til å flytte fokuset i barnevernssaker fra problemorientering til ressursorientering. Studien søker også å svare på om det er mulig for barnevernet - med et så klart definert kontrollmandat -, å gjøre bruk av en ressursorientert tilnærming for å fremme familienes salutogene krefter og mestringsstrategier. Studien bekrefter at en slik tilnærming er mulig, men at det fortsatt finnes faglige og etiske dilemmaer knyttet til en slik tilnærming.

  • 271.
    Kibsgaard Larsen, Frode
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Levealdersutvikling for personer med Downs syndrom i Norge fra 1969 og frem til 20502014Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Bakgrunn: Levealderen for personer med Downs syndrom har økt dramatisk på 1900 tallet i hele den vestlige verden. Imidlertid er det få undersøkelser om levealderfor denne populasjonen på 2000-tallet, og vi har ikke funnet noen norske undersøkelser.

    Hensikt:Undersøkelsen skal gi innsikt i levealdersutvikling i Norge fra 1969 og frem til 2010 og fremtidig forekomst av voksne og eldre med Downs syndrom frem til 2050.

    Metode:Det er en kvantitativ nasjonal demografisk registerundersøkelse for å beregne levealdersutviklingen for personer med Downs syndrom (n = 2 593). Registerdataene som er samlet inn er kontinuerlige data som er basert på løpende tellinger i den nasjonale fødsels-og dødelighetsstatistikken. Innsamlede data er personer registrert med diagnosekode Downs syndrom, årfødt, år død, alder ved død og kjønn.

    Hovedresultat:Gjennomsnittlig alder ved død for personer med Downs syndrom fra 1969 til og med 2009 økte fra 16,57 år til 53,40 år. Det var ingen statistisk signifikant forskjell på alder ved død mellom menn og kvinner. Gjennomsnittlig alder ved død for alle som døde etter fylte 40 år i studieperioden økte fra 53,95 år til 58,35 år. Forventet andel personer med Downs syndrom som vil bli 40 år og eldre vil øke fra 52 % for de som blefødt i 1967 til 94 % for de som ble født i 2009.

    Konklusjon:Levealderen for personer med Downs syndrom har økt betydelig fra 60-tallet og detteskyldes i hovedsak nedgang i spedbarnsdødeligheten. For de som overlever barneårene viser undersøkelsen imidlertid nesten ingen økning i rest levealder i løpet av undersøkelsesperioden. Frem til 2050 kan vi forvente en fordobling av antallet som vil være over 40 år

  • 272. Kjeldsen, Ulrik Boe
    et al.
    Wied, Morten
    Lange, Peter
    Tofteng, Maja
    Lindgaard, Kasper
    The Nordic Swan and companies: – Is it worthwhile to acquire the Swan Label?2014Bok (Övrigt vetenskapligt)
    Abstract [en]

    The purpose of the analysis is to study the implications it can have for a company to acquire the Swan License. The analysis takes a broad focus and investigates the following three themes:

    •The motivation for companies to acquire the Swan Label.

    •The implementation of the Swan Label.

    •The impact of acquiring the Swan Label.

    The project aims at doing this by performing company visits to 16 companies from the five Nordic countries representing different company sizes and sectors. The project is commissioned by the Swan group under the Working Group for Sustainable Consumption and Production group (HKP gruppen) of the Nordic Council of Ministers. The analysis is conducted by DAMVAD with expert assistance from Åke Thidell, Lund University.

  • 273.
    Kjeldsø Fastvold, Kristin
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Ledelse i et krysspress: en kvalitativ studie av hvordan ledere opplever å arbeide helsefremmende i offentlig sektor2010Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Resultat: To tema fremkom i studien Ledelse i et krysspress og Ledelse i en omsorgsrolle. De to temaene ble belyst med fem hovedkategorier med til sammen 14 underkategorier, som viste at lederne opplever et visst krysspress med hensyn til krav fra overordnede gjeldende resultater, måloppnåelse, og forventninger fra ansatte om ivaretakelse av deres arbeidsmiljø. Endringer i offentlig sektor medfører et økt fokus på det helsefremmende aspekt og et større press på lederne for å innfri dette. De beskrivelser som fremkommer i studien viser at lederne er bevisste hvilken rolle de som ledere har i arbeidsmiljøet med hensyn til kommunikasjon, inkludering og tilrettelegging, samt samhandling og egen tilstedværelse i miljøet. Lederne har et flerdimensjonert og ulikt bilde av hva helsebegrepet innholder og omfatter. Lederne uttrykker et helhetlig syn på helse.

    Konklusjon: Helsefremmende arbeidsplasser representerer både noe nytt og noe kjent for lederne. Sentrale momenter i utøvelse av ledelse for å implementere konseptet er bevissthet og balansering av lederrollen, samhandling og tilstedeværelse og å ha en løsnings fokusert tilnærming til problemstillinger og en støttende lederstil.Endringene i offentlig sektor i Norge er basert på New Public Management prinsippene med fokus på resultatoppfølging og økonomi. Dette har medført at lederne opplever å ha et mindre handlingsrom for å fremme helsen til ansatte på arbeidsplassen.

  • 274.
    Kjevik, Gry
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Mobbing i barnehagen ; innvirkning av samfunnsstrukturenes støttefunksjon og ansattes bruk av begrepet mobbing.: En kvalitativ studie i et folkehelseperspektiv.2014Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Hensikten med denne studien er å få mer kunnskaputifra et folkehelseperspektiv, om hvordan forståelsen og bruken av fenomenet mobbing, kan påvirke hvordan barnet opplever trivsel i barnehagen.

    Metode: I arbeidet ble fenomenografi brukt som tilnærmingsmetode, samt triangulering og emergent design. Pedagoger fra to barnehager, utvalgt på bakgrunn av ulik deltagelse i kurs i forhold til fenomenet, ble intervjuet med semistrukturel intervju guide. Dokumenter angående mobbeforebyggende arbeid ble analysert. En pedagogisk mobbeforebyggende undervisningstime for fire og femåringer ble observert. Ansatte innen statlige, fylkesmannsetaten og kommunale avdelinger, med legal, kontrollerende eller støttende mandat ble oppsporet og intervjuet angående deres mandat og rolle i det mobbeforebyggende arbeid forbarnehage.

    Resultat: Ansvaret for mobbeforebyggende arbeid funnet å væreopp til barnehagelederes egetiniativ. I forhold til folkehelsearbeid på systemnivåer fremkom det et svakt lovmessig mandat for at statlig, fylkesmannsetaten og kommunalt nivå skalkunne kontrolere og forebygge mobbing i barnehagen. Alle tre eksterne nivå hadde struktur for å distribuere oppdatert informasjonangående mobbeforebygging til barnehagene. Innhenting av informasjon var opp til den individuelle barnehage.Bruk av mobbebegrepet i barnehagemiljøet gav emosjonell respons angående aksept av mobbing. Ulik aksept gaulik bruk av begrepet. Dette påvirket innhentingen av tilrettelagt mobbeforebyggende informasjon og utvikling av barnehagens policy. Bruk av ulike definisjoner av mobbebegrepet ga rom for varierte tolkninger av episodermed hensyn til psykososial adferd blandt barna.

    Konklusjonen: Den svake lovhjemmel for kontroll fra stat, fylkesmann og kommune av barnehagens psykososiale miljø medfører at barnehagen og dens stab emosjonelle tolkning av mobbing blir grunleggende for mobbeforbygging i teoriog praksis. Derved blir det opptil foreldrene å sjekke ut det forebyggende mobbearbeid i den enkelte barnehagen.

  • 275.
    Kjær, Aggi
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Vold og Trusler om vold i arbejdet med stofbrugere: Et studie af problemets størrelse og mulige minimering2005Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [da]

    Formål: Bestemme omfangen, typen, udløsende årsager, bagvedliggende faktorer og konsekvenser af vold og trusler om vold mod behandlere i Københavns Amts Behandlingscenter for Stofbrugere samt at udvikle kliniske retningslinier for håndtering og minimering af vold og trusler om vold.

    Metode: Omfanget af voldsepisoder blev vurderet ved to metoder: 1) Retrospektiv anonym tværsnitsspørgeskemaundersøgelse af samtlige 84 fastansatte medarbejder 2) Kohorte undersøgelse med prospektiv registrering af alle psykiske og fysiske voldsepisoder i en tre måneders periode i 2001-2002. Årsager, faktorer og konsekvenser blev undersøgt i semi-strukturerede interviews med den voldsramte medarbejder og den voldelige klient. Håndteringen af voldsepisoderne blev vurderet i en audit procedure og kliniske retningslinier i relation til håndtering af arbejdsrelateret vold og trusler om vold blev udviklet .

    Resultat: I tværsnitsundersøgelsen svarede 73 (87%), 45% (n=33) af medarbejderne havde været udsat for vold af psykisk eller fysisk karakter indenfor det sidste år, 48% (n=35) indenfor de sidste fem år. Hyppigheden var uafhængig af medarbejderens alder, køn og arbejdserfaring. Kohorteundersøgelsen afslørede, med en svar procent på 57%, 16 tilfælde af ren psykisk vold medførende en incidens på 0.77 pr. arbejdsår pr. medarbejder eller 0.24 psykisk voldsepisode pr. dag, 11 tilfælde af kombineret psykisk/fysisk vold medførende en incidens 0.53 pr. arbejdsår pr. medarbejder eller 0.17 psykisk/fysisk voldsepisode pr. dag (ca. een ugentligt). Politi blev tilkaldt 5(19%) gange. Bagvedliggende faktorer inkluderede dybe frustrationer mod behandlersystemet, lavt selvværd og dårlig kommunikationsevne hos klienterne. Hovedparten af medarbejderne oplevede efterfølgende angstreaktioner. Sygemelding og psykologisk krisehjælp forekom kun i få tilfælde. På basis af audit-panelets rekommandationer blev der udviklet kliniske retningslinier for håndtering af vold og trusler om vold.

    Konklusion: Prævalenses og incidensen af vold og trusler om vold i arbejdet med stofbrugere er højere end i andre fagområder både i og uden for sundhedsvæsenet med væsentlige konsekvenser for både medarbejderen og specielt for den voldelige klient. Resultaterne i dette studie kvantificerer arbejdsrelateret vold som ikke fremgår af officielle registre (”mørketal”)

  • 276.
    Klaeson, Kicki
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Att bli jämngammal med sin mamma: Unga kvinnors upplevelser av bröstcancerbehandling2005Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Syftet med denna studie var att beskriva unga kvinnors upplevelser av förtidig menopausefter cytostatika- och/eller hormonbehandling. Ett ytterligare syfte var att beskriva hursexualiteten upplevdes efter dessa behandlingar. Undersökningen genomfördes i två etapper med fenomenologisk metod. Öppna individuella intervjuer valdes i delstudie 1. I delstudie 2 användes fokusgrupp. Sammanlagt deltog nio kvinnor i studien. Dessa kvinnor var yngre än 45 år vid diagnosen och hade slutat att menstruera pga. behandling. Essensen befanns vara: Att inte känna igen sig själv, med delkomponenterna den fertila sexuella kroppen, den åldrande kroppen, sårbarhet och bekräftelse. I fokugruppsintervjun utvecklades essensen: Utanförskap med delkomponenterna att inte vara hemma i sin egen ålder, stigma, sexuell lust och intima relationer, existentiell oro samtbekräftelse. Slutsatsen som dras är att man inom sjukvården bör utveckla samtalsformer som riktar uppmärksamhet mot dessa kvinnors upplevelser av identitetsförvirring och utanförskap. Vissa data tydde på att kunskap omsexualitet samt kroppskännedom mildrade de upplevda svårigheterna.

  • 277. Knudsen, Lisbeth E.
    et al.
    Hansen, Pernille Winton
    Workshop Report HBM4EU: Nordic workshop for scientists and regulatory agencies discussing HBM4EU - the European human biomonitoring initiative2017Rapport (Övrigt vetenskapligt)
    Abstract [en]

    The aim of the workshop was to bring together scientists and regulatory specialist from the Nordic countries to discuss priority setting of which substances to include in the biomonitoring programs and promote the communication between scientists and authorities regarding use of HBM data in a regulatory context (e.g. REACH). Discussions during the workshop will provide the basis for moving forward in future Nordic collaboration and contribution to HBM4EU. The prioritization of substances should be made with the concern of toxicity, exposure and persistency in mind. The substances or groups of substances that the participants find to be most important in the HBM4EU is additional metals, triclosan, nanomaterials, microplastics, poly- and perfluorinated substances, chemical UV-filters, pesticides, phosphorous containing flame retardants, organophosphates, preservatives and particles.

  • 278.
    Knutsen, Håvard
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Eldre menn som omsorggivere til demente ektefeller.: En kvalitativ studie om menn som omsorgsgivere til ektefeller med diagnosen aldersdemens.2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Ny statistikk viser økende forekomst av aldersdemens blant eldre. Menn utgjør en økende gruppe omsorgsgivere. Disse mennene har fått relativt liten forskningsmessig oppmerksomhet, det finnes en begrenset mengde litteratur tilgjengelig om menn som omsorgsgivere for ektefeller med aldersdemens. Der er derfor viktig å gi dette feltet forskningsmessig oppmerksomhet, blant annet for å kunne gi helsepersonell kunnskap om denne gruppen. Med økt innsikt i mennenes opplevelse av sin situasjon vil de kunne gis bedre følelsesmessig og praktisk assistanse i omsorgsarbeidet sitt. Det ble gjennomført en studie med fokus på ektefeller av menn med demente ektefeller ved bruk av Grounded Theory som metode. Studien ble basert på opplevelsene til ni menn, seks av dem hadde omsorg for hjemmeboende ektefelle, de tre andre hadde flerårige erfaringer med å ha dement ektefelle hjemme men hadde nå sine ektefeller i sykehjem og fulgte dem opp der. Data ble samlet gjennom dybdeintervjuer tatt opp på bånd. Intervjuene ble analysert ved bruk av Grounded Theory. Det ble funnet fem hovedkategorier, mestring, ensomhet, lojalitet, sorg og tap av felleskap med ektefelle

  • 279. Koline, Torsten
    et al.
    Nylander, Per Åke
    Tourunen, Jouni
    Giertsen, Hedda
    Leimar, Per
    Stenius, Kerstin
    Nordic Studies on Alcohol and Drugs NAD 6/12 Volume 292012Bok (Övrig (populärvetenskap, debatt, mm))
  • 280.
    Kopperstad, Audun
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Kvinnelige sykepleiere med langvarig yrkesaktivitet: en kvalitativ studie om forhold som motiverer til å opprettholde lange yrkeskarrierer2009Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Bakgrunn: Det er med bekymring man ser det økende antallet personer i arbeidsfør alder som står utenfor norsk arbeidsliv. Det er ansatte i helse- og sosialsektoren som har den høyeste raten nye uføre. Dette bildet forsterkes av at Norge har et udekket og økende behov for helsearbeidere.

     

    Hensikt: Hensikten med denne studien var å få mer kunnskap om faktorer en gruppe kvinnelige seniorsykepleiere subjektivt opplever som positive for å stå lenge i lønnet arbeid.

     

    Metode: Det ble gjort halvstrukturerte individuelle intervju av 11 kvinnelige sykepleiere med lang yrkeserfaring. Intervjuene ble analyserte ved bruk av innholdsanalyse, i tråd med retningslinjer gitt av Graneheim og Lundman (2004).

     

    Resultat: Det overbyggende tema ble uttrykt som Mening og selvrealisering. Dette temaet bestod av to hovedkategorier: (1) Drivkrefter, som består av indre og interpersonelle aspekter, og (2) Muliggjørende faktorer, hovedsakelig arbeidsrelaterte og/eller organisatoriske forhold, inklusive det psykososiale klimaet og meningsfull verdsetting fra ledelse og kolleger.

     

    Konklusjoner: Studien viser at når indre Drivkrefter og Muliggjørende faktorer i arbeidet virker i gjensidig samspill, skapes en god sirkel som leder til jobbtilfredshet, og opplevelse av mening og selvrealisering. Informantene uttrykker disse forhold som betydningsfulle for sitt lange yrkesliv

  • 281.
    Kranciukaite - Butylkiniene, Daina
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Quality of life after stroke: the EROS study in urban Lithuania2014Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    Objectives. This studyaimed to assess quality of life in first-onset stroke survivors, and to determine how stroke associates with social and demographic factors, peculiarities of lifestyle, and chronic non-infectious diseases.Material and methods.As part of the European Register of Stroke study, we recruited 508 stroke survivors aged 25–84 years (case group) in Kaunas city Lithuania, and randomly selected 508 age-and sex-matched residents from the city’s stroke-free population (controls). All participants completed the Short Form 12 Health Survey questionnaire. We analyzed participants’ physical and mental quality of life regarding social and demographic factors, lifestyle, chronic non-infectious disease morbidity, and the use of medications.

    Results. Quality of life among stroke survivors was poorer compared to controls in both the physical (Me=32.8/47.0, p<0.001) and mental (Me=55.9/60.5, p<0.001) health domains. Stroke survivors and controls with arterial hypertension reported poorer physical health, compared to subjects without hypertension (p<0.05 vs. p<0.001, respectively). Additionally, physical quality of life among survivors with atrial fibrillation was poorer compared to subjects without this disorder (p<0.001). Employed stroke survivors reported better physical health (Me=38.9, p<0.001) compared to unemployed survivors (Me=31.5), and we observed a similar pattern among controls (Me=50.8/38.9, p=0.005). Survivors and controls who used alcohol reported better physicalhealth (p<0.001). Notably,both controls (p<0.05) and stroke survivors (p<0.01) reported better health if they did not live alone. During the period from the 3rd up to the 12th month after stroke, average physical and mental quality of life increased significantly among survivors (5.1±0.4 points, p=0.001 vs. 1.4±0.3 points, p=0.001, respectively).

    Conclusions. Previous stroke impaired both physical and mental quality of life in survivors. This study revealed that chronic non-infectious diseases experiencedprior to stroke significantly influence quality of life.Survivors with arterial hypertension, atrial fibrillation, or diabetes mellitus rated their physical quality of life lower than those who did not have these illnesses. Interestingly, only controls with atrial fibrillation reported decreased quality of life. Both physical and mental health improved12 months after stroke compared to quality of life 3 months after stroke

  • 282.
    Kriaucioniene, Vilma
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Social variations in nutritional habits and their trends in Lithuanian adult population2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    The aim of this study was to assess the socio-demographic variations in nutritional habits and their trends over the last decade in Lithuanian adult population.

    Methods: Six health behaviour surveys were carried out within the international FINBALT HEALTH MONITOR project between 1994-2004. For every survey the national random sample of 3000 inhabitants aged 20-64 was taken from the National Population Register. The study material was collected through mailed questionnaires covering sociodemographic characteristics and some nutrition habits. Response rates ranged from 61.7% to 74.4%. Education was measured using five educational levels. The respondents were categorized into three groups: persons with incomplete secondary education (primary or incomplete secondary), secondary (secondary or vocational), and university education. The degree of urbanization was based on the administrative classification of the places of residence. The respondents were grouped as living in cities, towns, or villages. The effect of age, level of education, place of residence, and marital status upon nutritional habits was evaluated using multifactor logistic regression analysis that was carried out separately for men and women.

    Results: Positive trends in nutritional habits were observed between 1994-2004 in Lithuania. The diet of the Lithuanian population tended to become closer to the WHO recommendations for healthy nutrition. The intake of animal fat decreased. Almost a half of population replaced butter on bread by low fat margarine. The proportion of men using vegetable oil for cooking increased from 31.1% in 1994 to 82.6% in 2004, and the proportion of women – from 47.7% to 89.4, respectively. The consumption of fresh vegetables, fruit, and dark bread has increased. Although all social groups of the Lithuanian population have changed their diet, social differences in nutrition habits still remained significant. Women, highly educated persons and urban population have healthier diet than men, people with lower education and rural population. The odds ratio of using vegetable oil among men with university education was higher by 98% and among women – by 67% than that among persons with incomplete secondary education. The respondent with university education were more than twice as likely as low educated people to consume fresh fruits daily. The proportion of persons drinking whole milk was much higher in villages (OR 4.80 (CI 4.0-5.8) for men and 7.33 (CI 6.1-8.8) for women) compared to cities.

    Conclusions: Existing social differences in nutritional habits should be considered in the programs for the promotion of healthy nutrition and implementation of Lithuanian Food and Nutrition Action Plan development

  • 283.
    Kringeland, Tone
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Perspective of risk in childbirth, women’s expressed wishes for mode of delivery and how they actually give birth2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Aims: The main aim of this thesis was to study a perspective of women`s expressed wishes for mode of delivery and how they actually give birth. Additional aims were to examine the notion of risk applied to childbirth, to examine what characterizes women who want to give birth as naturally as possible without painkillers or intervention and the characteristics of women who would, if possible, choose to have a cesarean section.

    Material and methods: The notion of risk was examined in an essay. Self-rating instruments were completed by 55,858 MoBa participants during week 30 of their pregnancy and available from The Norwegian Mother and Child Cohort Study (MoBa) by April, 2007. Individually reported information on socioeconomic factors, lifestyle factors, feelings related to childbirth, factors concerning psychosocial health, physical, psychological and sexual harassment and information on satisfaction with antenatal care health services were collected from a MoBa questionnaire. Data on the mother’s age, parity, physical health before and during the pregnancy, previous cesarean sections and actual mode of delivery were collected through a linkage to the The Medical Birth Registry of Norway.

    Findings: General perspectives on risk differ depending on both the person and the profession. More and more childbearing women are in danger of being considered deficient and in the danger zone. Figures on risk are not objective values, and the association between risk and security is socially and culturally determined. Personal symbols can be basic assumptions about the life one leads, and the childbearing woman has preferences of her own. Interest in natural childbirth was expressed by 72 percent and a wish for caesarean section was expressed by ten percent of the women. Positive experience from previous childbirths, first birth or third or later birth, no dread of giving birth, and reporting positive intra-psychic phenomena are significantly associated with the wish for natural birth. Negative experiences from previous childbirths and fear of giving birth are two of the strongest factors associated with a wish for a caesarean section.Overall, 47 percent of the women who wanted ”as natural a birth as possible” had their preference fulfilled. The figures differed largely for primiparas and multiparas; the risk of acute caesarean sections was high among primiparas and the effects of the predictors of natural birth were stronger for primiparas than for multiparas.

    Conclusions:The factors that influence the chance of having a natural birth are different for primiparas and multiparas. The high rate of non-natural births among first time mothers who actually want to have a vaginal birth without interventions should call attention to the increasing incidence of cesarean section in Norway. The chance of actually having a natural birth for women with a preference for a natural birth is much larger for multiparas. Negative experiences from previous childbirths and cesarean section are, however, important factors associated with non-natural birth and should be taken into consideration in public health

  • 284.
    Kringeland, Tone
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Daltveit, Anne Kjersti
    Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway, Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.
    Möller, Anders
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    How does preference for natural childbirth relate to the actual mode of delivery?: a population-based cohort study from Norway.2010Ingår i: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, nr 1, s. 21-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In Norway, intervention in childbirth has increased from 3 percent in 1967 to 37 percent in 2006. The objectives of this study were, first, to estimate to which extent women who expressed a preference for natural birth actually were delivered vaginally without interventions, and second, to estimate the influence that emotions and maternal background factors have on the mode of delivery.

    METHODS: We used data from 39,475 pregnancies of participants in the Norwegian Mother and Child Cohort Study in which the pregnant woman had expressed a preference for natural birth, and linked these data with the pregnancy outcome as registered in the population-based Medical Birth Registry of Norway during 2000 to 2006. The influence of maternal factors on the mode of delivery was estimated with log-binomial regression models, stratified by parity.

    RESULTS: Among primiparas, 29.3 percent delivered vaginally without interventions (natural birth), 56.1 percent gave birth vaginally with interventions, and 14.5 percent had a cesarean section. The strongest predictor for actually having a natural birth was age below 25 years, having more than 12 years' education, carrying a single fetus, and having a low score for anxiety and depression. Among multiparas, 61.1 percent gave birth vaginally without interventions, 30.6 percent vaginally with interventions, and only 8.3 percent had a cesarean section. The effects of maternal age, education, and anxiety or depression on the outcome were smaller for multiparas than for primiparas.

    CONCLUSIONS: The chance of actually having a natural birth for women with a preference for a natural birth is much greater for multiparas than for primiparas. The factors that influence the chance of having a natural birth are different for primiparas and multiparas.

  • 285.
    Kringeland, Tone
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Daltveit, Anne Kjersti
    Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway, Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.
    Möller, Anders
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    What characterizes women in Norway who wish to have a caesarean section?2009Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, nr 4, s. 364-71Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The aim of this study was to describe the characteristics of pregnant women who wish to have a caesarean section.

    METHODS: Data were collected as part of the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. Pregnant women booked for antenatal care in Norway between 1999 and 2006 were invited to participate in the study. Data on women's interest in mode of delivery and a set of associated variables were gathered from a questionnaire completed by 55,859 women at 30 weeks of pregnancy.

    RESULTS: A wish for caesarean section was expressed by 10% of the women, and 33% thought that the woman herself should be allowed to decide whether to have a caesarean section or not. A negative experience from a previous labour, a second birth, an age>35, a low level of education, being single, being unemployed, having an assisted conception, expecting more than one foetus, experiencing urinary and bowel incontinence before current pregnancy, experiencing pelvic pain, having a fear of childbirth and reporting negative intra-psychic phenomena were significantly associated with a wish for caesarean section.

    CONCLUSIONS: At 30 weeks of pregnancy, one out of 10 women in a sample of Norwegian women would choose a caesarean section. Negative experiences from previous pregnancies and fear of giving birth are two of the strongest factors associated with a wish for a caesarean section and should be taken into consideration.

  • 286.
    Kringeland, Tone
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Daltveit, Anne Kjersti
    Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway, Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.
    Möller, Anders
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    What characterizes women who want to give birth as naturally as possible without painkillers or intervention?2010Ingår i: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 1, nr 1, s. 21-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the characteristics of pregnant women who wish to have as natural a birth as possible without analgesics and without intervention.

    STUDY DESIGN: National cohort study.

    SETTING: Norwegian Institute of Public Health.

    POPULATION: 55,859 pregnant women booked for antenatal care in Norway 1999-2007.

    METHODS: Data on women's interest in natural birth and a set of possible predictors were retrieved from a questionnaire completed at the 30th week of pregnancy and linked to the Medical Birth Registry of Norway.

    MAIN OUTCOME MEASURE: Natural birth and the characteristics of pregnant women with such preferences.

    RESULTS: Interest in natural childbirth was consistently expressed by 72%. Positive experience from previous pregnancies, first birth or third or later birth, no fear of giving birth, and reporting positive intra-psychic phenomena are significantly associated with the wish for natural birth.

    CONCLUSIONS: Positive experiences from previous childbirths and no fear of giving birth are the strongest factors associated with a wish for as natural birth as possible and should be taken into consideration in public health.

  • 287.
    Kringeland, Tone
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Möller, Anders
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Risk and security in childbirth.2006Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 27, nr 4, s. 185-91Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Risk and security are often defined as being complementary. Security is based on risk calculations, which undergo constant change. An increasing number of abnormalities can be uncovered in the human body, and more and more people are defined as being at risk for various diseases or at risk as child bearers. The aim of this paper is to examine the notion of risk, and to understand it in different ways as it is applied to childbirth. General and professional perspectives on risk are different; views vary as to what constitutes acceptable risk, and the association between normalcy and complications is socially and culturally determined. Figures for risk and reliability are not objective values. The safe and the risky are anchored in certain symbol systems. Alternative and dialogic notions have been introduced in conversations and thinking about risk, and medicalism and paternalism have been questioned. This questioning has thus far had little influence on clinical practice. The two opposite perspectives of risk and security in the area of pregnancy and birth should be taken into consideration. The childbearing woman has preferences of her own. Dialog with the health professional and information about professional facts and professional uncertainty should be offered.

  • 288.
    Kristianslund, Sverre Olav
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Destruktiv ledelse.: Makt og verdiers betydning vedlederes mobbingi organisasjoner – en litteraturstudie2014Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Målet med dette arbeidet er å få kunnskaper om lederes mobbing, relatere det til konseptet destruktiv ledelse, og undersøke hvilken betydning makt og verdier kan ha i denne prosessen. Hensikten er å bruke kunnskapen til å bekjempe mobbing.

    Metode: Dette er en litteraturstudie med et systemteoretisk perspektiv. Mobbingen blir sett på som en dynamisk prosess med interaksjon mellom lederen som mobber, mobbeofferet, arbeidsgruppen og organisasjonen, hvor de alle inngår i et flerdimensjonalt system. Det er lagt stor vekt på å presisere begrepene.

    Resultater: Det er funnetgode holdepunkter for å hevde at ledere som mobber utøveren meget skadelig form for ledelse. I denne prosessen som har en tendens til å eskalere over tid, spiller makt og verdier en viktig rolle. Ledere med en psykopatisk personlighet kan praktisere ledelse på en måte som får store negative konsekvenser for organisasjonen og de ansatte, og slike personer har en tendens til å misbruke makt. De kan likevel bli ansatt som ledere fordi de har egenskaper som organisasjonen søker og setter pris på. Det er ikke enighet om at mobbing er en uetisk handling. Litteraturen viser at enkelte ledere bruker mobbing strategisk for å oppnå egne fordeler, eller for kontrollere eller straffe de ansatte. Mobbing kan inngå i en bevisst ”organisasjonspolitikk” som blir aksepterti visse organisasjoner. Bedriftsetikk ser i mange sammenhenger ut til å være et begrep uten forpliktende innhold. Det er undersøkt hvordan begrepene managementideologi, instrumentell rasjonalitet og paradokser kan påvirkelederes mobbing. Managementideologien som gjennomsyrer synet på ledelse i store deler av samfunnet, i offentlige organisasjoner i form av New Public Management, er preget av instrumentelle verdier og en utilitaristisk etikk. Dette kan stå i motsetning til den grunnleggende respekt for mennesket som er et fundament i Emmanuel Kants etikk.

    Konklusjon:Studiet viser atlederes mobbingav ansatte er et meget utbredt og alvorlig problem som er svært ødeleggende for personer og organisasjoner. Det er dermed et betydelig folkehelseproblem.

  • 289.
    Kucinskiene, Danute
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Lifestyle and Migration as a Risk Factor Among Adult Foreigners in Vilnius and Kaunas Cities2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    Over the last decade the pattern of the world-wide migration has changed dramatically. There were no studies carried on lifestyle and migration as a risk factor in itself among well-off foreigners who came to Lithuania on basis of long term business or studies. Purpose. The purpose of the survey was to assess lifestyle (smoking, alcohol consumption and physical activities) and migration as a risk factor in itself among adult well-off foreigners in Vilnius and Kaunas cities. Object. The well-off foreigners from Europe and Israel were investigated. Age of the foreigners was 18 years and over. Method. The survey was based on convenience sampling. Aself developed questionnairewas used for sampling information from 50 well-off foreigners. A “real life” convenience sample was used. Results. Results about every parameter were gained from data in home country and in Lithuania. 1. Results which were not influenced by migration process were smoking, alcohol consumption and physical activities. Among foreigners 77 percent were non smokers neither in Lithuania nor in home country. We revealed that 34 percent of foreigners were not drinking beer at all, 68 percent of respondents were not using strong drinks. 2. Results under the impact of migration were the following: assessment of own health, incidence of diseases and foreigners opinion about factors affecting their health after migration. The rate of subjective health of foreigners was higher in home country than in Lithuania after migration. We pointed out that 70 percent of foreigners were exposed to long lasting stress after migration. Discussions. The results of our study increased understanding of motivations for health hazard behaviour i.e. smoking, alcohol consumption and physical inactivity. Though all foreigners assessed their health status as reasonably good, nearly all of them mentioned deterioration of it after migration. We revealed that the impairment in their own health status was due to long-lasting stress and instability in surroundings. Conclusions. The study showed that positive behaviour habits (scarce smoking, moderate alcohol, and dynamic physical activity) of well-off foreigners could act as an example of a healthier lifestyle for Lithuanian people although migration to Lithuania decreased the migrants’ subjective health. Migration by itself appeared to be an important risk factor for health status of foreigners and further investigations are needed in this field.

  • 290.
    Kulla, Gunilla
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    ÅLDRANDE, HÄLSA, MINORITET: äldre finlandssvenskar i Finland och Sverige2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Bakgrund: Minoritetsgrupper, inklusive invandrargrupper, tenderar att skatta sin hälsa sämre i jämförelse med majoriteten.

    Syfte: Det övergripande syftet med föreliggande avhandling var att beskriva, analysera, jämföra och fördjupa förståelsen för äldre finlandssvenskars hälsa i form av upplevd och självskattad hälsa återspeglad ur ett livsloppsperspektiv. Upplevd hälsa studerades kvalitativt bland äldre finlandssvenskar i Finland och bland äldre finlandssvenskar i Sverige och som återflyttare till Finland (delstudierna I, IV). Självskattad hälsa studerades kvantitativt bland äldre finlandssvenskar i Finland (delstudie II), samt bland äldre finlandssvenskar i Sverige jämfört med äldre finskspråkiga i Sverige (delstudie III). Migration (III, IV) och åldrandet (I, II, IV) återspeglade sig i äldres hälsa.

    Metod: Urvalen erhölls från Befolkningsregistet i Finland samt Statistiska Centralbyrån i Sverige. Studiegrupperna bestod av totalt n=982 personer. Data insamlades genom strukturerad muntlig och inbandad intervju, halvstrukturerad inbandad intervju, strukturerat intervjuformulär samt postad enkät. Data analyserades genom hermeneutisk ansats med kärnberättelser, tematisk kvalitativ innehållsanalys, kumulativ multipel regressionsanalys samt Chi2-test.

    Resultat: Äldres upplevda hälsa tog sig uttryck genom personligheten, fysisk hälsa, sociala relationer och samhället. Över hälften skattade sin hälsa som god. Hälsa skattades som bättre ju mindre mediciner man behövde, ingen värk/smärta, bättre funktionsförmåga, bättre livslust och bättre ekonomi. Äldre finlandssvenskar i Sverige skattade sin hälsa som bättre jämfört med finskspråkiga i Sverige. Migration hade medfört svårigheter i samband med flyttningen till Sverige och arbetslivet i Sverige. Återflyttningen kunde försvåras av ohälsa och åldrandet. Åldrandet medförde en anpassning till att sätta egen hälsa och nuläge i perspektiv. Resultaten visade att äldre kan bidra med kunskaper om friskfaktorer.

    Konklusion: Ur ett folkhälsovetenskapligt hälsofrämjande perspektiv är det av relevans att lyfta fram minoritetsgrupper ur ett resursperspektiv. Det är centralt att beakta att det kan förekomma skillnader i hälsa mellan minoriteter, inom minoriteter och inom etniska minoriteter. Sociala och kulturella skillnader kan inverka på hur äldre skattar sin hälsa. Äldre i minoritet kan vara mera sårbara på grund av ohälsa, migration och kön

  • 291.
    Kulla, Gunilla
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Ekman, Sirkka-Lsa
    Divison of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden,.
    Heikkilä, A Kristina
    School of Health Science and Social Work, Va ̈ xjo ̈ University, Sweden.
    Sarvimäki, Anneli
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Differences in self-rated health among older immigrants--a comparison between older Finland-Swedes and Finns in Sweden.2010Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, nr 1, s. 25-31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Research has shown a tendency among immigrants and ethnic minorities to have a lower health status compared with the majority population. This applies to Finnish immigrants in Sweden. This group, however, also consists of persons who belong to a small ethnic minority in Finland, the Finland-Swedes, who speak Swedish as their mother tongue. In Finland, this minority has been shown to have better health and longer lives than the majority of Finnish-speaking people. Most of the previous research has studied the objective health of immigrants and minorities, while less is known about their subjective health. The aim of this study was to describe and compare self-rated health in older Finland-Swedes and Finns living as immigrants in Sweden.

    METHODS: The study was carried out as a sample-based cross-sectional study. Data was collected by a postal structured questionnaire. The response rate among the Finland-Swedes was 47% (n = 169) and among the Finns was 54% (n = 643). Data was analyzed descriptively and tested with Pearson's chi-square test.

    RESULTS: The results showed significant differences between the language groups in self-rated health, age of retirement and causes for retirement. The Finland-Swede immigrants rated their health as better than the Finnish-speaking ones. They had retired at an older age and less frequently because of health problems.

    CONCLUSIONS: The results indicate that there may be significant differences in health, at least in subjective health, between immigrant groups. Due to the low response rate, the results cannot be generalized.

  • 292.
    Kulla, Gunilla
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Ekman, Sirkka-Lsa
    Divison of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden,.
    Sarvimäki, Anneli
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Experiential health from an ageing and migration perspective: the case of older Finland-Swedes.2010Ingår i: Journal of Immigrant and Minority Health, ISSN 1557-1912, E-ISSN 1557-1920, Vol. 12, nr 1, s. 93-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Research has shown that immigrants and minority groups tend to have a lower health status compared to the majority population. The Finnish immigrants in Sweden are no exception. The Finland-Swedes, i.e., persons living in Finland who have Swedish as their mother language, seem to be an exception, however. They have been found to have better health and longer life expectancy compared to the Finnish majority. Research on health among migrated Finland-Swedes is scarce. The aim of this study was to describe and deepen the understanding of how older Finland-Swedes living as immigrants in Sweden, as well as re-migrants in Finland, experienced their health. Data was collected through 39 qualitative interviews with 29 older Finland-Swedes aged 65 or more. Data was analysed through qualitative thematic content analysis. The analysis resulted in five themes: Ageing means becoming frail and closer to death; Despite frailty and old age it is possible to feel well and experience peace; Being grateful for health as a source of life; Health comes from inner strength and external sources; Migration meant a mental and physical burden to health. Overall, both ageing and migration were experienced as jeopardising health.

  • 293.
    Kulla, Gunilla
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Fagerström, Lisbeth
    Swedish Polytechnic, Health Care and Social Welfare, Vasa, Finland.
    Health resources and health strategies among older Swedish-speaking Finns: - a hermeneutic study.2006Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, nr 1, s. 51-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Research has shown that the Swedish-speaking Finns have better health than the Finnish-speaking majority. The aim of this paper was to explore the health resources and health strategies among home-dwelling Swedish-speaking Finns aged 75 or older. The objective was to develop health-promotive nursing care for this group. Data was collected through recorded semistructured conversations with 22 older persons. The conversations were transcribed and interpreted through a hermeneutic approach. The material was read through several times and compiled into 22 narratives with relevant quotations. The narratives were subsequently summarised into one core narrative under each major category, to present the health resources and health strategies. Six categories were found: the Positive, the Social, the Active, the Adaptable, the Stubborn and the Passive. Within the Positive category, morale played an important role as a health resource and health strategy. Within the Social category, social activities were regarded as both health resources and health strategies, whereas their absence was a health obstacle. Within the Active category, a wide range of physical activities played an important role. Within the Adaptable category, contentment was a health resource. Within the Stubborn category, stubbornness itself was a health resource, whereas strong belief was a health strategy. Within the Passive category, although health obstacles permeated the life context, contentment and caution were seen as health resources. The vision of the future varied from the confidence found in the Positive category to the uncertainty prevalent in the Passive category. The main health resources and strategies used by the elderly Swedish-speaking Finns were related to social and other activities as well as to personality. Transforming health obstacles into resources could be an important health-promotive nursing strategy.

  • 294.
    Kullen Engström, Agneta
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Ledarskap och medarbetarskap vid strukturella förändringar i hälso- och sjukvården: Nyckelaktörers och medarbetares upplevelser2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Bakgrund och syfte Inom hälso- och sjukvården har krav på ökad effektivitet, tillgänglighet och höjd kvalitet, samt en minskad ekonomisk ram, krävt förändringar i hälso- och sjukvårdssystemet. Ett syfte med denna avhandling är att utifrån professionellas upplevelser och erfarenheter belysa den praktiska innebörden av begreppet effektivitet i hälso- och sjukvården. Ett annat syfte är att utifrån olika perspektiv belysa ledarskap och medarbetarskap i samband med strukturella förändringar inom hälso- och sjukvården.

    Metod Avhandlingen bygger på fyra delstudier (I – IV) genomförda med hjälp av en kvalitativ forskningsansats. Delstudie I bygger på intervjuer kring begreppet effektivitet med strategiskt utvalda representanter för en organisations tre beslutsnivåer. Delstudie II och III bygger på intervjuer med medarbetare från olika professioner som deltagit i två olika sjukhussammanslagningar. I delstudie IV intervjuades medarbetare om sina upplevelser i anslutning till privatisering av en hälso- och sjukvårdsorganisation.

    Resultat Då en gemensam definition av begreppet effektivitet saknas i en Rorganisation ges olika aktörer utrymme att göra sin egen tolkning, vilket kan påverka måluppfyllelsen på ett negativt sätt. Vid strukturförändringar är det viktigt att medarbetare ges möjlighet till såväl delaktighet som att kunna balansera sina åtagande i processen. Det är även av vikt att medarbetare i en förändringsprocess har tillit till ledningen och organisationen. Strukturförändringar kan samtidigt innebära spännande utmaningar och nya möjligheter till utveckling.

    Slutsatser Strukturella förändringar inom hälso- och sjukvården, i syfte att effektivisera, är komplexa och mångfacetterade. Samtidigt är begreppet effektivitet mångtydigt och svårutvärderat. Det påverkas av såväl struktur och ledarskap som medarbetarskap. En förändringsprocess påverkar både ledarskap och medarbetarskap. Framgångsfaktorer är medarbetarnas möjlighet till delaktighet och balans, samt deras tillit till såväl struktur som ledarskap

  • 295.
    Kullen Engström, Agneta
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Axelsson, Lilian
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    The concept of effectiveness —a  blind alley?: A study of different interpretations in a Swedish county council2001Ingår i: The International Journal of Health Planning and Management, ISSN 1099-1751, Vol. 16, nr 1, s. 61-71Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Swedish health care organizations are experiencing pressure to make ever greater efforts to rationalize and to increase effectiveness in the way they plan and provide services. In order to gain a better understanding of the current practice of the three groups of key actors in Swedish health care—politicians, senior civil servants and operational managers—and their perception of effectiveness, a study was carried out in a Swedish county council using both qualitative and quantitative methods. While in general the concept of effectiveness is thought of as crucial, it is not clearly or uniformly defined within the organization. Each of the three groups defines the concept in a way that reflects their own function, which may lead efforts to achieve effectiveness into a blind alley. Copyright © 2001 John Wiley & Sons, Ltd

  • 296.
    Kullen Engström, Agneta
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Axlesson, Runo
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    The double spiral of change--experiences of privatization in a Swedish hospital.2010Ingår i: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 25, nr 2, s. 156-68Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    UNLABELLED: Privatization is a trend in countries with a public health system. It involves organizational change, a cultural transformation and changes for the employees as well as a more strictly controlled work. The objective of this study is to describe, analyse and interpret how privatization is perceived by the employees of a health care organization in Sweden.

    METHODOLOGY: In-depth interviews have been performed with physicians, paramedics, secretaries, nurses, assistant nurses and local managers, in all 14 respondents, after a private entrepreneur had taken over the management of a hospital. The interviews were tape-recorded and have been analysed and interpreted following a grounded theory approach.

    FINDINGS: The transcribed interviews show that trust is a core category and linked with emotions, commitment and security. The analysis shows that employees' experience of privatization within a health care organization differs and is full of nuances and complexities.

    CONCLUSION: A simultaneous virtuous and a vicious circle of experiences and reactions may describe how employees experience privatization. It can also be concluded that leadership is an important factor in the success of organizational change.

  • 297.
    Kullen Engström, Agneta
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Rosengren, Kristina
    Nordiska ministerrådet, Nordic School of Public Health NHV. University of Borås, Sweden.
    Hallberg, Lillemor R-M
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Balancing involvement: employees' experiences of merging hospitals in Sweden.2002Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 38, nr 1, s. 11-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The health care of today stands in front of demands on financial and structural changes. New technology and global economy are forces driving on the change process.

    AIMS: The aim of this study is to describe and broaden the understanding of the employees' experience of being involved in a merger between two health care districts in Sweden.

    METHODS: This study was carried out from a qualitative approach according to the grounded theory tradition. From a theme guide with specific questions, 31 interviews were carried out with employees working in the health care.

    FINDINGS: Five categories emerged from the body of interviews: balancing involvement, trust respect, challenge and commitment. Balancing involvement was defined as an overall core category related to the other categories. The categories trust, respect, challenge and commitment were related to subcategories and affected the core category balancing involvement.

    CONCLUSIONS: The overall findings point to the importance of balancing the employees' involvement in order to reach goal fulfilment change in a merger process.

  • 298.
    Kužniece, Ingrida
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Epidermiology and Treatment of Tuberculosis in Liepaja (Latvia) 1993-20022006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    Aim To describe the epidemiology of tuberculosis in the city of Liepaja during the last 27 years and the management of patients with tuberculosis during the period 1993-2002; to identify problems in tuberculosis management relevant to increasing level of morbidity and the registered high levels of drug-resistance. Material and methods The cases were all persons reported with tuberculosis in 1975-2002. The data sources were the yearly Health Statistics books at the Latvian Office of Medical Statistics. The study used data from the available 655 individual patient records from Liepaja Tuberculosis Dispensery and TB Register of 1993 – 2002. Information was extracted selectively and extraction sheets containing the variables of interest were developed. The incidence differences according to sex and age, possible clustering of patients in high-risk living areas of the city, differences in occupation of the patients were studied. The differences of time from disease symptoms to diagnosis, as well as investigation data, treatment regimens, the proportions of treatment outcomes were analysed. Analysis was done using EPI-INFO programme for statistical analysis.

    Results In the 1980s tuberculosis was under control in Latvia and the incidence was at the European average level. After Latvia had regained independence in 1991, with economical and political disruption and changes in the health care system, TB incidence and mortality in the country increased rapidly as well as in Liepaja. Although not very high compared to global TB rates, there was great concern about TB control in Latvia. In addition, the emergence of drug resistance and multi-drug resistant bacteria made the TB epidemic more serious. The TB incidence increase in children suggested that there was quite a big number of undetected cases of TB. Tuberculosis control and early detection activities were not integrated into the PHC system. Treatment results of TB were quite poor and showed high proportions of interruptions, defaults, relapses. The tuberculosis control Programme in Latvia and Liepaja put much effort into the improvement of the epidemiological situation with TB, focusing on TB control activities and management during the period 1993-2002. The incidence of tuberculosis in Liepaja was higher than in Latvia, particularly in some living areas in the city, and above endemic level. Mortality rate in average was higher as in the whole country. The proportion of socially sensitive groups (children, unemployed, pensioners, disabled) comprised more than 50 % of the tuberculosis incidence. Incidence among medical staff was higher than in general population in the all professional groups. Medical delay of diagnosis decreased, but early detection of tuberculosis was not fully integrated in PHC system. There were quite big differences in numbers of MDR-TB in years 1993-2002. DOTS was introduced in Liepaja five years later than in Latvia –in year 2000 and strategy was not fully successful. The number of positive treatment outcomes increased, but the registered numbers of treatment relapses and defaults were higher than in Latvia .

    Conclusions The situation with regard to tuberculosis development and tuberculosis management in Liepaja during the period under study was unfavourable. Particularly : the incidence and mortality rates, much variation in the diagnostic process, results of treatment ,a high proportion of MDR-TB , unsatisfactory links between local government, family doctors and medical professionals and multi-sectoral collaboration in TB control activities , the objectives set up by WHO for DOTS treatment were not reached

  • 299.
    Kvali, Frode
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Eksternaliserende samtaler: et narrativt perspektiv på undersøkelsessaker i barnevernet2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Studien tar utgangspunkt i et metodeutviklingsprosjekt ved et barnevernkontor i Oslo, kalt ”DuKanJo” – et forsøk på å anvende eksternaliserende samtaler som en form for empowermentstrategi allerede i undersøkelsesfasen i en barnevernsak. I alt fire familier ble invitert til å delta i såkalte ettersamtaler – en form for evaluering av et empowermentprosjekt – samtaler som også utgjorde de primære forskningsdata i studien. Studien bruker en narrativ tilnærming både som forskningsmetode og som metodisk tilnærming i ettersamtalene og kan derfor betraktes som både en evaluering av en empowermentsrategi og som et forskningsprosjekt. Hensikten med studien er å belyse om hvorvidt en narrativ metodikk i undersøkelsessaker kan bidra til å flytte fokuset i barnevernssaker fra problemorientering til ressursorientering. Studien søker også å svare på om det er mulig for barnevernet - med et så klart definert kontrollmandat -, å gjøre bruk av en ressursorientert tilnærming for å fremme familienes salutogene krefter og mestringsstrategier. Studien bekrefter at en slik tilnærming er mulig, men at det fortsatt finnes faglige og etiske dilemmaer knyttet til en slik tilnærming.

  • 300.
    Kvinlaug, Per
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Tannhelseutvikling på klinikknivå ved ulik forebyggende praksis2011Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Formål: Denne studien ville undersøke tannhelseeffekt ved et intervensjonsprogram for forebygging av karies på klinikknivå.

     

    Metode: Et ex post-facto quasi-eksperimentell design ble anvendt til kvantitativ analyse av

    data fra journal programmet i Tannhelsetjenesten i Vest-Agder fylke, Norge. Effekten av et

    beskrevet intervensjonsprogram for forebygging av karies ble analysert ved sammenlikning

    mellom tre klinikker, og delvis med fylkesgjennomsittet for Vest-Agder. De sosioøkonomiske

    forhold i klinikkenes tilhørende bydeler ble beskrevet med indekser ut fra gitte kriterier.

    Kalibreringsøvelser med røntgenbetrakting på behandlernivå ble utført post hoc for å få en

    formening om mulige målefeil og presisjon i det statistiske materialet.

     

    Resultat: Planmessig, nytenkende og godt folkehelsearbeid i undersøkelsesperioden 2004– 2008 med tidlig intervensjon på småbarn og praktisk opplæring i effektiv tannpuss, gav betydelig tannhelsegevinst for 5- åringene.

    Resultatene var mindre entydige for 12- og 18-åringene. Klinikken med det forebyggende intervensjonsprogrammet var beliggende i et område med bra sosioøkonomisk indeks, hvilket kan forkludre resultatene. Forskjell i diagosenivå mellom klinikerne, viser hvordan helseresultater kan bli påvirket av behandlervariasjon. Ulik diagnose- og behandlernivå blant klinikerne slik det kommer fram i studien, ser ut for å være en vedvarende utfordring for tannhelsetjenesten. 

     

    Konklusjon: Studien understreker betydningen av intensiv og målrettet forebyggende intervensjon fra tidlig alder, og at forebyggende arbeid og tannhelseresultat må ses i et langtidsperspektiv. Ulike sosioøkonomiske forhold i et undersøkt område, reduserte mulighetene for å konkludere om helseresultater i denne quasi-eksperimentelle studien.

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