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  • 401.
    Thorpenberg, Stefan
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Folkhälsoforskning i fem nordiska länder: kartläggning och analys.        Appendix        Nordiska högskolan för folkhälsovetenskap (NHV)och organisationer med liknande verksamhet2009Report (Other academic)
    Abstract [en]

    The definition of Public Health research is today often discussed in normative terms by experts in the area. This report has a more descriptive approach and compares Nordic School of Public Health to other institutes and institutions in the area of Public Health in the five Nordic countries based on the material of abstracts found in the database Web of Science –sometimes called ISI. The Nordic Public Health therefore can be said to present it self, but since Public Health has always been a trans-disciplinary research with an aim to apply its results, it opens for a discussion of the area according to recent theories in research policy. Nordic Public Health research seems to have a resemblance to Gibbons et al ́s Mode 2 concept, which describe a general tendency of trans-disciplinary collaborations and also a growing social reflexivity among researchers. Public health research can be seen as an exemplary model for this development because of its trans-disciplinary approach, its close connection to other social interests and its more obvious relevance for society in general. This view opens also for a discussion on research ethics, since its necessary to ask if there can be situations when the researchers come too close to different social interests, in an arearelevant not only for Governments but also for ordinary citizens.The material of 3284 abstracts were collected from ISI:s database from year 2005 using the addresses of 73 institutes and institutions mentioned by Nordic public health researchers. Using a sampling technique 1 186 abstracts were coded with a model, which looked at settings, collaborations, scientific perspective, disciplinary directions (medicine, social science) lifestyle directions and different relevance directions, and finally methods (laboratory, clinical and social science methods). The abstracts were also read and interpreted with a qualitative approach to find examples of specific interests, which were difficult to see with the quantitative coding.The results show that Nordic Public Health research has a similar look of Mode 2 oriented research in the five Nordic countries. Still there are small general differences; a biological perspective is slightly stronger in Finland, and obesity research seems to be weak in Denmark. A qualitative reading of abstracts makes also the differences between the countries according to alcohol policy visible. Danish alcohol research more often rely on ordinary peoples skills to handle the situation, where the rest of the Nordic countries, and perhaps especially Swedish researchers, rely on Government regulations as a tool to minimize alcohol consumption generally in the population. Especially when Public Health researchers work in poor countries outside Europe, relevance aspects become stronger in the abstracts. In Sweden more often relevance for Government programs are seen, while in Denmark often relevance for the individual is mentioned. The differences in research approaches seem to be influenced by the cultural and political backgrounds in the Nordic countries.Nordic School of Public Health (NHV) seems in this report to be an organisation with a complex research, covering epidemiology, preventive medicine, health promotion, international collaborations, etc, with relevance for individuals as well asGovernments. In an Appendix it is shown that articles from NHV also have a surprisingly high citation frequency, which must be interpreted as a sign of good quality.

  • 402.
    Tran Khanh, Toan
    Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University (HMU), Hanoi, Vietnam.
    ANTENATAL AND DELIVERY CARE UTILIZATIONIN URBAN AND RURAL CONTEXTS IN VIETNAM: A study in two health and demographic surveillance sites2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. Pregnant women need adequate antenatal care (ANC) and delivery care fortheir own health and for healthy children. Availability of such care has increased in Vietnam but maternal mortality remains high and variable between population groups.

    Aims. The general aim of this thesis is to describe and discuss the use of antenatal and delivery care in relation to demographic and socio-economic status and other factors in two health and demographic surveillance sites (HDSS), one rural and one urban. One specificaim of the thesis is to present experiences of running the urban HDSS.

    Methods. Between April 2008 and December 2009, 2,757 pregnant women were identifiedin the sites. Basic information was obtained from 2,515 of these. The use of ANC was followed to delivery for 2,132. Three indicators were used. ANC was considered overall adequate if the women started ANC within the first trimester, used three or more visits and received all the six recommended core services at least once during pregnancy. Delivery care was studied for all the 2,515 women.

    Main Findings. Nearly all 2,132 participants used ANC. The mean numbers of visits were 4.4 and 7.7 in the rural and urban areas. Mainly due to less than recommended use of core ANC services, overall ANC adequacy was low in some groups, particularly in the rural area (15.2%). The main risk factors for not having adequate ANC were (i) living in a rural area,(ii) low level of education, (iii) low economic status and (iv) exclusive use of private ANC providers. Rural women accessed ANC mainly at commune health centers and private clinics. Urban women accessed ANC and gave birth at central hospitals and provincial hospitals. Caesarean section (CS) was common among urban women (38.5%). Good socioeconomic condition and male babies were associated with delivery in hospitals and CS births. Almost all women had one or more antenatal ultrasound examination, the mean was about 4.5. Rural women spent 3.0% and 19.0% of the reported annual household income percapita for ANC and delivery care, respectively, compared to 6.1% and 20.6% for urbanwomen. The relative economic burden was heaviest for poor rural women.

    Conclusion. The coverage of ANC was high in both contexts but with large variations between population subgroups. The major concerns are that poor women in the rural area received incomplete services according to recommendations and that many women, particularly the well-off, in the urban area appeared to overuse technology, ultrasound scanning, delivery in highlevel health care and CS delivery. National maternal healthcare programs should focus on improving ANC service content in rural areas and controlling technology preference in urban. The pregnant women with relatives and friends as well as ANC providers share the responsibility for a positive development. All parties involved must be targeted to improve knowledge, attitudes and practices.

  • 403.
    Tran, Toan Khanh
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University (HMU), Hanoi, Vietnam.
    Eriksson, Bo
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Pham Nhat, An
    The National Hospital for Pediatrics, Hanoi, Vietnam.
    Nguyen Thi Kim, Chuc
    Family Medicine Department, Hanoi Medical University (HMU), Hanoi, Vietnam.
    Bondjers, Göran
    Nordic Council of Ministers, Nordic School of Public Health NHV. Sahlgrenska Academy, University of Gothenburg (GU), Gothenburg, Sweden.
    Gottvall, Karin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Technology Preference in Choices of Delivery Care Utilization from User Perspective: A Community Study in Vietnam2013In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 1, no 1, p. 10-17-Article in journal (Refereed)
    Abstract [en]

    Choices for delivery care are made based on the available resources and influence health outcomes of women and their children. The aim of the paper is to study utilization and preference for delivery care and related factors in one urban and one rural area of northern Vietnam. Two cohorts of pregnant women were carried out in DodaLab and FilaBavi Health and Demographic Surveillance Sites (HDSS) in Hanoi, Vietnam from April 2008 to December 2009. Together, 2515 pregnant women were identified and followed until delivery through quarterly household interviews using structured questionnaires. Almost all women delivered at health care facilities. Most of the rural women gave birth at primary health care facilities (88.5%) while urban women primarily used secondary and tertiary hospitals (93.6%). Caesarean section (CS) was used for 38.5% of births in the urban area and 12.4% in the rural. Giving birth in hospitals and CS were more common among highly educated women, employed women, women living in households or communities with good economic conditions, and women expected to give birth to a son. Technology preference in delivery care was associated with better socioeconomic conditions and expecting a boy. Improving the quality and reputation of primary health care facilities, informing women about CS risks and monitoring indications of CS are important policy issues.

  • 404.
    Tran, Toan Khanh
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University, Vietnam.
    Eriksson, Bo
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Nguyen, Chuc Thi Kim
    Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University, Hanoi, Vietnam.
    Horby, Peter
    Bondjers, Göran
    Nordic Council of Ministers, Nordic School of Public Health NHV. Sahlgrenska Academy, University of Gothenburg (GU), Gothenburg, Sweden.
    Petzold, Max
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    DodaLab: an urban health and demographic surveillance site, the first three years in Hanoi, Vietnam.2012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 8, p. 765-72Article in journal (Refereed)
    Abstract [en]

    RATIONALE: Health and demographic surveillance sites (HDSSs) are important sources for health planning and policy in many low and middle income countries. Almost all HDSSs are in rural settings. The article aims to present the experiences and some concrete results for the first three years of operation of an urban HDSS in Hanoi, Vietnam, and discuss advantages and disadvantages of conducting health studies in HDSSs.

    DESIGN, POPULATION AND SAMPLE SIZE: The DodaLab urban HDSS was established in 2007 in three communes at different economic levels in Dong Da district, Hanoi, Vietnam. Demographic, social and economic information about 10,000 households and their 37,000 persons was obtained through household interviews. Quarterly follow-up was initiated to provide information about vital events, birth, death and migration. A new household survey was undertaken in 2009. The existing rural HDSS FilaBavi, started in 1999, with 12,000 households and 52,000 persons, was used as the blueprint.

    CONCLUSIONS: It was possible to establish and run an urban HDSS with experiences from the rural site. The urban and rural contexts are different and demographically, economically and socially complex, but the use of HDSSs can facilitate research beyond very simplified models for comparisons. General statements about external validity of results from the HDSS cannot be made. This issue has to be considered specifically in every situation as an integral part of the research so that the results can be made useful outside the researched HDSS and in performing relevant comparisons.

  • 405.
    Tran, Toan Khanh
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University, Vietnam.
    Gottvall, Karin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Nguyen, Hinh D
    Ascher, Henry
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Petzold, Max
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam.2012In: BMC health services research, ISSN 1472-6963, Vol. 12, p. 40-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Antenatal Care (ANC) is universally considered important for women and children. This study aims to identify factors, demographic, social and economic, possibly associated with three ANC indicators: number of visits, timing of visits and content of services. The aim is also to compare the patterns of association of such factors between one rural and one urban context in northern Vietnam.

    METHODS: Totally 2,132 pregnant women were followed from identification of pregnancy until birth in two Health and Demographic Surveillance Sites (HDSS). Information was obtained through quarterly face to face interviews.

    RESULTS: Living in the rural area was significantly associated with lower adequate use of ANC compared to living in the urban area, both regarding quantity (number and timing of visits) and content. Low education, living in poor households and exclusively using private sector ANC in both sites and self employment, becoming pregnant before 25 years of age and living in poor communities in the rural area turned out to increase the risk for overall inadequate ANC. High risk pregnancy could not be demonstrated to be associated with ANC adequacy in either site. The medical content of services offered was often inadequate, in relation to the national recommendations, especially in the private sector.

    CONCLUSION: Low education, low economic status, exclusive use of private ANC and living in rural areas were main factors associated with risk for overall inadequate ANC use as related to the national recommendations. Therefore, interventions focussing on poor and less educated women, especially in rural areas should be prioritized. They should focus the importance of early attendance of ANC and sufficient use of core services. Financial support for poor and near poor women should be considered. Providers of ANC should be educated and otherwise influenced to provide sufficient core services. Adherence to ANC content guidelines must be improved through enhanced supervision, particularly in the private sector.

  • 406.
    Tran, Toan Khanh
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University, Vietnam.
    Nguyen Thi Kim, Chuc
    Nordic Council of Ministers, Nordic School of Public Health NHV. Family Medicine Department, Hanoi Medical University (HMU), Hanoi, Vietnam.
    Nguyen, Hinh D
    Eriksson, Bo
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Bondjers, Göran
    Nordic Council of Ministers, Nordic School of Public Health NHV. Sahlgrenska Academy, University of Gothenburg (GU), Gothenburg, Sweden.
    Gottvall, Karin
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Ascher, Henry
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Petzold, Max
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Urban - rural disparities in antenatal care utilization: a study of two cohorts of pregnant women in Vietnam.2011In: BMC health services research, ISSN 1472-6963, Vol. 11, p. 120-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of antenatal care (ANC) varies between countries and in different settings within each country. Most previous studies of ANC in Vietnam have been cross-sectional, and conducted in rural areas before the year 2000. This study aims to compare the pattern and the adequacy of ANC used in rural and urban Vietnam following two cohorts of pregnant women.

    METHODS: A comparative study with two cohorts comprising totally 2132 pregnant women were followed in two health and demographic surveillance sites, one rural and one urban in Hanoi province, Vietnam. The women were quarterly interviewed using a structured questionnaire until delivery. The primary information obtained was the number and the content of ANC visits.

    RESULTS: Almost all women reported some use of ANC. The average number of visits was much lower in the rural setting (4.4) than in the urban (7.7). In the rural area, 77.2% of women had at least three visits and 69.1% attended ANC during the first trimester. The corresponding percentages for the urban women were 97.2% and 97.2%. Only 20.3% of the rural women compared to 81.1% of the urban women received all core ANC services. As a result, the adequate use of ANC was 5.2 times in the urban than in the rural setting (78.3% compared to 15.2%). Nearly all women received ultrasound examination during pregnancy with a mean value of 6.0 scans per woman in the urban area and 3.5 in the rural. Most rural women used ANC at commune health centres and private clinics while urban women mainly visited public hospitals. Expenditure related to ANC utilization for the urban women was 7.1 times that for the urban women.

    CONCLUSION: The women in the rural area attended ANC later, had fewer visits and received much fewer services than urban women. The large disparity in ANC adequacy between the two settings suggests special attention for the ANC programme in rural areas focusing on its content. Revision and enforcement of the national guidelines to improve the behaviour and practice of both users and providers are necessary.

  • 407.
    Trollvik, Anne
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Barn med astma og deres foreldre: læring, deltakelse og samarbeid2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aim: Asthma is the most common chronic childhood disease,many children and families are personally and socially affected which makes asthma a public health problem. The overall aim of this thesis was to develop an asthma education programme for children with asthma and their parents, where the pedagogic approach takeschildren’s, parents’and health care personnel’s experiences and views as a starting point.

    Methods: This thesis includes 5 studies (I–V) from 2 projects performed in a paediatric ward in Norway in 1995–1998 and 2004–2007. In studies I and IIa hermeneutic phenomenological approach was used, in which 9 parents participated in qualitative research interviews. In study III, 90 persons participated in a co-operative inquiry. Data were analysed by content analysis. Study IV used a hermeneutic phenomenological approach: 15 children (7–10 years of age) participated in qualitative research interviews. In study V, 3 children and 2 health care personnel participated in an observational study. Content analysis was used in the analysis.

    The results showed that both the children and the parents experienced fear in their experiences of asthma in everyday life (I, IV). The parents expressed feelings of uncertainty, helplessness and guilt (I). The children experienced fear of exacerbations and how the asthma affected their bodies. They used many different words when they described how asthma affected them. They felt asthma in their whole body,and the condition could change quickly. The fear of being ostracised concerned all aspects of the children’s livesand they related a dilemma of keeping the asthma secret or being open about it (V). Sharing experiences in group settings was experienced as meaningful to both children and parents (II, V). The adult’s child perspectives were taken into account throughout the project, while the children’sown perspectives were taken into account during the period of intervention (III). During the asthma education programmethe children actively participated and learned from each other. As the pictures and stories were related to their experiences made it easier for them to express their own feelings. Drawings were a good way toinitiate a dialogue with the children and to get access to their lifeworld (V).

    Conclusion: This thesis shows that in order to support children and parents to cope with asthma, it is crucial to build on their perspectives in learning processes. Active involvement of the children shows a bottom-up perspective that can lead to confidence in their own strength and empowerment. Overall, this approach corresponds to an educational approach and learning theory that takes meaningful learning into account. Meaningful learning strengthens children’s comprehensibility, manageability and meaningfulness and their Sense of Coherence (SOC). A strong SOC leads to better health and a better quality of life

  • 408.
    Trollvik, Anne
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Eriksson, Bengt G
    Hedmark University College, Norway.
    Ringsberg, Karin
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hummelvoll, Jan Kåre
    Hedmark University College, Norway.
    Children’s participation and experiential reflections using co-operative inquiry for developing a learning programme for children with asthma2014In: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 12, no 3, p. 315-336Article in journal (Refereed)
    Abstract [en]

    Action research is potentially a useful method for changing clinical practice by involvingpractitioners in the process of change. The aim of this study was to explore the utility ofaction research in bridging the gap between research and practice. Diabetes educatorsin collaboration with researchers developed and implemented a participatory, group-based diabetes education program in a diabetes clinic in the Danish health care system.The research process included a variety of qualitative methods: workshops, classroomobservations, video recordings and semi-structured interviews. These methods aimedat obtaining contextual sensitivity, allowing dynamic interactions with educators andpeople with diabetes. Despite challenges, the study demonstrates how action researchmethods contribute to development and change of diabetes education practice whilesimultaneously adding knowledge to the action research community

  • 409.
    Trollvik, Anne
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Nordbach, Reidun
    Innlandet Hospital Trust, Norway.
    Silén, Charlotte
    Karolinska Institutet, Stockholm, Sweden.
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Children's experiences of living with asthma: fear of exacerbations and being ostracized.2011In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 26, no 4, p. 295-303Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to explore children's experiences of asthma to tailor a learning program based on their perspectives. Fifteen children (7-10 years) were interviewed, and they narrated the meaning behind their drawings; a phenomenological hermeneutical approach was used in the analysis. The findings are described in two themes with five subthemes: fear of exacerbation (bodily sensations, frightening experiences, and loss of control) and fear of being ostracized (experiences of being excluded and dilemma of keeping the asthma secret or being open about it). Drawings are a good tool for initiating a dialogue with children.

  • 410.
    Trollvik, Anne
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ringsberg, Karin C
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Silén, Charlotte
    Karolinska Institutet, Stockholm, Sweden.
    Children's experiences of a participation approach to asthma education.2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 7-8, p. 996-1004Article in journal (Refereed)
    Abstract [en]

    AIM AND OBJECTIVES: To explore the participation and responses of children to an asthma education programme that was developed with the aid of children with asthma. In a larger perspective, the aim was to understand how educational approaches can be designed to help children learn to live and cope with asthma.

    BACKGROUND: A literature search showed that programmes where children participate in the development of educational materials or programmes are lacking.

    DESIGN: An exploratory descriptive design was chosen to get an in-depth understanding of the communication and collaboration between children and healthcare personnel.

    METHODS: Data were collected through observations, tape recordings of the conversations and notes of the interactions between the children and the healthcare personnel and analysed by content analysis.

    RESULTS: The significance of the asthma education programme emerged in four themes: (i) children are learning from each other: in a positive learning climate, the children were able to express emotional themes that they may not have communicated before; (ii) children are learning through an interaction with the educational material: the children discussed stories and pictures in a fellow interplay: when one child expressed something, another child would recognise it and continue the story; (iii) children are learning from their interaction with healthcare personnel and vice versa: adjusting the vocabulary according to the children's experiences, they were met on their level of understanding; and (iv) children can express and discuss their understanding of asthma.

    CONCLUSIONS: The unique aspect about this programme is that it emanates from children's perspectives. The children were actively involved and learnt from each other's shared knowledge and experiences, which is a good source of meaningful learning and empowering processes.

    RELEVANCE TO CLINICAL PRACTICE: Future educational approaches should use children's perspectives in a manner in which their questions, thoughts and daily challenges are emphasised.

  • 411.
    Trollvik, Anne
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Severinsson, Elisabeth
    Institutt for helsefag, Det samfunnsvitenskapelige fakultet, Universitetet i Stavanger, Norway.
    Influence of an asthma education program on parents with children suffering from asthma.2005In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 7, no 3, p. 157-63Article in journal (Refereed)
    Abstract [en]

    Several studies have evaluated the effectiveness of various methods of asthma education for parents. This study adds a qualitative and inner perspective from the families of children suffering from asthma. The aim was to illuminate the influence of an asthma education program (AEP) for parents. The study sample consisted of nine parents of five children with moderate to severe asthma in the 2-6 years age group. Data were collected by interviews and qualitative analyses were used. The main findings were that the parents experienced an increased understanding of their child's experience of asthma after having participated in the program. Three themes were revealed: sharing experiences, accepting the illness, and partnership building. In conclusion, the parents in the study expressed that they promote increased self-understanding by meeting other parents in groups.

  • 412.
    Trollvik, Anne
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Severinsson, Elisabeth
    Institutt for helsefag, Det samfunnsvitenskapelige fakultet, Universitetet i Stavanger, Norway.
    Parents' experiences of asthma: process from chaos to coping.2004In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 6, no 2, p. 93-9Article in journal (Refereed)
    Abstract [en]

    The aim of the present qualitative study was to describe nine parents' everyday experiences of living with a child suffering from asthma. Data were collected by means of in-depth interviews and phenomenological content analysis. Four main themes emerged: feelings of uncertainty, helplessness and guilt; the need for support and help from healthcare professionals; adaptation to everyday life; and the development of coping strategies. In addition, two subthemes; trying out and seeking information, emerged. Trying out was found to be an important strategy for parents in managing the illness. In encounters with healthcare professionals, parents felt that they were not respected and that their competence was questioned. In conclusion, this study emphasizes the importance of a mutual dialogue between healthcare professionals and parents to enable the parents to develop the competence necessary to care for their child.

  • 413.
    Tufte, Elisabeth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Norske kvinners ammeproblemer2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    There is a consensus that "Breast is best” within the health care professions. Norwegian health care authorities subscribe to the recommendations of WHO, and promote breastfeeding as the sole source of nutrition for the first six months followed by solid food for the remainder of the first year. Health care workers share a responsibility for providing information, help and support to mothers in order to implement these recommendations. While breastfeeding is a natural ability for women, experience and other forms of knowledge are required to avoid or solve problems associated with breastfeeding. Systematic knowledge of the incidence and nature of Norwegian mothers’ experience of breastfeeding problems has until now not been available. Thus, the purpose of this study was to describe self-reported problems with breastfeeding in a nation-wide sample of Norwegian mothers, focusing on the most frequent problems reported and the time of their debut. Additionally, sources of help and the efficacy of help as perceived by the mothers was evaluated. Data stem from a cross sectional and descriptive study. A questionnaire included 32 structured items, where space also was provided for the respondents’ free commentary. The findings will contribute towards a knowledge base from which health care professionals may develop more efficient counseling. Sore nipples, engorgement, mastitis and perceived inadequacy of milk supply were the four most frequently reported problems. Debut of breastfeeding problems was concentrated to the first days after giving birth. Only 12% of the mothers experienced no breastfeeding problems during the period of lactation. Thus, this study confirms that Norwegian women breastfeed despite problems, and not because the problems experienced eventually disappear. Even though a majority reported problems, few mothers indicated being under external pressure to continue breastfeeding. Most respondents were satisfied with the advice and counseling provided. However, many mothers did not seek additional help at the well-baby clinic after discharge from the hospital, if breastfeeding problems occured. Clinical practice and future research should focus on the communication process, and on the mother as the central resource. In this perspective, the health care professional is a mentor communicating skills and competencies that every mother can adapt for her own unique needs before discharge from hospital. Also, it appears crucial to develop systems for alerting the well-baby clinic to breastfeeding problems prior to discharge. This will serve to avoid the uncertainty associated with current practice, where it is dependent on the mother to request assistance for problems already documented.

  • 414.
    Tysland, Kjersti Høibø
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Spiller yrkesbakgrunn og rolle en rolle?: En kvalitativ studie om kommunikasjon i det tverrfaglige folkehelsearbeidet.2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background:Research shows that interdisciplinary collaboration is difficult. Public health work spansmany sectors and demands collaboration among different professionsand sectors.

    Purpose:This study aimed to gain greater insight into the impact of roles and professional backgrounds on communication in the collaborative process of public health.

    Method:This study used a triangulation strategy involving document analysis, three observations and 12 semi-structured interviews. A phenomenographic approach was used to analyze the interviews.

    Result: Document analysis enhanced understanding of the composition of the teams observedin this study. The observations allowed for analysis of verbal communication as wellas meta-communication, and the interviews offeredinsight into communication both as an entiretyandinits complexities. Interviewanalysis produced four main categories:representationof professionals and sectors, participants who collaborate in teams, the individual and the human in collaboration,and the meaning of the whole. Analysis showed that professional background plays a significantrole incommunication and collaboration (i.e.aperson is characterized by his/her profession). Differences in competence and breadth ofrepresentation contribute to richer discussion and a wider ground forsolutions. Many of the factors that emerged were otherwise independent ofprofession and related instead to individual characteristics.The ability to see beyond one`sown profession and understand the importance of other professional groups is essential.

    Conclusion: The study shows functionality of interprofessional collaboration and communication,it’s revealingthe meaning of confidentprofessionals who areable to see the big pictureand reflect upon its meaning. The findings point to various factors that are important for roles and communication such astrust, respect, dignity, learning and openness. Roles and their interpretation are important incommunication. Professional background derivesmeaningnot only through the individual participant andhis/herrole, but also through his/her properties, personality and perspectives. Public health is an area no one owns but everyone takes part in and has responsibility fo

  • 415.
    Törnblom, Cia
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Ett hälsofrämjande projekt i skolan ur ett lärarperspektiv: en kvalitativ studie2010Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Schools have long been considered a good arena for health promotionactivities. The Health workshop was a health promotion project that was implemented in 13schools in the Helsinki area during 2006–2008. The three health habits used were physicalactivity, nutrition and sleeping patterns.Aim: This study aimed to explore how teachers experienced their participation andengagement in the Health Workshop project.Results: Good communication between schools and project administrators was crucial for afruitful process. Factors such as initial commitment and teachers’ approach, whethersupportive or unsupportive, influenced their experience, and communication andinformation flow influenced their commitment to the project. Internal management figuredimportantly in the project organization, affecting teachers’ ability to manage and participatein the work. Teachers wanted well-designed and easily integrated tools based on theparticular needs of the school. They perceived school as a good arena for health promotion,and they experienced the chosen health habits as meaningful. They ranked the projectprocess as logical and easy, but also as fragmented. The schools’ goals for the project wereunclear, making it difficult to describe the implementation of the tools. However, theteachers’ felt that they gained new insights and positive experiences, and that much had beenaccomplished during the project period.Conclusion: Good communication and active dialogue among all participants supportinvolvement and participation in school-based health promotion projects. Appropriatelydesigned tools and well-organized tasks make health promotion both manageable andunderstandable for teachers.

  • 416.
    Ulland, Erna
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hvordan oppdager og formidler helsesøstrene et godt samspill mellom foreldre og barn ialderen 0-3 år?2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The purpose of this study is to gain knowledge of how health visitors discover and affect a happyinterplay between parents and children in the age of 0-3 years. Besides, its goal is also to get insight into health visitors' interest, competence, and possibilities to enter into difficult situations in their work with parent-child-interaction. The qualitative research interview is chosen to collect data. Interviews were undertaken with ten health visitors, who worked in eight different health stations, fromfour different urban districts in Norway. All informants, but one, finished their healthvisitor education for tenyears ago. They have mainly worked as health visitors since they finished their education. The method used to analyze the collected data is content analysis combined with Steinar Kvale’s three levels of interpretation. The study shows that the parent-child-interaction affects the quality of attachment of the latter to the former. The children, who are experiencing a good attachment to the caregivers, care providers close to them, develop a good rolemodel in relations towards other people. A good attachment is considered important to the child’s social, emotional and cognitive development. Norwegian societyhas during the last ten years been through many great changes. These changes have also influenced family patterns. Health services have to adjust in a larger scale to these new demands for health care. One conclusion of the study is that health visitors can be important caregivers in situations, in which there is an emotional flaw in the attachment between parents and children. Another conclusion drawn from the study is that the health visitors’ task or felt duty to improve the child-mother attachment is easily put aside, due to plenty of other duties that have to be done byhealth visitors during a days work. There is however sufficient reason to believe that this particular task for health visitors should be strengthened, since as researches show, a good child-mother attachment plays a fundamental role in the child development.

  • 417.
    Ulvik Hauge, Hilde Christine
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Faktorer som bidrar til fortsatt fysisk aktivitet etter deltagelse i Frisklivssentral.: En kvalitativ studie.2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim This studyaimed to identify various factors that contribute to continue physical activity following an interventionby Frisklivssentralen (i.e.,physical activity onprescription), as seen from theuser`s perspective.

    Method We interviewed 23 adults divided into five focus groups. The criteria for selecting people was that they had participated in the programme, exercise on prescription,oneto four years ago, and had continued with regular exercise for at least three hours weekly. We used qualitative analysis anda phenomenographic designto examine all data.

    Results We identified three categories: (i) physical activity on prescription is a useful intervention (ii) organized groups and training opportunities in the community motiv atestobeing active, (iii)mastering physical exercise providesa sense of accomplishment,and gives health benefits thatinspire ongoing physical activity.

    Conclusion Physical activity on prescriptionin a Frisklivssentral (public healthcare center) can help participants to acquire knowledge and skills to be able to continue with physical activity after the prescription period. Exercise groups with appropriate training and activities, events and activity settingsin the community encourages physicalactivity. Mastering physical activity and experiencing its health benefits (e.g., improved physical fitness and improved quality of life in general)can motivate people to remainphysically active

  • 418.
    Vanagas, Giedrius
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Work characteristics and work-related psychosocial stress among general practitioners in Lithuania2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background. There are a number of studies showing that general practice is oneof the most stressful workplaces for health care workers. Since the Baltic States regained independence in 1990, a reform of the health care systems took place in which a new role and more responsibilities were allocated to general practitioners.

    This study aimed to explore the psychosocial stress level among Lithuanian general practitioners (GPs) and examine the relationship between their psychosocial stress and work characteristics.

    Methods. A cross-sectional study was madeof 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multivariate logistic regression to estimate odd ratios for each of the independent variables in the model.

    Results. The study shows that 48% of the respondents could be classified as suffering from work related psychosocial stress by the Reeder scale. The highest job strain prevalence was among widowed, single and female GPs. The lowest job strain prevalence was among males and GPs of older age. Job strain occurs when job demands are high and jobdecision latitude is low.

    Conclusions. The greatest risk tophysical and mental health from stress occurs to general practitioners facing high psychological workload demands combined with low decision latitude in meeting those demands. High job demands, patient load more than 18 patients per day and young age of general practitioners can predict a statistically significant effect on job strain.

  • 419.
    Vest Hansen, Hanne
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Rygmarvsskadede patienters involvering i beslutninger om egen rehabilitering2011Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: This study aimed to increase understanding of how patients newly injured with spinal cord lesion experience rehabilitation planning conferences with their clinicians and therapists.

    Method: I used a qualitative methodology within a phenomenographic research approach. Data was collected during 15 qualitative and semi-structured interviews with eight hospitalized patients (three women and five men) ranging in age between 28 to 75 years.

    Results: The data suggests that patients view participation in rehabilitation conferences as essential. Indeed, some patients deemed participation a necessary and natural part of their rehabilitation. Four main categories were identified: patient conferences support rehabilitation; emotional vulnerability; family participation matters; and atmosphere and location of conferences are critically important.

    Conclusion: The results show that patients newly injured by spinal cord lesion can and want to participate in decisions about their own rehabilitation, even when they are grieving and in a state of shock. Interdisciplinary patient conferences that include relatives provide an ideal environment and help patients gain oversight and control in an often chaotic life situation resulting from complex and substantial physical disabilities. The data also revealed areas for improvement that will help ensure meaningful and satisfactory patient conferences

  • 420.
    Veyhe, Anna Sofía
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Færøske kvinders kostvaner i tredje trimester2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    The purpose of this project was to find out whether pregnant women in the Faroe Islands had a dietary intake, which were in accordance with recommendations for pregnant women. 148 women participated in the survey, which involved three 24 hour recall and six days diary, and a food frequency questionnaire for the last 12 months. The results of total energy, the energy distribution of protein, carbohydrate and fat and the micronutrients vitamin-A, -C, -D, -E, folic acid, iron and calcium are compared with recommendations for pregnant women in the Nordic countries, especially from Denmark because the Faroe Islands follow the Danish recommendations. In average the total energy consumption per day was 10,0 MJ, and the distribution was 15% protein, 52% carbohydrates and 33% fat. Dietary fibre intake was 17,4 gram per day, which is lower than recommended. The intake of saturated and monounsaturated fatty acids followed the recommendations whereas the intake of polyunsaturated fatty acids and n-3 fatty acids was lower then recommended, 3,6% and 0,6%. Supply of vitamin-C and calcium through the food was sufficient, whereas the supply of the other micronutrients was too low compare to recommendations. 85% of the women took vitamin supplements and 64% took iron supplements. Intake of fish was 280 gram per week, cereal products 323 gram per day, meat 139 gram per day, sweets 128 gram per day, fruit and vegetables 193 gram per day, fruit juice 98 gram per day. The results from this project can put a focus on the connection between diet and pregnancy as well as there is a need for a detailed dietary survey among the general population, where the results can used in further health promotion

  • 421.
    Vikan, Astri
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Fra narkoman til nykter. Kvinner forteller om sine erfaringer.2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim: Using the experiences of recovered, female heroine abusers, their lives as heroin users, process of rehabilitation and how they experience drug free lives will be described and analyzed.

    Method: The study, using qualitative methods/narrative case study, included seven women. They recounted their stories of the beginning of their drug use, their addiction to illegal drugs, their road to recovery and living a drug free life.

    Results: A main theme in their narratives was the significance their various relationships have for identity and identity changes. In particular, their stories document experienced violations/infringements and misuse of power of workers in the public health and social services. The battle to get help in maintaining relationships to and responsibility for their children is characterized by mistrust of the child welfare authorities; this creates barriers to constructive processes. The quality of assistance and whether one receives assistance seems to be dependent on where one lives and personal contacts. Relationships to men have been characterized by abuse and dependency on them for access to drugs. Fathers are invisible in their stories.The transition from drug abuser to drug free is painful. They experience a sense of purpose in life as a drug free person, but daily living holds its own problems such as tight socioeconomic framework conditions and mental and physical health problems.

    Conclusions: Understanding for drug abuse and recovery issues must be bound to long term processes and be seen in a life course perspective. Psychosocial support measures should be based on individual needs concerning scope, content and time. In regards to ending drug abuse, women are especially dependent on a developed network. Key situations must be attended to such as pregnancy and their role in care giving. Society’s interventions towards women and men who are past or current drug abusers and their children must be accomplished with a focus on a gender specific perspective. The gender perspective concerning support and treatment of/for women is of great importance in understanding both women and men’s need for specific types of support and treatment. This is especially true when society intervenes; it must be done in light of the changing roles of the masculine and the feminine in modern culture. Research that focuses on the personal story and experience of the drug abuser’s journey from becoming drug addicted to living drug free is necessary

  • 422.
    Wallström, Aina
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Att orka bära sitt öde: Hälsofrämjande copingstrategier hos personer som genomgått käkbensrekonstruktionefter komplikation till cancerbehandling2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Mandibular osteoradionecrosis is a complication of radiotherapy for head and neck cancer. Treatment of this condition sometimes involves mandibular reconstruction. Little is known about howpatients handle their situation after a mandibular reconstruction.

    Aim:This study aimed to increase and gaina deeper knowledge about coping strategies among mandibular reconstruction patients.

    Method: Classical grounded theory was used to analyze 11 open qualitative interviews with steoradionecrosis patients. Consecutive and theoretical sampling was performed until saturation. This method seeks to predict and explain the studied phenomena

    Results: Interview analysis revealeda core category “coping to carry one’s fate”. Patients, treated with mandibular reconstruction due to osteoradionecrosis, used four main active coping strategies. They take the chances they get; start over againtaking one day at a time; gain a new perspective on life; and seek support from other people in all available contexts.

    Conclusion:Patients with osteoradionecrosis need increased support. To increase quality of life and empowerment, health care settings could teach such patients these active health promoting coping strategies

  • 423.
    Wang Børseth, Anita
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Enerom, et smitte- og sykdomsforebyggende tiltak i sykehus?2011Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aims: This study aimed to investigate whether single-occupancy rooms reduce the incidence of Clostridium difficile (C. difficile) among hospitalized patients.

    Methods: The study used a descriptive epidemiologic approach to investigate the incidence of C. difficile infection in patients in four hospitals during 2001–2010, in relation to the number of single rooms. In addition, we conducted a retrospective study to investigate the risk for C. difficile infection in a hospital ward, in relation to the transfer of a hospital department from old hospital premises that contained only a few single rooms to a new hospital building containing single-occupancy rooms for almost all patients.

    Results: This study determined no correlation between the incidence of C. difficile infection and increased access to single-occupancy rooms. However, the incidence of C. difficile infection was considerably different in the four hospitals. The old hospital buildings showed higher but insignificant risk of C. difficile infection compared to the new hospital building. We were unable to demonstrate a lower risk of C. difficile infection among patients in single-occupancy rooms.

    Conclusions: Although the proportion of single-occupancy rooms increased in several of the hospitals during the study period, we were unable to show that the single-occupancy rooms prevent C. difficile infection in hospitalized patients. Single-occupancy rooms likely facilitate improved infection prevention behaviours in health professionals. Preventing the spread of C. difficile infection requires a collection of several preventive measures, including single-occupancy rooms.

  • 424.
    Webb, Lisa
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Smoking in the age of obesity: an investigation of secular trends in body fat and cigarette smoking2011Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Objectives: In recent decades, obesity reached epidemic proportions in western countries, while cigarette smoking decreased. Traditionally, smoking is associated with lower relative weight (body mass index, BMI) but high abdominal obesity (waist-hip ratio, WHR). However, several recent studies suggest that BMI is higher among today’s smokers compared with non-smokers. Therefore, the present study examined whether the relationship between smoking and each of the body measures, BMI and WHR, has changed over time.

    Material and Methods: Data were collected from 5907 male and female residents of Gothenburg, Sweden, aged 25-65 years, and drawn randomly in four sequential cross-sections (1985, 1990, 1995, 2002) from the city’s population register. The study used general linear models to test trends over time, and adjusted all differences for age.

    Results: The data reported here showed higher WHR in both male and female smokers compared with non-smokers. BMI was lower in female smokers compared with female non-smokers, but did not differ significantly between male smokers and male non-smokers. Among female participants, differences in WHR between smokers and non-smokers increased significantly throughout the study. Although male participants showed a similar tendency, the differences were not significant. Adjustment for educational level did not affect the results.

    Conclusions: WHR was higher among smokers compared with non-smokers; this difference increased over time. Thus, concern for obesity does not provide a valid reason to continue smoking; on the contrary, it may be a reason to quit.

  • 425.
    Westbacke, Kerstin
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    HYGIENE, EATING HABITS AND ORAL HEALTH AMONG CHILDREN IN THREE NEPALESE PUBLIC HIGH SCHOOLS2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Currently, many developing countries are experiencing rising prevalences of caries associated with changes in lifestyle and living conditions.

    Objectives: To describe the hygiene, eating habits, and oral health status of Nepalese children.

    Materials and Methods: A stratifiedsample of 231 children 5–7, 11–13, and 15–16 years of age (53% boys, 47% girls) who attended public high schools in the rural area of the Lalitpur District, Nepal was selected. The study was a field study combining a clinical examination (plaque, gingivitis, calculus, and caries) and a questionnaire. The questions concerned sanitary conditions, health support, personal hygiene, tooth cleaning, and eating habits.

    Results: During the school day, half of the children ate nothing at all. General personal hygiene was associated with tooth-cleaning frequency.Four out of five children in the entire sample cleaned their teeth once/day or more, using their own toothbrush. The use of fluoride toothpaste was rare.More frequent tooth cleaning and lower plaque indices were seen among girls and older children. More plaque was found on the occlusal surfaces of erupting permanent molars than on fully occluded permanent molars. Most children had a low prevalence of manifest caries in the primary and the permanent dentitions. However, every fifth 5–7-yr-old had manifest caries in three or more primary teeth. The occlusal surfaces of molars accounted for almost all registered caries in both dentitions.

    Conclusion: Although the prevalence of manifest caries was low, the low level of preventive activities may cause an increase in the prevalence of caries, as in other developing countries. The presumed risk scenario needs to be met by comprehensive and systematic health promotion and preventive measures.

  • 426.
    Wiberg Larsson, Bodil
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Sammenhæng i genoptræning: relateret til rygsygdom og den danske strukturreform2010Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Cohesiveness in health care activities is a current topic. The Danish structural reform of 2007 intended to create coherence, efficiency and quality in health care and to further the development of Denmark´s democratically run public health care system.

    Purpose: This study aimed to look more closely at the phenomenon of cohesive rehabilitation in relation to the structural reform, particularly regarding low back pain.

    Method: The investigation used group interviews with patients and health professionals, and a modified fenomenological model of analyses. Its theory is based on three different perspectives: a health planning perspective, a particular subject perspective and an integration perspective.

    Results: Cohesive rehabilitation exists when the basis for rehabilitation includes an evident diagnosis, subject orientated, considerations of resources, and completely exploited professional knowledge.

    Conclusion: An evident diagnose is a crucial aspect of cohesive rehabilitation for both patients and health professionals. Although reform changed the settings and responsibilities of rehabilitation it did not increase cohesiveness. Cohesiveness can be related to the model of evaluation including structure, process and outcome.

  • 427.
    Wiklund, Susanne
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Vad innebär det att drabbas av ESBL-bildande tarmbakterier?: En kvalitativ studie.2011Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Extended spectrum beta lactamase (ESBL), an enzyme produced by bacteria in normal intestinal flora, renders such bacteria resistant to many antibiotics. Some patients infected with ESBL respond poorly to antibiotic treatment, and even trivial infections may require hospitalization.Purpose: To increase understanding of the emotional impact of ESBL-producing intestinal bacteria.Method: This study used a modified version of grounded theory during seven open interviews to analyze coping mechanisms for ESBL infection.Results: Our analysis identified a core category (i.e., being thrown into scary and unknown territory without a map and compass). All respondents felt they received no or insufficient information about the diagnosis, and reported that any information they did receive arrived only by phone or letter. Consequently, respondents questioned whether they had been infected through medical care or through their own actions. They believed that lack of knowledge and attitude problems among healthcare providers (perceived as carelessness, lack of understanding, and unwillingness or lack of time to answer questions) stigmatizes patients. Such deficits led respondents to take matters into their own hands as they tried to obtain information by other means (e.g., the Internet). Respondents described extreme hygiene measures as a "protective suit" against inadequate hygiene. Female respondents constructed individual coping mechanisms (e.g., instructing others about hand washing technique, disinfecting objects during healthcare visits and at home, avoiding metro or bus travel, avoiding social interactions, and informing others of the infection). Conversely, male respondents took no special measures and lived as they did before infection. No one wanted to worry relatives/significant others, and no one told their children about the diagnosis.Conclusion: It is to important that attending doctors provide good information to individuals infected by ESBL-producing bacteria. Moreover, such individuals must develop good life management and coping skills.

  • 428.
    Wikström, Git
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Women’s Perspectives on Pathway to Diagnosis of Pulmonary Tuberculosis: Women Voices from Community Level in Uganda2011Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Objectives:  A qualitative study to explore the perceptions and ideas of women at community level in Uganda, about factors influencing their health care-seeking behaviour when symptoms that could indicate pulmonary tuberculosis. To let the women identify barriers to health care-seeking and to let them present ideas how to overcome barriers.

    Method:  Focus Group Discussions (72 informants) and In Depth Interviews (19 informants) were conducted in rural Uganda with women of reproductive age. For triangulation purposes discussions and interviews also included health care providers, traditional healers and a few men.

    Main Results: The data showed a wide range of health care-seeking behaviours including no action at all, self-treatment using traditional herbs or western medicines, consulting traditional healers and consulting various formal or informal healthcare facilities. The data also identified many barriers that could prevent women from getting a proper diagnosis, including lack of financial resources, lack of power, male supremacy in decision-making, lack of knowledge, perceived corruption in healthcare facilities, fear of stigma and this fear heavily boosted by the idea that PTB equates HIV/AIDS.

    Conclusion: These data support the idea that successfully fighting PTB among Ugandan women and increasing case finding, demands recognition that tuberculosis is a multifaceted disease: economical, social, psychological and medical. Therefore, approaches to eradicating tuberculosis must target different sectors and reach all levels of society

  • 429.
    Winther, Rolf B
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Legeshopping - indikator for legemiddelmisbruk?: En registerstudie2008Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    BACKGROUND: Abuse of prescription drugs is an important public health issue. Some patients go from one physician to another in so-called doctor-shopping (or physician-shopping) with the intention to have as much as possible of addictive drugs prescribed. This is a problem when trying to restrict prescription drug abuse in the population. The Regular General Practitioner (RGP) Scheme which was introduced in Norway in 2001 had among other things the intention to counteract doctor-shopping. So far there are no studies in Norway or other countries that have presented estimates of the proportions of patients that practice doctor-shopping.

    AIM: To explore the extent of doctor-shopping in the population in Norway and try to unveil if the use of several doctors is primarily a prescription drug shopping or if it has other reasons.

    MATERIAL AND METHODS: Data from The Norwegian Prescription Database (NorPD) for the year of 2004 was studied. The register includes information on the number of doctors used by individual patients and the amount of drug dispensed. There is also information about concomitant use of opioids and benzodiazepines. Users of the addictive drugs diazepam, carisoprodol and codeine combinations were compared to users of the non-addictive drugs esomeprazole, metformin and salbutamol.

    RESULTS: Most patients use only one or two doctors for prescription of the same drug over a period of one year. However the proportion of patients who uses three or more doctors for the addictive drugs is more than twice the comparable proportion of patients using the non-addictive drugs. For those who uses five or more doctors the proportion is nearly ten times larger. The amount of dispensed drug increases considerably more by increasing number of doctors used for users of the addictive drugs than for the users of the non-addictive drugs, as do the amount of concomitantly dispensed opioids and benzodiazepines.

    CONCLUSION: Also after the introduction of the Regular General Practitioner (RGP) Scheme in Norway doctor-shopping is still going on to a limited but significant extent by patients who appear to have the intention to get as much as possible of addictive drugs. This is a public health issue that has to be taken seriously by both prescribing doctors and health authorities.

  • 430.
    Worren Kløcker, Tone
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Svømmekurs med fokus på svømmeferdigheter og sosial integreringsom helsefremmende tiltak for kvinner med innvandrerbakgrunn2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background:Norwegian surveys have reported that the health of immigrants compares negatively with the health of the general population. Norwegian society emphasizes thesocial and cultural value ofphysical activity such as swimming,andintegration policypromotes improved living conditions for immigrants. Moreover, inability to swim heightens the risk of drowning.

    Purpose: This study aimed to develop swimming instruction as a health-promoting intervention among immigrant women.It also examined whether such swimming lessons improve women's health by increasing skills and social integration.

    Method: Sixteen women from six different countries participated in swimminglessons between 15 November 2012 and 26 October 2013. This thesis used a triangulation of methods (i.e., surveys, group interviews,and observations)to investigate whether increased swimming skill, social integration, and other factors affect the health of immigrant women. I used qualitative content analysis to evaluate alldata.

    Results: As immigrant women became better swimmers, their sense of security in the water improved. Additionally, swimming enhanced cultural openness and personal development, and participants’ social networks expanded across cultures. Public swimming pools increasedsocial activity. Finally, as participants’perceptions of their own health improved,they encouraged their family and friends to learn how to swim.

    Conclusion: This intervention shows that activities organized for immigrant women promote factors that have a positive effect on health, such as improved swimming skills. Swimmingis a gateway to social integration

  • 431.
    Woxberg, Anna-Kari
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hälsofrämjande skola: en sambandsanalys mellan hälso- och riskvariabler2005Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    It is increasingly stressed as more important to increase the possibility for young people to live a healthy life, both through an individual as well as a community perspective. The school is therefore a perfect health promoting setting. WHO:s conferences in Ottawa, 1986 and Sundsvall, 1997 both stressed the need to shift perspective from prevention to promotion. WHO also took initiative to set up several international networks. “Health promoting school” was one example involving creating a supportive and health promoting physical, mental and social environment for health, wellbeing and learning as well as strengthening the health education. The aim of this study was to survey and describe the connection between some health- and risk related variables to test a hypothesis about the school as a health promoting setting. The hypothesis was formulated: -schools with a high percentage of students with health-related experiences has a low percentage of students with risk behaviours and vice versa. Available data from two different questionnaires were used, the “Health questionnaire” and the more risk-related “CAN questionnaire”. The two questionnaires were both conducted among all students within the ninth school year in the county of Gävleborg. They were administrated as separate but adjacent studies during the spring term of 2002. Five questions were chosen from each questionnaire. Responses from the students consists the material used in this study. The analyses were made in two steps. Initially, school level connections were studied, later individual level connections. The result did not find any connections between more health related and risk related variables. The formulated hypothesis is therefore rejected. There are several studies in the literature supporting the findings in this study. At the same time there is continuing or increasing support for the idea of a health promoting school. In the future the concept “Health promoting school” needs to be clarified as well as strategies, organisation and leadership.

  • 432.
    Yadav, Agata
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Spiseforstyrelser. Sagsbehandling i danske kommuner: en kvalitativ undersøgelse af kommunerne i Region Hovedstaden2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Aim:Thisstudy aimedto examine grant-competent social workers’experiences and understanding of adults with eating disordersin Denmark’s Capital Region. In particular, we aimed to identify social needs, benefits grantedor denied and for what purposes, and the public health perspective.

    Method: We used semi-structured qualitative interviews with ten social workers from nine municipalities in the Capital Region. All data was analyzed using Hermeneutic philosophy.

    Results: Our dataidentifiedfive major themes: (i) responsibilities between regions and municipalities; (ii) contact between individuals with eating disorders and social workers; (iii) case management; (iv) the primary sector; and (iv) social workers’ knowledge and use of theory. We determined that sector responsibility and financial budgets contribute to public landing between the community sector and the regional sector. Each year, social workerssee one or two individuals with eating disorders, often young girls suffering from anorexianervosa, bulimia nervosa,or binge eating disorder. When clients exhibit co-morbidityand social problems, cases are lengthy and sometimes requirein voluntary hospitalization, most often facilitated by §85, §100, §107, and §108 of the Law on Social Services.Cases with the best outcomeare characterized by cooperation with medical experts. Specialist theory is involved to a limited extent (e.g.,examples, recovery, health promotion, motivational interviewing, balance sheet,and the appreciative approach.

    Conclusion: Social workers operateon a generalized level,professional experience and instructions to treat clients. They see no need for the establishment of efforts directed towards specialized eating disorders units in the primary sector.If social workers in local authorities are granted to detect disease, initiate treatment, initiate referrals, involuntarily institutionalize clients and record their progress,and detect recurrence on the basis of subjective empiricism,they need clear guidance and direction for locating information about professional partnerships, health care facilities, and referral methods. Importantly, eliminating barriers to services that include therapy will enhance the primary sector's ability to meet legal requirements

  • 433. Zhan, Shaokang
    et al.
    Wang, Lanxiang
    Yin, Aitian
    Blas, Erik
    Nordic Council of Ministers, Nordic School of Public Health NHV. UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), The World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
    Revenue-driven in TB control--three cases in China.2004In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 19 Suppl 1, p. S63-78Article in journal (Refereed)
    Abstract [en]

    One quarter of all TB cases occur in China, which, during the past 20 years has moved from a planned economy to a socialist market economy. In the health sector, an important proportion of the financing originates from user payment. TB control is not an exception and different programmatic models are in place. This study examines, using a case study approach, three different TB programmes, one supposed to provide free service, one subsidized service and one with full cost recovery. The aim was to better understand the driving forces for programme performance in terms of case detection, case management and patient payments. The study found for all models that control and case management approaches were, to some extent, adapted to generate maximum income to the providers. The drive for income led to fewer cases detected, administration of unnecessary procedures and drugs, and a higher than necessary cost to the patients. The latter possibly leading to exclusion of poor people from the services. If user charges are to stay, TB control programmes need to be designed to take advantage of the financial incentives to improve performance. The referral system needs to be restructured, not to provide disincentives for good practices.

  • 434.
    Ákadótti, Þóra
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Nurse assistants’well-being at work: is there a link to nurse leadership2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Introduction: As jobdemands in the healthcare system increases, one of the main protective factors involves support within the work environment. Limited knowledge exists about the work environment of nurse assistants and their well-being at work. A relatively small number of studies on this topic in the Nordic countries, and their results indicate high job demands and risk for negative health outcomes. Purpose:This study aimed to investigate nurse assistants’ perception of job demands, the servant leadership of their next superior, job satisfaction, symptoms of emotional exhaustion, and physical well-being at work. It wasalso investigatedwhether perception of servant leadership of their next superior related to job satisfaction and symptoms of emotional exhaustion.Methods: Questionnaires sent to all nurse assistants with registered email addresses at the Icelandic Nurse Assistants Association yielded 588 participants (49% response rate). A new Dutch inventory on servant leadership (SLI) was used to measure perception of servant leadership in nursing; additional questions explored work environment, demands, control and support at work, symptoms of burnout, and job satisfaction. To answer the research questions, a cross-sectional descriptive designwas used Results:The majority of participants experienced high job demands and reported on control and support at work. Despite high levels of burnout, the majority of nurse assistants weresatisfied at work. Servant leadership was practicedsomewhat within nurse assistant’s workplaces. The correlation between perception of servant leadership, job satisfaction, and emotional exhaustion was significant for all SLI sub-factors except courage, and the strongest correlation was for empowerment, humility, and stewardship as sub-factors of servant leadership.Conclusion:This study highlights supportive factors within the work environment, particularly regarding the leadership-empowering role of servant leadership in nursing. Results showhow thissupportis related to nurse assistants ́ well-being at work andsuggeststhat servant leadership can support health promotion within the work environment of nurse assistants. These findings are valuable for nurse assistants, nurse managersand leadershipin the health care system, thus contributingto public health

  • 435.
    Ákadóttir, Þóra
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Nurse assistants’well-being at work: is there a link to nurse leadership?2012Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Introduction: As jobdemands in the healthcare system increases, one of the main protective factors involves support within the work environment. Limited knowledge exists about the work environment of nurse assistants and their well-being at work. A relatively small number of studies on this topic in the Nordic countries, and their results indicate high job demands and risk for negative health outcomes.

    Purpose:This study aimed to investigate nurse assistants’ perception of job demands, the servant leadership of their next superior, job satisfaction, symptoms of emotional exhaustion, and physical well-being at work. It was also investigated whether perception of servant leadership of their next superior related to job satisfaction and symptoms of emotional exhaustion.

    Methods: Questionnaires sent to all nurse assistants with registered email addresses at the Icelandic Nurse Assistants Association yielded 588 participants (49% response rate). A new Dutch inventory on servant leadership (SLI) was used to measure perception of servant leadership in nursing; additional questions explored work environment, demands, control and support at work, symptoms of burnout, and job satisfaction. To answer the research questions, a cross-sectional descriptive designwas used

    Results: The majority of participants experienced high job demands and reported on control and support at work. Despite high levels of burnout, the majority of nurse assistants were satisfied at work. Servant leadership was practiced some what within nurse assistant’s workplaces. The correlation between perception of servant leadership, job satisfaction, and emotional exhaustion was significant for all SLI sub-factors except courage, and the strongest correlation was for empowerment, humility, and stewardship as sub-factors of servant leadership.

    Conclusion: This study highlights supportive factors within the work environment, particularly regarding the leadership-empowering role of servant leadership in nursing. Results showhow thissupportis related to nurse assistants ́ well-being at work andsuggeststhat servant leadership can support health promotion within the work environment of nurse assistants. These findings are valuable for nurse assistants, nurse managersand leadershipin the health care system, thus contributingto public health

  • 436.
    Åhgren, Bengt
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Frisack, Johan
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Röster om patientsäkerhetskultur: Analys av öppna svar från Västra Götalandsregionens patientsäkerhetskulturmätning 20132013Report (Other academic)
    Abstract [sv]

    Nordic School of Public Health, NHV, har på uppdrag av Västra Götalandsregi-onen genomfört en analys av de öppna svaren från den undersökning av patient-säkerhetskulturen som genomfördes i regionen under våren 2013.Totalt omfattar studien drygt 3 600 öppna svar som kodats i sex övergri-pande grupper och 69 underliggande grupperingar. För att öka förståelsen av materialet har utgångspunkten varit de kategorier för bakomliggande orsaker som används vid händelse och riskanalyser i hälso- och sjukvården.Totalt valde knappt 19 procent av de som besvarade enkäten att lämna någon form av öppen kommentar. De som gav en skriftlig kommentar kring patientsäkerhet och förbättringsförslag för en säkrare vård hade generellt en mer kritisk inställning till patientsäkerheten i verksamheten än den genomsnittlige respondenten i undersökningen. Detta syns även i de öppna kommentarerna där en ytterst liten del av de öppna svaren ger en positiv bild av verksamhetens patientsäkerhet.Det stora flertalet av de öppna svaren berör förbättringsmöjligheter och patientsäkerhetsrisker inom vårdens omgivning och organisation och kommu-nikation och information i verksamheten. Koderna i dessa grupper berör exem-pelvis personalbrist, arbetsbelastning, arbetsmiljö, ledarskap, kommunikation med klinik och verksamhetsledning, intern kommunikation i verksamheten och brister kring återföringar av rapporterade avvikelser.Patientsäkerhetsproblem och organisationskultur är vanligtvis lokala feno-men och rapporten ger i första hand en övergripande bild av samtliga öppna svar i undersökningen. Analysen visar också en hel del återkommande kommentarer som mycket väl kan användas för att övergripande utveckla och förbättra säker-hetskulturen i regionens verksamheter. I materialet framkommer att många medarbetare fortfarande inte upplever att det systematiska arbetssättet kring patientsäkerhet har genomförts fullt ut. Vidare finns det, i samtliga större yrkesgrupper, en återkommande oro över att resursbrister och ett högt patienttryck skapar situationer där patientsäkerheten nedprioriteras till förmån för produktion. Fortsatt fokus på att utveckla en läran-deorganisation, öka chefsnärvaron i det dagliga arbetet och att öppet diskutera verksamhetens mål och uppdrag är aspekter som efterfrågas av medarbetarna. Vetenskapligt finns det också god evidens för att detta är arbetssätt som de facto skapar ett bättre arbetsklimat med ökat fokus på säker vård

  • 437.
    Ödegård, Synnöve
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    From punishment to prevention: Medical errors reported in Sweden in 1989 and 19931999In: Safety Science Monitor, ISSN 1443-8844, Vol. 3Article in journal (Refereed)
  • 438.
    Ödegård, Synnöve
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Safety management in civil aviation: a useful method for improved safety in medical care?2000In: Safety Science Monitor, ISSN 1443-8844, Vol. 4, no 1, p. 1-12Article in journal (Refereed)
  • 439.
    Ödegård, Synnöve
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Säker Vårdpatientskador, rapporteringoch prevention2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Syfte. Avhandlingen syftar till att bidra med ökad kunskap om faktorer som kan antas påverka patientsäkerheten dels på system-, dels på individnivå. Metod.Det nationella rapporteringssystemet Lex Maria analyserades före och efter Socialstyrelsens regionalisering av tillsynsorganisationen 1990/91. I en av de två studierna analyserades särskilt ärenden som överförts till HSAN för prövning av disciplinär påföljd. I tre empiriska studier analyserades kompletterande metoder till rapportering för att få information om risker i hälso- och sjukvården. Personal har intervjuats om deras uppfattning av potentiella risker som skulle kunna hota patienternas säkerhet. Vårdbiträdens och undersköterskors kunskaper om diabetes undersöktes i en enkätstudie. Eventuella samband mellan vårdbiträdens och undersköterskors kunskapsnivå och medicinskt ansvariga sjuksköterskors uppfattning om säkerhetsrelaterade frågor undersöktes i en uppföljande enkätstudie. I en kvalitativ studie undersöktes flygets metoder för säkerhetsrelaterat arbete vilket jämfördes med motsvarande arbete inom hälso- och sjukvården. Resultat.Lex Maria-rapporteringen ökade efter regionaliseringen av tillsyns-verksamheten och en minskad andel ärenden överfördes till HSAN för disciplinär prövning. De kompletterande metoder för att identifiera risker som undersökts visade sig vara värdefulla tillägg till traditionell rapportering. Intervjuerna inom barnsjukvården uppvisade en annan riskbild än den som fås genom rapporteringssystemet Lex Maria. Enkäten till vårdbiträden och undersköterskor visade ett tydligt samband mellan bristande kunskap om diabetes och en ökad risk att vidta en riskfylld åtgärd. Studien indikerade brister på systemnivå, vilket bekräftades av resultaten från enkätstudien till medicinskt ansvariga sjuksköterskor i motsvarande kommuner. Studien visade på behovet av ökad uppmärksamhet på hur sjukvårdens stödsystem påverkar yrkesutövarna i frontlinjen. Jämförelsen mellan flyget och hälso- och sjukvården visade att flyget hade ett mera proaktivt och bredare förhållningssätt till säkerhet än vad hälso- och sjukvården uppvisade. Slutsatser. Studien har visat att yrkesutövare som befinner sig i frontlinjen och möter den enskilde vårdtagaren är särskilt sårbara när hälso- och sjukvårdens stödsystem uppvisar brister. Förebyggande säkerhetsanalyser som komplement till rapportering visade sig ge värdefull information för det förebyggande säkerhetsarbetet. En sammanhållen strategi baserad på aktuell säkerhetsforskning kan bidra till att utveckla hälso- och sjukvårdens säkerhetsarbete. Nyckelord: Patientsäkerhet, rapportering, prevention, händelseanalys, säkerhetsanalys, Lex Maria, ansvarsärenden, disciplinära åtgärder

  • 440.
    Ödegård, Synnöve
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Andersson, D K
    Knowledge of diabetes among personnel in home-based care: how does it relate to medical mishaps?2001In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 9, no 2, p. 107-14Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the influence of knowledge about diabetes on the performance of diabetes care for the elderly involving insulin treatment, with special attention to aspects of patient safety in home care.

    DESIGN: A questionnaire was administered to nurse's aides and assistant nurses (n = 3144). Answers to questions about knowledge of diabetes were related to "relevant" or "risky measures" as judged from a hypothetical diabetes case. A 94% response rate was obtained. The study took place in January 1997 in 15 of Sweden's 289 municipalities.

    RESULTS: Insufficient theoretical knowledge about how the blood sugar is related to an insulin reaction led to an almost threefold increased risk of taking a "risky measure". Insufficient knowledge about reasons for an insulin reaction also resulted in a higher risk, as was the case for personnel working in home based care in contrast to those working solely in Institutional care. In addition, the risk that a nurse's aide would take a "risky measure" was higher than that for an assistant nurse. This may indicate that the basic theoretical knowledge of nurse's aides is inadequate.

    CONCLUSION: Deficiencies in basic knowledge of diabetes among nurse's aides and assistant nurses constitute a major cause of potentially serious mishaps in home care of elderly diabetic patients treated with insulin.

  • 441.
    Ödegård, Synnöve
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Edgren, Lars
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Reporting system, disciplinary measures and patient safety: a Swedish study2006Article in journal (Refereed)
  • 442.
    Ödegård, Synnöve
    et al.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Hallberg, Lillemor
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Perceived potential risk factors in child care.2004In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 18, no 1, p. 38-52Article in journal (Refereed)
    Abstract [en]

    This study is based on semi-structured interviews focusing on staff members' opinions about potential risk factors that could threaten patient safety. The aim was to acquire more in-depth knowledge about the causes of patient injuries. The study, which was conducted at a children's hospital, has a qualitative approach that is influenced by the critical incident technique. A total of 28 persons were interviewed. Analysis of the data resulted in five qualitatively differentiated categories of potential risk factors: a large influx of patients, a lack of professional experience, a lack of inter-professional communication and cooperation, and deficiencies related to work hours and to the physical environment. The results reflect a complex picture where the risks, as described by the informants, can either alone or in concert directly or indirectly affect the individual in the practice of his or her profession or contribute to a mistake.

  • 443.
    Ørnevik, Grethe
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Smitteverntiltak ved Clostridium difficileinfeksjon.: En kvantitativ tverrsnittsstudie blant helsepersonell i et norsk sykehus2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Clostridium difficile(CD) causes 20 %–30 % of all nosocomial infectious diarrhea, resulting in significant morbidity and increasing healthcare costs. Good antibiotic stewardship reduc-es the incidence of CD, andcompliance with infection control measures limits its spread. In recent years, ribotype 027, a new strain of CD, caused several disease outbreaks. Ribotype 027 spreads more easily and increases disease severity and relapse. Thus far, ribotype 027 has caused few prob-lems in Norway.

    Objective: This thesis aimed to determine whether hospital-based healthcare professionals comply with recommended infection control measures for CD prevention and identify how they learn about such measures.

    Method: A retrospective cross-sectional survey and questionnaire was performed among healthcare professionals at Sørlandet Hospital, Norway,during the spring and fall of 2011.

    Results: Survey participants included 168 health professionals (59 physicians and 109 nurses). The response rate was 94 %. Medical doctors (94 %) and surgeons (38 %) said that their clinics impose antibiotic restrictions (x ² = 10.756, p< 0.001). After contact with a CD patient, physicians and nurs-es (73 % and 64 %, respectively) said they disinfect and wash their hands (x ²= 6.451, p< 0.011). Notably, only 8% of physicians and 36 % of nurses always give patients information about the im-portance of hand hygiene (p< 0.001). Even 25 % of physicians and 6 % of nurses reported using ethanol (does not eliminated CD spores) to disinfect stethoscopes before leaving a CD isolation room (x ² = 22.273, p< 0.001). Medical and surgical nurses (48 % and 43 %, respectively) incorrectly used Virkon as a disinfectant in the CD patient’s room. Physicians and nurses (63 % and 72 %, respective-ly) mainly obtain knowledge about infection control measures from colleagues, compared to physi-cians and nurses (14 % and 46 % , respectively) who gain such knowledge from the hospital’s infec-tion control program (p< 0.001).

    Conclusion: Healthcare professionals have some knowledge about infection control measures, but lack knowledge specific to limiting the spread of CD. Increased compliance with infection control measures is crucial to meeting the challenge of new and more potent strainsof CD. Guidelines alone are likely insufficient to keep healthcare professionals up to date. The lack of specific knowledge about infection control measures for CD may expose hospitalized patients to CD infection

  • 444.
    Ørtoft, Merethe
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Det sårede selv: Kvalitativt studie om at blive ramt af kræft i æggestokkene2010Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Purpose: The purpose of the study was to obtain an increased understanding of how women with newly diagnosed ovarian cancer are experiencing their own coping and how meaning and identity constructed in the first period after the diagnosis

    Method: Used a qualitative approach with narrative interviews with six women who have been diagnosed with ovarian cancer within six months. Data analysis used a narrative analysis method "The Holistic Content Perspective" to get an overall picture of the informants' themselves, as it was presented in their stories

    Result: The study shows three different development paths that must be considered in conjunction with women's age, life period, and the spread of disease. A development path used by younger women who experience the disease as threatening to the identity that they defend themselves by denying the seriousness of the disease and in no way identify with this. They choose to live life the same as before they became ill and the experience of meaningful attempts maintained through denial of the seriousness of the disease. Another path of development emerged in the elderly women who understand the disease as a part of life and quickly begin a providing of meaningful and maintenance of identity, how they relate to disease and its potential consequences such as loss of life. These women learn to live with the disease as part of their identity. A third path of development was found in women where the disease was in an advanced stage and the physical and social suffering becomes dominant. These women struggle to retain or find meaning, instead characterized by meaninglessness, while identity is difficult to maintain, with self image and self-understanding recover from, because they can no longer know themselves

    Conclusion: The construction of meaning and identity as a part of it to cope with newly discovered cancer of the ovary are important for women, but the processes around how women cope, is different depending on age, life duration and spread of the disease. Health promotion interventions to improve coping processes among these women must keep pace with these different development paths to ensure maximum health.

  • 445.
    Østraa, Inger Elisabeth
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Evaluering av det lovbaserte legefordelingssystemet i Norge i perioden 1999 til 20132014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Purpose: This study aimedto investigate the effect of the legally based system for allocating new positions for physiciansunder a policy that wasin effectin Norway between 1 January 1999 and 30 June 2013.The study also aimed to increase understanding of a government-regulated physician distribution system.

    Method: The primary methodology involved using quantitative descriptive analysis to review registry data and available statistics. Case documents and decisions related to theallocation of physician positions, and case and policy documents related to the original justification for the government-regulated physician distribution systemw ere also reviewed. The theoretical thesis and framework for this study is public health, organization theory, and the "result chain" as a management tool for executing evaluations and deliberations.

    Result: Theresults of the study show that vacant positions for physicians, both primary and specialists, decreased to less than 1% during the study period. During this same time period, 54% of all new hospital positions were assigned a priority specialty. Positions for specialist education increased 36%. Among the Nordic countries, Norway had the highest increase in coverage by primary care physiciansper 1,000 capita during the past 15 years.

    Conclusion:The government-regulated physician distribution systemin Norway has been effective. Robustness, consensus building, and broad participation are key conditions and ingredients in the recipe for success.

  • 446.
    Þórisdóttir, Jóhanna G.
    Nordic Council of Ministers, Nordic School of Public Health NHV.
    Follow-up interventions and measurement instruments for patients suffering from psychotic disorder: A literature review2014Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    Background: Continuity of care and post-discharge follow-up visits can improve the quality of care and reduce the likelihood of relapse and re-hospitalization in patients with psychotic disorders.

    Purpose: This study aimed to analyze post-discharge follow-up interventions in patients with psychotic disorders, and to identify measurement instruments for intervention outcomes.

    Method: The literature review described here used a specific framework, where the follow-up interventions and the measurement instruments were analyzed systematically, to investigate fifteen studies identified through electronic databases such as Pubmed, Psychinfo, ProQuest, Cinahl, Medline, and Scopus.

    Results: The studies used interventions including psychoeducation, cognitive-behavioral therapy, cognitive behaviorally oriented service, optimal clinical management, relapse prevention plan, software suggested intervention, ambulatory outpatient care, community re-entry module, integrated treatment, and hospital-based community psychiatric service. Additionally these studies used thirty-eight measurement instruments to assess change in psychiatric patients or their relatives, based on psychological, social, and occupational factors as well as specific symptoms and symptom severity. The instruments also measured quality of life, insight, self-esteem, and cognitive function. Further, the studies examined therapeutic alliances and the experience of family members. The most commonly used instruments were the Global Assessment of Functioning and the Positive and Negative Syndrome Scale.

    Conclusion: The interventions reviewed here emphasize an individualized approach that targets education, illness management, coping strategies, social skills training and relapse prevention, and seeks to alter any harmful understanding of the illness. Although researchers can choose among numerous interventions, psychoeducation was the most appealing follow-up intervention for patients suffering from psychotic disorders. Importantly, evaluation instruments must be relevant to psychological symptoms, treatment, time and resources available, and what questions were being sought to answer. Approximately eleven of the thirty-eight instruments reviewed here showed weak or unclear reliability and validity. The most practical instrument for evaluating the outcome of an intervention for patients suffering from psychotic disorders wasthe Positive and Negative Syndrome Scale.

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