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  • 51.
    Björklund, Margereth
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Berg, Agneta
    Kristianstad University College, Kristianstad, Sweden.
    Health promoting contacts as encountered by individuals with head and neck cance2009Ingår i: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 1, nr 3, s. 261-268Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim.  To describe the characteristics of health promoting contacts with health professionals as encountered by individuals with head and neck cancer.

    Background.  Head and neck cancer has a profound and chronic impact on the individual’s everyday life, e.g. physical problems that hinder speaking, breathing, eating and drinking. Furthermore, fear and uncertainty can lead to long-term psychological and psychosocial problems. The National Institute of Public Health in Sweden advocates that all care contacts should improve the quality of the individual’s health.

    Design.  A qualitative descriptive and explorative design was used. Eight participants were interviewed in the year 2005 and a qualitative thematic content analysis of the data was performed.

    Findings.  Health promoting contacts were defined as contacts where health care professionals contribute positively to the well-being of individual patients. Characteristics include being available, engaged, respectful and validating. Three themes were identified: being believed in one’s illness story; having a working relationship with health professionals and receiving individualised, tailored care.

    Conclusions.  Health promoting contacts were experienced mainly during the treatment phase, when patients had daily contact with specific, qualified health professionals. Although the interview questions focused on health promoting contacts, nearly half of the contacts were experienced as not health promoting. Feelings of abandonment were particularly manifested before and after treatment. The starting point for achieving health promoting contact lies in understanding the patient’s lifeworld in relation to health, illness and suffering and focusing on the individual’s personal strengths and health resources.

    Relevance to clinical practice.  The findings highlighted the importance of ensuring that patient interests and concerns are core considerations in health care. The participants viewed continuing individualised, tailored care and access to ear, nose and throat healthcare professionals as highly important.

  • 52.
    Björklund, Margereth
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Berg, Agneta
    Kristianstad University College, Kristianstad, Sweden.
    Health promotion and empowerment from the perspective of individuals living with head and neck cancer.2008Ingår i: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 12, nr 1, s. 26-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to shed light on health promotion from the perspective of individuals living with head and neck cancer. Eight informants were interviewed and latent content analysis was used. Individuals living with head and neck cancer experienced many problems that had a negative impact on their health. One overarching main theme was demonstrated; the ability to regain control and empower oneself. Three themes emerged: (1) Being enabled by dialogue with one's inner self, including three sub-themes: transformed and improved self-esteem, recognising and embracing existentiality, and increased self-determination. (2) Being enabled by means of contact with a social network, including two sub-themes: emotional support and practical support. (3) Being enabled by means of contact with and a passion for the environment, including two sub-themes: nature, hobbies and activities. Empowerment, the goal of health promotion, was understood as an ongoing process, and the ability to promote health varied and was dependent on internal and external enabling of acting and doing. The interpretation of this ongoing process demonstrates interplay assisted by a dialogue with one's inner self, contact with a social network and a passion for the environment. Altogether, these findings may inspire nurses and other health care professionals to support the individual's empowerment process and pose non-pathology-oriented questions such as "what improves your health?" or "what makes you feel good?"

  • 53.
    Björklund, Margereth
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Sarvimäki, Anneli
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Berg, Agneta
    Kristianstad University College, Kristianstad, Sweden.
    Living with head and neck cancer:: a profile of captivity2010Ingår i: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 2, nr 1, s. 22-31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim.  To illuminate what it means to live with head and neck cancer.

    Background.  Patients could experience head and neck cancer as more emotionally traumatic than other cancers because of visible disfigurement and its life-threatening impact on vital functions. This long-term illness often leads to lifestyle changes such as to physical function, work and everyday tasks, interpersonal relationships and social functioning.

    Design.  This study used a qualitative and explorative longitudinal and prospective design with semi-structured interviews and open-ended questions. Twenty-one interviews were conducted with six participants with newly diagnosed or newly recurrent head and neck cancer. The analysis was descriptive and interpretive.

    Findings.  The participants were living ‘in captivity’ in the sense that their symptoms were constant reminders of the disease. Our findings also revealed existential loneliness and spiritual growth, as interpreted within six themes: altered sense of affiliation; hostage of health care; locked up in a broken body, but with a free spirit; confined in a rogue body, forced dependency on others, and caught up in a permanent illness trajectory.

    Conclusions.  Living with head and neck cancer involves emotional and existential vulnerability. The participants and their next of kin experienced insufficient support from health services and inadequate coordination between phases of their lengthy illness trajectory. These findings call for changes in oncological rehabilitation and management. Patient care must take a holistic view of everyone involved, centring on the individual and the promotion of health. A care coordinator could navigate between the individual patient needs and appropriate health services, hopefully with results that lessen the individual’s emotional and existential confinement.

  • 54.
    Bjørnerud, Anne Merete
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Fysisk aktivitet på resept.: Tre års oppfølging av aktivitetsnivå og helserelatert livskvalitet.2014Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Bakgrunn: Frisklivssentralen, eller fysisk aktivitet på resept,er en kommunal forebyggende helsetjeneste i Norge med tilbud om hjelp til endring og mestring av levevaner.Forskning som dokumenterer langtidseffekten av deltagelse i tilbudeter begrenset.

    Formål: Denne studien undersøker om Frisklivssentralenoppnår målsettingen om varig endring av fysisk aktivitetsnivå og helserelatert livskvalitet,målt tre år etter deltagelse.

    Metode: Tre år etter deltagelse i Frisklivssentralen (04.2010-03.2011) ble en spørreundersøkelse besvart av 33 tidligere deltagere for å utforske deres nåværende fysisk aktivitetsnivå, opprettholdelse av aktivitetsnivå, faktorer som påvirker opprettholdelse av aktivitet, helserelatert livskvalitet og erfaringer fra oppfølgingen i Frisklivssentralen. Resultatene ble sammenlignet med data innsamlet ved baseline og tre måneders oppfølging. Deskriptive statistikker ble brukt for å beskrive utvalget og fordelingav svarene. Ikke-parametriske tester ble brukt for å se på endring over tid og for å sammenligne subgrupper.

    Resultater: Resultateneviserat denpositiv endringeni aktivitetsnivå fra baselinetil tre måneder vedvarte til tre år etter(P=0.001). Fra baseline til tre år hadde 39,4% av respondentene økt aktivitetsnivået. De som ikke økte aktivitetsnivået hadde et høyere aktivitetsnivå ved baseline. Etter tre år var medianen for hele utvalget etaktivitetsnivå på > 4 timer per uke. Uavhengig av endring i aktivitetsnivå fra baseline til tre år,rapporterte deltagerne positiveendring i helserelatert livskvalitet(P≤0.001).

    Konklusjon: Frisklivssentralen øker fysisk aktivitetsnivå og helserelatert livskvalitet. Deltagere som i utgangspunktet var mindre aktive (f.eks. 1-2timer per uke)økte sitt aktivitetsnivå til > 4 timer per uke og opprettholdt det i tre år. Respondentene oppnådde bedring i helserelatert livskvalitet uavhengig av endring i aktivitetsnivå.

  • 55.
    Blas, Erik
    Nordiska ministerrådet, 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.
    1990 - 2000: A Decade of Health Sector Reformin Developing Countries: Why, and What Did We Learn?2005Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Objective: The overall aim of the work is to contribute to a better understanding of the dynamics between health sector reform policies and practices as well as the factors that determine and shape the thinking about global public health; and to try out a framework for understanding the inter-linkages and interactions between the determinants for and the elements of health sector reforms and their implementation.

    Methods: The object of study was a contemporary phenomenon, consisting of a diverse array of interventions in many different directions and fields within a complex political, social and economic environment. It is difficult to attribute the effects of the reforms to any single intervention or to establish exact boundaries between the phenomenon and the context. Therefore, a multi-stage case study research strategy, based on the work of R.K.Yin, was chosen. The study involved two major sub-units of analysis, i.e., the macro and the micro level. Each of these involved several sub-units of analysis. The analysis of the micro level further comprised a cross-case analysis of 10 individual case studies conducted in six developing countries.

    Results: Clear linkages were found between the greater societal processes and the shape and results of reforms during the decade. The reforms had not been completed in any of the countries studied, but appeared to be stuck with undesired effects, lacking energy to move forward. Contributing to this was the diminishing role of the state, which bordered abdication from public health in most of the countries, leaving the drive to the market and individual demands and interests. The net effect could well be a reversal of some of the public health achievements of the past - however, it was also found that reverting to dedicated disease control programmes would not be the answer, as these were found unsustainable and undermining the health systems.

    Conclusion: There is a divide between libertarian and utilitarian values on the one side and communitarian and egalitarian values on the other. Thus, it is not just about public health practitioners not being good enough to implement, it is more so about what we want to achieve and what it acceptable respectively not acceptable and reaching compromises. This place the societal processes at centre-stage for public health. However, it is also about implementation, it is about how public health policy-makers and reformers can effectively dialogue and facilitate achieving consensus and translate the societal 'wants' and 'want nots' into managerial bites. Implementation becomes a process of constant adjustment and readjustment oscillating between political and technocratic levels

  • 56.
    Blas, Erik
    Nordiska ministerrådet, 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.
    The proof of the reform is in the implementation.2004Ingår i: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 19 Suppl 1, s. S3-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In 2000, TDR funded a series of studies to examine the opportunities and threats of health sector reform to the control of tropical diseases. This article is a cross-case analysis of ten of those studies, exploring the similarities in patterns across the countries covered: Colombia, China, Nigeria, the Philippines, Sudan, Tanzania and Uganda. The implementation experiences across countries were strikingly similar despite very different socio-economic and epidemiological situations. The reform implementation was neither complete nor clean and had in all the countries found some sort of least-energy equilibrium where the processes had stopped at a sub-optimal stage needing considerable renewed 'change-energy' to achieve its objectives. The role of the state had, in several cases, been reduced to a situation where it neither pursued the interest of the public nor protected the individual against harm caused by the behaviours of others. Whether one should follow a dedicated disease control programme or a systems approach is not a relevant question. Effective disease control cannot be implemented without strong and functioning health systems and health system performance cannot be improved without considering which purpose the system is to serve.

  • 57.
    Blas, Erik
    et al.
    Nordiska ministerrådet, 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.
    Limbambala, M
    The challenge of hospitals in health sector reform: the case of Zambia.2001Ingår i: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 16 Suppl 2, s. 29-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Zambia underwent a period of health sector reform from 1993 to 1998. The reform attracted substantial support from the World Bank and bilateral donors. While significant achievements were made with respect to decentralization, increased accountability and donor collaboration, the reform stalled in 1998 without having achieved its objectives, largely because of the handling of hospital reform and the civil servants in the health sector. This study was an attempt to analyze this experience with the hospital issue. Service and infrastructure information was collected from all 88 hospitals in the country. Further, information was collected about the social, economic, and political context of the reform. The results show that an historical legacy from the colonial and post-colonial eras has left the country with an expensive and skewed hospital structure that is rapidly deteriorating and very difficult to reform. The referral system is not functioning: higher-level hospitals provide a higher level of care to their immediate catchment populations than is available to the population in general. The reality is thus far from the vision of equity of access to cost-effective quality care. Zambian doctors have either left the country or are concentrated at the highest referral levels in two provinces, leaving the lower levels and most of the country in the hands of expatriate doctors. There are no resources in the government or the private systems to maintain the current hospital infrastructure and things will likely deteriorate unless radical decisions are taken and implemented. The study further shows that the question of hospital reform is a political high-risk zone. If the problems are to be dealt with, the Zambian planners must, together with the politicians, work to create a broad national consensus for understanding the situation, its urgency, and the limited options for forward action.

  • 58.
    Blas, Erik
    et al.
    Nordiska ministerrådet, 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.
    Limbambala, M
    User-payment, decentralization and health service utilization in Zambia.2001Ingår i: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 16 Suppl 2, s. 19-28Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The study was undertaken to assess the impact of health sector reform from 1993 to 1997 in Zambia in respect of health care service utilization and the shift of caseload from hospitals to health centres. Four key indicators were chosen: general attendance, measles vaccinations, general admissions, and deliveries. Complete sets of district data were analyzed, covering 4.5 million people out of the total population in 1997 of 9.7 million. The results show, on the one hand, a dramatic decrease of about one-third in general attendance for both hospitals and health centres over a 2-year period, followed by a period with a continued but slower decrease. On the other hand, the results also show increases at health centres in measles vaccinations (up 40%), in admissions (up 25%) and in deliveries (up 60%). The study further documents a shift of caseload from hospitals to health centres for some key services. The health centre share increased from 72.2% to 79.8% for measles vaccinations, from 23.9% to 31.0% for general admissions, and from 22.9% to 32.4% for deliveries. However, the intended overall shift in outpatient caseload from hospitals to health centres did not materialize. The main lessons are: utilization patterns can be influenced by policies such as user-payment and decentralization; user payment in poor populations leads to dramatic declines in utilization of services; and decentralization with local control of resources could be an alternative to the traditional vertical disease programme approach for priority interventions.

  • 59.
    Blix, Ellen
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    INNKOMST-CTG. En vurdering av testens prediktive verdier, reliabilitet og effekt: Betydning for jordmødre i deres daglige arbeid2006Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
  • 60.
    Blix, Ellen
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV. Nordic School of Public Health NHV.
    Ohlund, Lennart S
    Norwegian midwives' perception of the labour admission test.2007Ingår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 23, nr 1, s. 48-58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To explore what information and knowledge the labour admission test is perceived to provide and what meaning the test carries in the daily work of practising midwives.

    DESIGN: In-depth interviews transcribed verbatim and analysed using the grounded theory technique.

    SETTING: Four different labour wards in Norway.

    PARTICIPANTS: A theoretical sample of 12 practising midwives.

    FINDINGS: The core category "experiencing contradictions" was identified during the analyses, indicating that the midwives found conflicting interests within themselves, or between themselves and others when using the labour admission test. They experienced contradictions between professional identity and the increasing use of technology, between feeling safe and feeling unsafe and between having power and being powerless.

    KEY CONCLUSIONS: The labour admission traces could be difficult to interpret, especially for newly qualified midwives. Some midwives thought that a labour admission trace could protect them in case of litigation. The hierarchy of power in the labour ward influences the use and interpretation of the labour admission test. Some midwives felt their professional identity threatened and that midwives in general are losing their traditional skills because of the increasing use of obstetric technology.

    IMPLICATIONS FOR PRACTICE: The findings of the present study should be taken into consideration when changing practice to not routinely perform the labour admission test. There is also a need for further research on what effect the increasing use of obstetric technology has on traditional midwifery skills.

  • 61. Blix, Ellen
    et al.
    Oian, Pål
    Interobserver agreements in assessing 549 labor admission tests after a standardized training program.2005Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 84, nr 11, s. 1087-92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The labor admission test is a short cardiotocography (CTG) performed upon admission to the maternity ward. The aim of the present study is to examine interobserver agreements when the labor admission tests were assessed by midwives and obstetricians who had received training in interpreting CTG.

    METHODS: Five hundred forty-nine high- and low-risk women who delivered at Hammer-fest Hospital were included. The tests were assessed by three midwives and three obstetricians who had completed a standardized training program. The traces were assessed as normal, intermediary, or abnormal. Weighted kappa (kappaw), proportion of agreement (Pa), and predictive values were calculated.

    RESULTS: Between the pairs of observers, kappaw varied between 0.57 and 0.75; Pa for a normal test between 0.78 and 0.88, and Pa for an intermediary/abnormal test between 0.56 and 0.69. At a cutoff intermediary test, mean sensitivity was 0.43 (range=0.39 -- 0.48), specificity 0.75 (range=0.69 - 0.81, positive predictive value 0.13 (range=0.12 -- 0.15), negative predictive value 0.94 (range=0.94 -- 0.94), likelihood ratio (LR) for a positive test result 1.73 (range=1.53--1.99), and LR for a negative test result 0.76 (range=0.75--0.77).

    CONCLUSIONS: Midwives and obstetricians who had completed the training program achieved good levels of agreements in assessing labor admission tests. The agreements in normal tests were better than those in intermediary/abnormal tests. Obstetric staff should be aware that there are disagreements in assessing labor admission tests; especially in tests assessed as intermediary/abnormal.

  • 62.
    Blix, Ellen
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV. Nordic School of Public Health NHV.
    Reiner, Liv M
    Klovning, Atle
    Oian, Pal
    Prognostic value of the labour admission test and its effectiveness compared with auscultation only: a systematic review.2005Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 112, nr 12, s. 1595-604Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To assess the effectiveness of the labour admission test in preventing adverse outcomes, compared with auscultation only, and to assess the test's prognostic value in predicting adverse outcomes.

    DESIGN: Systematic review.

    SETTING: Labour wards in hospitals.

    POPULATION: Pregnant women in labour. Three randomised controlled trials including 11,259 women and 11 observational studies including 5831 women.

    METHODS: Literature searches in Medline, EMBASE, CINAHL, SweMed, The Cochrane Central Register of Controlled Trials, reference lists from identified studies and contact with experts.

    MAIN OUTCOME MEASURES: Obstetric interventions (augmentation of labour, continuous electronic fetal monitoring, epidural analgesia, fetal blood sampling and operative deliveries) and neonatal outcomes (perinatal mortality, Apgar score, seizures, resuscitation and admission to neonatal unit).

    RESULTS: Meta-analyses of the controlled trials found that women randomised to the labour admission test were more likely to have minor obstetric interventions like epidural analgesia [relative risk (RR) 1.2, 95% confidence interval (95% CI) 1.1-1.4], continuous electronic fetal monitoring (RR 1.3, 95% CI 1.2-1.5) and fetal blood sampling (RR 1.3, 95% CI 1.1-1.5) compared with women randomised to auscultation on admission. There were no significant differences in any of the other outcomes. From the observational studies, prognostic value for various outcomes was found to be generally poor. Likelihood ratio (LR) for a positive test was above 10 in 2 of 28 single outcomes and between 5 and 10 in six outcomes.

    CONCLUSIONS: There is no evidence supporting that the labour admission test is beneficial in low risk women.

  • 63.
    Blix, Ellen
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Sviggum, Oddvar
    Koss, Karen Sofie
    Øian, Pål
    Inter-observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts.2003Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 110, nr 1, s. 1-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To assess the inter-observer agreement in assessment of the labour admission test between midwives and obstetricians in the clinical setting and two experts in the non-clinical setting, the inter-observer agreement between two experts in the non-clinical setting and to what degree fetal distress in labour could be predicted by the two experts.

    DESIGN: Observational study.

    SETTING: The maternity unit of Hammerfest Hospital, Norway.

    POPULATION: Eight hundred and forty-five high and low risk women.

    METHOD: The labour admission test was first assessed by the midwife or obstetrician in the clinical setting, and was later assessed by two experts. The traces were assessed as normal, equivocal or ominous. Weighted kappa (kappaw), proportion of agreement (Pa) and predictive values were calculated.

    MAIN OUTCOME MEASURES: Weighted kappa, proportion of agreement, sensitivity, positive predictive value and likelihood ratios.

    RESULTS: Inter-observer agreement between Expert 1 and Expert 2: kappaw 0.38 (CI 0.31-0.46), Pa for reactive labour admission test 0.86 (CI 0.83-0.88) and Pa for equivocal/ominous test 0.33 (CI 0.26-0.40). Agreement between Expert 1 and midwives/obstetricians: kappaw 0.25 (CI 0.15-0.36), Pa for reactive labour admission test 0.89 (CI 0.87-0.91) and Pa for equivocal/ominous labour admission test 0.18 (CI 0.11-0.25). Agreement between Expert 2 and midwives/obstetricians: kappaw 0.28 (CI 0.20-0.37), Pa for reactive labour admission test 0.85 (CI 0.82-0.88) and Pa for equivocal/ominous test 0.20 (CI 0.14-0.26). Totally 5.9% of the newborns had fetal distress. At cutoff equivocal test, sensitivity was 0.22 and 0.31 in the two observers. Positive predictive values were 0.13 and 0.11. Likelihood ratio for a positive test was 2.30 and 1.92 and likelihood ratio for a negative test 0.86 and 0.83.

    CONCLUSION: A labour admission test is still routine practice in most obstetric units in the Western world when there is little evidence on its benefits. The results from this study may provide some reconsideration for such practice, and for more research.

  • 64.
    Blix, Ellen
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV. Nordic School of Public Health NHV.
    Øian, Pål
    Labor admission test: an assessment of the test's value as screening for fetal distress in labor.2001Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 80, nr 8, s. 738-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: To determine if the labor admission test (LAT) can predict fetal distress in a population of laboring women, and in subgroups of low- or high-risk women, who delivered within six hours or between six and 24 hours after LAT.

    METHODS: The data charts of all women who delivered at Hammerfest Hospital in 1996, 1997 and 1998 were retrospectively read. If the woman was admitted to the hospital because of onset of labor, was in the first stage of labor and delivered within 24 hours after admission, she was included. In the study period, 1639 gave birth and 932 were included in the study. A descriptive analysis of the population and assessment of LAT's sensitivity, positive predictive value, specificity and negative predictive value at different cut-off values was done.

    RESULTS: In the study population 5.8% had fetal distress, and 5.3% had an operative delivery because of fetal distress. LAT's sensitivity in the whole population was 0.15 and positive predictive value was 0.16. Specificity was 0.95 and positive predictive value was 0.95. In the subgroups of low- and high-risk women, who delivered within six hours or between six and 24 hours after LAT, sensitivity varied between 0 and 0.36, and positive predictive value varied between 0 and 0.27. Specificity varied between 0.92 and 0.96, and negative predictive value varied between 0.89 and 0.97.

    CONCLUSIONS: According to these results, LAT cannot be recommended as a screening test for fetal distress in labor in low-risk women. Sensitivity is too low, and there are too many false-positive tests. It is unclear if LAT has benefits among high-risk women.

  • 65.
    Bloch, Bente
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    ”Hygiejne på tværs”: tværsektorielt samarbejde omkring patient/borger med behov for infektionshygiejnisk bistand – hvordan løses opgaven?2012Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [da]

    Baggrund: Patientbehandling på sygehuse sker i et højt specialiseret tempo, hvor flere patienter modtager kompliceret pleje og behandling, som ofte fortsætter i kommunerne efter udskrivelsen. Efter strukturreformen skal aftaler om infektionshygiejnisk bistand fra sygehus til kommune indskrives i sundhedsaftaler.

    Formål: Formålet med studiet var at udforske og analysere samarbejde på tværs af sektorer, og få en øget forståelse for fænomenet tværsektorielt samarbejde i relation til patient/borger med behov for ydelser, hvori der indgår infektionshygiejnisk bistand.

    Metode: Studiet er et kvalitativt multiple casestudie, hvor empirien hentes via semistrukturerede interviews. Teorigrundlaget er perspektivet på tværsektorielt samarbejde, eksempler på modeller for samarbejde, og styrker og svagheder i samarbejde.

    Resultat: Studiet viste, at motiverende faktorer for tværsektorielt samarbejde i praksis var: fokus på organisering og struktur i organisationerne, at arbejde sammen i netværk, bevidsthed om klare kommunikationsveje og fokus på faglighed og kompetencer i forhold til infektionshygiejne. Struktureret samarbejde mellem kommune og sygehus med oprettelse af hygiejneorganisation mellem sektorer, gav adgang til ekspertviden, tryghed hos plejepersonalet og motivere til at arbejde med infektionshygiejne som indsatsområde.

    Konklusion: Nosokomielle infektioner hos patienter og borgere i sektorovergange, kan sandsynligvis forebygges ved dels at tilføre viden om infektionshygiejne til personale på alle niveauer i organisationerne, og dels ved at indgå et formelt samarbejde mellem kommune og sygehus omkring etablering af en tværsektoriel hygiejneorganisation.

  • 66.
    Blomberg, Carina
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Att förebygga osteoporos i en svensk kommun: En beskrivning av ett tioårigt befolkningsinriktat interventionsarbete ”Vadstena en benhård kommun2008Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Benskörhet (osteoporos) och frakturer orsakade av osteoporos är ett stort globalt problem. Syftet med det tioåriga projektet ”Vadstena en benhård kommun” var att utvärdera om man med en befolkningsinriktad interventionsstrategi kunde minska osteoporos och osteoporosrelaterade frakturer i en kommun. Ett representativt urval av befolkningen i åldern 20-79 år, 15% av en population på 7800 personer, blev tillfrågade om att delta vid fyra undersökningstillfällen som innebar att fylla i en enkät och att bentäthetsmätas. Vid första tillfället deltog 70%, första uppföljningen 69%, andra uppföljningen 79% och vid den tredje uppföljningen 65%.Syftet med denna MPH-uppsats är att beskriva det praktiska interventionsarbetet utifrån dagboksanteckningar och att presentera befolkningens upplevelser av interventionsarbetet.Vi nådde uppskattningsvis 5000 personer (65%) av befolkningen med direkt information.De personer som fick individuella riskprofiler baserade på angivna svar i frågeformulär och bentäthetsvärden var de som gav mest positiv respons och kan tillskrivas en lyckad individuell intervention.Den grupp som varit med en eller flera gånger tidigare (interventionsgruppen) var de som vid sista undersökningen 1999, hade fått ökad kunskap om osteoporos (P<0,001). Den gruppen kände även bäst till projektet (P<0, 001), men även den nya gruppen (befolkningsgruppen) kände i hög grad till projektet (75 %). På frågan om deltagarna ville förändra sina vanor var båda grupperna lika villiga (65 % respektive 64 %), vilken kan tillskrivas en lyckad generell intervention.Sjukdomen osteoporos och dess följder tar lång tid att utveckla. Det tar därför även lång tid att mäta effekt av att projekt som detta, som dessutom innefattar en hel befolkning. Nu, 18 år efter projektets start görs en uppföljning av projektet där delar av de mål som sattes upp i början av projektet mäts, bland annat frakturincidens och kunskap om osteoporos hos befolkningen.Nyckelord

  • 67.
    Blomfeldt, Anita
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Impacts of infectious diseases on poverty: What do we know and what way forward?2007Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    Combating infectious diseases and poverty are hot topics on the world development agenda. The vicious cycle of ill health and poverty is reinforced by a “medical poverty trap” relating to households being impoverished due to escalating illness-related out-of-pocket costs, especially in combination with loss of income due to incapacity to work. Evidence-based knowledge on the impacts of ill health on household welfare is essential to design adequate interventions and evaluate their efficiency. This thesis presents the findings of a critical review of studies assessing the impacts of infectious diseases on households’ ability to utilize their resources and generate income in rural Sub-Saharan Africa. The review revealed a dearth of relevant studies (merely 15), poor methodological quality in short-term geographically limited surveys, and large diversity in study design obstructing comparison of results and extraction of general conclusions. Major research obstacles are discussed and recommendations for coordination, standardization and scaling up of data collection that allows adequate impact assessment are suggested. Experimental intervention studies are recommended to improve quality and efficiency of interventions and guide prioritizing processes prior to large scale implementations to avoid waste of time and resources. The linkages between infectious diseases and poverty are complex and multifaceted and thus imply multi- and interdisciplinary research approaches. Collaboration between various disciplines like health sciences, economics, geography and sociology give opportunities of linking data in innovative ways to provide new insights and perspectives that have the potential to analyse the impacts of infectious diseases on poverty in a more comprehensive manner. Methodological standardisation and consensus will enable us to accumulate comparable results and scale up research and thereby contribute to foundation of efficient interventions to accomplish sustainable improvements in health and significant reductions in poverty.

  • 68.
    Bock, Catharina
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Svenska komplementär- och alternativmedicinska terapeuters praktikmönster och samarbete med legitimerad sjukvårdspersonal2009Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Historiskt har den medicinska professionen sökt exklusiva rättigheter att praktisera i en miljö där många olika yrkesgrupper fanns. I Sverige har detta lett till att komplementär och alternativ medicin (CAM) hamnade utanför den etablerade sjukvården, vilket inneburit en bristfällig kunskap om hur bl.a. CAM terapeuter arbetar. Användning av alternativ medicin har ökat i Sverige vilket motiverar att studier genomförs för att få bättre kunskap om yrkets utövande.

    Syftet med uppsatsen är att beskriva CAM terapeuters praktikmönster och inställning till samarbete med traditionell skolmedicin.

    Utifrån en litteraturstudie utarbetades en enkät som skickades till 102 CAM terapeuter i Sverige för att undersöka deras praktikmönster och sociodemografiska egenskaper. 63 terapeuter (62 %) svarade, varav 59 uppfyllde forskningskriterierna och kunde delta i de fördjupande telefonintervjuer som följde efter enkätstudien och som syftade till att ta reda på deras syn på samarbete med den skolmedicinska sjukvården.

    Resultaten av undersökningen visade att 55 %, av de 59 intervjuade var kvinnor, 10 % hade legitimation i andra sjukvårdsyrken, 69 % arbetade ensamma med i snitt 24 patienter i veckan. 79 % var positiva till samarbete med skolmedicinen och 37 % hade redan regelbunden kontakt med läkare.

    Intervjuerna visade att CAM terapeuter generellt ansåg att det var viktigast att patienters behov och önskemål beaktades i utformningen av den vård som erbjöds. Patienternas kostnad för behandling, respekt för CAM terapeuter, legitimation, konkurrens, samarbete med och kunskap om de olika yrken var andra viktiga faktorer som belystes ur olika perspektiv.

    Studien ger ny kunskap om CAM i Sverige och avslöjar många hinder som gör samarbete mellan skolmedicin och CAM till en utmaning för CAM terapeuter. Resultaten från denna studie kan hjälpa till att utveckla en sjukvård som omfattar olika utövare av läkekonsten

  • 69. Bolin, Ylva Sjögren
    et al.
    Lindeberg, Ingrid
    Undeclared allergens in food: Food control, analyses and risk assessment2016Bok (Övrigt vetenskapligt)
    Abstract [en]

    Denmark, Finland, Norway and Sweden collaborated during 2015 in a control project on allergen labeling. Products were also analysed for the allergens milk, egg, hazelnut, peanut and gluten. Correct labeling is the only aid for allergic consumers to avoid products which could pose a serious health risk. The widespread use of non-regulated precautionary allergen labeling (PAL) might decrease the amount of products available for allergic consumers. It can also pose a risk since the PAL might be ignored. On 10% of the controlled products, the allergenic ingredients were not correctly transcribed in the list of ingredients and EU regulations were thus not followed. Milk was the most frequently found undeclared allergen, especially in chocolate and bakery products, and therefore constitute a risk for allergic consumers. The results might give input to achieve EU legislation regarding PAL.

  • 70.
    Boström, Inger
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Multipel skleros – hög prevalens i Värmland?: En epidemiologisk studie2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Syftet med denna studie var att beräkna preliminär prevalens för sjukdomen multipel skleros (MS) i Värmland, med prevalensdag 21 december 2002, och jämföra den med andra prevalensstudier i Sverige. Utifrån patientjournaler vid länets sjukvårdsinrättningar noterades basala och medicinska data på ett registreringsformulär. För klassificering av MS har Poser ́s kriterielista tillämpats och granskningen av journaler har utförts av specialist neurologer. Prevalensen för definite/probable MS i Värmland, baserad på siffror som var insamlade augusti 2004, var 151/105 (95% CI 136-165), för kvinnor var prevalensen 211/105 (95% CI 187-235) och för män 89/105 (95% CI 73-105), vilket innebär att MS var 2,37 gånger vanligare för kvinnor. Vid jämförelse av den preliminära prevalens för Värmland och Västerbotten visade det sig att Värmland hade nästan lika hög prevalens och kan liksom Västerbotten betecknas som högriskområde för MS.

  • 71.
    Botne, Bjørg
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Hjelle, Kjell
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Fra begrensninger til mulighet.: Kan systemrevisjon som tilsynsmetode stimulere til systematisk forbedringsarbeid i kommunehelsetjenesten?2005Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Staten fører tilsyn med at kommunene i Norge oppfyller lovkrav som gjelder for kommunehelsetjenesten. Siden 1995 har tilsynsmetodikken i hovedsak vært systemrevisjon. I tillegg til at Fylkeslegen/Helsetilsynet i fylket kontrollerer at lovbestemmelser blir fulgt, er systemrevisjonene ment å bidra til systematisk forbedringsarbeid i kommunehelsetjenesten. Målsettingen med denne studien har vært å beskrive hvordan systemrevisjoner påvirker forbedringsarbeidet. Dette er en kvalitativ studie gjennomført som et case-study i to norske fylker. Datainnsamlingen ble gjort høsten 2001 gjennom dokumentgranskning og i fire fokusgrupper – to i hvert fylke. Det ble fokusert på hvilke forventninger 28 ansatte (14 ledere og 14 ”førstelinjepersonell”) i 19 ulike kommuner hadde til systemrevisjonene, hvordan resultatene var håndtert i kommunen og hvilken nytte de ansatte mente tilsynet hadde hatt. Resultatet viser at systemrevisjonene fikk fart på prosesser i kommunene. Tilsynet forarget noen og gledet andre. Hovedskillet går mellom et ønske om hjelp til faglig forbedring av helsetjenesten og ønsket om et friere kommunalt selvstyre. Det var tre forhold ved gjennomføringen av tilsynet som viste seg å være betydningsfulle med tanke på å bidra til systematisk forbedringsarbeid i kommunehelsetjenesten: språket/kommunikasjonen, individuell tilpasning og at kommunens øverste ledelse ble direkte involvert under tilsynsbesøket

  • 72. Bremberg, Sven
    Unga mäns hälsa i de nordiska länderna2018Rapport (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Den socialt betingade ojämlikheten i hälsa har tilltagit under de senaste decennierna. Den här utvecklingen har särskilt drabbat unga män i form av ökad förekomst av drogrelaterad sjuklighet och död, värk i nacke och rygg, självmord och skador betingade av våld.

    Utvecklingen har sannolikt en grund i ökade krav för inträde på arbetsmarknaden, vilket i sin tur hänger samman med ökad global konkurrens.

    Den här rapporten tar upp fyra frågor: först beskrivs hälsoutvecklingen bland unga män, sedan utvecklingen av sociala skillnader bland unga, följt av en diskussion om några tänkbara förklaringar till att hälsan är sämre bland män än bland kvinnor. Rapporten avslutas med ett avsnitt som diskuterar förklaringar till varför hälsan bland unga utvecklats sämre än hälsan i andra åldersgrupper.

  • 73.
    Brjánsson, Guðjón S.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Managerial aspects on governance of healthcare in Iceland2014Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    Purpose: This study aimsto analyze managerial aspects of governance within Icelandic healthcare institutions, particularly regarding job descriptions and policy-making plans.

    Method: We used a qualitative research method and content analysis to examinedata collected from semi-structured interviews Ten participants (5 malesand 5 females) who worked as senior managers, middle-management executives in the healthcare service, and Ministry of Welfare officials. The participants reflected a breadth of experience and education across the spectrum of age, length of service, and work experience in both hospitals and primary care.

    Results: Data analysis revealed three main categories including policy-making plans in healthcare, which identified a considerable gap between managers and executives on one side and the Ministry of Welfareon the other, especially regarding strategy. Incidental control and effect of politicians on healthcare operation. Second, inrelation to the Ministry of Welfareand healthcare institutions we observed unstructured, onerous, and remote communications and organization that focused too little on professional issues. The Ministry of Welfare tended to interfere with managers’ responsibilities and scope of work. Third, we observeds trengths and weaknesses in management. Strengths includedad ministrators’ enthusiasm, ideas of empowerment, short lines of communications, and often straightfor ward interactions, compared withweaknesses in the workprocesses within healthcare institutions and toward the Ministryo f Welfare, and also in job descriptions and vague definitions of the institutions’role.

    Conclusion: The indications reported here suggestun clear policy-making plansfor healthcare institutions. Although managers and executives maintained that visions for the futureare vague, the Ministry of Welfare stated that the strategy was clear. The study identified a need of strengthening and restructuring the way of communications, as well as clarifying managers’ role toward the Ministry of Welfare

  • 74.
    Broch Brantsæter, Arne
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Evaluering av det norske BCG: vaksinasjonsprogrammet for ungdommer i et nordisk perspektiv2008Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Mål: Å vurdere effekten av det norske BCG-vaksinasjonsprogrammet blant ungdommer ved(1) å vurdere om forskjeller i tuberkuloseepidemiologi i fire nordiske land er assosiert med forskjeller i bruk av BCG og (2) å estimere betydningen av BCG vaksinasjon blant ungdommer i Norge.

    Metode: Studieperioden var 1975-2005, med hovedvekt på 1996-2005. Artikler, overvåkingsrapporter, EuroTB-databasen og nasjonale tuberkuloseregistre var datakilder. Data fra EuroTB ble brukt til å beregne insidensrater for tilfeller rapportert som “born in country/national” i Norge, Sverige, Finland og Danmark. Data fra de norske og svenske tuberkuloseregistrene ble brukt til å beregne insidensrater for tilfeller som var født i de respektive land og som hadde foreldre som begge var født i et land med lav insidens av tuberkulose. Insidensrater for aldersgruppene 0-14 and 15-29 år ble sammenlignetHovedresultater: Fra 1975 til 2005 var det et fall i insidensrate i alle landene, mest uttalt i Finland. I 1996-2005 hadde Finland lavest insidensrate i aldergruppen 0-14 år, og Norge hadde lavest insidensrate i gruppen 15-29 år. Dette er forenlig med beskyttende effekt som følge av BCG-vaksinasjon av nyfødte i Finland og av 12-14-åringer i Norge. Vi estimerer at det norske BCG vaksinasjonsprogrammet blant ungdommer gir 61-64% beskyttelse i aldersgruppen 15-29 år. Om man forutsetter 50-80% beskyttelse, er det nødvendig med 14918 - 51409 vaksinasjoner for å forebygge ett tilfelle av tuberkulose. I 1996-2005 kan tidligere BCG-vaksinasjon blant ungdommer ha forebygget 1,2 – 3,9% av tilfeller av tuberkulose blant norskfødte, og 0,4 – 1,2% av totalt antall tilfeller.

    Konklusjoner: BCG-vaksinasjon av norske ungdommer med lav risiko for tuberkulose kan ha bidratt til redusert risiko for tuberkulose i en periode på 15 år etter vaksinering. Men et stort antall vaksinasjoner er nødvendig for å forebygge ett tilfelle.

  • 75.
    Bru, Grete Karin
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Dagsenterets betydning for brukerne2005Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Hensikten med denne studien var å søke kunnskap om brukerne ved dagsenter i Norge, og hvilken betydning det hadde for deres hverdag at dette tilbudet eksisterte. Dybdeintervju med ni brukere av dagsenter ble foretatt. I innsamling og analyse av data ble Grounded Theory brukt. En kjernekategori kom frem: Gjennom aktivitet og sosial kontakt med andre motvirkes opplevelsen av sosiale savn og depresjoner. Funnene viste at det var mye ensomhet og isolasjon blant informantene. Dagsenter-tilbud to-tre ganger i uken ga dem mulighet for et sosialt nettverk og sosial aktivitet. Dette førte til at de følte seg friskere og ved bedre helse. De viktigste funnene var at dagsentrene representerte fellesskap med andre eldre, aktivitet, trivsel ,og omsorg.

  • 76.
    Brännström Forss, Birgitta
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Må bra på äldre dar: en studie av ett hälsofrämjande samverkansprojek2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Syftet med denna studie är att förstå den erfarenhet och kunskap om samverkan som deltagarna i Må bra på äldre dar - projektet fått i det hälsofrämjande samverkansprojektet. Studien fokuserar på framgångsfaktorer och hinder för samverkansprocessen, hur projektet påverkat maktförhållandena mellan de ideella och offentliga organisationerna, deltagarnas organisatoriska erfarenheter av samverkan, deras uppfattning av arbetsklimatet och upplevelse av KASAM i projektet. Forskning kring hälsofrämjande samverkan bland äldre är sparsam. En kvalitativ ansats användes med fokusgrupper som datainsamlingsmetod. 11 fokusgrupper genomfördes med 62 deltagare. Intervjuade var representanter för de deltagande organisationerna, äldre och blivande äldre som deltagit. Projektledarens svar på intervjufrågorna redovisades skriftligt. Analys av materialet genomfördes med kvalitativ innehållsanalys. Nio teman framkom vid analys av framgångsfaktorerna: 1. Ledare, eldsjälar, mål, varaktighet, att lyssna mm, 2. offentliga organisationer har störst betydelse, men alla är viktiga, 3. människor möttes och skapade en process som gav flow, 4. delaktighet, 5. gränsöverskridande ett nytt sätt att arbeta, 6. människor och organisationer lärde sig av varandra, 7. nätverksbyggandet ökade i samhället, 8.helhet och sammanhang samt 9. positivt arbetsklimat och ingen stress. Nio teman framkom vid analys av de hinder de olika organisationerna upplevt inom projektet (de äldre och blivande äldre omfattades av fem av dem och projektledarens av sju): 1.bristande stöd och legitimitet, 2. bristande resurser och resursutnyttjande, 3. bristande organisatoriska förutsättningar, 4. ojämlik makt och ekonomiska förutsättningar, 5. otillräcklig förankring, 6. revir och konkurrens, 7. bristande delaktighet och tillit, 8. bristfälliga metoder och 9. stressande arbetsklimat. Deltagarna upplevde delaktighet inom projektet. Både offentliga och ideella företrädare upplevde inte att projektet påverkat de offentliga organisationernas arbetssätt. Projektets legitimitet minskade under projekttiden. Deltagare i projektet fick ny kunskap om att arbeta i samverkan, ny kompetens om att arbeta gränsöverskridande, om vikten av att bygga relationer och skapa nätverk. Projektets arbetsklimat uppfattades både som hälsosamt och stressande. Formuläret SOC 13 användes för att mäta deltagarnas KASAM. Resultatet visare en relativt hög känsla av sammanhang i projektet bland deltagarna. Studien visar på svårigheter att bedriva hälsofrämjande arbete bland äldre. Tecken finns att den offentliga sektorn inte är redo för detta paradigmskifte. Det finns dock mycket att vinna på att initiera hälsofrämjande arbete, social gemenskap utvecklas i ett demokratiarbete med empowerment som metod, ytterst för en hållbar utveckling.

  • 77.
    Bråthen, Tone
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Kunnskap og mestring av en kronisk sykdom: en kvantitativ studie av pasienter med ankyloserende spondylitt2010Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [no]

    Hensikt: Å kartlegge hvilken kunnskap norske pasienter med ankyloserende spondylitt har om sykdommen og i hvilken grad deres tiltro til egen mestringsevne påvirker deres helserelaterte livskvalitet.

    Metode: Tverrsnittstudie i form av en spørreundersøkelse for å kartlegge og beskrive deltagernes kunnskap om sykdommen og hvordan denne kunnskapen påvirker deres livssituasjon. Studien ble gjennomført på 150 pasienter i forbindelse med deres deltagelse på en behandlingsreise til utlandet.

    Resultat: Pasientene var mest fornøyde med den informasjonen de fikk fra spesialist i revmatologi og fysioterapeut. De anga også medpasienter som en viktig kilde til informasjon. Deltagelse i mestringskurs og informasjon fra sykepleier var de informasjonskildene færrest respondenter var fornøyde med. Respondentene hadde mest kunnskap om sykdommens symptomer og trening, mens kunnskap om medikamenter og hjelpemidler/tiltak for tilrettelegging hjemme og på arbeidsplassen var de temaer de hadde minst kunnskap om. De som var mest fornøyde med den kunnskapen de hadde om sykdommen, hadde en signifikant bedre tiltro til at de kunne påvirke sine smerter og sykdomssymptomer.

    Konklusjon: Kunnskap om sykdommen bidrar positivt til å påvirke pasientenes helserelaterte livskvalitet. Læring gjennom utveksling av kunnskap og erfaringer med andre i samme situasjon, synes å være en riktig og positiv måte å tilrettelegge pasientundervisningen på. Målgruppen bør imidlertid kartlegges, slik at undervisningen kan tilpasses deltagernes utdannelsesnivå. Likeledes bør helsepersonellets roller og funksjoner avklares og tydelig defineres.

  • 78.
    Bröms, Margareta
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Attitudes among Swedish medical personnel towarduniversal varicella vaccination and other new vaccines for children2014Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [en]

    Background: Thea ttitudes, knowledge, and experience of health personnel regarding vaccines and preventable diseases contribute importantlyto the success of vaccination programs.

    Aim: This study aimed to valuate the opinions of healthpersonnel involved in the care of children on the introduction of various new and older vaccines to the Swedish childhood vaccination. We particularly examined the knowledge of varicella diseaseas chickenpox and shingles and attitudes toward the varicellavaccine.

    Method: We created and administered aquestionnaire on vaccineprioritization forseveral vaccines, including hepatitis A and B,BCG(BacilleCalmette-Guérin) vaccine to preventtuberculosis, pneumococcal, meningococcal, HPV (human papilloma virus), rotavirus, influenza,respiratory syncytial virus,andTBE(tick bornencephalitis virus),and also explored health personnel’s knowledge about the VZV (varicella zoster virus) vaccine and its diseases. In 2006, the study targeted 600 nurses and physicians in Gothenburg, Sweden, whereas the current study in 2012 followed up with 160 school healthcare personnel.

    Results: The 2006 questionnaire generated 191/600 responses (32%), compared withthe 2012 follow-up questionnaire, which generated 40/160 (25%) responses from school health care personnel. Medical personnel ranked vaccination against hepatitis B highestin both studies. However, our data showed an important shift in attitude regarding HPV and rotavirus vaccination, which ranked lowestin 2006 but higher priority in 2012. Respondents also gave high priority to BCG. In 2006,only 34 of 138 respondents (25%) knew that a varicella vaccine was available, and universal varicella vaccination was generally ranked lower compared with other various vaccines. Additionally, pediatricians and personnel from infectious diseases department in the hospital having direct experience with these verity of varicella and zoster diseases were more likely to support universal varicella vaccination. Interestingly, in 2012 only one third of school healthcarepersonnel favored universal varicella vaccination.The health professionals xpressed a general demand for information and in-depth nowledge about the newer vaccines.

    Conclusion: If Swedish authorities decide to implement universal varicella vaccine into the current successful vaccination program for children, relevant healthcare personnel will require further education about VZV vaccineand disease

  • 79.
    Buus, Lise
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Forældres oplevelse af effekt af Botulinumtoxin type A til børn med spastisk cerebral parese2008Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [da]

    Formål: At undersøge, hvordan forældre til børn med spastisk cerebral pare­se (CP) oplevede effekt af behandling med Botulinumtoxin type A (BTX) på deres barns funktioner.

    Metode og materiale: Der blev anvendt triangulering af metode, kilder og observatører. Den kvali­ta­tive del bestod af to fokusgruppeinterview af eksperter og tre forælderinterview. Analyseme­toden var indholdsanalyse. Den kvantitative del bestod af en spørgeskemaundersøgelse til forældre til børn behandlet med BTX på Hillerød Hospital. Spørgeskemaer blev sendt til begge forældre til 47 børn.

    Resultat: Fokusgruppeinterviewene gav indblik i, at der i spørgeskemaet skulle spørges detaljeret til alle funktioner i barnets hverdag fra BTX blev tilbudt til efter endt effekt af BTX-behandling. Forældreinterviewene viste, at to af tre forældre ville tage imod et nyt tilbud om BTX-behandling; at ventetid på BTX-dagen var uacceptabel lang; at arbejdsgange på BTX-dagen burde optimeres, så de passede til handicappede børn. Spørgeskemaet blev returneret af 41 forældre til ialt 30 børn (to – 17 år). Børnene var behandlet med BTX på Hillerød Hospital i perioden 2004-2007. Af de 41 forældre var der 12 fædre og 29 mødre. Størst effekt af BTX oplevede forældrene på nedsættelse af barnets spasticitet. To tredjedele af de børn, som kunne gå før BTX behandling, fik forbedret gang. Derud­over sås effekt i nye måder at bevæge sig på. Toogtyve af 41 forældre så den effekt af BTX, som de havde fået stillet i udsigt. Størst effekt af BTX sås indenfor tre til seks måneder. Virkningen af BTX for det enkelte barn var forskellig fra behandling til behandling med en dalende tendens. Studiet viste, at forældre og børn blev godt mødt og blev hørt på børneafdelin­gen, var trygge ved persona­let, og oplevede BTX-dagen som god. Ventetid og et manglende måltid mad efter BTX var et stort pro­blem. Der sås ingen forskel i fædres og mødres opfattelse af sundhedsydel­ser til børn med CP. Nationale retningslinier for behandling med BTX ef­terspørges.

    Konklusion: Majoriteten af forældre ville tage mod et nyt tilbud om behandling med BTX. De væ­sentligste begrundelser var, at forældrene havde set god effekt af behandlingen, eller at de håbede på en effekt. Et mindretal af forældre ville ikke tage imod et nyt tilbud om behandling med BTX, fordi de enten ikke havde set effekt af behandlingen, eller fordi de oplevede mange strabadser for et meget lille udbytte. Praksis omkring BTX dagen bør udvikles og forbedres i forhold til handicappede børn

  • 80.
    Cabrera, Claudia
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Socio-economic Status and Health in Women: Population-based studies with emphasis on lifestyle and cardiovascular disease2005Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The aim of this thesis was to investigate socio-economic status in relation to morbidity and mortality, in particular cardiovascular disease among women using data from two population based studies from Sweden. The secondary aim was to explore mechanisms potentially linking socio-economic status to health, assessing for example dental, dietary, and lifestyle factors. Samples: The Population Study of Women in Gothenburg Sweden was begun in 1968-69. A representative random sample of 1,622 women was selected according to date of birth and within the strata 38, 46, 50, 54, and 60 years of age; the participation rate was 90 percent. The Gerontological and Geriatric Population Studies in Gothenburg (H-70) are based on representative samples of 70-year olds from Göteborg, Sweden who participated in a series of cross sectional and longitudinal studies between1971 and 2000. Participation rates ranged from 86 percent for men and 83 percent for women in the 1901/2 birth cohort to 65 percent for men and 69 percent for women in the 1930 birth cohort. Main results: High socio-economic status was associated with a decreased risk for cardiovascular disease [RR 0.49; CI 0.24 – 0.99] in middle aged women independently of risk factors such as smoking and obesity;moreover opposing monotonic trends were seen for mortality from cancer and cardiovascular disease in relation to socio-economic status. Tooth loss, a proxy for cumulative lifetime oral infection was also associated with an increased risk for cardiovascular disease in women independently of socio-economic factors such as the husband’s occupational category, income, and educational level. Among 70-year old cohorts, later-born women were heavier and had higher body mass index than earlier-born women within the high education group only. However, secular increases in waist-hip ratio were seen in both educational groups. Compared to earlier-born cohorts of 70-year old men, later-born cohorts had higher body mass index and cholesterol levels across social strata, and heart disease and diabetes mellitus became more prevalent. Among the elderly, secular trends indicated greater improvements in cardiovascular risk factors among women than men, with exception to smoking and alcohol consumption. Diet quality and food selection were assessed in relation to socio-economic status in the youngest cohort of 70-year olds born in 1930. Socio-economic disparities in diet quality were detected in men but not in women. Conclusions: From a public health perspective, it is suggested that risk factor patterns should be investigated in association with socio-economic status in order to expose health inequalities, and to develop more equitable interventions for cardiovascular disease prevention.

  • 81.
    Cabrera, Claudia
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Hakeberg, Magnus
    Ahlqwist, Margareta
    Wedel, Hans
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Björkelund, Cecilia
    Bengtsson, Calle
    Lissner, Lauren
    Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the population study of women in Gothenburg, Sweden.2005Ingår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 20, nr 3, s. 229-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this study was to evaluate the association between number of missing teeth and all cause, cardiovascular, and cancer mortality as well as morbidity and to explore whether socio-economic factors mediate this association. An ongoing prospective cohort study of 1462 Swedish women included a dental survey in 1968/69 with follow-up until 1992/93. The dental examination included a panoramic radiographic survey and a questionnaire. Number of missing teeth at baseline was analysed in a Cox proportional hazards model to estimate time to mortality and morbidity. Number of missing teeth, independently of socio-economic status variables (the husband's occupational category, combined income, and education) was associated with increased all cause mortality and cardiovascular disease mortality respectively (relative risk (RR): 1.36; 95% confidence interval (95% CI): 1.18-1.58) and (RR: 1.46; 95% CI: 1.15-1.85 per 10 missing teeth), but no associations were found for cancer mortality (RR: 1.18; 95% CI: 0.91-1.52). The relation between poor oral health and future cardiovascular disease could not be explained by measures of socio-economic status in this study.

  • 82.
    Cabrera, Claudia
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Helgesson, Östen
    Wedel, Hans
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Björkelund, Cecilia
    Bengtsson, Calle
    Lissner, Lauren
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Socioeconomic status and mortality in Swedish women: opposing trends for cardiovascular disease and cancer.2001Ingår i: Epidemiology (Cambridge, Mass.), ISSN 1044-3983, Vol. 12, nr 5, s. 532-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We examined relations between socioeconomic status and cardiovascular disease, cancer, and diabetes mellitus in a 24-year prospective study of 1,462 Swedish women. Two socioeconomic indicators were used: the husband's occupational category for married women and a composite indicator combining women's educational level with household income for all women. The husband's occupational category was strongly associated with cardiovascular disease and cancer mortality in opposite directions, independent of age and other potential confounders. Women with husbands of lower occupational categories had an increased risk of cardiovascular disease mortality [relative risk (RR) = 1.60; 95% confidence interval (95% CI) = 1.09-2.33] while experiencing lower rates of all-site cancer mortality (RR = 0.69; 95% CI = 0.50-0.96). A similar relation was seen with the composite variable: women with low socioeconomic status had an increased risk of cardiovascular disease (RR = 1.37; 95% CI = 1.01-1.84) but a somewhat lower risk for cancer of all sites (RR = 0.86; 95% CI = 0.66-1.11). Finally, morbidity data (diabetes mellitus, stroke, and breast cancer) yielded results that were consistent with the mortality trends, and breast cancer appeared to account for a major part of the association between total cancer and high socioeconomic status. In summary, higher socioeconomic status was associated with decreased cardiovascular disease mortality and excess cancer mortality, in such a way that only a weak association was seen for all-cause mortality.

  • 83.
    Cabrera, Claudia
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Rothenberg, E
    Eriksson, Bo G
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Wedel, Hans
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Eiben, G
    Steen, B
    Lissner, Lauren
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Socio-economic gradient in food selection and diet quality among 70-year olds.2007Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 11, nr 6, s. 466-73Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes.

    DESIGN: Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg.

    PARTICIPANTS: A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden.

    METHODS: One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI).

    RESULTS: Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men.

    CONCLUSIONS: Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

  • 84.
    Cabrera, Claudia
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Wilhelmson, Katarina
    Allebeck, Peter
    Wedel, Hans
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Steen, Bertil
    Lissner, Lauren
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Cohort differences in obesity-related health indicators among 70-year olds with special reference to gender and education.2003Ingår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 18, nr 9, s. 883-90Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to describe cohort differences in health indicators among four birth cohorts of 70-year old men and women from Göteborg, Sweden, born in 1901/2, 1905/6, 1911/12, and 1922. With special reference to gender, education, and obesity, it is hypothesized that changes in health among elderly men and women may not be occurring in a uniform manner. The variables studied were: systolic and diastolic blood pressures, triglycerides, cholesterol, height, weight, body mass index, waist-hip ratio, physical inactivity, current smoking, and alcohol consumption, plus selected prevalent diseases. Logistic and linear regression models were used to test for secular trends and effect modification by gender. Most trends in metabolic and lifestyle indicators varied in relation to gender as well as education. For instance, later-born male cohorts were more overweight than earlier-born groups while the later-born female cohorts had similar relative weights but a more centralized fat patterning. These cohort differences further varied by education where later-born men with less education and later-born women with higher education tended to be more overweight, compared to earlier-born cohorts. Finally, significant cohort differences in previously diagnosed myocardial infarction, stroke, and diabetes mellitus at age 70 were observed in men only. Interaction terms revealed that the gender difference was statistically significant only in the case of diabetes mellitus. In conclusion, secular trends in many obesity-related health indicators among 70-year old Swedish cohorts were dependent on both gender and socio-economic factors.

  • 85.
    Carlsson, Lennart
    Nordiska ministerrådet, Nordic School of Public Health NHV. Västra Götalandsregionen.
    Utvärdering av verksamheten vid Enheten för Asyl- och flyktingfrågor, Västra Götalandsregionen: RAPPORT – 26 Maj 20092010Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Vi inleder med en kort beskrivning av NCHSA, det centrum som fått föreliggande utvärde-ringsuppdrag. Nordic Centre for Health and Social Assessment (NCHSA), verksamt vidNordiska högskolan för folkhälsovetenskap (NHV), har till uppgift att erbjuda nordiska organisationer och institutioner inom välfärdsområdet utvärderingskompetens på uppdragsbasis. NCHSA håller samman ett kunskapsnätverk knutet till NHV som består av en mix av forskare som i sina uppdrag tillämpar vetenskaplig metodik. NCHSA är kopplad till akademiska institutioner vilket innebär att NCHSA endast tar uppdrag vars resultat och erfarenheter får användas i forskningssammanhang. NCHSA har, enligt styrelsens intentioner, under de första verksamhetsåren 2008-2009 koncentrerat uppdragen till Norge och Sverige. För mer utförlig information hänvisas till www.nchsa.se.

    Västra Götalandsregionen (VGR) har, via Regionöverläkare Karin Stenqvist, önskat en utvärdering av Enheten för Asyl- och flyktingfrågor (EAF) vid kanslienheten på hälso- och sjukvårdsavdelningen. EAF bildades 2004 och sägs ha skördat framgång-ar i sitt arbetssätt genom att ha skapat ordning, struktur och rutiner för hälso- och sjukvård till asylsökande och flyktingar. Man vill gå vidare genom att samtidigt som man bevarar sin initiala flexibilitet också utvecklar sin förmåga till förnyelse. Önskan om utvärdering ska ses som ett sätt att dels dokumentera och analysera verksam-hetens framgångsfaktorer, dels ge input till den avsedda förnyelsen. Uppdraget har lämnats till NCHSA. Det har genomförts av fil dr Lennart Carlsson, forskaranknuten till Karolinska Institutet. Lennart Carlsson ingår i NCHSA:s kunskapsnätverk.Uppdraget gäller genomförandet av en utvärdering med lärande ansats, där enhe-tens roll som kunskaps- och kommunikationsnav för hälso- och sjukvårdsfrågor för asylsökande ska beskrivas, analyseras och värderas.

    Genomförande

    Uppläggningen av arbetet har planerats och genomförs i tre faser enligt följande

    • dokument studie inklusive litteraturgenomgång
    • självvärdering genomförd av enhetens båda medarbetare
    • individuella intervjuer

    Dokumentstudien och självvärderingen genomfördes under hösten 2008. Intevjuer och komplettering av uppgifter till dokumentstudien genomfördes i huvudsak under första kvartalet 2009.

    En styrgrupp bestående av tre forskare vid NHV har följt och kommenterat arbetet under dess gång.

    EAF har analyserats ur tre olika aspekter. Den första handlar om enhetens uppdrag och organisering och omfattar: enhetens uppdrag, enhetens organisationsform och organisatoriska placering, rutiner för hälsoundersökning samt de asylsökandes boende- eller vistelseformer. Den andra handlar om information, där uppgiftsflöden mellan organisationsenheter analyseras. Den tredje handlar om relationering, där förmåga till nätverksbyggande analyseras.I analogi med den lärande ansatsen i utvärderingsarbetet avslutas rapporten med tre strategiska frågeställningar som bedöms viktiga att uppmärksamma inför fram-tiden. Dessa redovisas nedan.SlutsatserEAF upplevs av omvärlden som en trygg, tillförlitlig och uppdaterad kunskapskälla inom ett besvärligt verksamhetsfält. Verksamheten är dock sårbar genom sin liten-het beroende på att den bygger på ett nära samarbete mellan två medarbetare med kompletterande kompetenser. Utvärderingen visar att EAF har hög måluppfyllelse vad gäller både antal genomförda hälsoundersökningar och den tidsgräns på två månader som satts som mål för dessa undersökningar. Med detta menas att hälso-undersökning är utförd inom denna tidsgräns efter den asylsökandes ankomst till Sverige. Ett arbete som möjliggör kvalitetssäkring av hälsoundersökningar inklusive hälsosamtal har satts igång. Enhetens framgångsformel re – en sjuksköterska och en ekonom. Medarbetarna har korta beslutsvägar genom sin centrala placering. De har hälso- och sjukvårdsled-ningens förtroende och ges därmed möjlighet att arbeta självständigt. Enhetens re-sultat är mätbart och EAF fungerar idag som ett förtroendeingivande kunskapsnav för frågor om asylsökandes hälso- och sjukvård.

    1. Hur bidrar häslo- och sjukvårdslednigen till att ge EAF fortsatt legimitet?

    2. Hur omprövas uppdraget till EAF? Fokus på vårdens innehåll och kvalitet.

    3. Hur säkerställer EAF att verksamheten fungerar om fem år?

  • 86.
    Catalán Matamoros, Daniel Jesús
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Health Communication –a health content analysis of the main national Swedish newspapers from a Public Health perspective.2006Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [sv]

    Massmedia är ett av de viktigaste medlen att informera allmänheten om hälsofrågor. I Sverige är morgontidningar det mest trovärdiga mediet och kan informera om hälsonyheter med mer noggrannhet än TV eller radio och snabbare än veckotidningar. Dagstidningar har i Sverige en större mängd läsare än de flesta länder i Europa. ca 80 procent av befolkningen läser varje dag en dagstidning. Syftet med denna thesis är att analysera hur stor plats innehåll rörande hälsan har i svenska tidningar och debattera vilken typ av information om hälsa de svenska läsarna får via de tidningarna. Studien är baserad på en empirisk, beskrivande, tvärsnittsinriktad, induktiv och kvantitativ ansats. Undersökningen genomfördes på samtliga exemplar av de tre största svenska morgontidningarna under en månad. Studien visar att tidningarna hade 2,4 procent hälsonyheter i genomsnitt och av de tre var ”Svenska Dagbladet den tidning som hade mest material om hälsofrågor, (3,3%). Hälsoinnehåll brukade vara publicerad på de första sidorna (median var sidan 13 och ”the main mode” sidan 4). Artiklar om hälsa var till 81,3 procent skrivna av tidningarnas egna journalister. De vanligaste enskilda ämnena var cancer (25 st), alkoholproblem (19 st), dödshjälp (19st) och sjukanmälningar (19 st). De största sjukvårdsområdena var ”hälsoförvaltning” (105 st), hälsopolitik (100 st) och ”epidemiologi” (90st). Eftersom svenska tidningar är ett viktigt medium för hälsofrågor till allmänheten kan påverkan på sjukvården vara stor. Därför krävs att antalet specialiserade journalister inom detta område utökas

  • 87.
    Christensen, Inge
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Fortællinger om cancer og eksistens i det unge voksenliv2005Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [da]

    Baggrund : Meget få forskningsprojekter har udforsket den unge voksne cancerpatients mestring. Selvom antallet af unge voksne, som diagnosticeres med cancer er lille, anses det for væsentligt at opnå en kompleks og dyb helhedsforståelse af deres mestring, eftersom prognosen for helbredelse i denne aldersgruppe generelt er god, ogde således efterfølgende forventes at have et helt voksenliv at planlægge og håbe for, leve og mestre. Hensigt : at opnå en fordybet indsigt iden unge voksne cancerpatients levede erfaring af egen mest-ring gennem hendes/hans egne fortællinger med fokus på bevarelse/genskabelse af selvforståelse, virkelighedsforståelse og livsforståelse i behandlingsfasen af cancersygdommen. Metode : Som en væsentlig del af dette forskningsprojekt er udviklet en narrativ hermeneutisk - fænomenologisk forskningsmetode funderet i Paul Ricoeurs filosofi. Otte unge cancerpatienter imellem 21 og 31 år har deltaget i forskningsprojektet.Resultat :Fire metafortællinger om primært eksistentielle mestringstemaer i det unge voksenliv med cancer er vokset frem af deltageres fortællinger. Narrative mestringstemaer i disse er forandring og konstans i det unge voksenliv med cancer, nærhed og afstand i hverdagslivet med cancer, livsmod oglidelse i livetmed cancer, som parvis optræder i en kontinuerlig og samtidig bevægelse/spændingimellem hinanden og den eksistentielle betydning af metaforisk og symbolsk billedsprog og præfigurative, konfigurative og refigurative dimensioner i fortællingen for mestring i det unge voksenliv med cancer. Konklusion : Deltageres mestring fremstår meget situationsbunden, hvor samtidighed og kontinu-erlig bevægelse imellemovenstående mestringstemaer er kendetegnende for den unge voksne cancerpatients mestring, således at de kontinuerligt er/bevæger sig mange steder på samme tid i deresmestring. Deltageres mestring kommer til eksistens gennem fortælling, med tilblivelsen af narrativ identitet i en kreativ, refleksiv efterligning eller gendigtning af begivenheder/erfaringer i det levede liv. Fortællingens mimetiske dimensioner i deltageres samlede fortællinger fremstår således både som væsentlige kendetegn for deltageres fortælleproces og mestringsproces

  • 88.
    Christensen, Mette
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Sygeplejerskers efterlevelse af anbefalinger for håndhygiejne2008Självständigt arbete på avancerad nivå (masterexamen)Studentuppsats (Examensarbete)
    Abstract [da]

     

    Formål – At beskrive variationen i sygeplejerskers opfattelse af deres efterlevelse af anbefalinger for håndhygiejne samt hvilke faktorer sygeplejersker oplever, har betydning for om de udfører håndhygiejne som anbefalet.

     

    Design - Beskrivende og undersøgende undersøgelse med en fænomenografisk forsknings-tilnærmelse. Semi-strukturerede interviews med fokus på sygeplejerskers egen opfattelse af deres efterlevelse af anbefalinger for håndhygiejne.

     

    Ramme – Hvidovre Hospital.

     

    Informanter – 14 sygeplejersker (12 kvinder, to mænd) fordelt på 11 afdelinger, indenfor kirurgiske specialer, medicinske specialer, kvinde-barn specialer og intensivterapi.

     

    Resultat –  Analysen viser, at de interviewede sygeplejersker er af den opfattelse, at de stort set altid efterlever anbefalingerne for håndhygiejne. Endvidere blev der ved analysen identificeret seks forskellige opfattelser af de faktorer, der har indflydelse på, om sygeplejerskerne følger anbefalinger for håndhygiejne: Håndhygiejne er en naturlig handling; Smitterisiko; Akutte situationer, uforudsigelighed og travlhed; Omgivelsernes opmærksomhed; Håndhygiejnefaciliteter; Akkreditering, hygiejneaudit og håndhygiejnekampagne.

     

    Konklusion – Sygeplejerskers oplevelse af, at de udfører håndhygiejne som anbefalet og deres forskellige opfattelser af faktorer, der har betydning for, om de følger anbefalingerne for håndhygiejne bør have indflydelse på de håndhygiejneaktiviteter, der planlægges og iværksættes med henblik på at øge sygeplejerskers efterlevelse af anbefalingerne for håndhygiejne.

  • 89.
    Chudal, Roshan
    et al.
    Department of Child Psychiatry, University of Turku, Turku, Finland.
    Gissler, Mika
    Nordiska ministerrådet, Nordic School of Public Health NHV. Department of Child Psychiatry, University of Turku, Turku, Finland / National Institute for Health and Welfare, Helsinki, Finland.
    Sucksdorf, Dan
    Department of Child Psychiatry, University of Turku, Turku, Finland.
    Lehti, Venla
    Department of Child Psychiatry, University of Turku, Turku, Finland.
    Suominen, Auli
    Department of Child Psychiatry, University of Turku, Turku, Finland.
    Hinkka- Yli-Salomaki, Susanna
    Department of Child Psychiatry, University of Turku,.
    Brown, Alan S
    Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA, / Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA.
    Sourander, Andre
    Department of Child Psychiatry, University of Turku, Turku, Finland / Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA / Regional Centre for Child and Youth Mental Health and Child Welfare, University of Tromsø, Tromsø, Norwa.
    Parental age and the risk of bipolar disorders2014Ingår i: Bipolar Disorders, ISSN 1398-5647, E-ISSN 1399-5618, ISSN 1398-5647Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives:Studies on the association between parental age and bipolardisorder (BPD) are scarce and with inconsistent findings. The aim of thisstudy was to examine the association of parental age and age differencebetween parents with risk of BPD in offspring.Methods:This nested case–control study identified 1,861 cases ofindividuals with BPD born in Finland during 1983–1998 and diagnosedby the end of 2008, and 3,643 sex- and date of birth-matched controlsfrom nationwide population-based registers. Conditional logisticregression was used to examine the association adjusting for potentialconfounding due to age of the other parent, parental psychiatric history,educational level, and place of birth.Results:A U-shaped association of unadjusted odds ratios (ORs) forBPD risk was seen in different paternal age categories, with the oddsincreasing at both ends of the age spectrum. In the adjusted analyses,offspring of fathers aged≥50 years had a 2.8-fold increased odds[OR=2.84, 95% confidence interval (CI): 1.32–6.12] of BPD ascompared to those with fathers aged 30–34 years. The odds wereincreased 1.3-fold (OR=1.35, CI: 1.06–1.72) in fathers aged 20–24 years. No significant association was found between maternal ageand BPD in the adjusted analyses. Age difference between parents wasnot associated with BPD.Conclusions:The increased risk of BPD in offspring of the youngest andoldest fathers in the study suggests the involvement of differentbiological and psychosocial factors at the two ends of the paternal agespectrum. These findings may be significant in the context of advancingparental age in recent times.

  • 90.
    Clancy, Ann
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    A profession under threat? An exploratory case study of changes in Norwegian public health nursing.2007Ingår i: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 54, nr 2, s. 197-203Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The first courses for public health nurses in Norway were held in the 1920s-1930s. In 1957, the Act regulating public health nursing was passed. Norwegian public health nurses have a primary role in promoting health and preventing illnesses. Their role has changed with a changing society. This article shows some of the challenges the nurses have faced. It focuses on collaboration, tasks, leadership and authority/status.

    AIMS: The study's intentions are exploratory. It looks into how the nurses experience their changing role.

    METHODS: A single case with an embedded design is the method chosen; the case is 'Changes in the role of the Norwegian public health nurse during the period 1984-2005'. Document analysis and interviews are sources of evidence.

    FINDINGS: The findings show that public health nurses' visibility seems to be an important issue. There are some divergences between relevant literature on the nurses' professional status and the views of the nurses in the study. Several other public health professionals have lost tasks and formal positions of authority.

    CONCLUSION: The nurses interviewed still feel that they are a respected and trusted profession despite being less visible. A recent study among parents who frequent local clinics confirms their important role. Can the nurses' lack of visibility have undesired outcomes? A profession that is unassuming, not visible and that fights silent battles may have problems being heard when it tries to promote issues concerning family health. Further studies are indicated.

  • 91.
    Clancy, Ann
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Perceptions of public health nursing practice On borders and boundaries, visibility and voice2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Aim: The aim of this comprehensive thesis is to explore different perceptions of public health nursing practice. The intention being to contribute to developing the service, theoretically and practically, in throe with current and future public health needs.

    Methods: The thesis comprises five studies. Public health nurses, young people, parents and decision makers are interviewed and share their perceptions of public health nursing practice (studies I, II, III and IV). Consultations at local child health clinics, clinics for young people and at school health services are observed (study III). A cross sectional study amongst a sample of doctors, public health nurses, midwives and child protection workers is carried out (study V). The first four studies have an explorative, descriptive design. Study V, with its focus on interprofessional collaboration, is based on the results of studies I, II, and IV.

    Findings: Study I, a case study, provides a backdrop for the remaining four studies. It focuses on changes the nurses have faced during the period 1984-2005. The results point to issues of visibility and that respect is more important for the nurses than authority or status. Study II is a philosophical study based on interviews with public health nurses. It gives an introduction to the philosophy of Emmanuel Levinas and develops a novel theoretical and practical understanding of aspects of responsibility in public health nursing. Study III shows the importance of relationships with service users in public health nursing practice; and that not only pleasantness but also honesty and openness are important. This study has contributed to further developing models of public health nursing interventions. Decision makers in study IV point to the challenges public health nurses face regarding collaboration, visibility and boundaries. Study V is a cross sectional questionnaire study that focuses on interprofessional collaboration. The results show that size of municipality can influence frequency of meeting points and views on issues relating to collaboration; and that mental health services are those most missed in collaborative relationships. The findings warrant further research and should be of interest when organising municipal health- and social services in Norway.

    Conclusions: The thesis concludes that service users and decision makers are satisfied with public health nursing services, but that public health nurses face challenges related to collaboration, to boundaries for knowledge and involvement, and in making their health promotive function visible

  • 92.
    Clancy, Ann
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Gressnes, Thomas
    Harstad University College, Harstad, Norway.
    Svensson, Tommy
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Public health nursing and interprofessional collaboration in Norwegian municipalities: a questionnaire study.2013Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, nr 3, s. 659-68Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to examine collaboration relating to public health nursing in different sized Norwegian municipalities. It sought to gain insight into factors that are important for successful collaboration, frequency of meeting points for collaborating activities and missing professionals in different sized municipalities. A cross-sectional e-post questionnaire study was carried out on a national sample of public health nurses and their collaborators. A total of 849 public health nurses (43.64%), 113 doctors at clinics and school health services (54.8%), 519 child protection workers (16.34%) and 115 midwives (41.3%) returned the questionnaire. The data were analysed using descriptive and inferential statistics. Analysis of variance (anova), Kruskal-Wallis H and chi-square tests were used to tests differences between groups. Trust, respect and collaborative competence were ranked highest by all the respondents and formalised structures, economy and leadership ranked least important in collaborative activity. The majority of the respondents stated that they do not have fewer meeting points compared with 5 years ago. Collaboration with mental health services was missed most by all respondents. There were associations between frequency of meeting points and statements on collaboration related to municipality size. Norway is in the throes of a major coordination reform. The fact that relational factors were deemed most important for successful collaboration is an important finding at a time when focus is on structural change. The findings indicate the need for further in depth qualitative studies on reasons for 'missing collaborators,' on professional cultures in different sized municipalities and on interpersonal relationships. Qualitative enquiry is necessary to gain a greater understanding of how relational concepts of respect, trust and conflict are understood by municipal public health professionals.

  • 93.
    Clancy, Ann
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Svensson, Tommy
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    'Faced' with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing.2007Ingår i: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 8, nr 3, s. 158-66Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform 'hands on' nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the philosopher Emanuel Levinas (1906-1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses' stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses' responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable.

  • 94.
    Clancy, Ann
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Svensson, Tommy
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Perceptions of public health nursing consultations:: tacit understanding of the importance of relationships2010Ingår i: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 11, nr 4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim This study aims to describe and reflect upon how a sample of nurses, parents and young people experience consultations at local clinics and school health services. Central to the concept of health promotion is ensuring that focus is on the empowerment of clients through dialogue and participation. This study aims to explore public health nursing consultations with this in mind.

    Background Norwegian public health nurses are in contact with almost all families at the child health clinic. They meet children and young people at school health services and youth clinics; putting them in an important position to promote health and prevent illnesses.

    Methods Participant observations and in-depth interviews are the methods chosen. The data were analysed using qualitative content analysis.

    Findings The study shows that good relationships are not only sustained by pleasantness but also by honesty and directness, provided that the relationship is based on trust and sincerity. Continuity and trust in services seem paramount to the service users’ satisfaction. Service users were not always able to put the reason for their appreciation into words, just as the nurses had difficulty verbalising their strategies. Words often fall short when attempts are made to capture the essence of caring, trust and other life phenomena. Openness on agenda and focus on feedback from service users are important in order to ensure empowering services. Further studies should address the interconnectedness of the service and the subtleties of public health nursing consultations

  • 95.
    Clancy, Ann
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Svensson, Tommy
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Perceptions of public health nursing practice by municipal health officials in Norway.2009Ingår i: Public Health Nursing, ISSN 0737-1209, E-ISSN 1525-1446, Vol. 26, nr 5, s. 412-20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The objective of this study was to describe and analyze municipal decision-maker's views on public health nursing and to reflect upon and discuss the relevance of those views to the future of public health nursing in Norway.

    DESIGN: This explorative qualitative study using face-to-face interviews is part of a larger project, comprising 5 studies, that explores perceptions of public health nursing.

    SAMPLE: A purposeful sample of 11 municipal decision-makers was selected for interview during 2006-2007 to reflect variation in community size and perspective.

    RESULTS: Thematic content analysis of the transcribed interviews revealed 4 content categories: contribution, collaboration, challenges, and visibility. The decision-makers expressed satisfaction with the public health nursing services, showed concern about lack of visibility and clear boundaries, and some expressed irritation over lacking collaboration. The interviewees elaborated on their past experiences as the public health nurses coworkers, leaders, collaborators, and service users.

    CONCLUSIONS: The respondents recognized public health nursing's contribution to public health but they lack sufficient knowledge of its content and tend to take services at local health clinics for granted. Dialogue between nurses and decision-makers is necessary in order to ensure updated evaluation and continued development of public health nursing services.

  • 96.
    Clausson, Eva
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    SCHOOL HEALTH NURSING: Perceiving, recording and improving schoolchildren’s health2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of schoolchildren’s health and to analyse factors influencing the recording of school-children’s health in the School Health Record (SHR). An additional aim is to evaluate fam-ily nursing interventions as a tool for the school nurses in the School Health Service (SHS). Methods: The thesis comprises four papers. A combination of qualitative and quantita-tive methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early ad-olescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separate-ly. Qualitative content analyses were used to analyze the interview text with the school nurs-es and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically. Findings: The findings showed that nurses judged the schoolchildren’s mental health as dete-riorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environ-ment and family relations. The latter seemed to be the most important factor affecting school-children’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the im-proper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families ex-perienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was sup-ported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families. Conclusions: The results indicate that school nurses have a deep knowledge about schoolchil-dren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would de-mand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level.

  • 97.
    Clausson, Eva
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Berg, Agneta
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Family intervention sessions: one useful way to improve schoolchildren's mental health.2008Ingår i: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 14, nr 3, s. 289-313Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study examines the effectiveness of therapeutic conversations with families (through family sessions) in alleviating health complaints among adolescent girls in a school setting. Four girls with recurrent, subjective health complaints and their families were included in the study. Three sessions were held with each family, using genograms, ecomaps, interventive questions, and other family nursing interventions; practicing school nurses were also present. A therapeutic letter was sent to each family at the end of the sessions. The Strengths and Difficulties Questionnaire was used as a pre- and posttest measure. Evaluative interviews were carried out with the families and with school nurses. The families reported feeling relief and described positive affective, behavioral, and cognitive changes as a consequence of the interventions. The school nurses experienced the family sessions as time-saving and easy-to-use tools in their work. Involving the family when schoolchildren's recurrent mental health problems are addressed may reduce future suffering.

  • 98.
    Clausson, Eva K
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Köhler, Lennart
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Berg, Agneta
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Ethical challenges for school nurses in documenting schoolchildren's health.2008Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, nr 1, s. 40-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study explored Swedish school nurses' experiences of school health record documentation. Fifty per cent of a representative sample of Swedish school nurses (n = 129) reported difficulties with documenting mental and social health problems in family relationships, schoolchildren's behaviour, and school situations. Ethical considerations concerning fears of misinterpretation and practical barriers to documentation were expressed as reasons for their worries. Mental and social ill health is an increasing and often dominating problem among schoolchildren, thus proper documentation is a basic issue, both for individuals and for the population as a whole. School nurses obviously need professional guidance regarding documentation and ethical challenges. Systematic effort should be directed towards recognition and support of these nurses' unique opportunities to consider, follow and promote all aspects of schoolchildren's health.

  • 99.
    Clausson, Eva K
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Köhler, Lennart
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Berg, Agneta
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Schoolchildren's health as judged by Swedish school nurses: a national survey.2008Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, nr 7, s. 690-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: To use school nurses' knowledge and experience for a better understanding of schoolchildren's health problems and their association to socioeconomic background and gender.

    METHODS: Mail questionnaires were sent to a nationally representative, random sample of Swedish school nurses (n=129). The questionnaire included structured and open-ended questions asking for school nurses' judgement of schoolchildren's health status; changes over the previous two years; estimation of schoolchildren's most common reasons for consulting the school nurse; and estimation of factors influencing schoolchildren's health.

    RESULTS: Swedish school nurses judged schoolchildren's mental health to have deteriorated during the previous two years with increasing health complaints, especially among girls and in disadvantaged housing areas. Disturbed family relations were considered as one important explanatory factor. Girls were more inclined to consult school nurses with subjective health complaints. Boys more often consulted the nurses with physical injuries.

    CONCLUSIONS: School nurses work closely with the children and meet them continuously during the school age period. They have a genuine knowledge of schoolchildren's health, which should be used even more, both in research and practice. The results may be applicable in other countries with similarly organized school health systems.

  • 100.
    Clausson, Eva
    et al.
    Nordiska ministerrådet, Nordic School of Public Health NHV.
    Petersson, Kerstin
    Berg, Agneta
    School nurses' view of schoolchildren's health and their attitudes to document it in the school health record--a pilot study.2003Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, nr 4, s. 392-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study highlights school nurses' view of schoolchildren's health and their attitude to document it in the school health records. A strategic sample of 12 school nurses was interviewed. The interviews were semistructured and analysed with qualitative content analysis. The findings showed that the school nurses' viewed schoolchildren as physical healthy although they called attention to growing problems related to a changed lifestyle. Psychosocial ill-health was however increasing and the most common reason for visiting the school nurse was psychosomatic expressions. According to the nurses' descriptions, health was related to the individual, the school and the family situation. The family situation was mentioned as one of the most important factors of schoolchildren's health. The nurses described no problem to document schoolchildren's physical health. Ethical consideration, tradition, lack of time and the structure of the record were however factors that were said to hinder the documentation of the psychosocial health. In order to promote, protect and recover schoolchildren's health, more research is needed about how beliefs, experience, ethical consideration and resources influence the school nurse's daily work with schoolchildren's health.

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