Aim: To explore experiences with professional services among parents of disabled children in contact with Childrens Habilitation Department in Nord-Trøndelag, Norway.

Method: A descriptive cross-sectional survey among parents, who’s children received services from the Childrens Habilitation Department during one year, was done. MPOC-20 NO, a questionnaire developed for this target group and translated into norwegian, was used. It consists of five factors: enabling/partnership, general information, spesific information, co-ordinated/comprehensive care and respectful/supportive care. Each factor consists of 3 – 5 questions.

Results: The respons rate was 54,5%, parents of children with severe disabilities were overrepresented. Thus the results should be interpreted with care. The mean score on general information was lower than on other factors. The mean scores in Nord-Trøndelag was generally lower than in Canada, but about the same as results from Uppsala, Sweden.

Parents of children under 6 years had better experiences than parents with older children. Parents with children with minor disabilities were more satisfied than others. Parents under 36 years and mothers had better experiences than older parents and fathers. Parents living together with their child less than 11 days/month were less satisfied than others. Having a key worker and/or an individual service plan made a positive difference on information factors, but not on the other factors.

Conclusion: The answers showed that certain areas and qualities of the departments service should be better developed and some groups of parents should get a service delivery more fitted to their needs. Other methods should be considered to recruite parents and collect anwers to ensure a higher response rate.

Aim: This study aimed to increase understanding the information needs of cancer patients before and during radiation therapy. We also explored how cancer patients adapt such information to their new life situations.

Method: Among 10 participants in our qualitative interview survey, eight individuals were interviewed before radiation therapy commenced, one was interviewed during treatment and one was interviewed following CT examination. We used grounded theory to analyse our data.Results: Our study identified one core category: small things matter. Other categories included information synergy (desire for information and manner of delivery), vulnerability (emotions and lack of knowledge), and coping skills (comprehension and security).

Conclusions: This study identified the importance of answering patients´ questions. Providing accurate information, minimizing vulnerability, and enhancing coping skills all play an important role in optimizing patient preparation for radiation therapy. However, the process of developing a variety of communication methods (e.g., improved patient dialogue, printed information, and video presentations) will increase demands on the healthcare system.

In 1997 and 2002 the Østfold Hospital Trust conducted patient satisfaction surveys. This study presented the results of the 2002 survey and compares them with the 1997 results. This is done to ascertain if there are any changes with regards to the dimensions the hospital scored poorly on in 1997. The purpose of this study is to find out if the patient satisfaction survey conducted at the Østfold Hospital Trust in 1997 was a serious attempt to improve the quality of the health care provided or only a symbolic act. The concepts of innovation, rational choice and institutional theory were used as spectacles to analyse how the Østfold Hospital Trust acted on the results of the 1997 patient satisfaction survey. The choice of study design is not an "either / or" situation between the quantitative and qualitative approach, since both methods can strengthen each other. This study has therefore employed a form of methodological triangulation. The finding of the study showed that the Østfold Hospital Trust can be termed as innovative, when they implemented the patient satisfaction survey in 1997. This because there was no coercive forces from the hospital owners to implement such surveys. There were only signals in the form of strategy documents. In spite of the hospitals innovative action in implementing the non-mandatory survey in 1997, the hospital leadership did not use the results to improve quality. Based on the findings, the study can conclude that the implementation of the patient satisfaction survey in 1997 was more symbolic, rather than a quality improvement act. Looking further than 1997, it’s important to remark that the hospital leadership resolved a number measures to improve quality, based on the 2002 patient survey. At the time of writing the issue of patient feedback as a quality improvement tool is high on the agenda at the Østfold Hospital Trust. The development point in the direction of a paradigm shift

AIM: The study describes mothers and children who strived with the breastfeeding dyad. The aim was to see if information, help and close support increase duration of breastfeeding and to gather information of mothers’ experience of breastfeeding problems and breastfeeding support in practise.

METHOD: The study had a descriptive, retrospective design. Data were gathered through a postal questionnaire with 37 questions. The informants were Norwegian speaking mothers who had received extra breastfeeding help and support at a well-baby clinic in Oslo.

RESULTS: The majority of children were under a week old when discharged from hospital. There were no differences in gender. The children’s most reported problems were suckling problems, and failure to thrive. 75 % of the breastfeeding problems among mothers occurred during the first two weeks. More than half of the mothers reported the reason for breastfeeding problems to be sore, cracked and/or infected nipples. The majority of the mothers coped with breastfeeding in spite of huge breastfeeding problems, and breastfed for a long period. Knowledge of how mothers milk protects the baby was the most important motivation for coping with breastfeeding problems. To succeed with breastfeeding was related to the feeling of being a good mother. Support from the child’s father was important for the mother’s decision to continue or to stop breastfeeding. The mothers described that to be given knowledge, counselling and support from competent health workers increased their self confidence and motivation to continue breastfeeding.

CONCLUSION: The time of breastfeeding initiation was an indicator for mothers who needed breastfeeding support both in maternity ward and in the well-baby clinic. The use of supplements in addition to breastfeeding at an early stage was a marker for shorter duration of breastfeeding. It is important to ensure that mothers get breastfeeding support before discharge from hospital and that the support is individual and based on knowledge. Mothers’ need of breastfeeding support after discharge from hospital is a central part of health promotion at the well-baby clinic as it concerns the baby’s nutrition and the mothers mastering.

Background: Antimicrobial resistance is a serious threat to present and future patients. Despite several interventions, the increase in multidrug-resistant microorganisms is a global challenge in public health.

Aim: This study describes and analyzesthe viewpoint of infection control specialists (physicians and infection control nurses) regarding the threat of antimicrobial resistance. It was also evaluated whether specialists perceive a need to improve the match between individual specialist and decision makers.

Methods: Qualitative content theory was used to analyze empirical data based upon semi-structured interviews with infection control specialists. Management, inter-and cross-sector cooperation, and quality improvement and evaluationformed the theoretical framework for this thesis.

Results: Interviewees reported thatDenmark’s efforts to prevent the spread of infection and the development of new resistant micro-organisms have been insufficient. The interviewees viewed current national and international guidelines as sufficient but the interviewees expressed that there is in adequate compliance withvarious elements of the infection control program, including vocational training, guidelines, information and education, monitoring, and a national antibiotic strategy. However, there is a need for more focus and emphasis on implementation and information to all involved personnel.

Conclusion: Antimicrobial resistance requires greaterinter-and cross-sector cooperationin Denmark, regarding the overuse of antibiotics. This effort will require the participation of general practitioners, healthcare professionals, veterinarian specialists, as well as the involvement of leaders and relevant organizations and ministries

Purpose

This qualitative study aimed to increase understanding of  what the consequences have been

for Marte Meo therapists in dementia health care to have learned the method.

Method

We used grounded theory to analyze eight open interviews.

Results

The informants, all Marte Meo therapists reported that they gained a method they long have missed for dementia health care. The Marte Meo method helps them detect tacit knowledge, support and enforce known knowledge, and strengthen their self-confidence. They also gained increased awareness and a common language leading to an improved working environment and the individual needs of the patients are better seen and met.

Conclusion

The study shows that Marte Meo method has positive influence both because the staff have an improved working environment and because the staff experience that they are better able to detect the patients needs after having learned the method.

Complaints about dust in school environments are frequent. This work aims to investigate the amount of dust deposit on different horizontal surfaces in class rooms, how a professional cleaning consultant assesses cleaning in relation to measurements of dust deposit and how quickly a surfacebecomes filthy again after thorough cleaning and health effects. In this investigation we used the questionnaire MM060 NA Sp1 to estimate the students’ symptoms and experience of cleaning andmeasures deposit dust with BM-Dustdetector. The amount of dust deposit varies vastlybetweenschools probablydue to varying number of persons, the geometry of the rooms and cleaningroutines. The investigation supports the idea that the amount of dust deposit relates to the experience of the quality of cleaning but the relation is also dependent of manyother factors. Larger amounts of dust deposit are generally found on surfaces not normally cleaned. Thorough cleaning reduces considerably the dust deposit but it regrows quicklywith high loading of persons. There exist some relations between the association of the cleaning by a professional cleaning consultant, especiallycleaning of the floor, and measured amount of dust deposit but the relations are not very strong.Students complaining of “dust and dirt” and “stuffy, bad air” report significantly more symptoms than the reference group. Exposure to only “dust and dirt” gives more, general symptoms and more mucous membrane and skin symptoms. The results from this study indicate a health effect from “dust and dirt”. One out of four Swedish students have some form of allergies. It is thereforenecessary to have a clean school environment. Presumably good cleaning routines will improve the situation.

Background: This study is a follow up of a patient survey study done in the Physiotherapy outpatient clinic, Department of Physical Medicine andRehabilitation, Ullevaal university hospital, 2003. The previous study showed that patients with a non- Scandinavian mother tongue were less overall satisfied with the treatment than other patients.

Purpose: of this study was to find out why patients with a non- Scandinavian mother tongue were less overall satisfied with the treatment than other patients, and to assess with which factors the patients were most dissatisfied and how the patients had experienced the treatment.

Methods: The material consisted of patients who had finished their physiotherapy treatment for muscle skeleton diseases. Most of them came from Asia. Both quantitative and qualitative (phenomenography) research methods were used. In the patient survey 30 patients were included. Another four patients were included in focus group interviews.

Results: Older patients were more satisfied than younger. There was no significant association between gender and satisfaction. The main dissatisfaction factor was no improvement following treatment. However, many patients were satisfied despite that there had not been any improvement. Other factors that had impact on the overall satisfaction were communication, professional skills, information, enough time and expectations. Facilities and equipment were of less importance.

Conclusion: The results indicate that in addition to improved condition, communication, information and enough time were of great importance for patient satisfaction. These factors should be taken into consideration while treating patients with foreign culture and language

Background and objectives: This study focuses on the supervision of environmental andpsychosocial conditions in Norwegian accommodation centers for asylum seekers with long-term residence. We aimed to examine how professionals from the communities view current practice andto what extent they consider it compliant with legislative intentions. We further aimed to explore the sufficiency of available resources, guidelines, and conditions, and to determine their effect on the quality of the supervision.

Methods: This cross-sectional study used structured telephone interviews with 82 persons, a number that corresponds to 48.8% of the total number of professionals in Norwegian communities, based ona questionnaire comprising 28 closed and 2 open questions. Data was analyzed using descriptive statistics and qualitative content analysis.

Results: Employees who currently oversee regulations for environmental health reported too muchdiscretion-based supervision. They called for better policies and clearer requirements in laws an dsupervisors, respectively. Furthermore they announced more knowledge directly aimed at psychosocial factors in reception, and more focus from central government on courses and trainingand better facilities to carry out a proper inspection. Respondents viewed closer and more interdisciplinary collaboration with health professionals and immigration authorities, as well as intermunicipal organizations, as a force for improving the quality of inspections.

Conclusions: Evidence suggests that poor housing conditions, long-term residence, andidleness/pacification comprise the largest challenges for the psychosocial environment in asylum centers. The most important measures for improving the quality of supervision likely requireincreased knowledge in the field, especially regarding psychosocial factors; clearer requirements;legal and regulatory guidelines; and greater cross-discipline collaboration to fulfill the needs of a vulnerable group of people/residents in reception

The aim of this study was to understand how public health nurses work to trace women with postnatal depression, how effective they find their work and their attitude towards new knowledge and methods. Postnatal depression is common in the postnatal period and studies show that the conditionoften is not detected. Postnatal depression may lead to disturbances in the bonding between mother and child which can have a negative influence on the child’s development and health. Help and support given to these women will have a positive impact on both the mothers’ and the children’s future health. In a qualitative study 14 public health nurses wereinterviewed and asked how they trace these women, whether they miss some and their attitude towards using Edinburgh Postnatal Depression Scale (EPDS), which is aquestionnaire validated for use in primary health care to detect women with postnataldepression. The design had a hermeneutical/phenomenological approach. The results showed that the public health nurses do not have a method to trace women with postnatal depression. They rely on their experience, personality and intuition and are aware that they do not trace all.They are positive towards getting more knowledge about postnatal depression and to start using EPDS. Further research should include discussions about whether screening for postnatal depression is desired and how the follow-up for the women should be organized

Demografic development points to a significant increase in elderly people, creating challenges in how health care services are shaped in correspondence with user needs and resources. The aim of this study was to describe and analyse, how elderly people, experienced their own need for help. Qualitative research interviews were chosen as a method of collecting the material for this survey. Grounded theory was used for analysis of the gathered information. The interviews were based on the experience of nine elderly people living at home by themselves. All nine selected interviewees were dependent upon regularly daily help from the communal health care and home help services. “A user related service” was defined as a superior core category. Three categories were related to the core category: Resources and needs among the elderly people, the encounter with the “helper” and outer boundaries of the service provided. Conclusion: The major results of this study points to the lack of individual response, flexibility and predictability of the help provided. Despite of this the elderly seem to cope with their situation, and preferred to live in their own homes as long as possible.The results may lead to a closer look on the necessity of a more thorough survey related to the elderly population and their coping needs, before help and care services are provided. The focus has to be aimed on health assesment to prevent dysfunctional services from developing even further.

Introduksjon: QuantiFERON^®TB Gold (QFT) er en ny blodtest for påvisning av tuberkulosesmitte, men med få data så langt fra undersøkelse av immigranter. Målet med studien var å sammenligne resultat av QFT og tuberkulin hudtest blant nyankomne asylsøkere i Norge og å vurdere hvilken rolle QFT bør ha i screening for latent tuberkulose.

Metode: Alle asylsøkere, 18 år eller eldre, som ankom Tanum asylmottak fra september 2005 ble invitert til å delta og ble inkludert etter informert samtykke. Inkludering pågikk inntil et forhåndsbestemt antall på 1000 inkluderte ble nådd. Siste deltager ble inkludert i juni 2006. Deltagelse innebar en QFT test og standardiserte spørsmål, i tillegg til den lovpålagte tuberkulintesten og lungerøntgen.

Resultat: Totalt 2813 asylsøkere ankom Tanum asylmottak i inkluderingsperioden (sept 05-juni 06).  Blant de 1000 deltagerne hadde 912 gyldige testresultater og ble inkludert i analysen, 29 % (264) hadde positiv QFT, mens 50 % (460) hadde positiv tuberkulintest (indurasjon > 6mm). Det indikerer en høy andel smittede personer i denne gruppen. Blant deltagere med positiv tuberkulintest hadde 50 % negativ QFT, mens 7 % av dem med negativ tuberkulintest hadde positiv QFT. Det var en signifikant sammenheng mellom økning i tuberkulinutslag og sannsynligheten for å ha positiv QFT. Samsvar mellom testene var 71-79%, avhengig av grenseverdi for tuberkulin. Det var bedre samsvar mellom testene for ikke-vaksinerte personer.

Konklusjon: Ved å implementere QFT som rutine kan videre oppfølging avsluttes for 42% av dem som ville ha blitt henvist basert kun på tuberkulinresultat (> 6mm). Andelen som henvises vil være den samme enten QFT implementeres som erstatning for eller som supplement for å bekrefte en positiv tuberkulinreaksjon, men antallet som testes vil variere mye. Ulike tilnærminger vil identifisere samme andel (88-89%) av asylsøkere med positiv QFT og/eller sterkt positiv tuberkulinutslag (>15mm), men ulike grupper vil mistes.

Cancer is one of the most common diseases in the West World. Cancer is also a disease that accounts for much pain and decreases in quality of life in the suffering individuals. The assessment of dimensions of pain is very important for the individual treatment in the palliative care to increase quality of life in patients with cancer. The aim of this study was to describe the incidence and intensity, quality, location and duration of the present or “just now” and the usual or “every-day” cancer pain. An other aim was to describe the differences of factors, even deference of age and gender. Pain experiences were assessed with Pain-O-Meter (POM): The POM combines the qualities of McGill Pain Questionnaire and the Visual Analogue Scale into one tool, and is therefore useful for evaluation of different dimensions of the pain experience. POM also makes it possible to assess the location and duration of the pain. The result showed that all subjects experienced moderate to severe usual pain even though they were patients at a clinic specialized in palliative care for individuals suffering from cancer. The most interesting finding was that the patients in the assessment situation experienced their present pain to be more intensive then the usual or “every day” pain. These finding have implications for how to ask the patients about their pain. The results also indicated that the individuals experienced more intense pain during physical activities compared to the pain during rest. This will increase incidences of complications and decrease quality of life in this group of patients

Aim: Thisstudy aimedto investigatethe knowledge and attitudes of healthcareworkers regardinginfluenza, influenza vaccination,and vaccination practicesin emergency departments in Gothenburg, Sweden.

Method: This cross-sectional studyuseda self-administered questionnaire distributed tonurses, assistant nurses,and physiciansin three emergency departments atThe Sahlgrenska University Hospital in January–February2014.

Results: Among214 participants, 56% were nurses, 27% assistant nurses,and 17% physicians. The response ratewas 77%. A total of 66 participants (31%)werevaccinated against influenza during the previous12 months.The highest vaccination coverage occurredin the oldestage group(56%;P<0.05).Past vaccinationstrongly predicted future vaccinationbehavior (P<0.001). Ourdata revealed nosignificant difference invaccination coverage betweenprofession, work experience, hospital,or gender. The mean knowledge score was higher among vaccinated vs. unvaccinated health care workers (17.9 ± 2.7vs.16.8 ± 2.6, respectively; P< 0.05). Moreover, influenza risk perception was higher among participants who were vaccinated during the previous12 months compared to unvaccinated participants (P< 0.001). Interestingly, more un vaccinated health care workers believed that personal behavior determines health (higher internal locus of control) compared to vaccinated workers(P< 0.05). More than half of vaccinated health care workers stated that they got vaccinated to avoid influenza. Almost half of the unvaccinated workers voiced concern about vaccine side effects. Fourteen percent of all respondents mentioned patient protection as an important factor in their decision to receive influenza vaccination.

Conclusion:This study demonstrates a need for improved knowledge about influenza and influenza vaccinationin health care workers. Increased risk perception of influenza can increase vaccination coverage in emergency department personnel,and may reduce the incidence of healthcare-associated influenza.

Purpose: This qualitative study aimed to increase understanding of how pregnant women experience early ultrasound examination that includes risk assessment for chromosomal anomalies. Moreover, this study examined how such women rationalize test results.

Method: I conducted pre- and post-examination interviews of ten pregnant women undergoing risk assessment for chromosomal anomolies, and used grounded theory to analyze the results.

Results: The study generated a core category (I want a choice, but I don’t want to decide) and five main categories (existential choices, feeling of safety, anxiety, guilt, and counselling and care). Factors contributing to choice difficulty included anxiety, loss of control or coping, emotional connection to the fetus, feelings of guilt, and social pressures. The core category describes the conflict between choice and decision. Since the women sought independent choices without external influence, they also felt greater responsibility. The women’s understanding of actual risk varied, and they used different logic and methods to evaluate risk and reach a decision.

Conclusion: Pregnant women need for prenatal diagnostic information and want easy access to specialty services. This study shows the complex feelings pregnant women experience regarding early ultrasound examination that includes risk assessment for chromosomal defects. Stress, non-transparent information about actual and perceived risks, and personal moral judgments further complicate the decision-making process. Therefore, improved distribution of information and frequent contact with health professionals will help women to make informed choices in accordance with their values and beliefs.

Purpose: This study aimed to increase knowledge about teachers' and management's perceptions of, and experiences with, the concept of interprofessional collaboration. The study also sought to determine perceptions about the need and opportunity for implementing interprofessional collaboration in their work environment. Finally, the studie investigated whether past experiences influence motivation for structured cooperation.

Method: This study used a fenomenografic approach and interviewed 15 employees of a Norwegian junior high school. Study participants were divided into three focus groups; participants from the management, teachers with experience from structured interprofessional collaboration and teachers without such experience.

Results: Data analysis identified three categories and six subcategories. All participants described interprofessional collaboration as not well known and collaboration with other professions is described as rare, sometimes difficult, and random. They perceived the school's role in committed cooperation as difficult because it increases demands on the school. The study participants find prioritization between vocational training and topics that fall under the social skills difficult. Motivation for cooperation is based on a need for increased knowledge about the factors that influence students' individual and overall experience of school. Focus groups having greater experience with a structured interprofessional collaboratio, showed a more positive attitude toward cooperate with other professions. Participants perceived formal frameworks as a limiting factor for collaboration.

Conclusions: This study showed a need to clarify the meaning of the term interprofessional collaboration. The school should work to develop a good psychosocial environment in an interprofessional perspective. A positive experience with structured interprofessional collaboration, increases motivation for further cooperation.

Background: The 2006 employee survey from Anaesthesia Unit 2, at Oslo’s Rikshospital, revealedlow scores regarding anaesthesia nurses` opportunity to influence their own work situation.

Purpose: This study aimed to examine work factors that anaesthesia nurses perceive health promoting and to analyze how hospital leadership could initiate a healthier work environment. The value of this assessment is that factors that promote a healthy work environment for anaesthesia nurses will become visible to department management.

Method: A qualitative method was used, which included interviews with fourteen anaesthesianurses, working in six different departments. A modified Grounded Theory was applied as a methodfor analysis.

Result: Analysis of the interviews yielded a core category: Cooperation for Better or Worse-Anaesthesia Nurses` “Ticket” in the Workplace, and three categories: Leadership, An Organizer of Conditions; Well-being in an Operations Environment and Clarity of Roles.The core category illustrates the coordinated entirety that anaesthesia nurses consider a safeguard inrelation to the patients and other professions. Nurses described great satisfaction in their work aswell as an inkling that differences can occur. Leadership was crystallized as an important factor infacilitating a healthy working environment that satisfies basic personal and professional needs. The respondents perceived production pressure and communication difficulties with close collaborators,as demotivators that sometimes caused lack of trust. Collegial support was a crucial factor in creatingthe perception of a good working environment. A model was developed, which illustrates the basic conditions of practicing the profession, obstacles and restrictions, how nurses experience optimal patient care and fundamental and potential influence of department leadership on both positive and negative factors.

Conclusions: The study shows that several important factors contribute to a healthy working environment for the anaesthesia nurses. Leadership should work more actively toward developing ajustifiable framework of management and initiating health promoting efforts that motivate better cooperation between team members. Other important factors for well-being in the workplace included independent work and interdisciplinary collaboration around patient care.

Situations of life characterised by numerous complex psychosocial and health problems demand another extent in interprofessional co-operation in social and health service. At the same timeincreased focus on prevention and health promotion have raised the necessity of knowledge andcompetence creation that is able to deal with these complex challenges. The aim of this study is to identify possible patterns of experience with creation of shared knowledgeand competence in interprofessional co-operation with focus on prevention and health promotion.The studyis based on qualitative interviews in focus groups and memorized theme guide was used.The analyzing process was based on grounded theory. 25 professionals represented eight occupationgroups from nine social and health service teams. The overall core categories emerge as: ”social cultural organization sets the agenda for creation of knowledge and competence”. Three additional overall categories related to the core category definedas: ”the needful professional foundation”, “the discourse of prevention and health promotion” and“the tacit knowledge and competence”. Conclusions: The overall findings pointed out the essential influence of the social culturalorganization on the possibility of the interprofessional co-operation to create shared knowledge in the prevention and health promotion. If space for learning and reflection in community of practice is not created the feasibility of meetings between tacit and explicit knowledge will be reduced

Background: Municipal planning sets important conditions for a population's personal choices and lack of choices. Well-planned communities can help motivate people to adopt a more activedailylifestyle.

Purpose: This thesis aimed to illuminate city planners’ viewof concepts such as community and public health. It also sought to identify city planners’ most relevant experience.

Method:Fourteen municipal planners responded to 20 questionnaires, and six municipal planners in three municipalities participated in interviews.I used content analysis to evaluate all responses.

Results:Many respondents mentioned the value of physical improvements, such asreduced sound levels,more cycle paths,and safe pedestrian walkways. Other suggestions includedimproving the visual quality of our surroundings, well-being, and affiliating with relevant factorsin urban planning.

Conclusion:Multidisciplinary cooperation between planners and health sectors couldcontribute to a common understanding of the challenges connected to municipal planning for health promotion

Pharmacoepidemiological analyses are needed as a background for evaluation of drug use and for making cost-effective priorities. Drug sales and prescription databases provide useful tools for analysis of drug consumption and expenditures. In this essay, an analysis of the sales and prescribing of proton pump inhibitors (PPIs), drugs used for acid related gastric disorders, are presented. Since 1996, the consumption of PPIs in Norway has increased by approximately 10 % per year, with esomeprazole as the most commonly used drug. An increasing number of individuals are using these drugs with considerable costs for the reimbursement schemes, e.g., in 2006 more than 450 million NOK. Verified reflux oesophagitis is the predominant indication for reimbursement prescribing. There are, however, indications of an overprescribing of PPIs. The prescribing in Norway is different from Denmark and Sweden, both regarding choice of drug and level of consumption. The prevalence of PPI use increased with age, reaching a maximum of nearly 12 % in the age groups 70-79 and 80-89 years of age. A considerable proportion is long-term users (> 2 years). These groups have a high risk of polypharmacy treatment. Even though the PPIs have been on the market for many years, negative effects associated with long term use are being discussed and need to be further explored. Attention should be focused on the rational use of PPIs and not only on the reduction of costs for PPI therapy.

Background:Research has shown that insufficient communication skills and lacking continuity has led to poor quality of the children's health services. In some cases this has caused incorrect diagnosis and treatment and insufficient information to the parents. The Norwegian Board of Health appointed a working group that created a parent-held child health record. The group proposed the record to betried out in a selected population and evaluated before introducing it for the whole country.

Aim: Tostudy parents use of the PHCHR, and to evaluate participation in decisionmaking and communication with the professionals. We also wanted to determine the PHCHR’s influence on health care utilisation, knowledge about child health and self-care.

Setting: Maternal child health centres in ten municipalities in the North-west of Norway between October 2001 and January2003.

Method: A sample of 309 children born between Jan 8. 2000 (00.08.01) and Oct 1. 2001 (01.10.01) was recruited successively at routine health surveillance visits and randomised into an intervention ora control group. First-born children were excluded. We used self-completed questionnaires, which had standardised, specific and closed questions. Both groups answered part one before and after the intervention, and the intervention group also answered part two after the intervention. It was 289(94%) parents who answered the questionnaires before the intervention, and 260 (84%) after. Public health nurses introduced both the PHCHR and the questionnaires. The nurses were interviewed to validate the interpretation of the results.

Results: 3/4 of the parents used the PHCHR when visiting the maternal child health centres, 3/4 reported that the record had been helpful to them and 3/4 had entered information in the PHCHR themselves. Half of the parents claimed that the PHCHR led to better view of the child's health and development, and that they got more involved in decisions. The PHCHR was less used visiting other health professionals. The use of PHCHR did not influence the utilisation of health care services, parents’ knowledge of child's health, or the parents' satisfaction of information and communication with professionals.

Conclusions: The PHCHR was well acceptedand frequentlyused in this randomised controlled trial, but the survey does not support the positive results using PHCHR shown in earlier descriptive follow up studies. Still, the public health nurses taking part in the study believe that an earlier introduction of the parent-held child record – at the first home visit, and more training would alter the results. Further studies are needed before one is to decide what to do about PHCHR in health promotion in children

Background:Frisklivssentralen, or physical activity on prescription, is an intervention used by Norwegian municipalities for preventive health services. This approach helps individuals change lifestyle habits and increase physical activity. Research documenting thelong-termeffects of participation in Frisklivssentralen is sparse.

Objective:This study aimed to evaluate whether Frisklivssentralen achieves its goal of permanently changing individuals’ activity level and health-related quality of life, as measured three years after participation.

Method: Three years after the Frisklivssentralen intervention (04.2010–03.2011) concluded, 33 former participants answered a questionnaire exploring their current level of physical activity, adherence to physical activity, factors affecting such adherence, health-related quality of life, and experiences from participation at Frisklivssentralen. We compared their answers to data collected at baseline and the 3-month follow up. We used descriptive statistics to assess the range and is tribution of participants and their answers. Non-parametric tests explored changes over time and compared subgroups.

Results: Our results revealed that the positive change in activity level achieved from baseline to 3-month follow upp ersisted three years later(P=0.001). From baseline to three years, 39.4% of participants increased their activitylevel. Interestingly, participants in the current study who reported no increase in activity were more activeat baseline. After three years, the median activity level for the total sample was> 4 hours per week. Regardless of changes in activitylevels from baseline to three years, participants reported positive changes in health-related quality of life (P≤0.001).

Conclusion: Frisklivssentralen increases physical activity levels and health-related quality of life. Participants who initially were less active (i.e., 1–2 hours/week) increased their activity level to > 4 hours per week and maintained it for 3 years. Respondents improved their health-related quality of liferegardless of changes in activitylevel

Background: Today, patient care in hospitals is highly specialised and undertaken at high speed. Many patients receive complex treatment and care, which often continues in the primary-care sector after the patient is discharged. Structural reform of the health care sector requires infection control measures in intersectoral health agreements.

Aim: This study aimed to investigate and analyse intersectoral collaboration and gain better understanding of collaboration across health sectors in relation to the treatment and care of patients requiring treatment and care for infection control.

Method: This is a qualitative, multiple-case study, wherein semi-structured interviews form the basis of the empirical knowledge. The theory underpinning the study is the perspective on intersectoral collaboration, examples of models of collaboration, and the strengths and weaknesses of collaboration.

Results: The findings showed that the motivational factors for intersectoral collaboration include focus on organisational structure and organisation, collaboration through networks, awareness of the importance of clear communication, and focus on the relationship between professional competencies and infection hygiene. Structured collaboration with the establishment of an actual infection control organisation resulted in access to expert knowledge, security among personnel, and motivation to work with infection control as an area of focus.

Conclusion: Patient transference of nosocomial infections from one health sector to another likely can be prevented by increasing workers’ knowledge of infection control in all sectors, and by formalised collaboration across health sectors to establish an intersectoral, infection control organization.

Osteoporosis and fractures due to osteoporosis are an increasing global health problem. The aim ofthe ten-years Vadstena Osteoporosis Prevention Project (VOPP) was to evaluate if it was possible toreduce osteoporosis and osteoporotic-related fractures with a community-based prevention programA representative sample aged 20-79 years (Vadstena population of 7800) was invited to participatein the study comprising four measurements including questionnaire and bone mineral densitymeasurement. At baseline 70% participated, at first follow-up 69%, second follow-up 70% and at thethird follow-up 65 %.The aim with this MPH- essay is to describe the intervention from a diary and to present thepopulations experience of the VOPP.We met approximately 5000 persons (65%) of the citizens directly with our intervention. Theparticipators who received individual feedback letters on their answers in the questionnaire and theresults from the bone measurement gave us the best response.The group that participated once or more had the best knowledge about osteoporosis (p< 0.001)and were to an high extent familiar with the project (p<0.001). Even the single participating grouphad god knowledge about the project (75 %). Both groups stated that they wanted to change lifestyle(65 % vs. 64 %) showing a successful general intervention.Osteoporosis is a disease that is present for a long period without signs, before resulting in theclinical sign, fractures. Therefore results of a preventive program towards a whole population isexpected to be found not until after several years. Now eighteen years later a follow up is planned inorder to measure the incidence of osteoporotic fractures and the knowledge about osteoporosis in thepopulation.

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.

This study aims to describe the practice patterns of complementary and alternative medicine (CAM) practitioners and their collaboration with traditional medical professionals in Sweden. Historically, the medical profession has dominated medical practice in an environment of different healing professions. This domination placed CAM professionals outside the established medical system. Consequently, information about CAM is inadequate. Since today’s patients increasingly seek consultations with CAM practitioners, the need for a better understanding of these professions has grown.

      To investigate the practice patterns and sociodemographic characteristics of CAM practitioners, we developed a literature-based questionnaire and sent it to 102 CAM practitioners. Among the 63 practitioners (62%) who replied, only 59 matched our research criteria for participating in further telephone interviews that allowed them to state their opinions on collaborating with conventional medical professionals.

      Fifty-five percent of the telephone interviewees were women, 10% were licensed in other medical professions, and 69% worked in solo practices, seeing 24 patients per week on average. Furthermore, 79% felt collaboration would be positive, and 37% had already established regular contacts with medical doctors. CAM practitioners generally considered patients’ needs and desires to be an essential component of healthcare provision. They also elucidated the importance of treatment costs, respect for CAM professionals, licensing, competition, collaboration, and knowledge of a variety of professions.

 This study provides new information about the challenges faced by CAM profession in Sweden and reveals many obstacles to collaboration. Our results can assist in the development of a health care system that includes a variety of different professions.

The purpose of this study was to estimate the preliminary prevalence of multiple sclerosis (MS) in the County of Värmland, with prevalence date 21 December 2002, and to compare this with other prevalence studies in Sweden. The clinical data of the patients were collected from medical files at the medical care facilities in the county. For classification of MS the criteria by Poser were used. The diagnoses were scrutinised by neurologists. Based on the collected data, August 2004 the prevalence of definite/probable MS in Värmland is 151/105 (95% CI 136-165), for women 211/105 (95% CI 187-235), for men 89/105 (95% CI 73-105), resulting in a female to male ratio of 2,37. When comparing these results with prevalence numbers from Västerbotten County in the north of Sweden and Gothenburg respectively, our prevalence number reaches the level of that from Västerbotten, indicating that Värmland, as well as Västerbotten, is a high risk zone for MS.

Norwegian Board of Health controls that the municipal authorities in Norway fulfil their legal obligations as regards the municipal health service. Since 1995 system auditing has been the main method of supervision. In addition to Norwegian Board of Health in the Counties controlling that the legal obligations of the municipalities are upheld, system audits are meant to encourage systematic improvement efforts in the municipal health services. The aim of this essay has been to describe how the system audits affect improvement efforts. This is a qualitative study conducted as a case study in two Norwegian counties. Data collection was done during the autumn of 2001, by studying documents and in four focus groups – two in each county. The main focus was on what expectations 28 employees (14 leaders and 14 professionals) in 19 different municipalities had to the system audits, how the results were handled in the municipalities, and how useful the employees felt that the auditing had been. The results show that the system audits lead to greater activity in processes in the municipalities. The audits upset some and pleased others. The main differences were between a wish for more aid regarding professional improvements of the health service and a desire for greater municipal autonomy. Three areas of the audits were shown to be important for encouraging systematic improvement efforts in the municipal service: language/communication, individual adjustments, and that the municipality top management was directly involved during the audits.

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

Purpose: to assess the effectiveness of the Norwegian adolescent BCG vaccinationprogramme by (1)examining if differences in tuberculosis epidemiology in four Nordiccountries is associated with different use of BCG and (2) using evidence from this and paststudies on BCG efficacy to estimate the impact of vaccination in the present epidemiologicalsituation.

Method: The study period was 1975-2005, with main focus on 1996-2005. Data sourceswere articles, surveillance reports, the EuroTB database, and national tuberculosis registers.EuroTB data were used to calculate incidence rates for cases reported as “born incountry/national” in Norway, Sweden, Finland and Denmark. Data from the Norwegian andSwedish tuberculosis registers were used to calculate incidence rates for cases that were born in the respective countries and that had parents who were both born in countries with low incidence of tuberculosis. Incidence rates in the age groups 0-14 and 15-29 years were compared.

Main results: From 1975 to 2005 all countries experienced a reduction in incidence rates,most pronounced in Finland. During 1996-2005 Finland had the lowest incidence rate in the0-14 year age group, and Norway had the lowest incidence rate in the 15-29 year group. Thisis consistent with protection by BCG vaccination of newborns in Finland and of 12-14 yearolds in Norway. We estimated that the Norwegian adolescents BCG vaccination programme confers 61-64% protection in the age group 15-29 years. Assuming 50-80% protection, 14918 - 51 409 vaccinations are needed to prevent one case of tuberculosis. During 1996-2005,prior BCG vaccination of Norwegian teenagers may have prevented 1.2 - 3.9% of cases oftuberculosis among Norwegian-born and 0.4 - 1.2% of total cases.

Conclusions: BCG vaccination of low-risk Norwegian adolescents may have contributed to reduced risk of tuberculosis for a period of 15 years after vaccination. However, a large number of vaccinations must be given in order to prevent one case of tuberculosis.

The aim of this study was to gain more insight about the users of day-care centres for the elderly and how their every-day lives benefited from having access to this service. For the purpose of this study, in-depth interviews with nine users were conducted. The principle of Grounded Theory was used in the data collection and analyses. One of the core categories that emerged was: The feeling of social deprivation and depression is amended through activities and social contact with other senior citizens. The results showed that loneliness and isolation were widespread among the participants. Having access to the day-care service two-three times a week provided them with a social network and social activities. This, in turn, made them feel more comfortable and in better general health. The most important findings were that the day-care centre represented a sense of community with other senior citizens, activity, a sense of well-being, and care

The aim of this study is to understand the experience and knowledge of intersectoral collaboration of the participants in the health promotional project “Feel good in the old age”. The study focuses on successful factors and barriers in the collaboration process, how the project have affected the power between the non governmental and the public organisations, the participants organisational experiences of collaboration, their view of the working climate in the project and their experiences of SOC in the project. Research in intersectoral collaboration in health promotion among elderly is sparse. The methodology is a qualitative study with focus groups. 11 focus groups was made with 62 participants from the different organisations – non governmental and public- and old and people becoming elderly. The project leader wrote the answers before the focus groups were made. Content analysis was used. As successful factors nine themes appeared: 1. leaders, energizers, duration, listen, 2. the public organisations are the most important but all are valuable, 3.people met and created a process with flow, 4. participation, 5. working over boundaries is a new way of working, 6. people and organisations learned from each other, 7. building of networks increased in the society, 8. sense of coherence and 9. positive working climate and no stress. Nine themes appeared in the analysis of barriers (elderly and becoming elderly was grasping five of them and the project leader seven): 1. insufficient support and legitimacy, 2. insufficient resources and use of available resources, 3. insufficient organisational conditions, 4. unequal power and economical conditions, 5. insufficient anchoring, 6. preservations and competition, 7. insufficient participation and trust, 8. insufficient methods and 9. the work in the project was under stress. The participants experienced participation in the project. Both public and nongovernmental representatives did not think the project had influenced the public organisations. The legitimacy of the project decreased during the run. The participants got new knowledge in how to work in collaboration, new competence of how to work over the boundaries and of the importance of building relationships and networks. The working climate was seen as healthy and as with stress. The SOC 13 formula was used to measure the participant’s sense of coherence in the project. The score was relatively high. The study shows difficulties in intersectoral collaboration. There are some signs that the public sector is not yet ready to change the paradigm. There are though a lot to win to initiate health promotion. A social fellowship develops in a democracy process with empowerment as the method, farthest out to reach a sustainable development

Aims: This study sought to explore the knowledge Norwegian patients with ankylosing spondylitishave about the disease and to what extent belief in their own capacity to master the disease affectshealth-related quality of life.

Methods: We used questionnaires to explore and describe participants’ knowledge about ankylosingspondylitis. The questionnaires also assessed how this knowledge affected participants’ lifesituations. The study included 150 patients who participated in a rehabilitation programme abroad.

Results: The patients were most satisfied with information provided by rheumatologists and physiotherapists. They also considered fellow patients as an important source of information. Less satisfactory was information provided by nurses and courses in disease mastery. Respondents werevery knowledgeable about disease symptoms and physical exercise. However, they described their knowledge about medication and appliances designed for use at home or in the workplace as limited.The patients who were most satisfied with their knowledge about the disease had a significantly better belief in their ability to cope with pain and disease-related symptoms.

Conclusions: Knowledge about their disease contributed positively to patients’ health-related quality of life. Sharing knowledge and personal experience with others who are in similar situations enhances learning and appears to be a useful and positive way of providing patient education.However, adapting training to the educational background of participants will require careful assessment of the target group. Similarly, the roles and domains of health care professionals require clear definition.

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

This study aimed to assess how parents of children with spastic Cerebral Palsy (CP) evaluated the efficacy of Botulinum Toxin A (BTX) treatment on their child.

Method: Triangulation of measurement processes, i.e., qualitative assessment including two focus group interviews with experts and three interviews with parents; quantitative assessment involving questionnaires send to parents of 47 children treated with BTX at Hilleroed Hospital. The qualitative data were analysed using content analysis.

Results: Focus group interviews indicated that questionnaires should seek detailed information about the daily activities of children undergoing BTX treatment, beginning treatment initiation and continuing until BTX effect declined. Parent interviews showed that two out of three would allow another BTX injection; waiting time on treatment day was too long; and hospital routines should be optimized to meet the needs of disabled children. Forty-one parents (12 fathers and 29 mothers) completed the questionnaire. The study included 30 children receiving BTX between 2004 and 2007. Parents described the best effect of BTX as reduced spasticity. Walking ability improved in 67% of children who could walk before treatment, and improved motor skills provided new ways of moving. Twenty-two parents believed that BTX treatment fulfilled doctors’ expectations. Maximum BTX effect occurred after three to six months. Effects differed with each treatment, mostly on a declining scale. Parents felt very welcome in the children’s ward and also felt that the staff listened to them; their overall assessment of treatment day experience was good. Major concerns included waiting time and a missing meal following treatment. Views of healthcare services for children with CP did not differ between fathers and mothers. The study indicates that development of national guidelines for BTX treatment will be highly recommended.

Conclusion: The majority of parents agreed to repeat BTX injections, mainly because outcome was positive or met their expectations. A minority would refuse future BTX treatment, primarily due to lack of effect or because of significant problems for small benefit. Optimizing hospital routines on treatment day would help disabled children navigate BTX treatment more successfully

The mass media are a powerful way to disseminate health information to the entire population. Newspapers are the media with most impact in Sweden and can convey health news and breakthroughs more thoroughly than television or radio, and more quickly than magazines. Newspapers in Sweden have a high amount of readers compared with other European countries. The purpose of this essay is to analyse the space related to health found in the Swedish newspapers and to discuss what readers consume about health. This study is based on an observational, descriptive, cross-sectional, inductive reasoning and quantitative scientific approach. The sample was constituted by daily editions from three major Swedish newspapers selected during one month –Svenska Dagbladet, Dagens Nyheter and Göteborgs-Posten. The main findings show that newspapers included 2.4% on the average of health contents (HC), being Svenska Dagbladet the one with most publications (3.3%). HC used to be published within the first pages, the median is in page 13 and the main mode in page 4. 81.3% of all contents were written by journalists, and, in 73.6% of all contents, writers used sources of information. Most frequent topics were 25 about cancer, 19 about alcohol, 19 about euthanasia and 19 about sick leave at work. Besides, contents dealt with the following main public health areas: 105 with health management, 100 with health policy and 90 with epidemiology. Newspapers in Sweden are clear ways of delivering health information to the population and they might influence to Public Health. Therefore, it’s a need to increase the number of health specialist journalists

Background : Very few research projects have studiedthe coping of the young adult cancer patient.Even though the number of young adults diagnosed with cancer is small, it is considered essential togain a comprehensive and deep understanding of the coping of this age group as the prognosis of being cured is verygood. The majority may therefore have a whole adult life to plan and hope for, live and cope with. Purpose : To gain a comprehensive and deep understanding of the lived experience of coping of the young adult cancer patient through personal narratives focusing on preservation/recreation of self-understanding, understanding of realityand understanding of life in the treatment phase of the cancerdisease. Method : As an integral part of this research project a narrative hermeneutic - phenomenological research method based on the philosophy of Paul Ricoeur has been developed. Eight young adultcancer patients have participated in the research project. Result : Four metanarratives about primarily existential coping themes in the young adult life with cancer have developed from the narratives of the participants. Narrative metathemes of these arechange and constancy in young adult life with cancer, nearness and distance in everyday life withcancer, life-force and suffering in life with cancer, which appear in couples in a continuous and simultaneous movement/tension between each other, and the existential meaning of metaphoric andsymbolic figurative language and prefigurative, configurative and refigurative dimensions in nar-ration/narratives for coping in the young adult life with cancer. Conclusion : The coping of the participants appears very situational, in that simultaneity and continuous movement between the above coping themes are characteristics of the coping of the young adult cancer patient, as they continuously and simultaneously are/are moving in many places in their coping. The coping of the participants come to existence through narration/narratives with the creation of narrative identityin a creative,reflective imitation or reinvention of events/ experiences of the lived life. The mimetic dimensions of narration/narratives in the narratives of theparticipants appear thus as essential characteristics of their narration process as well as coping process.

Aim – To describe variations in nurses’ ways of experiencing compliance with recommendations for hand hygiene and factors nurses experience as having influence on their compliance with hand hygiene.

Design – Descriptive and explorative study using a phenomenographic approach. Semi-structured interviews, focusing on the nurses’ own experiences regarding compliance with recommendations with hand hygiene.

Setting – Hvidovre Hospital.

Subjects – 14 nurses (12 women, 2 men) from 11 different wards, within the surgical speciality, the medical speciality, the women-child speciality and intensive care.

Results – The analysis shows that the interviewed nurses perceive that they nearly always follow the recommendations for hand hygiene. Furthermore six different perceptions of factors with influence on nurses’ compliance with recommendations for hand hygiene were identified in the analysis: Hand hygiene is a natural action; Infection risk; Acute situations, unpredictability and busyness; The attention of the surroundings; Facilities for hand hygiene; Accreditation, hygiene audit and hand hygiene campaign.

Conclusion – Nurses’ experiences of compliance with recommendation for hand hygiene and the different perceptions of factors influencing wether they follow recommendations for hand hygiene ought to influence the planning and implementations of hand hygiene activities in order to promote nurses’ compliance with recommendation for hand hygiene.

Aim  The municipalities in Norway have for the last decades been given a lot of new tasks and the economy has been poor.  In order to reduce costs many municipalities  has chosen to restructure the organisation.  There has been little attention given to what a reorganisation really costs in terms of loss of time, frustrations, stress, increased sick leave and actual expenditures.

Method 14 employees from all over the organisation were interviewed on their experiences with reorganisations.  These results were put together with the results of the sick leave statistics and the numbers from the accounts. 

Result  The employees were very concerned not to exaggerate the use of time.  They would rather not estimate any time used.  All the same, the time used was of incredible dimensions. 

This municipality’s statistics on sick leave did not give any evidence that the reorganisations caused more sickness in the organisation.  But the employees told about being sick from the processes.

The expenses for the reorganisation process were accounted for in the ordinary accounting system.  It was not possible to identify and extract the actual expenses 3 – 4 years later. The exception was the expenses connected to the consultants.

Conclusions  The expenses in terms of time used are huge.  The employees get sick from stress and lack of control, increased workload, pressure and uncertainty. Expenses as the costs of consultants, expenditures of new outfits and moving expenditures must also be considered.   In an evaluation of the savings made through a reorganisation, the all expenses must be considered in full in order to have a true evaluation.  Until today such evaluation do not seem to have been done.   It is a recommended to do further research on this subject

Background: Activities in preschool expose children, staff members, and society at large to com-municable diseases. The risk of infection among preschool children is 2-to 3-fold higher compared to children cared for at home.Recent studies show that simple changes in preschool e.g.written hy-giene guidelines,-and adherence to recommended hygiene practices for changing diapers, improved hand-washing technique, and parental education can prevent infection-based illness and decrease the spread of communicable diseases.

Aims: This study aimed to (i)survey the knowledge of preschool staff regarding the spread and pre-ventionof contagious diseases and (ii) investigate the attitude of parents toward current guidelines in preschools.

Methods: 123 staff members and 104 parents at preschools in Kiruna,Sweden completed an inter-net-based questionnaire.

Results: Our results identified a lack of continuing education for staff members, the absence of writ-ten guidelines at preschools, inadequate understanding of how infection is spreads, and limited knowledge of information sources for communicable diseases. Parents wanted information about current hygiene guidelines, whereas the staff members requested more education to help them better inform parents about the guidelines.The supply of protective gloves, alcohol-based handdisinfect-ants,and paper towels was available at all preschools in accordance with the recommended hygiene practices. We also determined that it was common to travel abroad both among the staff members and the children which, together with the other identified shortcomings at the preschools contributes to an increased risk of spreading infections.

Conclusion: Because preschool staff members mainly perform pedagogical activities, they currently lack formal education about health care. However, preschools must offer excellent care to all chil-dren, regardless of health status.Although government regulations require preschools to control hy-giene internally, including documentation, the absence of routines and guidelines is serious. There-fore, preschools should focus on guidelines that improve hygiene. Importantly, preschool staff can both work to prevent communicable diseases.This requires skilled staff, collaboration on different levels, and suitable and well-equipped facilities

Aim: Using interviews with six professional in four Nordic countries to discuss, analyze and describe what knowledge there is about how one person’s alcohol- or drug abuse can affect others.

Method: The study, using six qualitative interviews submitted with a hypothesis generating analysis, using Grounded Theory. The findings from the interviews were discussed with findings from other theory and empirical data from search in documents, articles and sciences.

Results: The main finding show that in the four Nordic countries, there is an evident knowledge about how one person’s alcohol or drug abuse can affect others in a negative way. Findings show that for every person with a misuse problem, up to three others can get reactions and symptoms directly linked to the abuser’s behaviour and problems. Estimates show that more than 80 millions people globally have a serious misuse problem and cautious estimates show that more than 200 millions relatives are affected by this. There are particularly three groups of problems for affected relatives. They are harms and strains which indirectly and directly give somatoform symptoms with adults and particularly strains due to injuries and violence against spouses, partners and children. Families living with their misuse experience a high level of strains and show evident traces of living with a high level of stress.

Conclusions: The four Nordic countries have knowledge about how relatives are exposed to great mental and physical strains. Estimates show that 150 to 200 000 children in each of the four Nordic countries, live in families with a misuse problem. From the search here, finding show that three out of four Nordic countries have launched a national project in 2007 with a particular focus on children living with misusing parents. There have been no evident findings of knowledge that shows what structural grip is needed in order to build services and functions that might help or support the relatives who are affected by one person’s misuse problem. From the findings here, it is also shown the lack of adequate knowledge of what efforts and treatment service that best can have effect.

Background: Buildings that implement universal design provide increased participation and activity levels for many people.

Purpose: This study aimed to show how a Norwegian community could use universal design for a planned rehabilitation of school and pre-school buildings. We sought to describe the steps necessary to achieve universal design.

Methods: Our case study formed the basis of our investigation regarding the potential of universal design in school buildings. To raise awareness in study participants, we showed them photographs illustrating universal design. We also mapped the buildings according to their fulfillment of the “Guidelines to technical regulations” provided by both the construction plan and building legislation. One year following the mapping exercise, we surveyed six central participants; executive officer, manager of the property department, local politicians, managers and department heads of 2 childcare units. The following questions were posed: Which political decisions have been taken? What does the participant know about universal design? Describe planning processes in the local authority? What economical considerations have been taken? Describe the important factors necessary to implement universal design?

Results: Mapping revealed insufficient design regarding mobility, adaptation ability, and indoor climate. Our study identified criteria that are essential to achieving universal design, including increased knowledge and understanding of universal design; political and administrative funding of the work; common understanding and interaction between the health sector, user organizations, and the technical sector; accountability; and economic recourses. Interviews indicated that study reports aided the municipality in laying groundwork for further rehabilitation of the buildings.

Conclusions: While reports and implementation criteria contribute importantly to achieving universal design, it is important to use such information and guidelines early in the planning process. Further research is required to determine a possible connection between universal design and perception of health.

The study was user survey method based, performed to get the overview of use and perceptions of health caremanagers towards Lithuanian computerized health information system as a tool for decision – making.

Aims of the study were to describe LCHIS, its inputs and potential use; to account for a surveyofpotential users, health care administrators; to discuss the need for improvement of the system and itsuse.

Methods. User survey method was applied. Literature search was performed and the questionnaire was constructed after interview with four respondents and clarification of questions. Totally 100 ofrespondents from different health care institutions were interviewed. Data was analysed using normal statistical methods, using MS Excel 2000 and statistical package SPSS 10.0 as tools.

Main results. Concerning the awareness about the existing of LCHIS, 68% of the respondents saidtheyhave heard about it and 15% said theyhave been using this system daily. As many as 68% of respondents didn’t really take care about the existence of LCHIS, while the size of respondents being satisfied and not was pretty the same. The number of satisfied with the structure was rather small ifcomparing with those partially satisfied. As many as 76% of the respondents said they haven’t been using the system at all. 24% of the respondents were satisfied with the certain groups of healthindicators within the system. Group of morbidity indicators and group of hospital activity indicatorswere among the mostly used (17% together). Almost 20% of the respondents said it was easy for them to use LCHIS; the same number of health care administrators trusted the information comingfrom LCHISand they have experienced the situation, where they have used LCHIS for planning ormanagement in current situation. As many as 82% of health care managers agreed heads or administrative staff of hospitals supposed to be the key members, who must encourage them to use the system.

Conclusions. About two thirds of health care administrators interviewed knew about LCHIS and the rest had been or were users. In the comments this group claimed they were supporting their decisions by using the systemand indicators in it. As many as 96% of the respondents stated there was a needfor statistical information and skills for dailydecision - making and managerial activities. The respondents, who used LCHIS, trusted the information in the system and found it useful in their dailywork as health managers. The main comments, why respondents didn’t use the system or didn’tknow about it, was lack of information technologies in work place, lack of computer skills and lackof support from hospital authorities

Background: On 1 January 2007 the Local Government Reform came into force. The formation of regions is the biggest change of the public sector since the Local Government Reform in 1970. The regions’ main task will be the responsibility for health service.

Purpose: To describe, analyse and discuss the structural changes taking place in the Danish health service, with emphasis on hospitals.

Method: The starting point of the essay is official sources and explanations as well as scientific literature.

Results: The structural reform is a centralisation is inspired by the New Public Management philosophy. The financial system in the health care area has been changed significantly through the Local Government Reform. It is dubious to assume that local government measures are cheaper than the regional health services, and that the net saving is sufficient to drive the substitution process.

A reduction of the treatment guarantee from two to one month must be expected to stimulate the private health service market, thereby causing undermining of the integrated model with public ownership and operation of health service.

Conclusion: The new financing model will affect the financial incentives in the system as the individual players are only rewarded for the services they deliver to the patient with no relation to the remaining treatment. The increasing activity depending financing presents a significant management challenge. With the reduction from two months to one the waiting time guarantee will assume the character of being a service goal instead of a guarantee of treatment of high professional quality.

Background

Peer groups for children of divorced parents have been shown to have a positive effect. Participants experience increased self-esteem, become happier, and report better well-being and a more positive family experience.

Aim

This study aimed to identify and increase understanding of the positive consequences of participating in peer groups for children of divorced parents.

Method

Twenty-eight pupils, 14–16 years of age, from three various communities in Norway participated in seven focus group discussions. Grounded Theory was applied in the analysis.

Results

Peer groups create a sense of community that provides health promotive effects for children experiencing divorce. Group members who share similar experiences gain a feeling of openness and support, providing increased confidence and self-confidence as well as better influence and control over their own lives. Peer groups also increase understanding of divorce, parents/step-parents, and ability to see the positive aspects of divorce.

Conclusion

This study shows that peer groups for children of divorced parents may provide an important public health measure.

Background:Enterohemorrhagic Escherichia coli(EHEC) is a toxin-producing bacterium responsible for sporadic cases of infection as well as serious outbreaks. Symptoms rangefrom uncomplicated or bloody diarrhea to hemolytic uremic syndrome (HUS). In Sweden, most EHEC casesoccurin 1-4-year-old children.

Aims:This study aimed at investigate the value of EHEC screening in children younger than 10 years of age by evaluatingthe prevalence of EHEC and the distribution of serotypes and stxtypes. We also aimed t ocorrelate clinical symptoms with EHEC serotypes and stxtypes. Furthermore the duration of faecal shedding of stxwas investigated.

Methods: The study examined stool samples collected fromall children younger than 10 years of age between1 May 2003 and April 2013 in the County of Jönköping. We divided the children into a physician-requested EHEC analysis group and ascreening group. Children who tested positive for stxwere sampled weekly after initial EHEC diagnosis. We used a questionnaire and reviewed medical records to collect clinical data.

Results: Among 191 children (87 girls and 104 boys) with confirmed EHEC, 162 specimens were index cases and 29 were found by contact tracing. The EHEC prevalence was 1.8 % in the EHEC requested group and 1.5 % in the screening group (p=0.5). The median duration of stxdetection in faeces was 20 days (1-256 days). Symptoms were more severe in children with Stx2-producing EHEC, and seven children developed HUS, all infected in Sweden. We were able to determine the source of infection in five cases.

Conclusions: This study showed that the EHEC prevalence and severity of symptoms where equal between the requested and screening group. HighEHEC prevalence and a high proportion of non-O157 isolates were found. Our results emphasize the need for serotype-independent methods for EHEC detection. The long duration of stxdetection in stools indicates a risk for transmission. Most children with Stx2 were infected in Sweden, suggesting a higher risk forsevere symptoms. Our results confirm the value of EHEC screening in children.

Background: Insufficient physical activity is a public health problem. Nordic healthcare professionals use physical activity on prescription (PaP) to increase physical activity.

Purpose: This study aimed to evaluate the effectiveness of PaP that includes organized exercise.

Method: Prospective data was obtained from four Swedish counties during fall 2009 and spring 2010. The study population comprised 98 patients whose healthcare professional prescribed PaP to prevent or treat disease. Questionnaires administered at baseline, three and six months after initiating PaP evaluated self-reported physical activity levels, adherence, factors influencing adherence, and experience of PaP.

Results: Although the majority of patients receiving PaP including organized exercise are middle-age women, there are a wide distribution regarding e.g., age, socioeconomic status and reason of receiving PaP. Most participants received initial support from healthcare providers and activity organizers, and most were satisfied with the support they got. Approximately 70% participated in several activities at all measuring points. Although PaP including organized exercise increased activity levels only marginally, sedentary behavior decreased significantly. Six months after initiating PaP including organized exercise, 68% adhered to the prescribed physical activity level. Most participants deemed PaP including organized exercise a good method for becoming physically active. However, there is a need for regularly and longer support. Importantly, individualized instruction, adjusted exercise regimens, and support from other participants provide positive reinforcement. On the other hand, PaP with organized exercise imposes additional costs and decreases flexibility including both time commitment and scheduling constraints.

Conclusion: Adherence levels to PaP with organized exercise are similar to those achieved by other chronic disease treatments. PaP including organized exercise can decrease sedentary behavior, an important factor in promoting public health in the Nordic countries.

BACKGROUND: Individuals who have experienced difficult life events, limited here todivorce or death of a spouse, show elevated risk regarding general and oral health.

AIM: This study investigated how and to what extent difficult life events, i.e., divorce ordeath of a spouse, affect general and oral health. I also sought to determine whether a globalquestion can identify different aspects of oral health.

MATERIALS AND METHOD: This cross-sectional quantitative study used an existingquestionnaire already distributed to all (8,313) 65-year-old citizens in two Swedish counties.Within the questionnaire, a global question measured general as well as oral health, and sixadditional questions assessed oral health. Descriptive analysis sought to determinedifferences between groups, and logistic regressions were used to compare them further.

RESULTS: The questionnaire response rate was 73.1%. The results showed statisticallysignificant differences in general and oral health among individuals who experienceddivorce or death of a spouse compared with individuals without such experiences. Thedifferences among groups, i.e., better general and oral health among individuals withoutdivorce or death of a spouse, were significant and systemic, p<0.05. Further, differencesremained statistically significant even when using a global question on oral health. However,this global question focused mainly on chewing capacity and appearance.

CONCLUSIONS: This study shows the importance of accurate anamnesis, includingquestions on civil status. A global question about self-perceived oral health providesimportant information for judging patients’ oral health and determining preventive actions.The study also suggests that risk for deteriorating oral health lingers long after difficult lifeevents have occurred.

Methicillin-resistant Staphylococcus aureus(MRSA) associates with increased risk of morbidity and mortality. In Norway,public health officials recommend comprehensive infection control measures to prevent the spread of MRSA in healthcare institutions, includingnursing homes. Previous recommendations advisedsingle-room isolation for MRSA-positive nursing home residents. National MRSA-guidelines (2009)recommended avoidinglong-time isolation.

Aim: Thisstudy aimed to determine whether the new MRSAregime,which no longer requires isolation ofresidents with MRSA,was equally effective as the former regime,which required isolation ofMRSA-positive patients,in preventing the spread of MRSA among residents in nursing homes.

Method: This noninferioritycohort study used historical data on registered MRSA-cases in Norwegian nursing homes, information aboutinfection control measures in each nursing home,and statistics regarding the use of resources in primary health care.

Results: The incidence rate for secondary cases of the same MRSA spa-type in the same nursing home was 6.3 per 1,000 person-years in nursing homes thatdid not isolateMRSA-infected residentsversus 18.5 per 1,000 person-years in nursing homes that did isolate such residents. The incidence rate ratio for new versus former MRSAregime was 0.34 (95% CI: 0.17–0.63).

Conclusions: Thenonisolating MRSA regimeis equally effective as the isolatingregime in preventing the spread of MRSA. Our results suggest that allNorwegian nursing homes should implement the current national guidelines regarding MRSA

Background:

Stillbirths or intrauterine fetal death have wide effects on families. This is  about women’s and children’s health as well as equity in health for all. As Sweden becomes more multicultural, new challenges in equity on women’s and children’s health develope related to culture, communication, women –and family matters, lifestyle and medical issues.

Aim:

The aim of this study was to assess the occurence of stillbirths in immigrant women compared to Swedish women and investigate factors related to stillbirths.

Method:

Data from 904 646 newborns and their mothers during the period 1992-2001 was analysed using bivariat analyses. A literature study was undertaken with a systematic appraisal of relevant national and international research in the field.

Results:

The analyses showed that stillbirth was more common in non-European immigrant women. OR: 1,45 (95% CI 1,28-1,63). Non-European immigrant women in Sweden had higher odds of stillbirths compared to the background population.

The litterature showed that non-European immigrant women have 2-3 times the risk of stillbirths, and the risk of stillbirths is also increased in women of lower socioeconomic status (SES). Other risk factors indicated to be important are age, consanguinity, smoking and the quality of perinatal care.

Conclusions:

Non-European immigrant women in Sweden have higher odds of stillbirths compared to the background population. These women also have an increased risk of low SES, which is itself a riskfactor of stillbirth. Appropriate knowledge of difference in health needs in different groups in the community is important for filling the health care needs and improving the medical treatments. Further research is needed from different sectors to assess the importance of lifestyle, language limitations and how these women are treated by the health care system.