A malária continua sendo um problema em saúde global. Nas Américas, em 2017, o Brasil e Venezuela foram os países que mais contribuíram no número de casos. No Brasil, 99% dos casos ocorreram na Amazônia Legal. Apesar dos grandes progressos do Brasil desde 2005, nos últimos anos tem se encontrado um aumento dos casos e a persistência de áreas de alta transmissão. São poucos os estudos epidemiológicos recentes que abordam este problema para a Amazônia Legal. Existem associações entre a transmissão da malária e fatores de risco ambientais e socioeconômicos, mas, existe uma falta de consenso nestes fatores, influenciados pela escala de análise. Objetivo: Caracterizar e analisar os fatores de risco da transmissão da malária nos municípios da Amazônia Legal entre 2010 e 2015. Métodos: Foram utilizados os dados de malária autóctone por município entre 2010 e 2015 da base de dados SIVEP-malária da Secretaria de Vigilância em Saúde. Os fatores de risco analisados foram: índice Gini, taxa de analfabetismo, presença de minas, área de reservas indígenas no município, taxa de floresta no município e duração da estação seca. Para a seleção dos fatores de risco ambientais foi realizada uma revisão sistematizada e os fatores socioeconômicos foram embasados na literatura. A unidade espacial foram os 310 municípios dos estados do Acre, Amazonas, Amapá, Pará, Rondônia e Roraima. Os casos de malária foram analisados mediante o Índice Parasitário Anual (IPA) e a incidência mensal através da estratificação local dos dados. Para os fatores de risco uma regressão logística foi executada para um modelo ambiental, socioeconômico e completo, sendo o IPA a variável dependente e estratificando o risco de transmissão em baixo, médio e alto. Resultados: No período 2010 - 2015 houve redução de 61% no IPA, cumprindo a meta proposta pelo Plano Nacional de Controle e Prevenção da Malária no Brasil. No entanto, essa redução não aconteceu de igual forma em todos os municípios, e um conjunto de 13 municípios apresentam um mínimo de 40% dos casos ao longo dos 5 anos. É relevante destacar que tem estados que reduziram o efeito da sazonalidade enquanto outros não. A revisão sistematizada deixou claro que existem divergências na seleção dos fatores de risco ambientais e da influência na transmissão dependendo do espaço tempo e da escala. A análise dos fatores de risco apresentou que os modelos que incluíam fatores ambientais e socioeconômicos tinham um melhor desempenho ao longo dos anos e nos estratos de transmissão. Positivamente o índice Gini e negativamente a duração da estação seca foram os fatores de risco mais importantes para a transmissão. Conclusão: A malária é multifatorial e deve ser abordada tendo em conta o espaço tempo e a escala de atuação, para implementar intervenções eficientemente. As inequidades na população se apresentam como o grande empecilho para obter melhores resultados no seu controle e eliminação, e embora o Brasil tinha feito progressos muito meritórios, não conseguirá acabar com o problema da malária enquanto não aborda-lo como um problema à saúde global que vai além de programas específicos contra a doença. / Introduction: Malaria is still a global health problem. In the Americas in 2017, Brazil and Venezuela were the countries that most contributed to the number of cases. In Brazil, 99% of the cases are in the Legal Amazon. In the last years, there has been an increase of cases and areas of high transmission despite the significant progress in Brazil since 2005. Few recent epidemiological studies approached this issue for the Legal Amazon. There is a relationship between malaria transmission and environmental and socioeconomic risk factors. However, there is a lack of consensus on the influence of them due to the scale of analysis. Objective: Characterize and analyze the malaria transmission risk factors in the Legal Amazon municipalities from 2010 to 2015. Methodology: We used data of autochthonous malaria by the municipality from 2010 to 2015, extracted from the SIVEP-malária database from the Bureau of Health Surveillance. We analyzed the following risk factors: Gini index, illiteracy rate, mines presence, areas of indigenous reserve by municipality, forest rate by municipality and length of dry season. A systematized literature review was performed to select the environmental risk factors. Socioeconomic risk factors were selected based on the literature. The 310 municipalities in the states of Acre, Amazonas, Amapá, Pará, Rondônia and Roraima were our unit of analysis. Local stratification of Annual Parasite Index (API) and monthly incidence were used to analyze the data. Logistic regression was used to perform an environmental, socioeconomic and full model, stratifying by low, moderate and high-risk transmission; the dependent variable API. Results: From 2010 to 2015, there was a 61% API reduction, achieving the Brazilian National Malaria Control and Prevention Plan goal. However, the decline was heterogeneous among municipalities. There are 13 municipalities that at least had the 40% of all cases during the 5 years period. It is relevant to note that some states minimized the seasonality while others do not. The systematized review made clear the divergences to select the risk factors and the influence of them into the transmission due to the space-time and the scale. The full model showed a better performance to analyze the risk factors by strata and transmission intensity. Gini index positively and length of dry season negatively were the most important risk factors. Conclusion: Malaria is a multifactorial disease that has to be approached taking into account the space-time and the scale of analysis to implement effective interventions. Population inequities are the biggest obstacle to obtain better results in malaria control and elimination. Brazil advanced significantly but to end with the problem malaria has to be understood as a global health problem that goes beyond specific disease programs.

There is an increase in mental illness among children and adolescents through several reports, including through the social welfare and public health authorities. Symptoms seen include sleep disorders, anxiety, bodily pain and stress-related problems. Previous research shows that the increase in mental health is greatest among girls 16-18 years. Stress in a small amount has been seen to contribute to positive effects. However, among young people, there has been a direct negative link between stress and the brain, in which the reward system has suffered. A quantitative study was conducted at a high school in Stockholm. The purpose of the study was to search for stress symptoms in relation to the school and correlations between stress symptoms based on academic, family and socio-economic factors. Variables that were also investigated in this study were correlation between stomach ache, headache, psychosomatic symptoms and school. The survey was conducted on a total of 35 out of 61 students, 60% of boys 40% of girls aged 15-16 in grades 8-9. The result shows stress among the students at school as well as several correlations between stressors in the students and gender differences. / <p>Godkännande datum: 2018-08-20</p>

O objetivo desta pesquisa foi analisar os efeitos da globalização na cidade e na vida dos moradores no município de Ponta de Pedras, localizado no Delta do rio Amazonas, estado do Pará - Ilha do Marajó e suas repercussões na saúde, sob a ótica da Saúde Global e da Sustentabilidade. Métodos: Para a realização deste estudo foram levantados dados secundários (DATASUS, IBGE censitários) e realizada pesquisa de campo com aplicação de formulários à população residente e entrevistas com gestores públicos, além de observação de campo e registros fotográficos, no objetivo de conhecer o perfil da população. Resultados: A pesquisa de campo permitiu conhecer o perfil do morador de Ponta de Pedras, suas fontes de renda, seus hábitos de consumo e perfil de saúde. O município, apesar de ser inserido no circuito da globalização, com a produção do açaí, e por meio da tecnologia informacional, entre elas o acesso a internet, mídias sociais e outras, não apresenta boas condições de vida e de infraestrutura para a população, em especial na área da saúde. Outra constatação foi o acesso a uma variedade de produtos alimentícios industrializados e ultraprocessados, com alteração no padrão alimentar, sobretudo de jovens urbanos, mas relativa manutenção de padrões de consumo alimentar baseado em alimentos locais pela população mais idosa e, principalmente, entre os residentes da zona rural. Há consumo de alimentos industrializados enlatados e ultraprocessados, entretanto, o açaí, a farinha de tapioca e o peixe continuam sendo a base alimentar dessa população cabocla. Doenças que antes eram predominantes em médias e grandes cidades são encontradas também na pequena cidade ribeirinha. O processo produtivo de coleta do açaí, no presente, atende a uma demanda de comercialização e consumo internacionais, como resultado de uma globalização que altera não apenas o espaço urbano, mas o modo de vida ribeirinho. Como consequência, vimos que a globalização traz diferentes desafios que nem sempre estão alinhados à uma urbanização sustentável. / The aim of this research was to analyze the effects of globalization on a small town and on the life of the inhabitants of the municipality of Ponta de Pedras, located in the estuary of the Amazon, state of Pará - Ilha do Marajó, and its repercussions on health, using the framework of Global health and Sustainability. Methods: Use of secondary data (DATASUS, IBGE, and census) and field study with use of questionnaires applied to local residents and interviews with public officers, besides field observations and photos. Results: The study revealed the profile of residents, their income sources and consumer habits in Ponta de Pedras. The municipality, in spite of its insertion in the globalization circuit, by the production of açaí and use of informational technology, as internet and social media access, doesn´t present good life conditions and infrastructure for its population. Another finding was the access to a great variety of industrialized processed food, with alterations in the food pattern, mainly among young people in urban area, but maintenance of traditional food in the diet among older people and those living in the urban area. Açaí, tapioca flour, and fish continue to be the preference and the basis of eating habits of this population. Diseases that were predominant in middle size and large cities are also found as important in this riverine town. The productive process of açaí tends to respond to an international demand, as result of globalization, that changes urban space and way of life. As consequence, we highlight that globalization reflects on cities not necessarily in hands with sustainability.

A malária continua sendo um problema em saúde global. Nas Américas, em 2017, o Brasil e Venezuela foram os países que mais contribuíram no número de casos. No Brasil, 99% dos casos ocorreram na Amazônia Legal. Apesar dos grandes progressos do Brasil desde 2005, nos últimos anos tem se encontrado um aumento dos casos e a persistência de áreas de alta transmissão. São poucos os estudos epidemiológicos recentes que abordam este problema para a Amazônia Legal. Existem associações entre a transmissão da malária e fatores de risco ambientais e socioeconômicos, mas, existe uma falta de consenso nestes fatores, influenciados pela escala de análise. Objetivo: Caracterizar e analisar os fatores de risco da transmissão da malária nos municípios da Amazônia Legal entre 2010 e 2015. Métodos: Foram utilizados os dados de malária autóctone por município entre 2010 e 2015 da base de dados SIVEP-malária da Secretaria de Vigilância em Saúde. Os fatores de risco analisados foram: índice Gini, taxa de analfabetismo, presença de minas, área de reservas indígenas no município, taxa de floresta no município e duração da estação seca. Para a seleção dos fatores de risco ambientais foi realizada uma revisão sistematizada e os fatores socioeconômicos foram embasados na literatura. A unidade espacial foram os 310 municípios dos estados do Acre, Amazonas, Amapá, Pará, Rondônia e Roraima. Os casos de malária foram analisados mediante o Índice Parasitário Anual (IPA) e a incidência mensal através da estratificação local dos dados. Para os fatores de risco uma regressão logística foi executada para um modelo ambiental, socioeconômico e completo, sendo o IPA a variável dependente e estratificando o risco de transmissão em baixo, médio e alto. Resultados: No período 2010 - 2015 houve redução de 61% no IPA, cumprindo a meta proposta pelo Plano Nacional de Controle e Prevenção da Malária no Brasil. No entanto, essa redução não aconteceu de igual forma em todos os municípios, e um conjunto de 13 municípios apresentam um mínimo de 40% dos casos ao longo dos 5 anos. É relevante destacar que tem estados que reduziram o efeito da sazonalidade enquanto outros não. A revisão sistematizada deixou claro que existem divergências na seleção dos fatores de risco ambientais e da influência na transmissão dependendo do espaço tempo e da escala. A análise dos fatores de risco apresentou que os modelos que incluíam fatores ambientais e socioeconômicos tinham um melhor desempenho ao longo dos anos e nos estratos de transmissão. Positivamente o índice Gini e negativamente a duração da estação seca foram os fatores de risco mais importantes para a transmissão. Conclusão: A malária é multifatorial e deve ser abordada tendo em conta o espaço tempo e a escala de atuação, para implementar intervenções eficientemente. As inequidades na população se apresentam como o grande empecilho para obter melhores resultados no seu controle e eliminação, e embora o Brasil tinha feito progressos muito meritórios, não conseguirá acabar com o problema da malária enquanto não aborda-lo como um problema à saúde global que vai além de programas específicos contra a doença. / Introduction: Malaria is still a global health problem. In the Americas in 2017, Brazil and Venezuela were the countries that most contributed to the number of cases. In Brazil, 99% of the cases are in the Legal Amazon. In the last years, there has been an increase of cases and areas of high transmission despite the significant progress in Brazil since 2005. Few recent epidemiological studies approached this issue for the Legal Amazon. There is a relationship between malaria transmission and environmental and socioeconomic risk factors. However, there is a lack of consensus on the influence of them due to the scale of analysis. Objective: Characterize and analyze the malaria transmission risk factors in the Legal Amazon municipalities from 2010 to 2015. Methodology: We used data of autochthonous malaria by the municipality from 2010 to 2015, extracted from the SIVEP-malária database from the Bureau of Health Surveillance. We analyzed the following risk factors: Gini index, illiteracy rate, mines presence, areas of indigenous reserve by municipality, forest rate by municipality and length of dry season. A systematized literature review was performed to select the environmental risk factors. Socioeconomic risk factors were selected based on the literature. The 310 municipalities in the states of Acre, Amazonas, Amapá, Pará, Rondônia and Roraima were our unit of analysis. Local stratification of Annual Parasite Index (API) and monthly incidence were used to analyze the data. Logistic regression was used to perform an environmental, socioeconomic and full model, stratifying by low, moderate and high-risk transmission; the dependent variable API. Results: From 2010 to 2015, there was a 61% API reduction, achieving the Brazilian National Malaria Control and Prevention Plan goal. However, the decline was heterogeneous among municipalities. There are 13 municipalities that at least had the 40% of all cases during the 5 years period. It is relevant to note that some states minimized the seasonality while others do not. The systematized review made clear the divergences to select the risk factors and the influence of them into the transmission due to the space-time and the scale. The full model showed a better performance to analyze the risk factors by strata and transmission intensity. Gini index positively and length of dry season negatively were the most important risk factors. Conclusion: Malaria is a multifactorial disease that has to be approached taking into account the space-time and the scale of analysis to implement effective interventions. Population inequities are the biggest obstacle to obtain better results in malaria control and elimination. Brazil advanced significantly but to end with the problem malaria has to be understood as a global health problem that goes beyond specific disease programs.

Introduktion: Antibiotikaresistens är ett ökande globalt problem som på sikt påverkar möjligheterna till effektiv sjukvård. Insatser mot ökad antibiotikaresistens genomförs på flera håll i världen men sjuksköterskor har inte i någon större utsträckning varit involverade. På senare år har deras roll dock börjat diskuteras allt mer. Syfte: Att undersöka sjuksköterskors skattade kunskap om antibiotika och mikrobiologi samt upplevda hinder för ökad delaktighet i arbetet med rationell antibiotikaanvändning inom slutenvården. Metod: En enkät skickades till omkring 700 sjuksköterskor på slutenvårdsavdelningar i Region Halland. De ombads att skatta sin kunskap om antibiotika och mikrobiologiska odlingar, att besvara frågor om egna erfarenheter kring dessa områden samt ange vilka hinder de såg för ökad delaktighet. Resultat: 171 sjuksköterskor (24 procent) besvarade enkäten. Majoriteten av sjuksköterskorna skattade sin kunskap om antibiotika och mikrobiologiska odlingar som god. Flest sjuksköterskor bedömde sin kunskap som låg rörande laboratoriets olika hantering av odlingar och läkemedelshantering gällande antibiotika. Otillräcklig kunskap hos sjuksköterskor och hög arbetsbelastning var de hinder för ökad delaktighet som flest uppgav. Slutsats: Än högre kunskap hos sjuksköterskorna kan påverka deras möjligheter att vara delaktiga i patientens antibiotikabehandling då högre kunskap visade sig påverka samarbetet mellan läkare och sjuksköterskor positivt. De sjuksköterskor som skattade sin kunskap om antibiotika som låg ansåg dessutom i högre utsträckning att otillräcklig kunskap var ett hinder för ökad delaktighet. Mer utbildade och delaktiga sjuksköterskor kan vara nyckeln till en smartare antibiotikabehandling och kan innebära att riskerna för onödigt bred eller lång behandling minskar och därmed minskar riskerna för negativa konsekvenser för patienten.

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Background The prevalence of reported food hypersensitivity among children has increased in Western countries. However, the prevalence varies largely due to differences in methods used in different studies. Double-blind placebo-controlled food challenge (DBPCFC) is the most reliable method to verify or exclude food hypersensitivity. The use of double-blind food challenges is increasing in clinical praxis, but since the method is time- and resource consuming it is rarely used in population-based cohort studies. There is a lack of knowledge on how adolescents and mothers experience participation in double-blind placebocontrolled food challenges and to what extent the food is reintroduced after a negative challenge. While several studies have described the impact of IgEmediated food allergy on Health-Related Quality of Life (HRQL), few studies have described HRQL among children with other food hypersensitivity phenotypes. Aim The aim of this thesis was to estimate the prevalence of reported food hypersensitivity, associated risk factors, and symptom expressions among schoolchildren. We also examined HRQL among children with total elimination of cow’s milk, hen’s egg, fish or wheat due to food hypersensitivity as a group compared with children with unrestricted diet, and after we categorised the children with eliminated foods into different phenotypes of FHS. Finally, adolescents’ and mothers’ experience of DBPCFC was examined as well if the food had been reintroduced. Methods Three studies were based on the Obstructive Lung Disease in Northern Sweden (OLIN) paediatric cohort II. The cohort was recruited in 2006 when all children in first and second grade (7-8 years) in three municipalities in Norrbotten were invited to a parental questionnaire study and 2,585 (96% of invited) participated. The questionnaire included questions about food hypersensitivity, asthma, rhinitis, eczema and possible risk factors. The children in two municipalities were also invited to skin prick testing with 10 airborne allergens, and 1,700 (90%) participated. Paper I is based on this initial survey of the cohort. Four years later, at age 11-12 years, the cohort was followed up using the same methods and with the same high participation rate. At the follow-up, 125 children (5% of the cohort) reported total elimination of cow’s milk, hen’s egg, fish or wheat due to food hypersensitivity. These children were invited to a clinical examination and to complete a generic (KIDSCREEN-52) and a diseasespecific HRQL questionnaire (FAQLQ-TF) (n=75). Based on the clinical examination the children were categorised into different phenotypes of food hypersensitivity: current food allergy, outgrown food allergy and lactose intolerance. In addition, a random sample of children with unrestricted diet from the same cohort, answered the generic questionnaire (n=209). Paper II is based on this HRQL study. Children categorised as having current food allergy were invited to a further evaluation including DBPCFC. Eighteen months after the challenges, these children were interviewed about their experiences during and after the challenge (n=17). Paper III is based on these interviews. Paper IV was based on interviews with mothers to children referred to a paediatric allergy specialist for evaluation of food allergy using DBPCFC (n=8). In the two interview studies results were analysed using qualitative content analysis. Results At age 7-8 years, the prevalence of reported food hypersensitivity was 21%. Food hypersensitivity to milk, egg, fish, wheat or soy was reported by 10.9% and hypersensitivity to fruits or nuts by 14.6%. The most common essential food to trigger symptoms was milk, reported by 9%. The most frequently reported food induced symptoms, were oral symptoms mainly caused by fruits, followed by gastrointestinal symptoms mainly caused by milk. The risk factor pattern was different for food hypersensitivity to milk compared to hypersensitivity to other foods. No significant difference in distribution in generic or disease-specific HRQL was found among children with reported total elimination of milk, egg, fish and/or wheat due to FHS compared to children with unrestricted diet. However, a trend indicated that the disease-specific HRQL was most impaired among children with current food allergy compared to children with outgrown food allergy and lactose intolerance. The proportion of poor HRQL defined as ≥75 percentile was significantly higher among children with current food allergy than the other phenotypes. A DBPCFC was an opportunity for the adolescents and the mothers to overcome the fear of reactions to food that had been eliminated for a long time. After the challenge, when the food was partially or fully reintroduced, socializing became easier and both adolescents and mothers experienced more freedom regarding food intake. A negative challenge was not consistently associated with reintroduction of the food. Reasons for reintroduction failure were fear of allergic reactions, that the adolescent did not like the taste of the food, or that living with an elimination diet was considered as normal. Conclusion In this population-based study, one in five of children at age 7-8 years reported food hypersensitivity to any food. The generic HRQL was similar among children with and without food hypersensitivity. However, poor disease-specific HRQL was more common among children with current food allergy compared to children with other FHS phenotypes. If the tested food was reintroduced after a DBPCFC, both adolescents and mothers described a changed life with less fear, and that life had become easier regarding meal preparations and social events. As reintroduction failure was present despite a negative food challenge, follow-ups and evaluations of food reintroduction should be performed independent of the outcome of a food challenge. / Bakgrund Andelen barn med rapporterad födoämnesöverkänslighet har ökat. Prevalensen varierar mycket beroende på var studien genomförts och vilka metoder som använts. Dubbel-blinda placebo-kontrollerade födoämnesprovokationer (DBPCFC) är den mest tillförlitliga metoden för att utesluta eller verifiera födoämnesöverkänslighet. I klinisk praxis används DBPCFC alltmer, men eftersom metoden är resurskrävande används den sällan i populationsbaserade studier. Det saknas kunskap om mödrars och tonåringars egna upplevelser av att delta i DBPCFC och i vilken utsträckning livsmedlet återintroduceras efter en negativ provokation. Studier har beskrivit IgE-medierad födoämnesallergi och dess påverkan på hälsorelaterad livskvalitet men det saknas studier om livskvalitet bland barn med andra fenotyper av födoämnesöverkänslighet. Syfte Syfte med avhandlingen var att undersöka rapporterad förekomst av födoämnesöverkänslighet, riskfaktorer och symtomyttringar bland skolbarn. Vi har även studerat hälsorelaterad livskvalitet bland barn som helt eliminerat baslivsmedel, som hel grupp jämfört med barn utan eliminerad föda, samt efter att barnen kategoriserats i olika fenotyper av födoämnesöverkänslighet. Ett ytterligare syfte var att beskriva ungdomars och mödrars upplevelser, konsekvenser av DBPCFC samt i vilken omfattning livsmedlet återintroducerades. Metod Tre studier baseras på en barnkohort som rekryterades 2006 inom OLIN studierna (Obstruktiv Lungsjukdom i Norrbotten). Kohorten innefattade alla barn i årskurs 1 och 2 (7-8 år) i Luleå, Kiruna och Piteå där 2585 (96 % av de inbjudna) deltog i en föräldrabesvarad enkät. Enkäten innehöll frågor om födoämnesöverkänslighet, astma, rinit, eksem och möjliga riskfaktorer. Barn från Kiruna och Luleå inbjöds även till pricktest med 10 luftburna allergen och 1700 (90 %) deltog. Artikel I baseras på denna initiala enkätstudie. Fyra år senare följdes kohorten upp med samma metoder och höga deltagande. Totalt 125 barn (5 % av kohorten) uppgav total elimination av mjölk, ägg, fisk och/eller vete på grund av födoämnesöverkänslighet. Dessa barn inbjöds till en klinisk undersökning och 94 barn deltog. Sjuttiofem (80 %) av dessa barn besvarade hälsorelaterade livskvalitetsfrågor innefattande det generiska mätinstrumentet KIDSCREEN-52 samt det sjukdomsspecifika frågeformuläret FAQLQ-TF. Frågeformuläret KIDSCREEN-52 skickades även till ett slumpurval av barn utan eliminationskost från samma kohort, och 209 barn (65 %) deltog. Artikel II baseras på denna hälsorelaterade livskvalitetsstudie. Baserat på den kliniska undersökningen kategoriserades barnen med eliminerad kost i olika fenotyper av födoämnesöverkänslighet: pågående födoämnesallergi, utläkt födoämnesallergi och laktosintolerans. De barn som bedömdes ha pågående födoämnesallergi inbjöds till DBPCFC. Arton månader efter provokationen intervjuades deltagarna om sina upplevelser av provokationen och i vilken omfattning livsmedlet återintroducerades. Artikel III baseras på dessa intervjuer. Den fjärde studien baseras på intervjuer av mödrar vars barn remitterats till en pediatrisk barnallergolog för utredning av misstänkt födoämnesallergi med DBPCFC. Intervjuerna har analyserats med kvalitativ innehållsanalys. Resultat Vid 7-8 år var prevalensen av rapporterad födoämnesöverkänslighet 21 %. Överkänslighet mot basföda (mjölk, ägg, fisk, vete eller soja) rapporterades av 10.9% och 14.6% uppgav att de reagerade på frukt eller nötter. Klåda i munnen var det vanligaste rapporterade födoämnesutlösta symtomet som huvudsakligen orsakades av frukt. Det näst vanligaste symtomet var mag- och tarmbesvär, huvudsakligen orsakat av mjölk. Riskfaktormönstret för födoämnesöverkänslighet mot mjölk skiljde sig från överkänslighet mot andra födoämnen. Vi fann ingen statistiskt signifikant skillnad i generisk eller sjukdomsspecifik hälsorelaterad livskvalitet mellan barn som helt eliminerat mjölk, ägg, fisk eller vete på grund av födoämnesöverkänslighet jämfört med barn utan eliminerad kost. En trend indikerade att barn med pågående födoämnesallergi hade sämre sjukdomsspecifik hälsorelaterad livskvalitet jämfört med barn med utläkt födoämnesallergi eller laktosintolerans. Dålig livskvalitet, definierat som den ≥75e percentilen i det sjukdomsspecifika frågeformuläret, var vanligast hos barn med pågående födoämnesallergi. Deltagande i DBPCFC var en möjlighet för tonåringar och mödrar att övervinna rädslan för födoämnesorsakade symtom. I de fall då det testade livsmedlet helt eller delvis återintroducerades efter provokationen, upplevde både tonåringarna och mödrarna att det sociala umgänget blev lättare och att de inte längre behövde ha samma kontroll över födoämnesintaget. Ett negativt provokationsutfall resulterade inte alltid i att det testade livsmedlet återintroducerades i kosten. Orsaker till att inte återintroducera födoämnet var rädsla för allergiska reaktioner, att livsmedlet inte smakade gott och att det upplevdes som normalt att leva ett liv utan det eliminerade livsmedlet. Slutsats Vart femte barn rapporterade någon form av födoämnesöverkänslighet i denna populationsbaserade studie. Det var ingen signifikant skillnad i generisk livskvalitet mellan barn med och utan födoämnesöverkänslighet men barn med pågående födoämnesallergi tenderade att ha sämre sjukdomsspecifik livskvalitet jämfört med barn med utläkt födoämnesallergi och laktosintolerans. De deltagare som återintroducerade det testade livsmedlet efter provokationstestet upplevde att livet var mindre begränsat jämfört med innan provokationen. Alla återintroducerade inte det testade livsmedlet trots en negativ provokation, vilket styrker vikten av uppföljning och utvärdering av födoämnesprovokationer.

Skolans miljö en är avgörande faktor för folkhälsoarbete, därför är hälsofrämjande arbete i skolan viktigt att belysa. Eleverna drabbas av stress, depressioner och ökade kunskapskrav. Bestämningsfaktorer som livsstil, trygga miljöer samt sociala nätverk påverkar en individs psykiska hälsa. Skolkuratorerna ansvarar mest av all personal på skolan för det hälsofrämjande arbetet. För att främja hälsan i skolarbetet är det av betydelse att identifiera hur skolkuratorerna arbetar.Syftet med studien är att undersöka hur skolkuratorer i Eskilstuna Kommun arbetar med att främja psykisk hälsa för barn i årskurs 7-9. En kvalitativ studiedesign och en manifest innehållsanalys har använts för att uppnå syftet med studien. Skolkuratorerna i Eskilstuna kommun har intervjuats med hjälp av en semistrukturerad intervjuguide.Kuratorernas arbete styrs utifrån styrdokumentet Elevhälsan. Samarbete tillsammans med personal som skolsköterskor anses viktigt. Kuratorernas arbete med eleverna styrs kring helheten. Trivsamma miljöer, aktiviteter samt att umgås tillsammans med eleverna är något som är av betydelse. Akutsamtalen tar upp för mycket tid i det dagliga arbetet, vilket även tidigare studier belyser. Studiens slutsats visar att Elevhälsans alla resurser behöver vara mer tillgängliga på skolorna än de är i dagsläget. Den stora kuratorsträffen som sker månadsvis behöver också en samordnare för att ge den respons som behövs.

Urbanisation and the associated nutrition transition have been linked with the recent rise in osteoporotic fragility fracture incidence in many countries. Predictions indicate that hip fracture incidence will increase 6-fold in Africa and Asia by 2050, partially attributed to demographic transition and population ageing. Differences in areal bone mineral density (aBMD) between rural and urban locations indicate that urban regions of high-income countries (HIC) have lower aBMD and a higher incidence of hip fracture. The few studies conducted in low and middle-income countries (LMIC) provide inconsistent results; in contrast to HIC, most have found higher aBMD in urban populations. To investigate the impact of migrating to an urban environment, detailed studies of bone phenotype and factors affecting bone health have been conducted in two groups of pre-menopausal Gambian women: urban migrant (n=58) and rural (n=81). Both groups spent their formative years in the same rural setting of Kiang West, urban women were known to have migrated to coastal districts, concentrated in Brikama and Kanifing, when aged ≥16 years. Bone phenotype (bone mineral content (BMC); bone area (BA); aBMD, and size-adjusted BMC (adjusted for height, weight and BA) of the whole-body, lumbar spine and hip) was measured by dual energy x-ray absorptiometry (DXA), with further characterisation by peripheral quantitative computed tomography (pQCT). Data were also collected on anthropometry, body composition, food and nutrient intakes, physical activity, socio-demographic characteristics, vitamin D status, and 24hr urinary mineral outputs (Na, K, P, and Ca). Mean age and height of rural and urban migrant groups were not significantly different (p > 0.05). Urban migrant women were significantly heavier (p < 0.01). Significant differences in BMC and aBMD were found between groups at all skeletal sites, with urban women having higher BMC and aBMD; BA was not significantly different. The greatest difference in BMC was found at the lumbar spine (8.5% ± SE 3.0, p < 0.01), a meaningful difference, equivalent to 0.76 of rural SD. T- Scores were also calculated using a young adult (white, female) reference population, mean T- scores were -1.03 and -0.22, for rural and urban groups respectively. After adjusting for size, differences in whole-body and hip BMC were mostly attenuated (p > 0.05), but difference in spine BMC remained significant (6.2% ± SE 2.1, p < 0.01). These results indicate that rural-to-urban migration is associated with higher BMC; BA and height were similar, and difference in body weight could not fully account for higher BMC at the lumbar spine. Calcium intakes were low in both groups, urban migrant 294mg/d (IQR: 235 to 385) and rural 305mg/d (IQR: 222 to 420). Urban women had significantly lower intakes of potassium, magnesium and dietary fibre (p < 0.01), related to lower consumption of fruit, green leafy vegetables and groundnuts. 25-hydroxy vitamin D status was good in both groups, urban migrant 64.0 ± 14.2nmol/L and rural 68.3 ± 15.7nmol/L (M ± SD, p > 0.05). Implications for bone health of the nutrition and demographic transition, principally future fracture risk and other non-communicable diseases require further research in LMICs. ORIGINAL CONTRIBUTION TO KNOWLEDGE To my knowledge, this is the first study investigating the impact of rural-to-urban migration on bone health to be conducted in sub Saharan Africa. It is the first study of bone health and determinants of bone health in an urban population in The Gambia.

Background: To achieve better health outcomes it is important to identify those aspects of health care delivery system that determines patient satisfaction. The health care planners must therefore be cognizant of the opinions and expectations of those who utilize health care facilities to achieve better health outcomes. This also applies to maternal satisfaction. The study aimed to measure mothers satisfaction with maternity care and its association with various socio-demographic characteristics. Method: The study presented here is a quantitative cross-sectional study that utilizes secondary data from facility-based survey conducted in 12 different tertiary hospitals of Nepal and included client exit interviews  (n=43756). The maternal satisfaction association with different exposures and potential confounders was determined using multivariate logistic regression analysis. Statistical Package for Social Sciences (SPSS) was used for data analysis. Results:. Better information and counselling is seen to be associated with higher satisfaction and recommendation [AOR: 1.67 [1.60-1.75]] and [1.68[1.57-1.80], respectively. Higher level of delivery preparation indicates lower overall satisfaction [AOR: 0.70 [0.66-0.74]]. Mothers were seen to be less satisfied with the religious and cultural aspects of the maternal health services. Mothers age and sex of child was not seen to be significant with any outcome. Conclusion: Better information and counselling indicates more satisfaction and recommendation. Mothers delivery preparation is seen as a significant predictor of their overall satisfaction; therefore, this should be a part of education and information strategy for mothers from the different backgrounds.