Bakgrund Celiaki är en autoimmun sjukdom som ger inflammation i tunntarmsslemhinnan vid intag av gluten. Symtom hos vuxna kan vara diffusa och därför svåra att koppla till celiaki. I Sverige är genomsnittstiden från första symtom till celiakidiagnos ungefär 10 år och det finns luckor i kunskapen om vilka konsekvenser fördröjningen till diagnos ger. Syfte Studiens syfte är att överblicka hur fördröjd diagnos av celiaki hos vuxna påverkar samhällets resurser, hur dessa individer upplever att symptomen påverkat deras sociala liv före och efter diagnos, samt om diagnostiken behöver effektiviseras. Metod I Sverige, september 2012, skickades en Internetbaserad enkät ut till 4337 medlemmar i Svenska Celiakiförbundet varav 611 kvarstod efter bortfall. Enkätens fokus var främst sjukfrånvaro, vårdkontakter och social påverkan p.g.a. symtom av celiaki. Enkäterna analyserades i SPSS (v.20.0) med p<0,05. Resultat Efter diagnos sjönk både sjukfrånvaro och vårdkontakter. Deltagarna undvek också sociala aktiviteter i mindre utsträckning och majoriteten upplevde förbättrad livskvalité. En stor del (39 %, n=238) uppgav att de fått diagnos först 10 år eller mer efter symtomdebut, varav majoriteten var äldre. Det var framför allt de som uppgav en fördröjning på fyra år eller mer från första symtom till diagnos som upplevde att deras livskvalité förbättrades av diagnosen. Slutsats Det är viktigt att celiakidiagnos ställs tidigt för att bespara kostnader som annars kommer av sjukfrånvaro och vårdkonsumtion, samt minska den negativa påverkan av symtom på det sociala livet och livskvalitén. Då mer än hälften av deltagarna i studien haft symtom i minst 5 år innan diagnos anser vi att åtgärder måste sättas in. Tidigare diagnos kräver antingen screening av befolkningen eller nya vårdplaner där diffusa symtom av celiaki uppmärksammas mer. Mer studier behövs för att avgöra vilken åtgärd som är mest hållbar. / Background Coeliac disease is an autoimmune disease where gluten causes inflammation in the mucosa of the small intestine. Symptoms in adults may be vague and therefore difficult to associate with coeliac disease. In Sweden, the average delay from first symptom to diagnosis is about 10 years. There are gaps in the knowledge of the consequences of a delayed diagnose. Objective The purpose of this study is to review the effect of the delay of coeliac diagnosis among adults on society’s resources, how the symptoms may have affected these individuals social life and the need of improved diagnosis. Method In Sweden, September 2012, an online questionnaire was distributed to 4,337 members of the Swedish Coeliac Society of which 611 was included in the study. The survey focus was mainly sick leave, health care contacts and social impacts due to symptoms of coeliac disease. The questionnaires were analyzed in SPSS (v.20.0) with p<0,05. Results Both sick leave and health care contacts decreased after diagnosis. The participants also avoided social activities to a lower extent and the majority experienced an improved quality of life. A large proportion (39%, n=238) reported that diagnosis delayed at least 10 years from the onset of symptoms, the majority of whom were older than the average. It was mainly those who reported a long delay from first symptom to diagnosis who experienced an improvement in quality of life due to diagnosis. Conclusion Early diagnosis is important in order to reduce costs that would otherwise derive from health care consumption and sick leave. Early diagnosis would also reduce the negative impact of symptoms on social life and quality of life. Since the majority of the participants reported a delay of at least 5 years from onset of symptoms to diagnosis, we believe that it is necessary to take action. In order to diagnose individuals with coeliac disease at an earlier stage it is necessary to apply effective methods such as screening or new care plans with more attention on vague symptoms. To determine which method is most sustainable, more studies needs to be done.

No description available.

<p><strong> </strong></p><p><strong>SAMMANFATTNING</strong></p><p><strong>Bakgrund </strong>Forskning inom området mat och hälsa har en lång tradition. Däremot finns lite forskning om den praktiska dagliga verksamheten för dietister. Dietister är nöjda med sitt arbete men det finns ett flertal faktorer som gör dem frustrerade såsom t ex tidsbrist. Dietisters verksamhet bygger på konceptet mat och hälsa. Folkhälsa har diskuterats mycket senaste åren då välfärdsjukdomar är ett växande problem. För att förbättra folkhälsan har <em>Fysisk aktivitet på Recept</em> (FaR®) tagits fram, vilket kan skrivas ut av all legitimerad sjukvårdspersonal, inkluderat dietister. Tidigare studier har undersökt hur implementeringen av FaR® har fungerat. I dessa studier har inga dietister medverkat utan enbart annan vårdpersonal. Resultatet har varit att vårdpersonalen har haft en positiv inställning till FaR® men det prioriteras lågt i ett kort perspektiv pga. tidsbrist och bristande rutiner. Arbetssituationen hos vårdgivare har visat sig vara oacceptabel på många sätt enligt tidigare studier.<strong> Syfte</strong> Att studera dietisters arbetssituation utifrån idén att införa ett nytt arbetsinstrument (FaR®) i den dagliga dietistverksamheten. <strong>Metod</strong><strong> </strong>Individuella kvalitativa intervjuer genomfördes med en frågeguide för att skapa struktur i intervjuerna. Därutöver var intervjun flexibel. Intervjuerna spelades in och transkriberades. Därefter lades de in i en kvalitativ datamatris för vidare analys. <strong>Material</strong><strong> </strong>Fem dietister inom primärvården från Stockholmsområdet intervjuades. De var mellan 30 och 45 år och hade arbetat mellan 3 och 14 år som dietister. <strong>Resultat</strong><strong> </strong>Intressanta teman såsom dietisters åsikter om hälsa, syn på FaR®, deras arbetssituation samt tvetydiga inställning till arbetet resulterade studien i. <strong>Diskussion</strong><strong> </strong>Dietisterna skulle gärna jobba med helhetsaspekten på hälsa där det både finns rum för kost och fysisk aktivitet. I nuläget krävs dock prioriteringar till fördel för kosten, för att leverera en bra kvalitet på patientbehandlingarna. Vilka faktorer som påverkar arbetstillfredsställelse analyserades i en teorimodell. Vissa starka, positiva faktorer kan väga upp andra negativa, missgynnande faktorer så att tillfredsställelsen av arbetssituationen ändå upplevs bra. <strong>Konklusion</strong><strong> </strong>Denna undersökning har fått agera katalysator för att belysa dietisters arbetssituation. Skulle mer tid och resurser läggas på dietister inom sjukvård och hälsovård skulle möjligtvis FaR® användas i större utsträckning.  </p> / <p><strong> </strong></p><p><strong>ABSTRACT</strong></p><p><strong>Background</strong> Research of food and health has been explored for centuries. However little is known about the practical daily work situation among dietitians. Dietitians are mostly satisfied with their work but they also feel frustrated over the fact that they have time limitations. The dietitians work is a mix of food and health. During the last years the public health has been debated because of the rising problems with metabolic diseases. To enhance the public health, a new kind of prescription has been developed, called <em>Physical activity on Prescription</em> (PaP). All authorized medical personnel, including dietitians, have been given the right to prescribe it. The implementation of PaP has previously been studied. No dietitians were represented in these studies but other medical personnel were. They had a positive attitude to PaP but in a short perspective they have given it a low priority because of lack of time and routines. In many ways the work situation among health care providers is unacceptable, according to previous studies. <strong>Objective</strong> To study the work situation among dietitians with PaP as an illustrating factor. <strong>Methods</strong> Individualized qualitative interviews were conducted with the assistance of a question sheet to create a structural interview result. To investigate further, the interview was also flexible. The interview was recorded and then transcribed. The transcribed material was then put into a qualitative data matrix for analysis. <strong>Subjects/Settings</strong> Five dietitians from the primary care in Stockholm were interviewed. They were 30 to 45 years old and have worked as dietitians for 3 to 14 years. <strong>Results</strong> The study has resulted in many interesting themes such as dietitians view on health and on PaP, their work situation and their ambiguous feelings towards their work. <strong>Discussion</strong> The dietitians in this study would like to have more time to work with both nutrition and physical activity but for now they are forced to set their priorities to nutrition to deliver a good quality to their patients. Work satisfaction was analyzed in a theory model to determine which factors were the most important. Strong and positive factors showed to compensate for the more negative and disfavorable factors. The result was that the dietitians felt satisfied with their work situation even though there were some unfavorable factors involved. <strong>Conclusions</strong> This study became a way to discover and highlight the work situation among dietitians. If more time and money would be invested in health care, dietitians would have an opportunity to possibly use PaP in a greater extent.  </p>

<p>The aim of the present thesis was to study elderly self-managing and disabled women’s dietary intake and meals in relation to age, household structure (single-living or cohabitant), disability and cooking ability. The women were aged 64-88 years and living at home, in the mid-eastern part of Sweden. The self-managing women were randomly selected. The disabled women – suffering from Parkinson's disease, rheumatoid arthritis or stroke – were selected from patient records. A total of 139 self-managing and 63 disabled women participated. Two dietary assessment methods were used: a repeated 24-h recall and a three-day estimated food diary, providing dietary intake for five non-consecutive days. The results indicate that elderly women still living in their homes seem to manage a sufficient dietary intake despite disability and high age. The reported energy intakes in all groups of women were low, which might be explained by an actual low intake and/or under-reporting. The portion sizes seemed to be smaller in the highest age group, leading to lower intakes of some nutrients. Thus also the nutrient density of the food should be given greater consideration. The meal pattern was shown to be regular and the distribution of main meals and snacks was found to be satisfactory. Meals and snacks that were defined as such by the women themselves thus seem to be more significant from an energy and nutritional perspective. Perceived cooking ability co-varied with energy and nutrient intake as well as with meal pattern.</p><p>Further, a qualitative dietary assessment method, FBCE, was analysed. It was concluded that it must be supplemented with a dietary assessment method providing energy intake figures to ensure a sufficient intake, especially when studying groups at risk for low energy intake. </p><p>Furthermore, the aim was to perform a dropout analysis. When studying older women and food, a low participation rate might be expected since the most active, the very ill as well as the disabled tend to decline participation, but also since food is a gender issue. Food could, especially for women, be a sensitive area of discussion, even though older women seem to choose "healthy foods" and eat "proper meals".</p>

<p>In order to study the <i>effect of production systems</i> aimed at sustainability<i> on product quality</i> and of sensory and non-sensory factors on product acceptance – the effect of farming system, year, milling and baking techniques on the sensory qualities of wheat bread as a model product was investigated using a descriptive test, and the effect of information and values on liking of bread using consumer tests.</p><p>Whole wheat and white breads were baked with wheat grown in six lots in established conventional and organic farming systems in field trails, in two subsequent years for the white bread.</p><p><i>Milling technique</i> influenced flours’ rheology and had greater impact on the sensory qualities of whole wheat bread and on the slice area than did <i>farming system</i> and <i>baking technique</i>. Bread baked with roller-milled wheat was characterized by sweetness, juiciness, compactness and smaller slice area than bread baked with stone-milled wheat, which was characterized by saltiness, deformity and roasted cereals.</p><p>The <i>effect of year </i>on the white bread was greater than the effect of <i>farming system </i>or <i>recipe modification</i>. Bread baked with wheat harvested in 1999 had significantly lower intensities of crumb attributes such as smoothness, juiciness and elasticity, but higher rancid flavour, springiness, compressibility, mastication resistance than bread baked with wheat harvested in 2000. Bread baked with conventional flour had significantly higher juiciness and elasticity than organic bread.</p><p>Image analysis did not show differences in slice area between bread baked with conventionally and organically grown wheat harvested in 1999 compared with 2000. <i>Information</i> affected liking in relation to the type of provided information. Information on organic origin enhanced most liking of bread, particularly for the less liked samples and frequent consumers of organic food. Significantly different <i>values</i> and different specific liking of breads were found among consumer segments. Results linked values and age with “taste”.</p>

In order to study the effect of production systems aimed at sustainability on product quality and of sensory and non-sensory factors on product acceptance – the effect of farming system, year, milling and baking techniques on the sensory qualities of wheat bread as a model product was investigated using a descriptive test, and the effect of information and values on liking of bread using consumer tests. Whole wheat and white breads were baked with wheat grown in six lots in established conventional and organic farming systems in field trails, in two subsequent years for the white bread. Milling technique influenced flours’ rheology and had greater impact on the sensory qualities of whole wheat bread and on the slice area than did farming system and baking technique. Bread baked with roller-milled wheat was characterized by sweetness, juiciness, compactness and smaller slice area than bread baked with stone-milled wheat, which was characterized by saltiness, deformity and roasted cereals. The effect of year on the white bread was greater than the effect of farming system or recipe modification. Bread baked with wheat harvested in 1999 had significantly lower intensities of crumb attributes such as smoothness, juiciness and elasticity, but higher rancid flavour, springiness, compressibility, mastication resistance than bread baked with wheat harvested in 2000. Bread baked with conventional flour had significantly higher juiciness and elasticity than organic bread. Image analysis did not show differences in slice area between bread baked with conventionally and organically grown wheat harvested in 1999 compared with 2000. Information affected liking in relation to the type of provided information. Information on organic origin enhanced most liking of bread, particularly for the less liked samples and frequent consumers of organic food. Significantly different values and different specific liking of breads were found among consumer segments. Results linked values and age with “taste”.

Syftet med detta arbete är att undersöka hur lärare och elever värderar ämnet hem- och konsumentkunskap (HK) jämfört med idrott och hälsa (IDH) i grundskolan. Undersök-ningen görs ur ett genusperspektiv och resultatet kommer även att jämföras med politikers värdering av ämnet. De frågeställningar jag utgått ifrån är följande:  Hur värderarlärare och elever HK i förhållande till IDH?  Finns det några skillnader mellan kvinnliga och manliga lärares syn på HK och IDH, och vilka är dessa i sådana fall?  Finns det några skillnader mellan flickors och pojkars syn på HK och IDH, och vilka är dessa i sådana fall? För att få fram elevers och lärares värderingar kring skolämnena har en kvantitativ under-sökningsmetod använts. Resultatet visar att HK varken har hög eller låg status bland lärare och elever då ämnet i genomsnitt placerar sig i mitten bland alla ämnen. Värt att notera är att IDH, som är den manliga motsvarigheten till det kvinnliga HK-ämnet, får hög status i skolan då det ses som ett viktigt hälsoämne. Hälsoaspekten, som har en framträdande roll även i HK-ämnet, uppmärksammas dock inte av deltagarna i studien.

The aim of the present thesis was to study elderly self-managing and disabled women’s dietary intake and meals in relation to age, household structure (single-living or cohabitant), disability and cooking ability. The women were aged 64-88 years and living at home, in the mid-eastern part of Sweden. The self-managing women were randomly selected. The disabled women – suffering from Parkinson's disease, rheumatoid arthritis or stroke – were selected from patient records. A total of 139 self-managing and 63 disabled women participated. Two dietary assessment methods were used: a repeated 24-h recall and a three-day estimated food diary, providing dietary intake for five non-consecutive days. The results indicate that elderly women still living in their homes seem to manage a sufficient dietary intake despite disability and high age. The reported energy intakes in all groups of women were low, which might be explained by an actual low intake and/or under-reporting. The portion sizes seemed to be smaller in the highest age group, leading to lower intakes of some nutrients. Thus also the nutrient density of the food should be given greater consideration. The meal pattern was shown to be regular and the distribution of main meals and snacks was found to be satisfactory. Meals and snacks that were defined as such by the women themselves thus seem to be more significant from an energy and nutritional perspective. Perceived cooking ability co-varied with energy and nutrient intake as well as with meal pattern. Further, a qualitative dietary assessment method, FBCE, was analysed. It was concluded that it must be supplemented with a dietary assessment method providing energy intake figures to ensure a sufficient intake, especially when studying groups at risk for low energy intake. Furthermore, the aim was to perform a dropout analysis. When studying older women and food, a low participation rate might be expected since the most active, the very ill as well as the disabled tend to decline participation, but also since food is a gender issue. Food could, especially for women, be a sensitive area of discussion, even though older women seem to choose "healthy foods" and eat "proper meals".

Bakgrund Prevalensen hos barn med diabetes typ I och den samtidiga förekomsten av celiaki varierar i studier mellan 2,4-16,4 %. Celiaki och diabetes typ I kräver båda en noggrant kontrollerad kost. Det tycks finnas få studier som undersöker hur kombinationen av de två olika kosterna fungerar i praktiken. Syfte Att utforska hur föräldrar till barn med dubbeldiagnosen celiaki-diabetes upplever att kosten fungerar. Metod En kvalitativ metod användes i form av skrivna berättelser, insamlade via ett webbaserat formulär. Informanterna var 26 föräldrar till barn i åldrarna 3- 16 år med dubbeldiagnosen celiaki-diabetes. Berättelserna analyserades med kvalitativ innehållsanalys. Resultat Informanterna upplevde att det var svårare att få maten att fungera då de hade båda sjukdomarna att ta hänsyn till och att dubbeldiagnosen krävde ständig planering av måltider. Föräldrarna upplevde bristande kunskap i omgivningen, exempelvis hos personal inom skola och restaurang. Det fanns små möjligheter att spara tid och pengar och matutbudet var ofta begränsat, särskilt vad gäller produkter med lågt glykemiskt index. Upplevelser av att vara till besvär och ett bristande bemötande från omgivningen kunde förstärka känslan av att inte vara som alla andra. Slutsats Svårigheterna att lita på omgivningens kunskaper kring de två kostbehandlingarna försvårade följsamheten till kosten och begränsade barnens sociala liv. Upplevelserna av bristande bemötande och förståelse i omgivningen kunde förstärka känslan av att inte vara som alla andra och att vara till besvär. Därför finns ett behov av utbildning riktad till skol- och restaurangpersonal för ökad kunskap och förståelse. Mer material rörande matlagning anpassat till dubbeldiagnosen skulle också underlätta, både för barnens familjer och omgivningen. Den ständiga planeringen begränsade vardagen och föräldrarollen påverkades till att bli mer kontrollerande vilket skulle kunna försvåra för föräldrarna i att lotsa barnet till mer självständighet. Utbudet av glutenfria specialprodukter med lågt glykemiskt index var begränsat, framförallt vad gäller bröd. Därmed finns ett behov av en vidare produktutveckling. / Background The prevalence of both coeliac disease and diabetes type I in the pediatric population varies between 2.4-16.4 %. Both diseases demand a strictly controlled diet A limited number of studies are investigating the practical implementation of the two diets. Objective To investigate parent’s experiences of the diet, when having a child with both coeliac disease and diabetes type I. Method A qualitative method was used in form of narratives, collected through a web based form. The informants consisted of 26 parents, having a child of age 3-16 years, diagnosed with both coeliac disease and diabetes type I. Qualitative content analysis was used to analyze the narratives. Result Difficulties were experienced by the informants considering the practical implementation of the two diets. The double diagnosis demanded frequent planning. Lack of knowledge in the surroundings was experienced, for example in staff at school and restaurants. The possibilities of saving time and money were limited and there were limitations also in the food supply, especially gluten-free products with low glycemic index. Due to experience of inconvenience and negative treatment from their surroundings, the feelings of being different were enhanced. Conclusion Difficulties in trusting others knowledge regarding the diet lead to compliance issues and put restraint to the children’s social life. Perceptions of lack of treatment and understanding in the surroundings could enhance the feeling of not being like everyone else and being a nuisance. A need for education aimed at staff in schools and restaurants exists to increase knowledge and understanding. More materials regarding cooking with the double-diagnosis are desirable. Constant planning lead to limitations in the daily life and the parenting role became more controlling, which could create difficulties when guiding the child into independence. Also the supply of gluten-free products with low glycemic index is limited and need further development.

Syfte: Undersöka möjliga metoder till att finna matglädje vid ätstörningar samt undersöka hur användbara dessa metoder kan vara för människor med ätstörningar både i och utanför behandling. Bakgrund: Ätstörningar är ett växande folkhälsoproblem och ett område där det krävs mer uppmärksamhet och forskning för att öka förståelsen och kunskapen av ätstörningar, samt även för att kunna öka förebyggandet och behandling av dessa sjukdomar. Denna uppsats inriktar sig på ätstörningar och matglädje. Det är oerhört viktigt att hitta glädjen för mat när man har en ätstörning för att kunna nå ett friskare liv och ett friskare tänkesätt kring mat och sin egen kropp. Denna uppsats har undersökt möjliga metoder som kan användas för att hjälpa människor med ätstörningar att finna matglädje. En studie har genomförts på Capio Anorexi Center i Malmö som fokuserade på hur personalen arbetar för att hjälpa patienter att finna glädje för mat under behandling, samt hur de arbetar för att förmedla mat på ett positivt sätt för sina patienter. Metod: Litteraturstudier genomfördes både innan och efter undersökningen på Capio Anorexi Center. Undersökningen bestod av kvalitativa halvstrukturerade intervjuer med två av personalen på Capio Anorexi Center, samt med en dietist och en anonym person som har lidit av ätstörningar och gått i behandling. Tre av intervjuerna genomfördes med ljudinspelning och en intervju genomfördes via mejl. Varje intervju varade i cirka 45 minuter. Intervjuerna sammanställdes genom att först skriva av de inspelade intervjuerna och sedan kategorisades svaren för varje intervju till relevanta områden. Därefter analyserades och jämfördes detta med litteratur som böcker, rapporter, vetenskapliga artiklar samt elektroniska källor som var relaterade till matglädje och ätstörningar. Resultat: Elva metoder har undersökts och presenterats i denna uppsats som kan vara användbara till att finna matglädje både i och utanför behandling för de som behöver stöd: att våga, pedagogiska måltider, att äta regelbundet, varierat och planera måltider, att tillaga och servera aptitliga och lockande måltider, mindfulness och mindfulness eating, måltidsmiljö och måltidens sociala betydelse, nutritionsbehandling, saperemetoden, att äta lugnt och avslappnat, måltidsundervisning via en video- och ljuduppspelning vid måltider samt att stänga ute myter, bantning och skönhetsideal. Slutsats: Elva möjliga metoder som kan vara användbara till att finna matglädje har funnits. Detta genom förstudier med litteratur, en undersökning på Capio Anorexi Center och intervjuer, samt genom en analys och jämförelser mellan intervjuerna och litteratur som relaterade till ätstörningar och matglädje. Dessa metoder kan vara möjliga att använda för att kunna återfå ett friskare tankesätt kring mat och måltider samt för att kunna finna glädje för mat. Att finna matglädjen vid ätstörningar är ett steg mot ett friskare liv, dock för att kunna bli helt frisk från en ätstörning krävs det att dessa metoder kombineras med andra olika terapiformer, då det är viktigt att även arbeta med bland annat självkänsla och självförtroende, samt eventuellt andra svåra problem och symtom. / Background: Eating disorders are a growing public health concern which requires more attention and research to increase the understanding and prevention of eating disorders. This paper focuses on eating disorders and its relation to the joy of food. It is very important to find joy for food when suffering from an eating disorder to achieve a healthier life and healthier thinking around food and the body. This paper has examined possible methods that can be used for treating people with eating disorders to enjoy food. The study was conducted at Capio Anorexia Center in Malmö, a daycare clinic for eating disorders, and the study was focused on how the staff works to help patients find joy for food during treatment, and how they work to express food in a positive way to their patients. Methods: Literature studies were carried out before and after the study at Capio Anorexia Center. Qualitative half structured interviews were also carried out with two of the staff at Capio Anorexia Center, and with a dietitian and an anonymous person who has suffered from an eating disorder and received treatment. Three of the interviews were conducted with sound recording and the other one was conducted via email. Each interview lasted about 45 minutes. The interviews were compiled by first writing of the recorded interviews and then the answers for each interview were categorized to relevant fields. An analysis and comparison of these interviews to various literatures like books, reports, scientific papers and internet sources related to enjoying food and eating disorders were also carried out. Results: Eleven methods were found that may be useful to find joy for food both in treatment and outside of treatment for those who need support: daring, educational meals, eating regularly, varied and plan meals, cook and serve appealing meals, mindfulness and mindfulness eating, eating environment and social importance when eating, nutritional therapy, the “sapere-method”, eating slow and relaxed, the use of vodcast during meals and to keep out myths, dieting and beauty ideals. Conclusions: Eleven possible methods that may be useful to find joy for food have been found. This by preliminary studies with literature, a study at Capio Anorexia Center and interviews, and also by analyzing and comparing the interviews with literature related to eating disorders and enjoying food. The eleven methods described may be useful when regaining joy for food and a healthier thinking when it comes to food and meal situations. An important step in recovering from an eating disorder is to find pleasure when eating; therefore these methods can be possible tools to help people with eating disorders to find the joy for food. However, to reach a healthy life free from an eating disorder these methods described in this paper has to be combined with a variety of other therapies, because it is also important to work with self-esteem, self-confidence, and other symptoms and problems of the eating disorder.