<p>Sammanfattning</p><p>SYFTE: I studien används Aaron Antonovskys begrepp <em>känsla av sammanhang</em> (KASAM). Känslan av sammanhang beror på hur väl en individ känner att tillvaron är begriplig, hanterbar och meningsfull. En stark KASAM innebär bra förutsättningar för att klara de svårigheter en individ kan utsättas för i livet.</p><p>      Syftet är att undersöka elevers känsla av sammanhang (KASAM) och analysera skillnader i KASAM mellan elever i olika socioekonomiska områden samt ta reda på vad eleverna tycker är viktigt för att må bra och trivas med livet.</p><p>      De frågor som ställdes var: Hur skattar elever sitt KASAM? Vilka faktorer anser eleverna är viktigast för att de ska må bra och trivas med livet? Hur skiljer sig KASAM mellan elever i olika socioekonomiska områden i Stockholm? Hur värdesätter eleverna i de olika socioekonomiska områdena de olika hälsofaktorerna och skiljer det sig något mellan områdena? Hur skiljer sig KASAM mellan flickor och pojkar? Hur värdesätter pojkar respektive flickor de olika hälsofaktorerna och skiljer det sig något mellan könen?</p><p> METOD: I studien deltog 467 elever i skolår 8 och 9 från fem olika skolor med hög respektive låg socioekonomisk status. Eleverna fick besvara en enkät som dels innehöll den förkortade versionen av KASAM-enkäten, KASAM-13, dels några frågor om vad de tycker är viktigt för att må bra och trivas med livet. KASAM-13 värdesätts sedan där lägsta värdet är 13 och högsta värdet 91. Statistikprogrammet SPSS användes för att bearbeta data.</p><p> RESULTAT: Medelvärdet för KASAM i hela gruppen var 59,46. Trivas i familjen och att ha vänner att umgås med var de faktorer som eleverna värdesatte högst. Att ha bra kontakt med föräldrarna var den enda oberoende faktorn som korrelerade med KASAM. Det skiljde sig inte mellan eleverna i de olika socioekonomiska områdena vad gäller KASAM. Eleverna från de låga socioekonomiska områdena värdesatte faktorerna bra ekonomi i familjen och att ha tid för sig själv högre. Pojkarna hade en starkare KASAM än flickorna. Pojkar värdesatte faktorerna att ha pojkvän/flickvän samt att vara fysiskt aktiv högre, medan flickorna värdesatte att ha en annan vuxen att tala med högre.</p><p> SLUTSATS: Socioekonomin har ingen betydelse för KASAM. Det som har störst betydelse är sociala relationer, framförallt familjen. Det är viktigt att ha det i åtanke i skolan. Är kontakten och samarbetet mellan skolan och hemmet goda så ökar elevens förutsättningar för att tillvaron ska kännas begriplig, hanterbar och meningsfull.</p>

<p><strong>Syfte och frågeställningar</strong></p><p>Syftet med studien var att undersöka vilka faktorer som samvarierar med utnyttjandet av friskvård på arbetsplatsen för att på så sätt få en djupare förståelse för vad som kännetecknar individer som är fysiskt aktiva eller inaktiva. Frågeställningarna var: Vilka är de främsta motivationsfaktorerna till att vara fysiskt aktiv? a) bland dem som utnyttjar friskvård, b) bland dem som inte utnyttjar friskvård men är fysiskt aktiva. Vilka är det vanligaste hindren till att inte utnyttja friskvård i form av fysisk aktivitet? Vilka olika beteendemässiga och sociala faktorer samvarierar med utnyttjandet av friskvård?</p><p><strong>Metod</strong></p><p>Undersökningen var en tvärsnittsstudie som genomfördes med hjälp av en web-enkät som mestadels bestod av strukturerade svarsalternativ. Urvalet bestod av 272 anställda inom administration och service. Bearbetningen av resultatet har gjorts i statistikprogrammet SPSS där signifikansnivån sattes till (p<0,05). Tolkningen av resultatet har gjorts med utgångspunkt från Social Cognitive Theory och<em> Self Determination Theory.</em><em></em></p><p><strong>Resultat</strong></p><p>De som utnyttjade friskvårdserbjudandena motiverades främst av att ”hålla sig i form och må bra” vilket enligt teorin är ett yttre motiv. De som inte utnyttjade friskvårdserbjudandena men var fysiskt aktiva motiverades främst av att de ”tycker det är kul” vilket tolkas som ett inre motiv. Det mest förekomna hindret för att inte vara fysiskt aktiv var ”jag hinner inte på grund av familjesituationen”. Resultatet visade en statistiskt signifikant samvariation mellan utnyttjande och ålder, kön, fysiskt aktiva vänner och måttet på självtillit/självförmåga.</p><p><strong>Slutsats</strong></p><p>Denna studie visar, liksom tidigare forskning antytt, att det finns ett samband mellan beteendemässiga och sociala faktorer och fysisk aktivitet. Personer som var fysiskt aktiva genom friskvård hade en högre självtillit/självförmåga än de som inte deltog, de uppgav också att de hade vänner som var fysiskt aktiva vilket antyder att det sociala stödet fungerar som en motiverande faktor men även utgör ett hinder när det saknas. Det är viktigt att sträva efter att individer styrs av inre motiv samt uppnår en hög självtillit/självförmåga som kan bidra till att man lättare klarar av de hinder som kan uppstå. Sett ur ett ledarskaps- och hälsopedagogs-perspektiv kan dessa kunskaper vara till hjälp i samband med friskvårdssatsningar på arbetsplatsen samt vid arbete med beteendeförändringar för fysisk aktivitet.</p> / <p><strong>Aim</strong><strong></strong></p><p>The purpose of this study was to investigate factors that covary with the use of wellness in the workplace in order to gain a deeper understanding of the characteristics of individuals who are physically active or inactive. Questions were: What are the main factors of motivation to be physically active? a) among users of the wellness benefit, b) among those who do not use the wellness benefit but are physically active. What are the most common barriers for not using health care in the form of physical activity? What are the various behavioural and social factors that correlated with the utilization of the wellness benefit? <strong></strong></p><p><strong>Method</strong></p><p>The study was a cross-sectional study conducted using a web survey that consisted mostly of structured answers. The sample consisted of 272 employees in administration and service positions. The results were processed using the statistical program SPSS where the significance level was set at (p <0.05). The interpretation of the results was based on Social Cognitive Theory and Self-Determination Theory. <strong></strong></p><p><strong>Results</strong></p><p>Those who used wellness benefits were primarily motivated by "keeping in shape and feel good" which in theory is an external motive. Those who did not utilize wellness benefits but were physically active were primarily motivated by the fact that they "think it's fun" which is interpreted as a single motif. The most common reason given for not being physically active was "I do not have time due to family situation". The results showed a statistically significant correlation between use and age, gender, physically active friends, and active friends, and the measure of self-efficacy.</p><p><strong>Conclusions </strong><strong></strong></p><p>This study indicated that there is a correlation between the behavioural and social factors and physical activity. People who were physically active through fitness had a higher self-efficacy than those who did not participate; they also reported that they had friends who were physically active, suggesting that social support acts not only as a motivating factor but also an obstacle when it is missing. It is important to seek that individuals are guided by an inner motivation and that they reach a high level of self-efficacy that can help them coop with the obstacles that may arise. From a leadership perspective these knowledge can be helpful in the context of wellness initiatives in the workplace and when working with behaviour change for physical activity.<strong></strong></p>

Stress-related diseases and burnout have increased in Sweden during the last decades. In 2006, the most common diagnoses for new cases of sickness compensation were mental and behavioural disorders in both women and men. In spite of the large group of people seeking care for and on long-term sickness absence due to stress-related diseases and burnout, there is no agreement on which treatment they should be offered. The overall aim of this thesis was to describe patients on longterm sick leave because of burnout and to evaluate rehabilitation programs for this patient group. Two patient samples were recruited from the Stress Clinic at the University Hospital in Umeå, Sweden: REST (Rehabilitation for stressrelated disease and burnout; n=136) and QIST (Qigong for stress-related disease and burnout; n=82). A general population sample was from the 2004 Northern Sweden MONICA survey (n=573). Patients in REST were randomised into a 1-year rehabilitation program to either program A (Cognitively-oriented Behavioural Rehabilitation (CBR) and Qigong), or to program B (Qigong alone). In Paper I, baseline data were compared with data from the MONICA sample. In paper II, programs A and B were compared regarding effects on psychological variables and sick leave rates, and in Paper III, 18 patients from program A and B were interviewed to explore subjective experiences of the rehabilitation programs. Patients in QIST were allocated to an intervention with Qigong twice a week for 12 weeks or a control group. Psychological and physical measurements were assessed in QIST. Data were collected by questionnaires, physical measurements, the register on sick leave, and interviews. Patients with burnout reported a more restricted social network and higher work demands than the general population. In relation to women from a general population, women with burnout more often worked “with people”, reported high job strain, a more sedentary work situation and less emotional support. A per-protocol analysis showed no significant differences in treatment effect between program A and B in REST or between the intervention and control group in QIST. All groups improved significantly over time with reduced levels of burnout, anxiety, depression, and fatigue. In REST, lower scores on obsessive-compulsive symptoms, stress behaviour, and sick leave rates were found in both programs and in QIST both groups increased dynamic balance and physical capacity. In an intention-to-treat analysis, patients in program A in REST had significantly fewer obsessive-compulsive symptoms, and larger effect sizes in stress behaviour and obsessive-compulsive symptoms compared to patients in program B. Patients in both REST programs perceived that the 1-year rehabilitation program gave them specific tools to use in secondary prevention. They also emphasised that the good encounters, affirmation and group cohesiveness they perceived during the 8 rehabilitation was a necessary basis for initiation of a behavioural change leading to recovery. In conclusion, compared to a general population, patients with burnout perceived more demands at work and less social support. Lack of emotional support seemed to be more associated with burnout among women. There were no differences in effect between CBR and Qigong compared to Qigong alone, or between a 12 week Qigong intervention compared to a control condition. Improvements were found in all groups in the rehabilitation programs. CBR combined with Qigong have some advantages compared to Qigong alone. An environment with good encounters and affirmation of the patients was experiences as important by the patients and group rehabilitation had advantages as recognition and support from the group. Early rehabilitation measures are important to prevent long-term sickness absence. In future rehabilitation programs it might be necessary to have a more individualized approach and choose treatments preferred by the patient.

Socioeconomic inequalities in health and disability are found in all countries where social gradients have been studied. Despite rapid economic growth and expanding health care systems, aiming at providing services to people according to need rather than according to wealth, persistent and even widening health inequalities are found in Europe after the second World War. In this research project we wanted to establish a method for measuring socioeconomic status based on occupational groups and education in the HUNT Study, thereby providing tools for research in social medicine. A social gradient scale based on the occupational grouping from the HUNT study questionnaires had not been established. When this study was planned however, educational level, which might serve as a proxy for socioeconomic status, had been monitored in both HUNT I and HUNT II. Disability pension has been a central element in social security legislation in Norway, established as a universal right for all citizens in 1967. This public income-maintenance program protects workers in case of disability, and comprises both universal and earningrelated programs. The main eligibility criterion has been permanent impaired earning ability by at least 50 % for reasons of illness or disease, injury or disability. Despite objective health improvement in the population the last decades, incidence of disability pension has increased. In epidemiology, socioeconomic status is not only an important variable in itself. It is also a confounder that should be taken into consideration in discussing almost all causal relationships. Thus, in population based health studies, measures of socio-economic status are essential. Occupation, education and income together determine the socioeconomic status of a person. However, these factors are sufficiently distinct to require that they should also be studied separately in relation to health. To study them separately is often preferable since this can suggest hypotheses on causal relationships between exposure and disease.

This thesis presents perspectives and experiences of different stakeholders and their ways of reasoning around pregnancy and pregnancy care. Data were generated from individual interviews with 25 health care providers, 18 women and 6 traditional birth attendants (TBAs) as well as 11 focus groups discussions with women, men and TBAs. The challenges experienced by health care providers in their provision of antenatal care, while attempting to change antenatal care through routines proven to have medical value, are highlighted. Changing some long established routines, such as weighing and timing of visits, proved difficult mostly because of resistance from the users of care, whose reasoning and rationale for using care did not correspond with the professional perspectives of care. Women also combined biomedical and traditional care. The women used the clinic to receive professional care and assurance that the pregnancy was progressing well and used TBAs, who are believed to have supernatural powers, for cultural forms of assurance and protection. The health care staff did not appreciate these aspects and discouraged women using TBAs. Midwives had problems to change routines of care because of their stressful working situations and the expectations of the women. In addition, they described the paradoxes in providing antenatal care in the context of HIV and AIDS. The caregivers were aware of the magnitude of HIV and AIDS and yet did not have any information on the HIV status of the women they cared for. This also caused fear for occupational transmission. HIV/AIDS is highly stigmatised in this area and women used various strategies to avoid testing. The study emphasised the need to broaden the conceptualisation and practice of evidence-based care to incorporate different types of evidence and include realities, knowledge and perspectives of not only the beneficiaries but also those implementing change as well as local knowledge. The necessity of reorganising the health care systems to accommodate the new challenges of the HIV/AIDS epidemic is also emphasised.

Globally, injury is a major public health problem. The extent of the problem varies considerably by demographic subgroups, regions and national income. The overall objective of this thesis is to examine the relationship between injury mortality and economic development, and to discuss its role in the changing patterns of mortality as described in health transition theory. By cross-sectional analysis between cause-specific injury-related mortality and income per capita, studies included in this thesis indicated that while unintentional injury mortality (UIM) and homicide rates correlated negatively with GNP per capita for total populations with varying patterns for age-specific mortality, suicide rates increased slightly by nations’ income per capita, especially among women. In age- and cause-specific injury mortality differentials between low-income, middle-income and high-income countries, ageing and injury interplay mutually with regard to health transition; declining rates in child UIM by income level contributes to the ageing process, while increasing UIM among the elderly, in combination with ageing populations boosts the absolute number of injury deaths in this segment. Between the income-based country groups, both cross-sectional and longitudinal analyses show that injury mortality for all three major causes (i.e. unintentional injury, suicide and homicide) first increase and then decrease with rising income per capita, following an inverted U-shaped curve. These results illustrate that injury is not a homogeneous public health phenomenon from a health transition perspective. While child unintentional mortality clearly agrees with ‘diseases of poverty’, unintentional injury in the elderly agrees with ‘diseases of affluence’. Patterns for homicide and suicide are more complex and uncertain. Generally, the strength and direction of injury mortality by economic development vary considerably by age, sex and type of injury. Further research on causations, mechanisms, broader indicators and data quality, as well as theoretical developments on health transition taking new findings and parallel frameworks into account, is needed to fully understand the complex relationship between economic development and injury mortality.

Det allmänna hälsotillståndet är ett resultat av de levnadsvanor som individen har och lever under. En förändring av vanor är starkt relaterat till individens attityd och inställning! Syftet med den här studien, är att undersöka ungdomars attityd till hälsosam kost och inställning till att förändra kostvana, samt söka klarhet i vilka eventuella hinder och incitament som föreligger vid en förändring av kostvana. / The overall health status is a result of the lifestyle that the individual has. A change of habits is strongly related to individual attitudes! The purpose of this study is explore adolescents attitudes to healthy eating and willingness to change a diet habit, and seek clarification of the possible barriers and incentives exist for a change in dietary habit.

Tidigare forskning behandlar vad och hur mycket barn äter samt hur mycket och på vilket sätt barn är fysiskt aktiva. Syftet med studien var därför att beskriva förskolepersonals syn på små barns rörelse- och matvanor samt på hur de kan stötta föräldrar till att skapa hälsosamma vanor för sina barn. Sex semistrukturerade kvalitativa intervjuer genomfördes med personer som arbetat inom förskola i minst 15 år. Intervjuerna spelades in med hjälp av diktafon vartefter de transkriberades och analyserades. Resultatet kunde delas in i tre kategorier: Små barns rörelse- och matvanor på och utanför förskola, Faktorer som påverkar små barns rörelse- och matvanor samt Kommunikation som stöd till föräldrar. Informanterna ansåg att små barn främst rör på sig genom organiserade aktiviteter utanför förskola. Informanterna ansåg att små barn äter mer på förskola än utanför, vilket kan förklaras av bekanta rutiner i kombination med en positiv och social kontext. Informanterna ansåg att de kan stötta föräldrar till att skapa hälsosamma vanor för sina barn genom kommunikation, samtidigt som de försöker få föräldrar att känna sig självständiga i sin föräldraroll genom att inte påpeka vad de anser är rätt eller fel. Då det framkom att informanterna upplever att många föräldrar är osäkra i sin roll och att de anser att det påverkar små barns rörelse- och matvanor, så vore det intressant att intervjua föräldrar om deras uppfattning av hur de kan stärkas i sin föräldraroll. / Previous studies have focused on what and how much children eat and also how much and in what way children are physical active. Therefore the aim of this study was to describe preschool teachers’ view of young children’s physical activity and eating habits and of how they can support parents to create healthy habits for their children. Six semi structured interviews were conducted with persons that have been working within preschool for at least 15 years. The interviews were recorded with a dictating machine and then transcribed and analyzed. The results were divided into three categories: Young children’s physical activity and eating habits in and outside of preschool, Factors that affects young children’s physical activity and eating habits and Communication as support to parents. The informant’s believed that young children are mainly physical active through organized activities outside of preschool. The informant’s believed that young children eat more at preschool because of familiar routines and a positive and social context. The informant’s try to support parents to create healthy habits for their children by communicating with them, and at the same time they try to make parents feel independent in their role as parents by not pointing out right from wrong. Since the study showed that the informants believed that many parents are insecure in their role as parents and that it affects young children’s physical activity and eating habits, it would be interesting to interview parents about how they believe that they can be strengthened in their role as parents.

Det psykiska hälsoläget har förbättrats totalt sett i befolkningen de senaste åren, men trots det är detfortfarande oroväckande många unga som upplever att de mår psykiskt dåligt. Ett fenomen som ökat under senare tid och som kopplats samman med psykisk ohälsa, är olika former av självskadehandlingar. Det har tidigare visats att andra typer av riskbeteenden sprids i populationer genom att individer influeras av varandra. Bakgrunden till den här studien var en tanke om att ökningen av självskadehandlingar kan vara ett resultat av en form av smittspridning snarare än enbart ett tecken på försämrad psykisk hälsa. Som primär kanal för spridningen av beteendet undersöktes Internet eftersom mycket av ungdomars sociala liv utspelar sig på den arenan. Studien grundar sig på en enkät (n=192) till gymnasieelever. Syftet var att undersöka hur väl ungdomar kände till fenomenet självskadebeteende samt hur de kommunicerade med och influerades av sina vänner. Resultatet visade att mer än hälften av ungdomarna kommit i kontakt med självskadebeteende i form av bilder eller skriftliga inlägg på Internet och 86 % av tjejerna och 71 % av killarna kände dessutom till minst en person i sin närhet som medvetet skadat sig själv. Eftersom ungdomar exponeras av beteendet från många håll är det rimligt att anta att individer som upplever någon form av psykisk stress kan influeras av andra att prova ett självdestruktivt beteende. Beteendet förefaller mer utbrett än vad som skulle kunna förväntas om en svårare psykisk ohälsa var den enda orsaken. Att tidigt arbeta med självkänsla och se till att barn och unga har trygga sociala nätverk runt omkring sig kan vara ett sätt att förse dem med den motståndskraft som behövs för att stå emot negativa influenser från omgivningen. / The mental health status has improved in the overall population recent years although it is still worrying many young people who feel that they have a poor psychological health. A phenomenon that has increased recently, and are linked to mental illness, are various forms of self-injury acts. It has previously been shown that other types of risk behaviours spread in populations by individuals influenced by each other. The background of this study was to examine whether the increase in selfinjury acts can be the result of a form of contagion, rather than merely a sign of impaired mental health. Since a lot of young people's social life takes place on the Internet, this was the arena which was investigated. The study is based on a survey (n = 192) and was designed to examine how well young people were aware of the phenomenon of self-injury, and how they communicated with and how they were influenced by their friends. The results showed that more than half of the participants had been in contact with self-injury such as pictures or written messages on the Internet. Among the respondents 86% of the girls and 71% of the boys also knew at least one person who deliberately harmed themselves. Since adolescents are exposed to this behaviour from many directions, it is reasonable to assume that individuals who experience some form of mental stress may be influenced by others to try self-destructive behaviour. The behaviour seems to be more prevalent than would be expected if a severer mental illness was the solely cause. Early work on self-esteem and ensuring children and young people have a safe social network around them can be a way to provide them with the resilience needed to withstand the negative influences from their surroundings.

Nollvisionens mål är att ingen ska omkomma eller skadas allvarligt i trafiken. Varje år dör ungefär sex personer och många flera skadas i samband med idrottsresor. Att arbeta förebyggande med trafiksäkerhet hos idrottsföreningar kan vara ett sätt att bidra till en ökad trafiksäkerhet i Sverige. Syftet i denna studie var att undersöka vad idrottsföreningar uttryckte kring förebyggande trafiksäkerhetsarbete. Vilka uppfattningar som framfördes gällande trafiksäkerhetspolicy och vilka förutsättningar som fanns, samt vad som kunde förstärka trafiksäkerhetsarbetet. Studien genomfördes med kvalitativ metod i form av halvstrukturerade intervjuer hos nio olika idrottsföreningar i en kommun i Skåne. I analysen plockades de viktigaste meningsbärande enheterna ut. Dessa grupperades och fick sedan utgöra grunden för de olika kategorier som skapades. Resultatet visade på att intresset för förebyggande trafiksäkerhetsarbete generellt var lågt och att en trafiksäkerhetspolicy inte upplevdes som motiverad hos idrottsföreningarna. Det var svårt att engagera föräldrar och andra frivilliga, då arbete med frågor som inte rörde själva idrottandet inte var något som intresserade dessa. Diskussionen tar upp att brist på tid och vilja i samhället har minskat resurserna för idrottsrörelsen. Även att trafiksäkerhet inte sågs som en angelägen fråga att arbeta med. Detta på grund av att det inte fanns ett konkret problem att koppla till den arbetsinsats som krävdes. Studiens slutsatser förmedlar att intresset för denna typ av frågor inom idrottsföreningar var lågt och att ideellt arbete spelade en avgörande roll för föreningars prioriteringar. Vidare att det krävdes någon utanför föreningen för att skapa uppmärksamhet kring ämnet och att denna någon mycket väl skulle kunna vara en folkhälsopedagog. / The goal of Vision Zero is that no one is going to be killed or seriously injured in traffic. About six people dies each year and many more is getting hurt in sports- related travels. Working with the prevention of road safety in sports can be one way to contribute to increased road safety in Sweden. The aim of this study was to examine what sports thought about preventive road safety work. What were their beliefs concerning road safety policy and the conditions that existed. Further what could enhance road safety. This study was conducted with a qualitative method using semi-structured interviews in nine different sports in a municipality in southern Sweden. Within the analysis we picked out the most important meaning-bearing units. These were placed into groups and then composed for the different categories we created. Results showed that interest in the prevention of road safety work in general was low and that a road safety policy was not perceived as motivated by sports. It was difficult to involve parents and other volunteers, when work on issues not related to the sport itself was not something that interested them. The discussion addresses that lack of time and will in the community have reduced resources for the sport. Also that road safety was not seen as an important issue to work with. All this because there was not a practical problem in connecting to the effort necessary. The conclusion of this study conveyes that interest in these types of issues in sports was low and volunteers played a crucial role in the union's priorities. Furthermore, the need for someone outside the club to create attention around the topic. This person could perfectly well be a pedagogue of public health.