De senaste åren har sömnproblemen ökat i Sverige. Detta gäller även för studenter i åldern 20-24 år. Sömnbesvär hör samman med psykisk ohälsa i en ömsesidig påverkan och en av orsakerna kan vara en oregelbunden och stressfylld livsstil. Studenter är en riskgrupp för detta.Syftet med denna enkätstudie var att se om det fanns något samband mellan hur studenters dagar är strukturerade i form av schemabunden undervisning och hur deras sömnvanor ser ut. Ett annat syfte var att se om det fanns ett samband mellan studenternas självrapporterade sömnkvalitet, sömnkvantitet och deras psykiska välbefinnande. Resultatet visade att studenter som hade fler än 10 lektionstimmar i veckan oftare svarade att de hade lätt att somna och hade en god sömn men inte sov tillräckligt jämfört med studenter som hade färre lektionstimmar. De med få lektionstimmar hade svårare att somna jämfört med övriga studenter. Studenter som sov dåligt och för lite hade också känt mer stress, ängslan, oro och ångest än de som sov gott och tillräckligt. / In recent years, sleep deprivation has been increasing in Sweden. This phenomenon has become quite apparent in the student category aged between 20-24 years old. Insomnia, which is correlated with mental well-being, has many causes some of which include an irregular and hectic lifestyle. Students particularly fall into this group and are becoming more and more vulnerable to this condition. The purpose of this study was to find and identify the links between the students’ busy academic schedules and the apparent inability to get a full and restful night sleep. This paper will also profile the psychological aspects of a carefully selected target group for the purpose of this research. Students with more than 10 academic tuition hours reported that they were able to fall asleep and slept well, but also indicated that the duration was insufficient for their need which is in direct contrast to students who had less than 10 tuition hours. This paper also identified that students with poor sleeping or insufficient sleep were more stressed, agitated and suffered from raised levels of anxiety as opposed to other students.

Bruket av tobak har idag blivit en viktig folkhälsofråga eftersom rökning och snusning har negativa effekter på såväl allmänhälsa som munhälsa. Trots det röker nästan var fjärde svensk kvinna och var femte svensk man. Syftet med den här studien var att kartlägga tobaksvanorna bland förstaårsstudenterna på sjuksköterske-, tandhygienist- och folkhälsopedagogiska programmet samt att undersöka vilka kunskaper studenterna på respektive program har om tobak och dess effekter i munhålan. Studien genomfördes som en enkätundersökning där 121 enkäter delades ut till studenterna på de tre programmen. Resultatet visade att 7% av studenterna var dagligrökare och 17% var feströkare. Störst andel rökare återfanns på tandhygienistprogrammet. Endast 4% av studenterna brukade snus. Lungcancer, KOL och hjärt-kärlsjukdom var de sjukdomstillstånd som flest studenter associerade med tobaksbruk och när det gäller effekterna i munhålan, såg studenterna starka kopplingar till flera av de listade tillstånden. Rökning förknippades främst med dålig andedräkt, missfärgning av tänderna och muncancer medan snusning också förknippades med frätskador på munslemhinnan. Studenterna visade relativt goda kunskaper om tobak och dess effekter på hälsan. Trots detta rökte en stor del av studenterna vilket indikerar att kunskap allena, inte får unga människor att avstå från tobaksbruk. / The use of tobacco has today become an important question in the public health work since smoking and snuff use has a negative impact on general as well as oral health. Despite this, almost one out of four Swedish women and one out of five Swedish men are current smokers. The aim of this study was to survey tobacco habits among first grade students of nursing, dental hygiene and public health and to study the students’ knowledge about tobacco and its effects on the oral cavity. The study was carried out as a questionnaire survey where 121 questionnaires were handed out to the students of the three programmes. The result showed that 7% of the students were daily smokers and 17% were occasional smokers. The largest share of smokers was found at the dental hygienist programme. Only 4% of the students were current snuff users. Lung cancer, COPD and cardio vascular disease were the states of illnesses most students associated with tobacco use. Regarding the effects on the oral cavity, the students found strong connections to several of the listed conditions. Smoking was mainly associated with oral halitosis, tooth staining and oral cancer, while the use of snuff was also associated with corrosion damage to the oral mucous membrane. The students showed relatively good knowledge about tobacco and its health effects. Despite this, a large part of the students was current smokers, which indicates that knowledge alone does not make young people refrain from tobacco use.

Background and aim: In society there is a growing awareness that a vital factor for patientswith chronic diseases, such as head and neck cancer (HNC), is how well they are able to function in their every day lives – a common, but often overlooked, public health issue. The overall aim of this thesis is to reach a deeper understanding of living with HNC and to identify the experiences that patients felt promoted their health and well-being. It also explores the patients' experiences of contact and care from health professionals and whether these encounters could increase their feelings of health and well-being; salutogenic approach. Methods: This thesis engages a qualitative data design. On three occasions, 35 purposivelyselected patients were interviewed (31 from Sweden and one from Denmark, Finland, Island, and Norway). The first study was conducted in the Nordic counties (I), and the remainingstudies were conducted in Sweden (II, III, IV). Interviews were performed on a single basis(I, II, III) and then repeated (IV). The individual, semi-structured qualitative interviews usedopen-ended questions (n=53). Three different forms of analyses were used: critical incident technique (I), thematic content analysis (II), latent content analysis (III), and interpretativedescriptive analysis (paper IV). Findings: Living with head and neck cancer was expressed as living in captivity, in the sensethat patients' sometimes life-threatening symptoms were constant reminders of the disease. The patients experienced a threat against identity and existence. Patients struggled to find power and control over everyday life, and if successful this appeared to offer them better health and well-being along with spiritual growth. The general understanding was that these patients had strong beliefs in the future despite living on a virtual rollercoaster. The patients went through a process of interplay of internal and external enabling that helped them acquire strength and feelings of better health and well-being. Consequently, they found power and control from inner strength and other health resources, e.g. social networks, nature, hobbies, activity, and health professionals. However, the findings also revealed the opposite; that some patients were more vulnerable and felt powerless and faced everyday life with emotional and existential loneliness. They were dependent on next of kin and health professionals. Having good interpersonal relationships and emotional support 24 hours a day from next of kin were crucial, as were health promoting contacts and care from health professionals. This health promoting contact and care built on working relationships with competent health professionals that were available, engaged, respectful, validating, and, above all experienced in the treatment phase. But many patients experienced not health promoting contact and care – and a sense of not being respected, or even believed. Added were the patients' experiences of inadequate coordination between phases of their lengthy illness trajectory. They felt lost and abandoned by health services, especially before and after treatment. Conclusions: Inner strength, good relationships with next of kin, nature, hobbies, andactivities could create strength and a sense of better health and well-being. Patients experienced a mutual working relationship during dialoguing and sensed co-operation and equality in encounters with competent health professionals. This could lead to enhanced power and control i.e. empowerment in a patient's everyday life. The findings highlight psychosocial rehabilitation in a patient-centred organisation when health professionals supportpatients' inner strength and health resources , and also offer long-term support to next of kin.Finally, this research suggests that if health professionals could gain a deeper understanding of the psychosocial, existential, social, and economic questions on patients' minds, they could better sense how patients feel and would be better equipped not only to offer greater support, but to raise their voices to improve health policy and health care for these patients. / Syfte och bakgrund: Avhandlingens övergripande syfte var att få en djupare förståelse för personer med huvud – halscancer vardagsliv samt vad som främjar deras hälsa och välbefinnande d v s ett salutogent synsätt. Kroniska sjukdomstillstånd såsom cancer räknas numera till de stora folksjukdomarna och vid huvud – halscancer är vikten av ett fungerande vardagsliv emellertid ett ofta förbisett folkhälsoproblem. Metod: Avhandlingen omfattar fyra delarbeten baserade på kvalitativa data. Resultaten baseras på semistrukturerade individuella intervjuer (n=53) som riktades till 35 utvalda personer. Den första studien (I) genomfördes i Danmark, Finland, Island, Norge och Sverige och de övriga i Sverige (II, III, IV). Intervjuerna genomfördes vid ett tillfälle (I, II, III) och vid upprepade tillfälle (IV). Tre olika textanalyser användes, kritisk händelse teknik (I), tematisk innehålls analys (II), latent innehållsanalys (III) och tolkande beskrivande analys (IV). Resultat: Att leva med huvud - halscancer beskrevs som ett liv i fångenskap och upplevdes som att åka i berg och dalbana mellan hopp och förtvivlan. De ofta livshotande symtomen påminde ständigt om sjukdomen och upplevdes som hot både mot existensen och mot identiteten. Detta till trots kom ibland en stark optimism och tro på framtiden till uttryck. Några av de intervjuades vardagsliv präglades dock av känslomässig och existentiell ensamhet och upplevelser av sårbarhet och maktlöshet. Att ha makt och kontroll över den egna livssituationen liksom närståendes känslomässiga stöd, ibland dygnet runt, främjade hälsan. Hälsofrämjande kontakter med vårdpersonalen upplevdes främst under sjukhusvistelsen. Avgörande var en god och bekräftande patient vårdar relation samt att personalen hade hög kompetens och visade engagemang och respekt i vårdsituationen. Flera av de intervjuade beskrev dock allvarliga brister i kontakten med sjukvården. Upplevelser av brist på respekt och att inte bli trodd i sin sjukdomsupplevelse beskrevs, vilket vanligast i perioderna före och efter sjukhusvistelsen. Samordningen mellan hälso- och sjukvårdens olika funktioner upplevdes som bristfällig under hela sjukdomsförloppet. Konklusion: Inre styrka, goda relationer med närstående, nära kontakt med naturen, hobbyer och andra aktiviteter skapade upplevelser av hälsa och välbefinnande hos personer med huvud - halscancer. I dialog med kompetent vårdpersonal, där samverkan och jämlikhet var tydlig, upplevdes ömsesidiga, vänliga relationer som en hjälp för dem att få ökad egenmakt och kontroll i vardagslivet. Resultatet visar på patienternas långvariga kamp med ett vardagsliv med ständig känslomässig, psykosocial, existentiell, social och ekonomisk oro. Resultatet pekar också på en brist på patientcentrerad organisation och psykosocial rehabilitering, där vårdpersonal stödjer patienters inre styrka och hälsoresurser. Förhoppningen är att resultatet kan leda till en ökad förståelse hos vårdpersonal för hur vardagslivet kan upplevas då man har en huvud- hals cancer, för att på så vis ge adekvat hjälp till dessa patienter och deras närstående.

Introduktion: Under de senaste decennierna har det förts en diskussion om behovet av att omorientera hälso- och sjukvårdens verksamhet för att på ett effektivare sätt bidra till befolkningens hälsa. Detta togs också upp som ett av målen i 2003 års svenska nationella folkhälsopolitik som sedan uppdaterades 2008. Målet ”en mer hälso- främjande hälso- och sjukvård anger att ett hälsofrämjande och sjukdomsförebyggande perspektiv ska genomsyra hela hälso- och sjukvården och vara en självklar del i all vård och behandling. Vårdpersonalen förväntas spela en nyckelroll i genomförandet. Deras inställning till och kunskap om hälsofrämjande kommer sannolikt att ha en stor inverkan på hur målet kommer att tillämpas i framtiden. Det övergripande syftet med denna avhandling är, att utifrån professionernas perspektiv, analysera möjligheterna till att omorientera hälso- och sjukvården mot en mer hälsofrämjande inriktning. De specifika frågeställningar som avhandlingen avser att besvara är hur vårdpersonalen uppfattar begreppen hälsa och hälsofrämjande, hur de uppfattar den hälsofrämjande rollen samt hur de uppfattar hinder och möjligheter för att ha en hälsofrämjande roll i det dagliga kliniska arbetet. Metoder: Avhandlingen baseras på fyra delarbeten utgående från två dataset, ett kvalitativt och ett kvantitativt. Sju fokusgrupper genomfördes med totalt 34 informanter från primärvård och olika sjukhuskliniker. Informanterna representerade sju av vårdens stora yrkesgrupper. Data analyserades med kvalitativ innehållsanalys. Uppfattningar och frågor som genererades av den kvalitativa datainsamlingen låg till grund för utformningen av en enkät, som pilottestades och användes i en undersökning. Av totalt 3.751 anställda som arbetade dagtid med kliniskt arbete i Västerbottens läns landsting inbjöds 1.810 att delta. Dessa representerade arbets- terapeuter, barnmorskor, dietister, kuratorer, läkare, sjukgymnaster, sjuksköterskor och psykologer. Huvudsakliga resultat och konklusion: Majoriteten av vårdpersonalen hade en holistisk syn på hälsa, samtidigt ansåg 40% att hälso- och sjukvården genomsyras av en biomedicinsk syn på hälsa. Begreppet hälsofrämjande framstod som diffust, svårgripbart och därmed svårt att tillämpa i praktiken. Detta var delvis kopplat till en brist på samsyn beträffande förhållandet mellan hälsofrämjande och sjukdoms- förebyggande. Avhandlingen visar att det finns ett starkt stöd för omorientering av hälso- och sjukvården mot en mer hälsofrämjande inriktning. Majoriteten av de tillfrågade ansåg att hälso- och sjukvården har stor betydelse när det gäller den långsiktiga hälso- utvecklingen i befolkningen och såg ett behov av att utveckla den hälsofrämjande och sjukdomsförebyggande rollen för att på sikt få en effektivare hälso- och sjukvård. Önskan att fokusera mer på hälsofrämjande och sjukdomsförebyggande rapporterades signifikant oftare av kvinnor än män och av primärvårdspersonal jämfört med sjukhus- personal. Speciellt viktigt att beakta är att män och läkare, dvs grupper som ofta har en hög maktposition, rapporterade mindre positiva attityder till en mer hälsofrämjande hälso- och sjukvård, samtidigt som psykologer, arbetsterapeuter och sjukgymnaster oftast rapporterade det motsatta. En medvetenhet om maktrelationerna spelar därför en strategisk roll i förändringsprocessen. De vanligaste hindren för att ha en hälso- främjande roll i det dagliga kliniska arbetet var en pressad arbetssituation, brist på riktlinjer och otydliga mål. Ledningens stöd är avgörande för tillgången till tid och andra resurser som krävs för vårdpersonal att bedriva hälsofrämjande och sjukdomsförebyggande arbete. / Introduction: There has been an on-going, active discussion about the need to re-orient health services to contribute more effectively to population health. This was addressed as one of the 2003 National Swedish public health policy goals, which demand health promotion and disease prevention be an integral part of the health care system and an important component of all care and treatment. Health care professionals are thus expected to play a key role in implementing the goal of “a more health-promoting health service”. Their approach to, and knowledge about, health promotion will consequently greatly influence how the goal will be applied in the future. The aim of this thesis is to describe and analyze the possibilities for re-orienting health services to more health promotion from the perspective of health professionals. The specific aims are to explore how health professionals interpret the concepts of health and health promotion, how they perceive their role in health-promoting practices, and how they view barriers and possibilities for having a health-promoting role in practice. Methods: The thesis is based on four studies with two sets of data. Seven focus group discussions were carried out with a total of 34 informants from both hospital and primary health care settings. The informants represented major professional groups. Data were analyzed using qualitative content analysis. Perceptions generated by the qualitative study resulted in formulation of a questionnaire that was pilot-tested and used in a survey. Out of a total of 3751 health professionals who work in daytime clinical practice in the province of Västerbotten, 1810 were invited to participate. They represented counselors, dieticians, midwives, nurses, occupational therapists, physical therapists, psychologists and physicians. Main findings and conclusions: The vast majority of informants hold holistic ideas about health. At the same time, 40% of the health professionals considered health services to be permeated by a biomedical perspective on health. The concept of health promotion appeared to be diffuse, elusive and difficult to apply in practice. This was partly linked to a lack of agreement about the relationship between health promotion and disease prevention. Thus, policy makers have to understand the need for clarification of concepts and the implications for practice. The thesis found strong support for a reorientation of health services in order to incorporate health promotion. The majority of the respondents believed that health services play a major role in long-term health development in the population and saw a need for health orientation as a strategy to provide more effective health care. Willingness to focus more on health promotion and disease prevention was reported significantly more often by women than men, and by primary health care personnel compared to hospital personnel. Especially noteworthy is that men and physicians, i.e., groups that often possess high positions of power, reported less positive attitudes to a more health-promoting health service, while psychologists, occupational therapists and physiotherapists most frequently reported the opposite. Therefore, awareness (analysis) of power relations must play a strategic role in the process of change. The most common barriers to health promotion roles in daily practice were reported to be heavy workloads, lack of guidelines, and unclear objectives. Management support is critical for the availability of time and other resources required for health professionals to engage in health promotion.

Sammenfatning Baggrund og formål: Apopleksisygdommen er ansvarlig for flest tilfælde af invalidering blandt voksne i eget hjem. I Danmark alene lever godt 50.000 mennesker med følgerne efter apopleksi. En følge kan være reduceret evne til at kommunikere, afasi. Forebyggelse kan reducere antallet af nye tilfælde og følgerne efter sygdommen. Livskvalitet ved kronisk sygdom har voksende bevågenhed. Rehabilitering medvirker til at patienten kan blive fysisk, psykisk og socialt fungerende på et niveau, men sygdommens indvirken på oplevelsen af helbredsrelateret livskvalitet er i Danmark ikke undersøgt med sygdomsspecifikke instrumenter. Patienter med afasi udelukkes som regel fra undersøgelser, der kræver intakt tale og forståelse. Afhandlingens overordnede mål er at tilvejebringe et instrument, som kan anvendes til at måle helbredsrelateret livskvalitet efter apopleksi inkl. afasi. Metode og materiale: Afhandlingen har en kvantitativ tilgang. Et nordamerikansk instrument, Stroke Specific Quality of Life Scale, version 2.0, SSQOL © (copyright Linda S. Williams), er blevet oversat og kulturelt bearbejdet til dansk i overensstemmelse med anerkendt systematik i studie I. Instrumentet dækker med 49 items 12 domæner med fysisk, socialt og mentalt fokus samt 13 items, der dækker en vurdering af domænerne og livskvaliteten sammenlignet med før apopleksien. Instrumentets psykometriske egenskaber er blevet testet ved hjælp af tre studiepopulationer rekrutteret dels retrospektivt, dels konsekutivt. I studie II blev reliabilitet og validitet undersøgt, og i studie III responsivitet og sensitivitet. Afprøvningerne er foretaget med referenceformularer som eksterne kriterier i form af etablerede generiske skalaer. I studie IV er afprøvet en proxy-version tiltænkt patienter, som er ude af stand til selv at udfylde skemaet eller som ikke er i stand til at kommunikere tilstrækkeligt. Afprøvningen blev udført af en nærtstående udpeget af patienten. I studie V blev en gruppe let ramte patienter beskrevet, og variabler med betydningsfuld sammenhæng med oplevelsen af forringet helbredsrelateret livskvalitet blev undersøgt. Data er blevet testet ved hjælp af gennemsnit og standarddeviationer, median og range, proportioner, korrelationer og logistisk regression. Resultater: Den danske version af SSQOL, SSQOL-DK, har god face- og indholdsvaliditet. Det udfyldes på 10-20 minutter. Stabilitet, undersøgt med test-retest metode, viste korrelationer i området rs 0.65-0.99. Intern konsistens undersøgt med Cronbach’s alfa viste værdier i områderne 0.81-0.94 i studie II, 0.75-0.96 i studie III og 0.64-0.87 i studie V. Der blev set en ceiling effekt, 24-52%, men beskeden floor effekt. Begrebsvaliditet viste moderat delte varianser med de eksterne kriterier, r2 0.03-0.62. Konvergent validitet var (r) > 0.40 med undtagelse af et enkelt item. SSQOL-DK var i stand til at klassificere retning af ændring i livskvalitet over tid i overensstemmelse med eksterne kriterier i 43-58 % af tilfældene. Proxy-versionen viste god overensstemmelse mellem patient- og proxy data. I en gruppe af let ramte patienter med apopleksi og transcerebral iskæmi, TCI, et år efter sygdommen vurderede 57 % deres livskvalitet som uændret i forhold til før apopleksien. Det mandlige køn (OR 3.77), erhvervsaktivitet (OR 2.84), og lavere scores på domænerne Mood og Work ved tre måneder var covariater, som var signifikant relateret til sandsynligheden for at vurdere livskvaliteten forringet efter sygdommen. Konklusion: Der foreligger nu et dansksproget instrument, SSQOL-DK, som har demonstreret tilfredsstillende reliabilitet og validitet, og som kan anvendes på gruppeniveau til dansktalende patienter med let til moderat apopleksi. Apopleksipatienten med større kommunikationsproblemer har dog stadig begrænsede muligheder med dette instrument, idet de foreliggende resultater fra proxy-afprøvningen fordrer yderligere undersøgelse af datas validitet / Abstract Background and aim: Stroke is most frequently the cause of adult disability. In Denmark more than 50.000 people suffer from the sequels of stroke. One of them may be aphasia, i.e. reduced ability to communicate. Primary and secondary prevention may reduce the incidence and the severity of stroke. The interest in quality of life with a chronic disease is increasing. Rehabilitation efforts are targeted for physical, mental and social function but the impact on health related quality of life after stroke has not been studied with stroke specific instruments. Aphasic patients are normally excluded from studies where communicative skills are required. The aim of this thesis is to develop an instrument suitable for measuring health related quality of life after stroke. Methods and material: The design of the thesis is quantitative. In study I Stroke Specific Quality of Life Scale, version 2.0, SSQOL © (copyright Linda S. Williams), an American instrument recently developed, was translated and culturally adapted to Danish according to established guidelines. With 49 items SSQOL covers 12 domains comprising physical and mental issues. Thirteen items covers an appraisal of each domain compared to pre stroke status and overall quality of life. Psychometric properties was examined by studying three samples of stroke survivors. Study II and III examined reliability, validity and responsiveness. Established generic scales were used as external criteria. Study IV tested a proxy-version meant for stroke patients with language impairment or patients who are unable to fill in a questionnaire. The patients chose the proxies. Study V provided health related quality of life in a group of mildly affected patients after stroke or transient ischemic attack, TIA. Significant covariates with deteriorated health related quality of life were studied. Data were analyzed with mean and standard deviations, median and range, proportions correlations and logistic regression. Results: The Danish version of SSQOL, SSQOL-DK, showed good face- and content validity. It can be completed in less than 25 minutes. Test-retest showed correlations rs 0.65-0.99. Internal consistency showed Cronbach’s alpha from 0.81-0.94 in study II, 0.75-0.96 in study III and 0.64-0.87 in study V. Ceiling effect was 24-52%, floor-effect was modest. Construct validity showed shared variance with external criteria, r2 0.03-0.62. Convergent validity showed (r) >0.40 for 48 out of 49 items. SSQOL-DK classified direction of change in over all quality of life concordantly from 43-58% with external criteria. The agreement between patient- and proxy data was good. Fifty seven (57) percent of mildly affected patients after stroke or TIA rated their overall quality of life unchanged one year after stroke compared to pre stroke status. In the regression model male sex OR 3.77), working outside home (OR 2.84), and less than 5.00 (maximum score) on the domains Mood and Work/productivity at three months were significant predictors for rating over all quality of life deteriorated at 12 months. Conclusion: The SSQOL-DK has demonstrated satisfactory reliability and validity and can be used on group level measuring health related quality of life among Danish survivors after mild to moderate stroke and TIA. Stroke survivors with severe communication problems are still limited as validity of the proxy data should be further tested

Aims: The general aims of this thesis were 1) To explore how non-western immigrant families’ different background and factors related to immigration and acculturation may affect the outcome of education and support in paediatric diabetes management; 2) To provide knowledge on how diabetes education and support for immigrant children and their families should be given to ensure them adequate competence in disease management and the children optimum metabolic control. Methods: The thesis comprises five studies carried out 2001-2006. Study I was based on national register data on metabolic control (N=977), questionnaires to all 20 Danish paediatric diabetes centres and structured interviews with 38 immigrant families. Study II was an intervention study including the development of guidelines and adapted educational material, followed by a re-education programme for 37 families. Study III was a case study of 11 Turkish and Kurdish children/families comprising data from medical records, a participant observation and qualitative interviews with the parents, one interpreter and three diabetes team members. Study IV included qualitative interviews with Arabic parents of 12 children, living as immigrants in Denmark and in Cairo/Egypt respectively. Study V comprised data on metabolic control and qualitative interviews with 11 young adult immigrants with type 1 diabetes since childhood or adolescence.Findings: The young immigrants were very unevenly distributed between the Danish paediatric centres. Most teams had little knowledge of and no special educational offers for immigrant families, just as the use of professional interpreters was limited. The immigrant parents had clearly different pre-conditions for diabetes education as compared with ethnic Danish parents, just as most had a low level of acculturation as evaluated by their need for an interpreter. Major differences were identified between the different ethnic groups and between the individual immigrants. The immigrant children and adolescents had different pre-conditions as compared to their parents; most, however, had non-optimum metabolic control. The design of an adapted educational programme could optimise the outcome of diabetes education, but was not sufficient to provide the families with competence in diabetes management and the children/ adolescents with good metabolic control of long duration. Many parents in particular experienced difficulty combining diabetes management with their principles relating to good parenthood. In addition, they appeared to be insecure and doubtful about the competence of the Danish health care professionals.Conclusions: A different ethno-cultural background is likely to create barriers to health education, learning and collaboration. The non-homogeneity of non-western immigrant families requires educational initiatives tailored to the pre-conditions and needs of the individual family members; adapted initiatives such as peer education are suggested. Special support for immigrant children and adolescents should be considered. A close, supportive and trust-filled relationship between the families and health care professionals is needed to facilitate learning, collaboration and good metabolic contro

Violence against women is a problem in all countries in the world, including the small autonomy of the Åland Islands. The violence ranges from psychological threats to femicide. In the Åland Islands the issue has been placed on the agenda of politicians and the authorities, while reports about severe violence against women have been brought to the public. In Åland no scientific research on violence against women has been performed. The overall aim of this dissertation is to gain a deeper insight into how battered women in Åland are cared for by nurses, and how the official organizations have responded to the government policy directives. In this thesis, the first study, a descriptive survey, describes how nurses identify and support battered women. In the second and third studies, the method of grounded theory was used to explore the experiences and perceptions of nurses and battered women of violence against women. In the fourth study a case study approach was used to explore government policies for intimate partner violence. The main findings in this thesis are that battered women used health services to receive help. We found that nurses identified and supported abused women, even though services for these women were inadequate. Nurses were willing to help the women, but they often lacked support. Battered women reported that they received ad hoc help. They were often left alone, dependent on a nearby person to escape, survive, and recover. Another finding was that the Government of the Åland Islands demanded that the official organizations should allocate services to battered women, but the organizations’ response to the directives had some limitations. From a public health perspective, the phenomenon presents an urgent challenge. Overall, the public health community can and should contribute greatly towards the understanding, prevention, and control of violence by applying and adapting already constructed principles, and by implementing strategies. / Våld mot kvinnor är ett problem som förekommer i alla länder I världen inkluderat det lilla autonoma området Åland. Fenomenet kan jämföras med terror. Våld mot kvinnor utövas i former från hot till mord. På Åland har problemet lyfts fram både genom politikers som tjänstemäns agendor, samtidigt som rapporter om allvarligt förekommande våld mot kvinnor rapporterats till allmänhetens kännedom. Våld mot kvinnor har inte studerats genom vetenskaplig forskning på Åland. Huvudsyftet med denna avhandling är att uppnå fördjupade insikter angående hur våldsutsatta kvinnor bemöts av sjukskötare och hur de offentliga organisationerna agerat utifrån regeringens direktiv. I denna avhandling är den första studien en beskrivande undersökning som beskriver hur sjukskötare identifierar och hjälper våldsutsatta kvinnor. Den andra och tredje studien har använtgrounded theory för att studera sjukskötare och våldsutsatta kvinnors erfarenheter och uppfattningar angående våld mot kvinnor. Den fjärde studien en case study studie har undersökt regeringens riktlinjer angående våld mot kvinnor. Huvudfynden i denna avhandling visar att våldsutsatta kvinnor söker hjälp från hälsovården. Vi fann att sjukskötare identifierar och stöder våldsutsatta kvinnor även då servicen var otillräcklig. Sjukskötare var villiga att hjälpa kvinnorna men de saknade ofta själva stöd. Våldsutsatta kvinnor rapporterade att de erbjöds en hjälp som de uppfattade som ad hoc. De var ofta lämnade ensamma helt beroende av en närstående person för att kunna fly, överleva, och återhämta sig. Ett annat fynd var att Ålands landskapsregering hade uppmanat de offentliga organisationerna att erbjuda service till våldsutsatta kvinnor, men organisationernas respons var begränsade. Fenomenet utgör en akut utmaning sett utifrån ett folkhälsoperspektiv. Slutligen, de ansvariga för folkhälsan i samhället kan och borde bidra med förståelse, prevention, och kontroll av våldet genom att tillämpa och anpassa redan konstruerade principer, och genom en implementering av åtgärder.

Hensikt: Hensikten med studien var å undersøke om enerom reduserer forekomsten av Clostridium difficile hos innlagte pasienter i sykehus. Metode: En deskriptiv epidemiologisk undersøkelse som benyttes for å kartlegge insidensen av C.difficile infeksjon hos innlagte pasienter på fire norske sykehus i perioden 2001-2010 knyttet til antall enerom. Det ble i tillegg gjennomført en retrospektiv undersøkelse der vi så på risikoen for C. difficile infeksjon i en avdeling før flytting i gammelt sykehus med få enerom, til nytt sykehus med bare enerom for nesten alle pasienter. Resultat: I denne studien fant vi ingen sammenheng mellom insidens av C. difficile og økt tilgang på enerom. Det var stor forskjell i insidens av C. difficile mellom fire store norske sykehus. Det ser ut til at risikoen for C. difficile infeksjon var høyere i gammelt sykehusbygg enn nytt sykehus i en avdeling med en høy forekomst av C. difficile infeksjon, men dette var ikke statistisk signifikant. Denne undersøkelsen kan ikke vise lavere risiko for C. difficile infeksjon for pasienter som ligger på enerom. Konklusjon: Andel enerom har økt ved flere sykehus i løpet av studieperioden, men denne studien har ikke klart å vise om enerom har en smitteforebyggende effekt i sykehus ved C. difficile infeksjon. Enerom kan sannsynlig tilrettelegge for bedre smitteforbyggende atferd hos helsepersonell. Det må til flere forebyggende tiltak, som blant annet enerom, for å forbygge spredning av C. difficile infeksjon. / Aims: This study aimed to investigate whether single-occupancy rooms reduce the incidence of Clostridium difficile (C. difficile) among hospitalized patients. Methods: The study used a descriptive epidemiologic approach to investigate the incidence of C. difficile infection in patients in four hospitals during 2001–2010, in relation to the number of single rooms. In addition, we conducted a retrospective study to investigate the risk for C. difficile infection in a hospital ward, in relation to the transfer of a hospital department from old hospital premises that contained only a few single rooms to a new hospital building containing single-occupancy rooms for almost all patients. Results: This study determined no correlation between the incidence of C. difficile infection and increased access to single-occupancy rooms. However, the incidence of C. difficile infection was considerably different in the four hospitals. The old hospital buildings showed higher but insignificant risk of C. difficile infection compared to the new hospital building. We were unable to demonstrate a lower risk of C. difficile infection among patients in single-occupancy rooms. Conclusions: Although the proportion of single-occupancy rooms increased in several of the hospitals during the study period, we were unable to show that the single-occupancy rooms prevent C. difficile infection in hospitalized patients. Single-occupancy rooms likely facilitate improved infection prevention behaviours in health professionals. Preventing the spread of C. difficile infection requires a collection of several preventive measures, including single-occupancy rooms. / <p>ISBN 978-91-86739-21-8</p>

Målet med studien er å undersøke og beskrive ansatte i lavterskel botiltak sine erfaringer med overdoser hos beboere. Gjennom å belyse den ofte tause kunnskapen de ansatte i lavterskeltiltak har om hva som karakteriserer en overdosesituasjon, er studiens hensikt å systematisere og presentere denne erfaringskunnskapen, og gjennom det kunne bidra til en kvalitetsforbedring av den tjenesten som ytes til beboerne.Datainnsamlingen ble gjort gjennom fokusgruppeintervjuer med ansatte på lavterskel botiltak. Flere av kodegruppene som ble arbeidet frem i analysen var tema i begge fokusgruppene. Temaene var overganger, tilgang, å legge lokk på det vanskelige, å dempe kriser og relasjonen til andre. Disse ble igjen rekontekstualisert til «min virkelighet» og «den rusfrie virkelighet,» sammenfattet som «når virkeligheten strammer grepet.»Hovedfunnet i studien er at ansatte opplever at det er når virkeligheten strammet grepet, når rusens dempende slør ikke kan holde virkelighetens krav på avstand, at risikoen for overdoser oppstår. Dette taler for viktigheten av gode relasjoner til hjelpeapparatet, og at de ansatte kjenner til hva som beveger seg i den enkelte beboers liv. / Objectives: This study aimed to investigate and describe how employees working in low threshold housing facilities experience overdosing by facility residents. We also aimed to enlighten the often silent employee knowledge about the characteristics of an overdose situation, thus enhancing the quality of resident services.Materials and Methods: Data was collected through focus group interviews with employees working in low-threshold housing facilities. Many of the code terms identified through data analysis were common to both employees and residents (e.g., “transitions,” “access,” “putting a lid on the difficulties,” “attenuating crises,” and “relation to others.” We recontextualized these codes to “my reality” and “drug-free reality,” or “when reality kicks in.”Results: Our study determined that employees recognize the risk of overdosing as the point at which reality kicks in (i.e., when the attenuating effect of the drugs can no longer keep reality at distance).Conclusion: This study shows that employees are fully aware of residents’ lives and activities. Therefore, policies that maintain good employee relationships with and within the different social and health services may contribute significantly to overdose prevention. / <p>ISBN 978-91-86739-07-2</p>

Baggrund: Kalaallit Nunaat (Grønland) har opbygget en unik organisering af det forebyggende og sundhedsfremmende arbejde, hvor centralt og lokalt niveau er forbundet gennem et forebyggelsesudvalg og en forebyggelseskonsulent i hver kommune. Paarisa, Center for Folkesundhed, havde lederskabet og har udviklet en uddannelse for forebyggelseskonsulenterne.     Formål: At samle og analysere indhentede erfaringer fra arbejdet med organiseringen af det forebyggende og sundhedsfremmende arbejde i perioden 1996 til 2007.   Metode: Officielle dokumenter blev analyseret ved et retrospektivt, deskriptivt og eksplorativt casestudie. Semistrukturerede interviews med udvalgte nøglepersoner og anbefalinger til det fremtidige forebyggende og sundhedsfremmende arbejde, som blev givet af forebyggelses-konsulenterne på et seminar i 2007, blev ligeledes inkluderet. Endelig blev der gennemført et litteraturstudie med henblik på at analysere partnerskaber som et redskab til at højne folkesundheden. Dette studie blev anvendt til triangulering af resultaterne.   Resultater: For at fremme af folkesundheden lokalt skal der arbejdes tværsektorielt og være vilje til koordinering og samarbejde. Dette kan ske ved netværksarbejde, men formelle partnerskaber anbefales. For at opnå succes, skal der desuden være forbindelse mellem centralt og lokalt niveau / Background: Kalaallit Nunaat (Greenland) has built up a unique organization of the preventive and health promotion work in which central and local level are linked through a preventive board and a consultant in each municipality. Paarisa, the Public Health Center, had the leadership and developed an education for the local consultants.   Aim: To collect and analyze acquired experiences of the process of organizing the preventive and health promotive work in the period from 1996 to 2007.   Method: Official documents were analyzed in a retrospective, descriptive and explorative case study. Semi-structured qualitative interviews with key-persons and recommendations to the future preventive and health promotion work provided by the preventive consultants at a seminar in 2007 were likewise included. A literature study was conducted in order to analyze partnerships as a tool to strengthen public health. This study was used for triangulation of the results.   Results: In order to promote public health locally, it is necessary to work cross-sectorial and have the will to coordinate and cooperate. This can be in form of networking, but formal partnerships are recommended. To achieve success, there should be connections between central and local level. / <p>ISBN 978-91-85721-91-7</p>