Bakgrund: Alkoholkonsumtionen bland ungdomar har sedan 2000-talets början minskat. Hur detta har påverkat ungdomarnas hälsa är i dagsläget okänt, då det råder brist på vetenskapligt underlag inom området. Emellertid har tidigare studier undersökt hälsan hos ungdomar som inte dricker alkohol i andra kontexter och tidsperioder, vilket indikerat på en koppling till hälsobrister snarare än hälsovinster framförallt vad gäller psykisk hhälsa. Syfte: Denna studie syftar till att undersöka huruvida avhållsamhet från alkohol bland ungdomar i årskurs två på gymnasiet är associerat med psykisk hälsa, samt om deras psykiska hälsa har förändrats från 2004 till 2012. Metod: För att undersöka sambandet mellan ungdomars avhållsamhet från alkohol och psykisk hälsa användes en kvantitativ metod med upprepade tvärsnittsstudier som studiedesign. Data från hälsoundersökningen Liv och Hälsa Ung Västmanland användes, med 2533 elever i årskurs två år 2004 och 2193 elever år 2012. Resultat: Andelen elever i årskurs två på gymnasiet som avhöll sig från att dricka alkohol var endast marginellt större år 2012 än 2004. Ungdomar som inte dricker alkohol uppvisade i mindre utsträckning antisocialt beteende jämfört med de som dricker, vilket gällde för båda åren. Dock i mindre utsträckning år 2012 än 2004, varvid alkoholkonsumtionen inte tycks ha varit av lika stor betydelse för graden av antisocialt beteende vid det senare undersökningsåret. Med avseende på psykosomatiska besvär och depression var ungdomars avhållsamhet från alkohol endast associerat med hälsofördelar det första undersökningsåret. År 2012 var icke-drickande snarare associerat med en högre grad av psykosomatiska besvär. Slutsatser: Ungdomars avhållsamhet från alkohol tycks inte vara associerat med några påtagliga hälsoeffekter bland ungdomar i årskurs två, med undantag för antisocialt beteende. Möjligtvis beror avsaknaden av hälsoeffekter 2012 på en ökad psykisk ohälsa bland både drickare och icke-drickare. / Background: Alcohol consumption among adolescents has declined since the beginning of the twenty-first century. Whether this has affected the health among the adolescents is currently unknown, due to the lack of empirical evidence regarding this area. However, previous studies have investigated the health of non-drinking adolescents in other contexts and time periods, which have indicated a connection to health deficiencies rather than health benefits. Especially regarding mental health. Aim: The aim of this study is to investigate whether alcohol abstinence among adolescents in the second year of upper secondary school is associated with mental health and whether their mental health has changed from 2004 to 2012. Method: In order to investigate the relationship between alcohol abstinence among adolescents, a quantitative method with a repeated cross-sectional design was used. Data from the Survey of Adolescent Life in Vestmanland was used, including 2533 second year students in 2004 and 2193 second year students in 2012. Results: The proportion of students in the second year of upper secondary school who abstained from drinking alcohol was only marginally greater 2012 than 2004. Non-drinking adolescents presented an antisocial behavior to a lesser extent than their drinking peers, which was applicable to both years. However, to a lesser extent in 2012 than 2004, where Conclusions: Alcohol abstinence among adolescents does not seem to have substantially affected the mental health of adolescents, except concerning anti-social behavior. Lack of health effects among the adolescents in 2012, may instead depend on a decrease in mental health among drinkers, as well as non-drinkers. Keywords: adolescents, alcohol abstinence, antisocial behavior, depression, mental health, psychosomatic symptoms.

Krisberedskap är ett aktuellt ämne som ur individperspektiv främst rör den egna förmågan att tillgodose sina grundläggande behov av vatten, värme, mat, kommunikation och medicin i minst 7 dygn om en kris inträffar. Detta ställer krav på individers medvetenhet och kunskap om kris och krisberedskap. Det saknas forskning på området och de studier som finns visar att medvetenheten och kunskapen är låg. Studiens syfte är att undersöka högskolestudenters oro för att en kris ska inträffa, deras kunskap och medvetenhet om kris och krisberedskap samt vilken beredskap studenter har att hantera en kris och eventuella samband mellan dessa. En kvantitativ enkätstudie genomfördes. Resultatet visar att studenternas medvetenhet och kunskap om kris och krisberedskap är låg. Studenterna har störst oro för att en terroristattack ska ske och anser det troligt att en terroristattack kan inträffa inom fem år. Generellt är dock studenternas oro för att en kris ska inträffa låg. T-test genomfördes för att undersöka eventuella samband och skillnader i krisberedskap utifrån grad av kunskap och medvetenhet. Inga signifikanta samband eller skillnader påvisades. Studiens resultat diskuteras i relation till teorierna Health belief model och Theory of planned behaviour. Då kris och krisberedskap är ett aktuellt men obeforskat ämne rekommenderas vidare studier.

Rift Valley fever (RVF) is an emerging viral zoonosis that causes frequent outbreaks in east Africa and on the Arabian Peninsula. The likelihood of RVF global expansion due to climate change and human anthropogenic factors is an important issue. The causative agent, RVF virus, is an arbovirus that is transmitted by several mosquito species and is able to infect a wide range of livestock as well as people. The infection leads to mass abortions and death in livestock and a potentially deadly hemorrhagic fever in humans. RVF has severe socio-economic consequences such as animal trade bans between countries, disruption of food security, and economic disaster for farmers and pastoralists as well as for countries. Human behavior such as direct contact with infected animals or their fluids and exposure to mosquito bites increases the risk for contracting the disease. To better understand the challenges associated with RVF outbreaks and to explore prevention and control strategies, we used the One Health approach. The local community had to be involved to understand the interaction between the environment, animals, and humans. We focused on Sudan, Saudi Arabia, and Kenya. First, we systematically reviewed the literature and then we performed cross sectional community-based studies using a special One Health questionnaire. Climatic and remote sensing data were used in combination with statistics to develop a sub-region predictive model for RVF. For both Saudi Arabia and Sudan, the ecology and environment of the affected areas were similar. These areas included irrigation canals and excessive rains that provide an attractive habitat for mosquito vectors to multiply. The surveillance systems were unable to detect the virus in livestock before it spread to humans. Ideally, livestock should serve as sentinels to prevent loss of human lives, but the situation here was reversed. Differences between countries regarding further spread of RVF was mainly determined by better economic and infrastructure resources. In Sudan, there was a lack of knowledge and appropriate practices at the studied community regarding RVF disease symptoms and risk factors for both animals and humans. The community was hesitant in notifying the authorities about RVF suspicion in livestock due to the lack of a compensation system. The perceived role of the community in controlling RVF was fragmented, increasing the probability of RVF transmission and disease. In Kenya, our study found that better knowledge about RVF does not always translate to more appropriate practices that avoid exposure to the disease. However, the combination of good knowledge, attitudes, and practices may explain why certain communities were less affected. Strategies to combat RVF should consider socio-cultural and behavioral differences among communities. We also noticed that RVF outbreaks in Kenya occurred in regions with high livestock density exposed to heavy rains and wet soil fluxes, which could be measured by evapotranspiration and vegetation seasonality variables. We developed a RVF risk map on a sub-regional scale. Future outbreaks could be better managed if such relevant RVF variables are integrated into early warning systems. To confront RVF outbreaks, a policy is needed that better incorporates ecological factors and human interactions with livestock and environment that help the RVF pathogen spread. Early detection and notification of RVF is essential because a delay will threaten the core of International Health Regulations (IHR), which emphasizes the share of information during a transboundary disease outbreak to avoid unnecessary geographical expansion.

Introduction Not all children seeking asylum without parents or other relatives are entitled to residence permits. In the last few years, more than one in four unaccompanied asylum-seeking refugee children have been forced to repatriate, either to their home country or to a transit country. Mostly the children refuse to leave the country voluntarily, and it becomes a forced repatriation. Five actors collaborate in the Swedish child forced repatriation process: social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians. When a child is forced to repatriate, the Swedish workers involved must consider two different demands. The first demand requires dignified repatriation, which is incorporated from the European Union’s (EU’s) Return Directive into Swedish Aliens Act. The second demand requires that the repatriation process be conducted efficiently, which means that a higher number of repatriation cases must be processed. The fact that the same professionals have different and seemingly contradictory requirements places high demands on the involved collaborators. Two professionals have a legal responsibility for the children until the last minute before they leave Sweden: social workers and police officers. That makes them key actors in forced repatriation, as they carry most of the responsibility in the process. Further, they often work with children who are afraid what will happen when they return to their home country and often express their fear through powerful emotions. Being responsible and obliged to carry out the government’s decision, despite forcing children to leave a safe country, may evoke negative emotional and mental stress for the professionals involved in forced repatriation. Aim The overall aim of this study is to explore and analyse forced repatriation workers’ collaboration and perceived mental health, with special focus on social workers and police officers in the Swedish context. Materials and methods The study combines a qualitative and quantitative research design in order to shed light at both a deep and general level on forced repatriation. In qualitative substudy I, a qualitative case study methodology was used in one municipality in a middle-sized city in Sweden. The municipality had a contract regarding the reception of unaccompanied asylum-seeking refugee children iv with the Swedish Migration Board. The municipality in focus has a population of more than 100,000 inhabitants. The city in which the data were collected has developed a refugee reception system where unaccompanied asylumseeking refugee children are resettled and await a final decision regarding their permit applications. This situation made it possible to recruit participants who had worked with unaccompanied refugee children without a permit. Semi-structured interviews were conducted with a total of 20 social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians. A thematic approach was used to analyse the data. In quantitative substudies II, III and IV, a national survey of social workers (n = 380) and police officers (n = 714), with and without experience of forced repatriation, was conducted. The questionnaires included sociodemographic characteristics, the Swedish Demand-Control Questionnaire, Interview Schedule for Social Interaction, Ways of Coping Questionnaire and the 12- item General Mental Health Questionnaire. Factor analysis, correlational analysis, and univariate and multivariable regression models were used to analyse the data. Results The qualitative results in substudy I showed low levels of collaboration among the actors (social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians) and the use of different strategies to manage their work tasks. Some of them used a teamwork pattern, showing an understanding of the different roles in forced repatriation, and were willing to compromise for the sake of collaboration. Others tended to isolate themselves from interaction and acted on the basis of personal preference, and some tended to behave sensitively, withdraw and become passive observers rather than active partners in the forced repatriation. The quantitative results in substudy II showed that poorer mental health was associated with working with unaccompanied asylum-seeking refugee children among social workers but not among police officers. Psychological job demand was a significant predictor for mental health among social workers, while psychological job demand, decision latitude and marital status were predictors among police officers. Substudy III showed that both social workers and police officers reported relatively high access to social support. Furthermore, police officers working in forced repatriation with low levels of satisfaction with social interaction and close emotional support increased the odds of psychological disturbances. In substudy IV, social workers used more escape avoidance, distancing and positive-reappraisal coping, whereas police officers used more planful problem solving and self-controlling coping. Additionally, social workers with experience in forced repatriation used more planful problem solving than those without experience. Conclusions In order to create the most dignified forced repatriation, based on human dignity, for unaccompanied asylum-seeking refugee children and with healthy actors, a forced repatriation system needs: overall statutory national guidance, interagency collaboration, actors working within a teamworking pattern, forced repatriation workers with reasonable job demands and decision latitude, with a high level of social support and adaptive coping strategies. The point of departure for an interagency model is that it is impossible to change the circumstances of the asylum process, but it is possible to make the system more functional and better adapted to both the children’s needs and those of the professionals who are set to handle the children. A centre for unaccompanied asylum-seeking refugee children, consisting of all actors involved in the children’s asylum process sitting under the same roof, at the governmental level (Swedish Migration Board, the police authority) and municipality level (social services, board of legal guardians), can meet all requirements.

The aim with this study was to compare and evaluate potential differences in self-assessed health between students where the school had worked systematically with MI and students where the school had not. To evaluate this a quantitative method through poll forms was used. 40 poll forms was sent to a school that did not use MI and compared the answers with existing poll forms from a school that used MI systematically. Theresults showed that boys from the school using MI had 10 times bigger chance of answering that they felt good than the boys that not have MI. The results for the girls did not indicate the same importance of the intervention. Instead the results showed that other factors, such as feeling sad, sleep quality and alcohol usage influenced their self-rated health. The conclusion from this is that the MI does have an effect on the self-assessed health for particularly boys. / Svenska skolungdomar anser idag att skolan är en bidragande orsak till att de mår dåligt då den bl. a. skapar både ångest och stress. Följderna av att stressen har ökat i skolorna har blivit att den psykosomatiska stressen också har ökat under åren. Skolan är en viktig miljö för det hälsofrämjande arbetet och där spelar både lärarna och elevhälsan en viktig roll för elevernas hälsa och välbefinnande. Syftet med denna studie är att, jämföra och utvärdera eventuella skillnader i självskattad hälsa hos eleverna i gymnasieskolor där elevhälsan arbetat systematiskt med MI och hälsosamtal med elever på en gymnasieskola där elevhälsan inte arbetat med MI under hälsosamtalet. För att undersöka detta användes en kvantitativ metod i form utav enkäter. Författaren till denna studie skickade ut 40 enkäter till den skola som inte använt sig utav MI under hälsosamtalet och jämförde sedan med befintliga enkäter från den skola som jobbat systematiskt med MI under hälsosamtalet. Utifrån resultatet kunde vi se att de killar som fått den systematiska MI interventionen har 10 gånger så höga odds att svara att de mår bra jämfört med de killar som inte fått samma typ av intervention. Däremot var det inte riktigt lika resultat för tjejerna. Där visade resultatet istället att det som hade en större påverkan på deras självskattade hälsa var orsaker som psykisk ohälsa (att de svarade attde var ledsen eller nedstämd), sov dåligt och/eller konsumerat alkohol. Slutsatsen som dras från denna studie äratt hälsointerventionen verkar ha större betydelse för killarnas självskattade hälsa än för tjejernas, men att samtliga som har fått interventionen har en bättre självskattade hälsa än de som inte fått det. Det är dock svårt att av göra om det enbart är interventionen som ligger till grund för detta eller om det är andra faktorer som också påverkar.

The present thesis concerns people with Usher syndrome (USH) and their health. People with USH have a congenital hearing loss of various degrees and an eye disease with a progressive course; for some, the balance is also affected. Three clinical groups have been identified 1, 2 and 3, and 13 genes have currently been identified. USH is the most common cause of deafblindness. Clinical knowledge and the limited research that exists have shown that people with deafblindness can experience difficulties in everyday life. Depression, anxiety and social withdrawal have been described. The general aim of the present thesis was to describe the health of people with USH. The empirical material employed was based on an extensive survey in which people with USH answered two questionnaires concerning health, anxiety, depression, social trust, work, health-care, financial situation, and alcohol and drug use. The focus of the present thesis is on general health, physical health and psychological health, social trust and finance. Three studies in the present theses focus on USH1, 2 and 3, respectively; finally, the fourth study provides an in-group comparison of people with USH. The results of studies I and III are compared with a crosssection of the Swedish population. The results revealed poor physical and psychological health, a lack of social trust and a strained financial situation regardless of clinical diagnosis. The discussion stresses the importance of taking a biopsychosocial approach when describing the health of people with USH, in which previous research is lacking. Additional research should focus on the mechanisms at different levels that affect people with USH and their health from a life- course perspective. Furthermore, research should include a salutogenic perspective to explore the resources and strengths of people with USH.

Inledning: En vanlig missuppfattning är att feta individer är lata och inte vill försöka uppnå viktkontroll, eller gå ner i vikt. Syfte: Identifiera faktorer, vilka respondenterna uppfattar påverkar viktuppgång som upphov till övervikt och fetma hos sig själva samt hos andra individer. Urval: Fyra kvinnor och två män i åldrarna 39-50. Ingen respondent har varit överviktig som barn, men har någon gång efter 18 års ålder upplevt fetma. Metod: Studien har en kvalitativ forskningsansats där semistrukturerade intervjuer har använts för att ta reda på respondenternas uppfattningar kring fenomenet viktuppgång. Intervjuerna transkriberades och analyserades enligt ett fenomenografiskt - hermeneutiskt perspektiv. Resultat: Intervjuerna genererade kategorierna Emotioner; Fysisk aktivitet; Bristande kunskap; Kosthållning; Socialt stöd; Förnekande; Tidsbrist, prioritering, vanor; Ålder, hormoner, ämnesomsättning; Ekonomi och Kriser. Slutsats: Viktökning och förlorad viktkontroll är en konsekvens av samverkande faktorer, och det är omöjligt att särskilja en primär kategori i denna urvalsgrupp. För begynnande viktuppgång, både hos respondenterna själva och gällande deras uppfattningar om andra individer, är kategorierna Fysisk aktivitet, Kosthållning och Tidsbrist, prioritering, vanor de dominerande. Förnekande är en betydande faktor för uppkomsten av fetma, och är bidragande för bristande viktkontroll men kan inte missförstås som lathet bland respondenterna i denna urvalsgrupp.

Underage drinking is common among Swedish adolescents and is related to problems for individuals, families, and society. From a public health perspective, it is of great importance that knowledge be gained about alcohol prevention. The overall aim of this thesis is, within the context of a national support program for NGOs, to study parents, a parental support program, and adolescents with regard to preventing underage drinking.  The Swedish National Board of Health and Welfare (NBHW) has a government commission to distribute funds to non-governmental organizations (NGOs) for alcohol and drug prevention efforts. Study I of the thesis describes and analyses this program with a special emphasis on research and development for an evidence-based practice. It is a research strategy case study with 135 projects and 14 embedded in-depth studies. The results reveal that this program to support NGOs has been successful in engaging a wide range of NGOs in prevention efforts. A trustful partnership between practitioners, national agencies, and researchers has also been developed, which has improved the quality and results of the different projects. Studies II, III, IV, and V all used data from a longitudinal questionnaire study with parents and adolescents within one of the 14 in-depth studies: the study of IOGT-NTO’s parental program Strong and Clear. Additional data, such as telephone interviews and other parental questionnaires, are also used.  Study II aims to analyse the significance of socio-demographic factors for parental attitudes and behaviour regarding adolescent alcohol consumption to see if any group of parents is especially important for intervention efforts. The results showed that fathers were more likely than mothers to have non-restrictive attitudes towards underage drinking and to have children who had drunk or tasted alcohol at home. Study III examines reasons for non-participation in the program. Parents with a low educational level were found more likely to be non-participants than highly educated parents. When parents stated their reasons for non-participation it emerged that they did not perceive a need for the intervention and that there were practical obstacles to their participation. Study IV is an effect study of Strong and Clear and showed that the program contributed to maintaining parents’ restrictive attitude toward underage drinking, postponing alcohol debut, and preventing drunkenness among the adolescents. Study V, only presented in the thesis, examined parents’ perceptions about Strong and Clear. Parents primarily thought it had led to their speaking more often about alcohol with their children, and had been a help in this conversation. Many also stated that the program had influenced their ability to set limits for their children. The school and IOGT-NTO were considered as suitable providers of Strong and Clear. This thesis showed that a national support program for NGOs including research and development contributes to a more evidence-based public health practice.

In low-income countries where maternal and child mortality remains high, there is limited use of context-specific evidence for decision making and prioritization of interventions in the planning process at the sub-national level, such as the district level. Knowledge on the utility of tools and interventions to promote use of district-specific evidence in the planning process is limited, yet it could contribute to the prioritization of high-impact interventions for women and children. This thesis aims to investigate, in the planning process, the use of district-specific evidence to identify gaps in service delivery in the district health system in Uganda in order to contribute to improving health services for women and children. Study I evaluated the use of the modified Tanahashi model to identify bottlenecks for service delivery of maternal and newborn interventions. Study II and III used qualitative methods to document the experiences of district managers in adopting tools to facilitate the utilization of district-specific evidence, and the barriers and enablers to the use of these tools in the planning process. Study IV used qualitative methods, and analysis of district annual health work plans and reports. District managers were able to adopt tools for the utilization of district-specific evidence in the planning process. Governance and leadership were a major influence on the use of district-specific evidence. Limited decision space and fiscal space, and limited financial resources, and inadequate routine health information systems were also barriers to the utilization of district-specific evidence. Use of district-specific evidence in the planning process is not an end in itself but part of a process to improve the prioritization of interventions for women and children. In order to prioritize high impact interventions at the district level, a multifaceted approach needs to be taken that not only focuses on use of evidence, but also focuses on broader health system aspects like governance and leadership, the decision and fiscal space available to the district managers, limited resources, and inadequate routine health information systems.

Bakgrunden till studien bygger på önskan om att barn och unga ska få en tobaksfri uppväxt. Tobak orsakar mycket ohälsa i världen och för att minimera den tobaksrelaterade ohälsan är det i ett folkhälsovetenskapligt intresse att arbeta med förebyggande insatser på flera plan. Då barnen är vår framtid så är det extra angeläget att ge dem verktyg för att göra hälsoval som bidrar till en hälsosam livsstil. Att välja bort tobak och att få växa upp i en tobaksfri miljö ger goda förutsättningar för att barn och unga får en ökad hälsa. Syftet med studien var att undersöka gymnasieelevers tobaksvanor samt inställning till policyn Tobaksfri skoltid och tobaksanvändning. Metod som användes för att samla in material var en enkätundersökning som innehöll både öppna och slutna frågor. I enkätundersökningen deltog 216 elever från en gymnasieskola i Skåne som tillhandahåller yrkesprogram. Resultaten gav en indikation på att elevernas tobaksvanor inte skiljer sig nämnvärt från andra studiers resultat. Resultaten visade även att eleverna var medvetna om att det fanns skilda regler för elever och skolpersonal vad gäller tobaksanvändning i relation till skolan. Eleverna efterfrågade tydlighet och regler från de vuxna och resultatet visade att eleverna påverkas av de vuxnas inställning, norm och agerande kring tobaksfrågor men även av hur regler implementeras och efterföljs. Slutsatsen vi kan dra av studien är att eleverna på gymnasiet vill att de vuxna sätter gränser och regler till förmån för deras hälsa. En ökad kunskap om elevernas tobaksvanor och inställning till tobaksfrågorna kan vara till hjälp i det tobakspreventiva arbetet på skolan. / The background to the study is based on the wish that children and adolescents get a tobacco-free growth. Tobacco causes a great deal of illness in the world, and to minimize tobacco-related illness, it is in the public interest to work on preventive action at several levels. As the children are our future, it is important to provide them with tools that contributes to a healthy lifestyle. To not choosing tobacco and growing up in a tobacco-free environment provides good conditions for our children and adolescents to get an increased health. The purpose of the study was to investigate high school student’s tobacco habits and the attitude to the Tobacco-free schoolday policy and the use of tobacco. Method used to collect material was a survey that contained both open and closed questions. In the survey attended 216 students from a senior high school in Skane who provided vocational programs. The results indicated that the students' tobacco habits do not differs from the results of other studies. They also showed that the students were aware of the separate rules for students and school staff. As well as the students, not only being influenced by the adults' attitude, norm and action on tobacco issues, but also how rules are implemented and followed. The conclusion we can draw from the study is that students in senior high school want the adults to set limits and rules in favor of their health. Increased knowledge about students' tobacco habits and attitude to tobacco issues can be helpful in tobacco-preventive work at school.