Background. There are a number of studies showing that general practice is oneof the most stressful workplaces for health care workers. Since the Baltic States regained independence in 1990, a reform of the health care systems took place in which a new role and more responsibilities were allocated to general practitioners. This study aimed to explore the psychosocial stress level among Lithuanian general practitioners (GPs) and examine the relationship between their psychosocial stress and work characteristics. Methods. A cross-sectional study was madeof 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analyses included descriptive statistics, interrelationship analysis between the different characteristics, and multivariate logistic regression to estimate odd ratios for each of the independent variables in the model. Results. The study shows that 48% of the respondents could be classified as suffering from work related psychosocial stress by the Reeder scale. The highest job strain prevalence was among widowed, single and female GPs. The lowest job strain prevalence was among males and GPs of older age. Job strain occurs when job demands are high and jobdecision latitude is low. Conclusions. The greatest risk tophysical and mental health from stress occurs to general practitioners facing high psychological workload demands combined with low decision latitude in meeting those demands. High job demands, patient load more than 18 patients per day and young age of general practitioners can predict a statistically significant effect on job strain. / <p>ISBN 91-7997-095-8</p>

Introduction: As jobdemands in the healthcare system increases, one of the main protective factors involves support within the work environment. Limited knowledge exists about the work environment of nurse assistants and their well-being at work. A relatively small number of studies on this topic in the Nordic countries, and their results indicate high job demands and risk for negative health outcomes. Purpose:This study aimed to investigate nurse assistants’ perception of job demands, the servant leadership of their next superior, job satisfaction, symptoms of emotional exhaustion, and physical well-being at work. It was also investigated whether perception of servant leadership of their next superior related to job satisfaction and symptoms of emotional exhaustion. Methods: Questionnaires sent to all nurse assistants with registered email addresses at the Icelandic Nurse Assistants Association yielded 588 participants (49% response rate). A new Dutch inventory on servant leadership (SLI) was used to measure perception of servant leadership in nursing; additional questions explored work environment, demands, control and support at work, symptoms of burnout, and job satisfaction. To answer the research questions, a cross-sectional descriptive designwas used Results: The majority of participants experienced high job demands and reported on control and support at work. Despite high levels of burnout, the majority of nurse assistants were satisfied at work. Servant leadership was practiced some what within nurse assistant’s workplaces. The correlation between perception of servant leadership, job satisfaction, and emotional exhaustion was significant for all SLI sub-factors except courage, and the strongest correlation was for empowerment, humility, and stewardship as sub-factors of servant leadership. Conclusion: This study highlights supportive factors within the work environment, particularly regarding the leadership-empowering role of servant leadership in nursing. Results showhow thissupportis related to nurse assistants ́ well-being at work andsuggeststhat servant leadership can support health promotion within the work environment of nurse assistants. These findings are valuable for nurse assistants, nurse managersand leadershipin the health care system, thus contributingto public health / <p>ISBN 978-91-86739-28-7</p>

The aim of this thesis was to investigate socio-economic status in relation to morbidity and mortality, in particular cardiovascular disease among women using data from two population based studies from Sweden. The secondary aim was to explore mechanisms potentially linking socio-economic status to health, assessing for example dental, dietary, and lifestyle factors. Samples: The Population Study of Women in Gothenburg Sweden was begun in 1968-69. A representative random sample of 1,622 women was selected according to date of birth and within the strata 38, 46, 50, 54, and 60 years of age; the participation rate was 90 percent. The Gerontological and Geriatric Population Studies in Gothenburg (H-70) are based on representative samples of 70-year olds from Göteborg, Sweden who participated in a series of cross sectional and longitudinal studies between1971 and 2000. Participation rates ranged from 86 percent for men and 83 percent for women in the 1901/2 birth cohort to 65 percent for men and 69 percent for women in the 1930 birth cohort. Main results: High socio-economic status was associated with a decreased risk for cardiovascular disease [RR 0.49; CI 0.24 – 0.99] in middle aged women independently of risk factors such as smoking and obesity;moreover opposing monotonic trends were seen for mortality from cancer and cardiovascular disease in relation to socio-economic status. Tooth loss, a proxy for cumulative lifetime oral infection was also associated with an increased risk for cardiovascular disease in women independently of socio-economic factors such as the husband’s occupational category, income, and educational level. Among 70-year old cohorts, later-born women were heavier and had higher body mass index than earlier-born women within the high education group only. However, secular increases in waist-hip ratio were seen in both educational groups. Compared to earlier-born cohorts of 70-year old men, later-born cohorts had higher body mass index and cholesterol levels across social strata, and heart disease and diabetes mellitus became more prevalent. Among the elderly, secular trends indicated greater improvements in cardiovascular risk factors among women than men, with exception to smoking and alcohol consumption. Diet quality and food selection were assessed in relation to socio-economic status in the youngest cohort of 70-year olds born in 1930. Socio-economic disparities in diet quality were detected in men but not in women. Conclusions: From a public health perspective, it is suggested that risk factor patterns should be investigated in association with socio-economic status in order to expose health inequalities, and to develop more equitable interventions for cardiovascular disease prevention.

Syfte. Avhandlingen syftar till att bidra med ökad kunskap om faktorer som kan antas påverka patientsäkerheten dels på system-, dels på individnivå. Metod.Det nationella rapporteringssystemet Lex Maria analyserades före och efter Socialstyrelsens regionalisering av tillsynsorganisationen 1990/91. I en av de två studierna analyserades särskilt ärenden som överförts till HSAN för prövning av disciplinär påföljd. I tre empiriska studier analyserades kompletterande metoder till rapportering för att få information om risker i hälso- och sjukvården. Personal har intervjuats om deras uppfattning av potentiella risker som skulle kunna hota patienternas säkerhet. Vårdbiträdens och undersköterskors kunskaper om diabetes undersöktes i en enkätstudie. Eventuella samband mellan vårdbiträdens och undersköterskors kunskapsnivå och medicinskt ansvariga sjuksköterskors uppfattning om säkerhetsrelaterade frågor undersöktes i en uppföljande enkätstudie. I en kvalitativ studie undersöktes flygets metoder för säkerhetsrelaterat arbete vilket jämfördes med motsvarande arbete inom hälso- och sjukvården. Resultat.Lex Maria-rapporteringen ökade efter regionaliseringen av tillsyns-verksamheten och en minskad andel ärenden överfördes till HSAN för disciplinär prövning. De kompletterande metoder för att identifiera risker som undersökts visade sig vara värdefulla tillägg till traditionell rapportering. Intervjuerna inom barnsjukvården uppvisade en annan riskbild än den som fås genom rapporteringssystemet Lex Maria. Enkäten till vårdbiträden och undersköterskor visade ett tydligt samband mellan bristande kunskap om diabetes och en ökad risk att vidta en riskfylld åtgärd. Studien indikerade brister på systemnivå, vilket bekräftades av resultaten från enkätstudien till medicinskt ansvariga sjuksköterskor i motsvarande kommuner. Studien visade på behovet av ökad uppmärksamhet på hur sjukvårdens stödsystem påverkar yrkesutövarna i frontlinjen. Jämförelsen mellan flyget och hälso- och sjukvården visade att flyget hade ett mera proaktivt och bredare förhållningssätt till säkerhet än vad hälso- och sjukvården uppvisade. Slutsatser. Studien har visat att yrkesutövare som befinner sig i frontlinjen och möter den enskilde vårdtagaren är särskilt sårbara när hälso- och sjukvårdens stödsystem uppvisar brister. Förebyggande säkerhetsanalyser som komplement till rapportering visade sig ge värdefull information för det förebyggande säkerhetsarbetet. En sammanhållen strategi baserad på aktuell säkerhetsforskning kan bidra till att utveckla hälso- och sjukvårdens säkerhetsarbete. Nyckelord: Patientsäkerhet, rapportering, prevention, händelseanalys, säkerhetsanalys, Lex Maria, ansvarsärenden, disciplinära åtgärder

Since the early 1990s, the Estonian health sector has been undergoing a number of reforms. At the same time, a number of legislative acts have also been established, forming a new legal basis for the health system. The introduction of a social health insurance in 1992 was the first reform in the Estonian health sector reorganisation, followed by a primary health care (PHC) reform, a hospital reform and a number of public health reforms. The aim of this thesis is to analyse these health sector reforms in Estonia, focusing on the outcomes of the health system from the population’s perspective. Proceeding from this general aim, the specific objectives of the thesis are as follows: 1) To analyse the PHC reform in terms of the access to the health services and the acceptability and satisfaction with these services. 2) To analyse the health insurance reform in terms of the acceptability and satisfaction with the new system. 3) To analyse the public health reforms and their impact on the health of the population. The empirical data were gathered with the following research methods: reviews of official health statistics and population surveys in 1998, 2002 and 2005 based on face-to-face interviews using structured questionnaires. The main results can be summarised in relation to the objectives of the thesis: 1) The primary health care reform has been implemented and most of the objectives have been achieved. In general, people accept the changes in the PHC system and the satisfaction with the family doctors has increased. Access to the PHC services is good. Based on the results of a population study in 2002 and 2005, more than half of the respondents could see the family doctor on the same day they made an appointment. Almost a half of the respondents (49%) were satisfied with the access to the health services. Satisfaction with the PHC services and family doctors were found to have positive effects on satisfaction with access to health services. Although people with chronic conditions were less satisfied with the access to the health services they did not experience organisational barriers in their access to such services. 2) The health insurance reform has been implemented and a high level of financial protection has been maintained. The solidarity principle of the health insurance system guarantees access to health services for all the insured people. About half of the population is satisfied with the present system. Compared to 2002, the percentage of satisfied people has increased in 2005, while the percentage of very dissatisfied persons has decreased. The most important predictor of satisfaction with the health insurance was the satisfaction with the existing PHC system. The satisfaction with the health insurance was higher in 2002 as well as 2005 among those respondents who had visited a family doctor or a specialist or were admitted in a hospital during the last 12 months before the survey, but lower among those who had visited a dentist. A small majority preferred the solidarity principles and comprehensive financing of health service by health insurance. The attitudes regarding financing principles were related to the personal contacts with the health services. The respondents who had used the PHC or ambulance services preferred a more comprehensive financing of health services, while those who had had contacts with a specialists or dentists would prefer less comprehensive financing if the waiting lists were short. More than three quarters of the respondents were informed about their rights concerning the access to the health services. Personal contacts with family doctors and specialists had positive impact on the level of awareness. 3) Some progress has been made in connection with the public health reforms. A number of national programs and projects to prevent the most essential health risks have been initiated. As a result, there is some evidence of a positive impact on the health of the population – positive trends in dietary habits and decreasing infant mortality, number of abortions, and incidences of sexually transmitted infections and tuberculosis. At the same time, however, the proportion of smokers and consumers of strong alcohol has not decreased. Moreover, there has been an explosive increase of new cases of HIV-infections in 2000, which is one of the most serious public health problems today. Greater progress has been achieved in the areas where health promotion and health education activities have been supported by political decisions to make a healthy choice for the population easier. However, a comprehensive national health policy and strategy is still lacking in Estonia. In public health, this is evidenced by a lack of long-term planning and understanding of the significance of intersectoral co-operation. Discussion. Up to now, the major reforms in the Estonian health system have been implemented. However, the environment is changing and the health system has to respond to these changes. The next step should therefore be to reach a public agreement about the common values of the health system and setting long-term health policy goals. To improve the effectiveness of policy implementation and reform, the importance of systematic research and evaluation should also be stressed.

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Sammanfattning Syftet med studien är att undersöka vilka motivationsfaktorer som finns bland kvinnor som endast styrketränar på gemensam del och bland kvinnor som styrketränar på tjejdel på gym i Stockholm samt om det skiljer sig åt mellan grupperna. Vad motiveras kvinnor av som styrketränar på gymanläggningar? Vad motiveras kvinnor av som endast styrketränar på den gemensamma delen på gymanläggningar? Vad motiveras kvinnor av som styrketränar på tjejdel på gymanläggningar? Finns det någon/några skillnader i motivationsfaktorer bland kvinnor som endast styrketränar på gemensam del och kvinnor som styrketränar på tjejdel på gymanläggning? Metod En kvantitativ studiedesign valdes för att besvara studiens syfte och frågeställningar. Urvalsmetoden som användes i denna studie var bekvämlighetsurval som syftar till att respondenterna ska vara lättillgängliga. Utdelningen av enkäterna skedde på två olika gymanläggningar i Stockholms innerstad vid två olika tidpunkter, en tidig morgon och en sen eftermiddag. Enkäten som användes i studien var den validerade enkäten Exercise Motivations Inventory (EMI-2). Enkäten sammanställdes genom att addera siffrorna från varje påstående i 14 underkategorier som därefter kunde delas in i fem nya överkategorier. Testerna som användes för att besvara studiens frågeställningar var Friedman-, Wilcoxon- och Mann-Whitneytest. Resultat Gruppen som endast styrketränade på den gemensamma delen och gruppen som styrketränade på tjejdelen, det vill säga kvinnor i Stockholm, motiverades mest av Fitnessmotiv och minst av Personliga motiv. Ingen skillnad kunde ses mellan vad som motiverar kvinnor till att styrketräna, oberoende av vilken del kvinnor använder på gymanläggningarna i Stockholm. Slutsats Motivation var inte en anledning till att kvinnor valde att styrketräna på tjejdelen på gymanläggning. Anledningen till att kvinnor valde att styrketräna på tjejdelen på gymanläggningar är fortfarande obesvarat.

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