The aim of this thesis is to contribute to existing knowledge. If the knowledge is not useful in building society it has limited value. In order to be a tool for decision-makers, Preventive Home Visits (PHVs) are described and discussed according to a realist synthesis approach. The premise of this approach is that a single trial cannot tell the whole story and that understanding theoutcome pattern is much more important than seeking regularities in results across different trials. In order to understand the o utcome pattern, the PHV strategy in Nordmaling is examined against other trials and scientific work, and also in grey literature such as reports and workingpapers. An increasing population of seniors means that resources for health and elderly care are being scrutinised in order to achieve the best possible health for the money invested. PHVs represent one strategy that attempts to promote health among independent seniors. This thesis is a multidisciplinary study aiming to gain knowledge about the effects of PHVs and to understand the mechanisms of importance when implementing this particular strategy. The point of departure is a study conducted in Nordmaling in the north of Sweden among healthy seniors aged 75 years and over. The study, conducted as a controlled trial during 2000 and 2001, showed a decrease in mortality as well as the utilisation of care, and an improvement in indicators of perceived health. Cost analyses showed significant savings for the municipality following a reduction in the use of home help. These and other savings combined with costs of the intervention were related to saved life years and used to conduct health economic analyses. Medical and social records from the primary health centre and the municipality, along with official registers provided information for modelling health economic analyses from a lifetime perspective. Results showed that the costs of PHVs were less than 10 000 Euros per gained life year, against an acceptable level of cost effectiveness of 50 000 Euros. Using a shorter time perspective, the result was even more favourable for PHVs. It was evident that the time window used in the analyses, the normative choice of including future healthcare costs or not, and how to handle the value of the seniors’ production were important factors in determining the results. Two years after the trial, in-depth interviews were conducted with 5 seniors who had experienced PHVs, in order to gain understanding of the outcome of the PHV trial in Nordmaling. Participants were selected with respect to their health and how they responded to advice given during the PHV trial. Grounded Theory was used to analyse the interviews. Seniors who used autonomous coping strategies in everyday life gained less from PHVs than other seniors. All participants could benefit from PHVs, but in order for these to be successful it was important for the home visitor to be professional and to understand how the different coping strategies of seniors worked. Taken together, the different aspects of this study raised normative questions that are discussed in this thesis. One, whether the production of seniors has any monetary value in health economic analyses conducted from a societal perspective, was addressed in a smaller diary study where 23 seniors were asked to keep a diary in order to identify everything they did over a oneweek period. It was evident that most of the respondents “produced” a lot, however the production of seniors is rarely taken into account in health economic analyses. The concept of “senior production” includes both the market value of what seniors do, as well as the value of what society can avoid doing if the seniors are independent and healthy.

Background During the 1990s, Tanzania, like many other developing countries, adopted health sector reforms. The most common policy change under health sector reforms has been decentralisation, which involves the transfer of power and authority from the central levels to the local governments. However, while decentralisation of health care planning and priority-setting in Tanzania gained currency in the last decade, its performance has, so far, been less than satisfactory. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority-setting in district health management were studied through action research. As part of this overall project, this doctoral thesis aims to analyse the existing health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness approach to priority setting in Tanzania. Methods A qualitative case study in Mbarali district formed the basis of exploring the socio-political and institutional contexts within which health care decision-making takes place. The thesis also explores how the Accountability for Reasonableness intervention was shaped, enabled and constrained by the interaction between the contexts and mechanisms. Key informant interviews were conducted with the Council Health Management Team, local government officials, and other stakeholders, using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting processes in the district were observed. Main findings The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The findings showed that decentralisation, in whatever form, does not automatically provide space for community engagement. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. In addition, the thesis found that while the Accountability for Reasonableness approach to priority setting was perceived to be helpful in strengthening transparency, accountability, stakeholder engagement and fairness, integrating the innovation into the current district health system was challenging.   Conclusion This thesis underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions. A broader and more detailed analysis of health system elements, and socio-cultural context, can lead to better prediction of the effects of the innovation, pinpoint stakeholders’ concerns, and thereby illuminate areas requiring special attention in fostering sustainability. Additionally, the thesis stresses the need to recognise and deal with power asymmetries among various actors in priority-setting contexts.

Introduction The human immunodeficiency virus (HIV) epidemic has led to the upsurge of tuberculosis (TB) infection globally, but most especially in areas with high HIV prevalence. In the past, there was lack of a coordinated global and national response between TB and HIV programmes to curb the devastating impacts of both infections. However, the ProTEST Initiative piloted in sub-Saharan Africa in 1997 demonstrated that TB and HIV programmes could collaborate successfully in delivering joint services. This prompted the development of the WHO interim policy on collaborative TB/HIV activities in 2004, aimed at reducing the burden of TB and HIV in populations affected by both infections. This thesis explores how collaborative activities between TB and HIV programmes have been established in Cameroon and implemented in the Northwest Region. It also highlights the achievements and constraints in delivering joint services to TB patients co-infected with HIV. Methods The study was conducted in the Northwest Region, one of the 10 regions of Cameroon with the highest HIV prevalence. The study uses health system research combining qualitative and quantitative methods to explore the research objectives. Qualitative methods were used to capture the perspectives of: i) the service providers; key informants from the central, regional and district levels concerned with the collaboration process and in delivering HIV services to TB patients, and ii) TB patients regarding HIV testing as an entry point to HIV services. Quantitative methods were used to ascertain TB patients’ access to HIV services provided for by the collaboration. Results The study demonstrated that although there were varying levels of collaboration between TB and HIV programmes from the central to operational level in the health system, delivering joint services was feasible. Furthermore, despite the challenges TB patients faced in testing for HIV, overall implementing TB/HIV collaborative activities increased TB patients’ acceptability and accessibility to HIV services. These were facilitated by the improved collaboration at the operational level, and enhanced service provider-patient alliance which was instrumental in building patients’ trust in the health system. Collaboration also led to cross-training and teamwork between staffs from both programmes, and improved networking between service providers and other actors involved in TB and HIV care. Nevertheless, there were health system constraints including inadequate leadership and management, shortage of human and infrastructural resources, frequent interruptions in the supply of essential drugs and laboratory materials Conclusion TB/HIV collaborative activities have improved service delivery and TB patients’ access to HIV services. Nonetheless, appropriate stewardship which guarantees joint planning, monitoring and evaluation of essential activities, and accountability at all levels in the health system is invaluable. Besides, the identified health system constraints which could adversely influence effective joint service delivery and a sustainable collaboration deserve due appraisal. / Introduction L’épidémie du virus de l’immunodéficience humaine (VIH) a conduit à une augmentation globale  de la tuberculose(TB), particulièrement dans les régions à forte prévalence du VIH. Il y’avait par le passé un manque de coordination tant sur le plan mondial que national, des programmes de lutte contre la TB et le VIH pour freiner les effets dévastateurs liés à la co-infection des deux pathogènes. Cependant, l’initiative pilote “ProTEST”  conduite en 1997 en Afrique sub-saharienne  a démontré que les programmes de lutte contre le VIH et la TB pouvaient collaborer avec succès en combinant leurs services. Cette étude pilote a inévitablement incité a un changement de politique du bureau intérimaire a l’Organisation Mondiale de la Santé (OMS), de lutte contre le VIH/TB  à mettre sur pieds en 2004 des objectifs pour la réduction de l’impact du VIH/TB parmi les populations atteintes des deux infections. Cette thèse explore comment la collaboration entre les activités des programmes  de lutte VIH/TB a été établie au Cameroun, et comment son application se fait  dans la région du nord ouest. Il est également mis en exergue et les réalisations les difficultés que rencontrent les services combinés lors de la dispensation des soins aux malades de TB avec une coïnfection au VIH. Méthodes L’étude a été faite dans la région du nord ouest, une des 10 régions du Cameroun, avec le taux de prévalence au VIH le plus élevé. L’étude utilise le système de recherche en santé combinant des méthodes qualitatives et quantitatives pour explorer les objectifs de la recherche. Les méthodes qualitatives ont été utilisées pour enregistrer les données suivantes: i) centre offrant les services combinés; les personnes en charge au niveau central, régional, et des districts, qui sont responsables de l’intégration au processus et qui d’autre part veillent a ce que les malades de TB bénéficient des services du VIH ; et ii) les malades de TB qui considèrent le dépistage du VIH  comme porte d’entrée dans les services VIH. Des méthodes quantitatives ont été utilisées  pour confirmer  l’accès des malades de TB aux soins de services VIH offerts par la collaboration. Résultats L’étude a démontré que bien qu’il y ait  plusieurs niveaux de collaborations entre les programmes de VIH et TB depuis le sommet jusqu’ à la base du  système de santé, la provision de services combinés  est faisable. Malgré les difficultés rencontrées par les malades de TB pour avoir accès au dépistage du VIH, l’application en somme de la collaboration des activités entre les programmes de VIH et de TB a augmenté l’acceptation et l’accessibilité des malades de TB aux services de VIH. Ceci fut facilité par l’amélioration de la coopération au niveau des opérations des deux programmes permettant ainsi  la facilitation de l’établissement d’une alliance entre le personnel de soin et le patient, alliance qui fut primordiale dans l’élaboration du rapport de confiance que le malade doit avoir à l’endroit du system de santé. La collaboration a également conduit  à un travail d’équipe et une formation croisée entre les équipes des deux programmes, il a été également établi une amélioration du réseau d’échange entre les personnels de soins et toutes personnes actives dans le secteur du VIH et TB.    Néanmoins, il a été relevé des défis dans le système de santé telle une insuffisance dans le leadership et la gestion de fréquente interruption dans la chaine de distribution des médicaments essentiels et du matériel de laboratoire. Conclusion La collaboration des activités des programmes VIH/TB a amélioré la qualité des soins et services  avec pour résultante une meilleure accessibilité des malades de TB aux services de VIH. Néanmoins, une conduite appropriée qui garantie une planification mixte, une évaluation et un suivi des activités essentielles, ainsi qu’une gestion fiable a tous les niveaux du système de santé est indispensable. Outre, les difficultés liées au système de santé identifiées par cette étude et qui méritent une évaluation, du fait  qu’elles pourraient affecter négativement l’application effective du but recherché et la collaboration durable entre les deux services.

Background: All over the world men and women show different health patterns, and therecan be many and various reasons for these differences. This thesis therefore evaluates theimpact of gender equality on health. To do this, we must be able to measure gender equality.In this thesis, we develop two new measurements of gender equality and evaluate the relationshipbetween gender equality and health. Methods: Two cross-sectional studies, one register-based and one survey study, are used tocompare different measurements of gender equality and different measurements of health,and the relationship between them. Differences between men and women in relation to healthoutcome are also discussed in the thesis. The register study, comprising 1 097 202 individuals,is based on public registers and includes information on workplace, income, sickness absence,full-time/part-time work, level of education, parental leave and temporary parental leave.A gender equality measurement, the Organizational Gender Gap Index or OGGI, was constructedand 123 companies in two sectors were ranked using the index. Employees in 21 of the mostand least gender-equal companies were invited to participate in a survey. A second genderequality index was constructed based on respondents’ own reports regarding gender equalityin their partner relationship. The variables measured were income, full-time/part-time work,educational level, and responsibilities for and sharing of household duties and parental leave.Both indices were evaluated using the single question: How gender equal is your workplace/your relationship with your partner? The four measurements were dichotomized and testedfor a relationship to health. Health was measured by three different measurements: registerbasedsickness absence, self-reported sickness absence in the past year, and self-rated health. Results: The thesis has produced two new measurements of gender equality, described above.On gender equality in the partner relationship, we found a difference between men and women.Men perceive higher gender equality than they report, while women report more gender equalitythan they perceive. When it comes to gender equality at work, we found that employees perceivetheir company to be more gender equal than the OGGI index shows. This thesis confirms thefindings that men have better health than women regardless of measurement. However, inthis study we also found that increased gender equality decreases these differences. If employeesperceive their company to be gender equal, they have higher odds of rating their health asgood, and this is especially so for women. Conclusion: This thesis supports the hypothesis that differences in health between men andwomen can be related to a lack of gender equality. When men and women have differentpossibilities and power to shape society and their own lives, their health will be affected throughembodiment of both biological and sociological determinants in accordance with the eco-socialtheory. Increased gender equality will decrease the differences in health between men andwomen through convergence. The theory of convergence explains why men and women areaffected differently by greater gender equality. Greater gender equality will also decrease thesocial injustice between men and women and improve justice in accordance with the theoryof justice to gender.The differences found between the indices and the single question on perceived genderequality make clear the need for “hard facts” as an complement to people’s own views on gender equality.

Background: Child sexual abuse is a global public health and human rights concern. Despite beinga crime in most countries, and with well-known physical and mental health consequences, the majority of sexual offences are not reported. Child sexual abuse is a maltreatment form characterized by contact or non-contact acts perpetrated by adults or older children toward younger children who have little power to resist. This thesis aims to understand the social context of child sexualabuse, and the perceived roles of parents, community, and key professionals in handling such incidents in urban Tanzania. Methods: A combination of qualitative and quantitative research designs were applied to four sub-studies performed in Temeke district, Dar es Salaam. Qualititative content analysis was conducted on 23 in-depth interviews to describe the perceptions of key professionals and their experiencesof handling cases of child sexual abuse, in addition, eight in-depth interviews with parents to capture their experiences of legal reporting of child sexual abuse incidents. Grounded theory was used to analyse 13 focus group discussions held with male and female community members to explore norm systems and community awareness related to child sexual abuse. Findings from these exploratory sub-studies paved the way for a school survey among 1359 students from 23 randomly selected secondary schools. Using descriptive statistics and multivariate regression analyses, prevalence, risk factors, and health consequences of child sexual abuse were estimated. Results: Lack of working tools and financial support were perceived as major problems among the key professionals. Corruption at community and institutional levels was seen as jeopardizing justice. Community passivity and lack of knowledge about laws regulating sexual offences were identifiedas additional challenges for conducting fair investigations. The community perspective illustrated that children’s rights were challenged by lack of agency. Community awareness about child sexual abuse was clear but there was also a lack of trust in that the healthcare and legal systems were capable of handling such cases. Myths and cultural beliefs justified abuse. Disclosure of abuse was threatened by fear of stigma and discrimination. Parental interviews identified four types of sexual abuse incidents. The type most strongly associated with a determination to seek justice was one with an innocent child. The youth who was forced into sex elicited feelings of parental betrayal. The consenting, curious youth created uncertainty in how to proceed, while the transactional sex youth evoked feelings of parental powerlessness. Shame and stigma, but also fear of perpetrator retaliation and breach of confidentiality, were seen as challenges for disclosure. The school survey showed that 28% (boys=30%, girls=26%) of the students were exposed to child sexual abuse, with boys more often affected than girls. Twenty-six per cent of boys and 19% of girls reported being forced to look at pornography. Forced sexual intercourse was experienced by 9.8% of boys and 8.7% of girls. Abuse increased with age and diminished self-rated health. Perpetrators were most often neighbours, teachers and peers. In contrast, survivor confidants were most often teachers, family members and friends. Most survivors did not want any action taken for the abuse. Proportions of students who perceived having fair/poor health increased with severity of abuse comparing the none-abused (7.0% and 6.3% of boys and girls respectively) with the ever abused (26% and 41% of boys and girls respectively) and those reporting penetrative sex (35% and 53% of boys and girls respectively). Likewise, suicidal ideation and attempts increased with severity of abuse when compared with those not abused. Conclusions and recommendations: Sexual abuse of children poses a devastating social, and public health challenge. In Tanzania neither the community nor the health or legal institutions are adequately prepared to handle these cases. Educating the community, economically empowering women and strengthening the medico-legal system are needed to increase the opportunity for human,legal and fair investigations and reactions. A national child protection system is needed to address the complexities of abuse at different levels and to safeguard the rights of children in Tanzania.

Klagomål på damm och smuts i skolmiljöer är vanligt förekommande. Detta arbete syftar till attundersöka hur mycket deponerat damm som finns på olika ytor i skolsalar, hur en professionell städkonsulent bedömer städningen i relation till tekniska mätningar av deponerat damm, hur snabbten yta återsmutsas efter storstädning samt eventuella hälsoeffekter. Vid denna undersökning har vianvänt inomhusenkäten MM060 NA Sp1 för att fånga upp elevernas rapporterade symtom ochupplevelsen av städningen samtmätt deponerat dammmed gelfiltertjep (BM-Dustdetector). Mängden deponerat damm varierar kraftigt mellan olika skolor, sannolikt beroende på varierandepersonbelastning, lokalernas utformning samt städrutiner. Undersökningen ger visst stödför att mängden deponerat dammrelateras till upplevelsen av städkvaliteten men förhållandet bestäms ävenav många andra faktorer. Generellt uppmäts högre halter av deponerat damm på ytor som inte underhållsstädas. Storstädningen reducerar halten av deponerat damm påtagligt men återsmutsningsker snabbare där belastningen och nedsmutsningen är större. Det finns vissa samband mellan hur enprofessionell städkonsulent värderar städningen, främst golvstädningen, och uppmätta halter avdeponerat damm men sambanden är inte särskilt starka. Elever som besväras av ”damm och smuts” samt”instängd (dålig) luft” rapporterar signifikant fler symtom relaterat de icke besvärade. Exponeringför enbart besvärande damm och smuts medför en signifikant ökad frekvens av allmänsymtom, slemhinnesymtom, främst ögonbesvär, samt hudsymtom.Resultatet från denna studie pekar på att man trots alla påverkande faktorer ser en viss hälsoeffekt relativt till förekomst avdamm och smuts. Då cirka var fjärde skolelev bedöms ha någon typ av allergi är det väsentligt attskolmiljön är så ren som möjligt. Förhållandena kan sannolikt förbättras genom en ökad ochförbättrad städning / Complaints about dust in school environments are frequent. This work aims to investigate the amount of dust deposit on different horizontal surfaces in class rooms, how a professional cleaning consultant assesses cleaning in relation to measurements of dust deposit and how quickly a surfacebecomes filthy again after thorough cleaning and health effects. In this investigation we used the questionnaire MM060 NA Sp1 to estimate the students’ symptoms and experience of cleaning andmeasures deposit dust with BM-Dustdetector. The amount of dust deposit varies vastlybetweenschools probablydue to varying number of persons, the geometry of the rooms and cleaningroutines. The investigation supports the idea that the amount of dust deposit relates to the experience of the quality of cleaning but the relation is also dependent of manyother factors. Larger amounts of dust deposit are generally found on surfaces not normally cleaned. Thorough cleaning reduces considerably the dust deposit but it regrows quicklywith high loading of persons. There exist some relations between the association of the cleaning by a professional cleaning consultant, especiallycleaning of the floor, and measured amount of dust deposit but the relations are not very strong.Students complaining of “dust and dirt” and “stuffy, bad air” report significantly more symptoms than the reference group. Exposure to only “dust and dirt” gives more, general symptoms and more mucous membrane and skin symptoms. The results from this study indicate a health effect from “dust and dirt”. One out of four Swedish students have some form of allergies. It is thereforenecessary to have a clean school environment. Presumably good cleaning routines will improve the situation. / <p>ISBN 91-7997-112-1</p>

Lithuania has one of the highest suicide rates for men in the world (81.7 per 100,000 men). 21.7% of the population feels depressed. A salutogenic model of health developed by Antonovsky provides new knowledge for betterunderstanding of the behaviour of individuals and explains why some individuals fall ill under stress and why some do not. The study is focussed on the analysis of sense of coherence (SOC) on the population sample of Lithuania (n=3390) using a simplified way of measuring SOC developed by Lundberg and Nyström Peck at the Swedish Institute for Social Research of Stockholm University. The data of the study showed that people with low SOC (60.1%) predominate among the Lithuanian population. A strong correlation between low SOC, depression and stress was found. Additional studies, preferably longitudinal, are needed to identify possible relationshipsbetween cognitive processes (SOC) and biological mechanisms, causing adverse effects on mental health / <p>ISBN 91-7997-106-7</p>

Bakgrunn Depresjon og demens er blant de to hyppigst forekommende psykiatriske sykdommene blant eldre globalt sett. Depresjon opptrer ofte sammen med demens. Sykdomene er underdiagnostisert. Pårørende kan oppleve stor belastning av å være omsorgsperson. Hensikt Studiens hensikt er a) å undersøke om det finnes en sammenheng mellom depresjon hos hjemmeboende personer som utredes for demens og ulike demografiske variabler som kjønn, sivilstand, alder, kognitiv funksjon og hjelpetilbud før og etter demensutredning, og b) å undersøke om det finnes en sammenheng mellom depresjon hos personer med mistanke demens og pårørendes belastning som omsorgsgiver. Metode Studien baserer seg på informasjon fra klinisk praksis om pasienter utredet for demens av demensteam i 33 kommuner i Norge i løpet av ett år (n=474). Anonymisert informasjon om pasientene og pårørende ble innhentet. Kun pasienter hvor en depresjonsvurdering ble gjennomført i demensutredningen ble inkludert (n=165). Resultat Depresjonsvurdering gjøres i 34.8 % av demensutredningene, og 46.1 % av de undersøkte har symtomer på depresjon (n=74). Pasientene med depresjon skiller seg ikke fra pasientene uten depresjon med hensyn til kjønn, alder, sivilstatus og kognitiv funksjon. Det er ingen sammenheng mellom forekomst av depresjon og det hjelpetilbudet som ytes av det kommunale tjenesteapparat. Det er imidlertid en sammenheng mellom depresjon ved mistanke om demens og belastning hos pårørende (r=0.44). Det er 31.6 % av de deprimerte pasientene som har en alvorlig grad av depresjon og deres pårørende oppgir at de har lett/moderat til alvorlig grad av belastning (n=24). Konklusjon Halvparten av pasientene har symptomer på depresjon. Pasientene med sympomer på depresjon skiller seg ikke ut fra de øvrige pasientene uten depresjon. Det finnes en sammenheng mellom depresjon hos pasientene og belastning hos pårørende.Depresjonsvurdering bør vektlegges mer av de som driver demensutredning i kommunene. / Background Depression and dementia are two of the most prevalent mental disorders among elderly individuals worldwide. Depression and dementia may occur simultaneously, and the disorders are often underdiagnosed. Relatives may experience great stress as caregivers. Aim This study aimed to a) examine whether depression in home-dwelling elderly assessed for dementia is associated with variables such as gender, marital status, age, cognitive function and need for assistance before and after a dementia assessment, and b) to examine if there is a association between depression in elderly undergoing dementia assessment and burden of their caregivers. Method The study is based on information about the patients treated in clinical practice for dementia assessment in 33 municipalities in Norway over the course of one year (n=474). Anonymised information was obtained from patients and their caregivers. The study included only patients who were assessed for depression as part of the dementia assessment (n=165). Results Depression assessments are conducted in 34.8 % of all dementia assessments, and 46.1 % of these patients have symptoms of depression (n=74). Patients with depression do not differ from patients without depression regarding gender, age, marital status and cognitive function.  Services from the community healthcare system do not differ, regardless of whether the patient has signs of depression. Depression is associated with caregiver burden (r = 0.44). In 31.6% of cases the patients had a severe degree of depression and their relatives reported a burden of care that ranged from easy/moderate to severe (n=24). Conclusion Half of the patients who participated in this study had symptoms of depression. Patients with depression do not differ from patients without depression. Depression is associated with caregiver burden. Dementia assessments in municipalities should place greater emphasis on assessments of depression. / <p>ISBN 978-91-86739-23-2</p>

Bakgrunn: Demens er en sykdom som vil berøre mange av oss i løpet av livet. Det er naturlig at vår reaksjon på en sykdom vil preges av den kunnskapen vi har om sykdommen fra tidligere. Mange vil oppsøke mer kunnskap om den aktuelle sykdommen og massemedia er da en av de kildene som benyttes for innhenting av informasjon. I Norden er avisene et av de viktige mediene som skaper og sprer kunnskap som sendes ut til allmennheten.   Hensikten med studien er å få dypere kunnskap om hvordan personer med demens fremstilles i de norske avisene.   Metode: Modifisert grounded theory har blitt benyttet til å analysere norske avisartikler fra 2010.    Resultat: Personer med demens fremstiller i avisene som en homogen gruppe.   Konklusjon: Fremstillingen i avisene bidrar til at personer med demens fremstår som stereotype og stigma relatert til demens kan opprettholdes. Personer med demens bør i større grad bli presentert med sine individuelle forskjeller og i ulike faser av demenssykdommen om man skal oppnå et mer demensvennlig samfunn. / Background: Dementia is a disease that will affect many of us during our lives. Our knowledge about a disease often reflects our response to it. Mass media is one resource that many people will use as they seek more information about dementia. In Nordic countries, newspapers are among the important mass media resources that create and spread information to the population.     Aim: This study aimed to gain deeper knowledge about how Norwegian newspapers present people with dementia.   Method: Modified grounded theory was used to analyze Norwegian newspaper articles published during 2010.   Results: Norwegian newspapers present people with dementia as a homogeneous group.   Conclusion: Articles in Norwegian newspapers label people with dementia as stereotypes, thus sustaining the stigma already related to this group. There is a need for a broader presentation of people with dementia, one that describes individual differences and the different phases of the disease to achieve a more dementia-friendly society. / <p>ISBN 978-91-86739-22-5</p>

Formål: Denne studien ville undersøke tannhelseeffekt ved et intervensjonsprogram for forebygging av karies på klinikknivå.   Metode: Et ex post-facto quasi-eksperimentell design ble anvendt til kvantitativ analyse av data fra journal programmet i Tannhelsetjenesten i Vest-Agder fylke, Norge. Effekten av et beskrevet intervensjonsprogram for forebygging av karies ble analysert ved sammenlikning mellom tre klinikker, og delvis med fylkesgjennomsittet for Vest-Agder. De sosioøkonomiske forhold i klinikkenes tilhørende bydeler ble beskrevet med indekser ut fra gitte kriterier. Kalibreringsøvelser med røntgenbetrakting på behandlernivå ble utført post hoc for å få en formening om mulige målefeil og presisjon i det statistiske materialet.   Resultat: Planmessig, nytenkende og godt folkehelsearbeid i undersøkelsesperioden 2004– 2008 med tidlig intervensjon på småbarn og praktisk opplæring i effektiv tannpuss, gav betydelig tannhelsegevinst for 5- åringene. Resultatene var mindre entydige for 12- og 18-åringene. Klinikken med det forebyggende intervensjonsprogrammet var beliggende i et område med bra sosioøkonomisk indeks, hvilket kan forkludre resultatene. Forskjell i diagosenivå mellom klinikerne, viser hvordan helseresultater kan bli påvirket av behandlervariasjon. Ulik diagnose- og behandlernivå blant klinikerne slik det kommer fram i studien, ser ut for å være en vedvarende utfordring for tannhelsetjenesten.    Konklusjon: Studien understreker betydningen av intensiv og målrettet forebyggende intervensjon fra tidlig alder, og at forebyggende arbeid og tannhelseresultat må ses i et langtidsperspektiv. Ulike sosioøkonomiske forhold i et undersøkt område, reduserte mulighetene for å konkludere om helseresultater i denne quasi-eksperimentelle studien. / Purpose: This study aimed to evaluate oral health results at the clinical level of an intervention program for the prevention of dental caries.   Method: An ex post facto quasi-experimental design was used for quantitative analysis of data using digital records in the Public Dental Health Service of County Vest-Agder, Norway. The effect of a described intervention program for prevention of caries was analyzed by comparing oral health data from the intervention clinic with two other clinics and also with the county average. The socioeconomic conditions in the neighbourhoods served by the clinics were described with indexes containing known criteria. The test of the treatment criteria of salaried dentists was based on post hoc x-rays to estimate the size of measurement error and precise statistical material.   Result: Systematic, innovative, and good public health practices conducted during the 2004–2008 study period provided early intervention treatment for toddlers and trained effective tooth-brushing skills, beneficially affected oral health results among 5-year-old children. However, the results were less clear among 12- and 18- years-old children. The clinic with the best oral health results was located in the best socioeconomic area in the study, possibly confounding the results. An unsatisfactory agreement of the diagnostic level between the clinicians showed that practice variations might influence health effects. Differing diagnostic and treatment levels among clinicians shown in the study, poses an ongoing challenge for dental service.   Conclusion: This study emphasizes the importance of initiating and maintaining intensive and targeted preventive dental activities in early childhood, and shows that preventive dental treatment and oral health results require a long-time perspective. Varying socioeconomic conditions in the trial area reduced the possibility of concluding health results in this quasi-experimental study. / <p>ISBN 978-91-86739-20-1</p>