Background: Insufficient physical activity is a public health problem. Nordic healthcare professionals use physical activity on prescription (PaP) to increase physical activity. Purpose: This study aimed to evaluate the effectiveness of PaP that includes organized exercise. Method: Prospective data was obtained from four Swedish counties during fall 2009 and spring 2010. The study population comprised 98 patients whose healthcare professional prescribed PaP to prevent or treat disease. Questionnaires administered at baseline, three and six months after initiating PaP evaluated self-reported physical activity levels, adherence, factors influencing adherence, and experience of PaP. Results: Although the majority of patients receiving PaP including organized exercise are middle-age women, there are a wide distribution regarding e.g., age, socioeconomic status and reason of receiving PaP. Most participants received initial support from healthcare providers and activity organizers, and most were satisfied with the support they got. Approximately 70% participated in several activities at all measuring points. Although PaP including organized exercise increased activity levels only marginally, sedentary behavior decreased significantly. Six months after initiating PaP including organized exercise, 68% adhered to the prescribed physical activity level. Most participants deemed PaP including organized exercise a good method for becoming physically active. However, there is a need for regularly and longer support. Importantly, individualized instruction, adjusted exercise regimens, and support from other participants provide positive reinforcement. On the other hand, PaP with organized exercise imposes additional costs and decreases flexibility including both time commitment and scheduling constraints. Conclusion: Adherence levels to PaP with organized exercise are similar to those achieved by other chronic disease treatments. PaP including organized exercise can decrease sedentary behavior, an important factor in promoting public health in the Nordic countries. / <p>ISBN 978-91-86739-16-4</p>

The study was user survey method based, performed to get the overview of use and perceptions of health caremanagers towards Lithuanian computerized health information system as a tool for decision – making. Aims of the study were to describe LCHIS, its inputs and potential use; to account for a surveyofpotential users, health care administrators; to discuss the need for improvement of the system and itsuse. Methods. User survey method was applied. Literature search was performed and the questionnaire was constructed after interview with four respondents and clarification of questions. Totally 100 ofrespondents from different health care institutions were interviewed. Data was analysed using normal statistical methods, using MS Excel 2000 and statistical package SPSS 10.0 as tools. Main results. Concerning the awareness about the existing of LCHIS, 68% of the respondents saidtheyhave heard about it and 15% said theyhave been using this system daily. As many as 68% of respondents didn’t really take care about the existence of LCHIS, while the size of respondents being satisfied and not was pretty the same. The number of satisfied with the structure was rather small ifcomparing with those partially satisfied. As many as 76% of the respondents said they haven’t been using the system at all. 24% of the respondents were satisfied with the certain groups of healthindicators within the system. Group of morbidity indicators and group of hospital activity indicatorswere among the mostly used (17% together). Almost 20% of the respondents said it was easy for them to use LCHIS; the same number of health care administrators trusted the information comingfrom LCHISand they have experienced the situation, where they have used LCHIS for planning ormanagement in current situation. As many as 82% of health care managers agreed heads or administrative staff of hospitals supposed to be the key members, who must encourage them to use the system. Conclusions. About two thirds of health care administrators interviewed knew about LCHIS and the rest had been or were users. In the comments this group claimed they were supporting their decisions by using the systemand indicators in it. As many as 96% of the respondents stated there was a needfor statistical information and skills for dailydecision - making and managerial activities. The respondents, who used LCHIS, trusted the information in the system and found it useful in their dailywork as health managers. The main comments, why respondents didn’t use the system or didn’tknow about it, was lack of information technologies in work place, lack of computer skills and lackof support from hospital authorities / <p>ISBN 91-7997-097-4</p>

Objectives – To ascertain the annual number of users who were discharged home after visits to the emergency department, grouped by age, gender and number of visits during the calendar year, and to assess whether an increasing number of visits to the department predicted a higher mortality. Methods – This is a retrospective cohort study, at the emergency department of Landspitali University Hospital, Reykjavik capital city area, Iceland. During the years of 1995 to 2001 19259 users visited the emergency department, and were discharged home and they were follow-up for cause specific mortality through a national registry. Standardised mortality ratio, with expected number based on national mortality rates was calculated and hazard ratios according to number of visits per calendar year using time dependent multivariate regression analysis were computed. Results – The annual increase of visits to the emergency department among the patients discharged home was seven to 14 per cent per age group during the period 1995 to 2001, with a highest increase among older men. The most common discharge diagnosis was the category Symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified. When emergency department users were compared with the general population, the standardised mortality ratio was 1.81 for men and 1.93 for women. Among those attending the emergency department two times, and three or more times in a calendar year, the mortality rate was higher than among those coming only once in a year. The causes of death which led to the highest mortality among frequent users of the emergency department were neoplasm, ischemic heart diseases, and the category external causes, particularly drug intoxication, suicides and probable suicides. Conclusions – The mortality of users of the emergency department who had been discharged home turned out to be higher than that of the general population. Frequent users of the emergency department had a higher mortality than those visiting the department no more than once in a year. Since the emergency department serves general medicine and surgery patients, not injuries, the high mortality due to drug intoxication, suicide and probable suicide is notable. Further studies are needed into the diagnosis at discharge of those frequently using emergency departments, in an attempt to understand and possibly prevent this mortality / <p>ISBN 91-7997-128-8</p>

Baggrunden er de mange forebyggelige indlæggelser, der kan mindskes ved tidlig opsporing og intervention i primær sektor Formål:Atafprøve udvalgte værktøjer i et design, som vil udgøre en effektiv metode til at lave tidlig opsporing af udsatte borgere i primær sektor, der viser tegn på begyndende sygdom som kan forebygges. Dernæstatudvikle og testeet IT-system til attriagere og risikovurderedisse borgere, samt et nyt spørgeskemaredskab til at vurdere forandringenaf den sundhedsfagligepraksis. Metode: Mikset metodologi anvendesfor atbesvare forskningsspørgsmåleneog formålet. Først testesi klinisk praksiset nyt sæt af metoder til tidligopsporing med efterfølgende triage og risiko-scoring af borgerne og dernæst afprøves en nyudviklet IT-platformhertil.Metoderne som afprøves er: Ændrings-skemaet med triage og TOBS (Tidlig Opsporingaf Begyndende Sygdom). Endeligpilottestes et nyt spørge-skema til at undersøge forandringen i den sundhedsfaglige praksis. Hovedresultater: Det er lykkedes at afprøve Ændringsskemaet med triage i trepleje-grupper (n=105)–således at alle borgeres habitualtilstand registreres og triageres. Alle borgere var ved testperiodens slutning monitoreret påoversigtstavler i plejegrupperne. Man havde fundet de kategorier som havde mindrefunktionstab og sygdomstegn(12,4%)og dem som var i risiko for forværring eller indlæggelse(8,6%). Der var iværksat opfølgende handling og forebyggende indsatser i forholdtil disse borgere.TOBS måling af vitale værdier (Puls, vejrtrækningsfrekvens, temperatur, bevidsthedsniveau og systolisk blodtryk) er introduceret og afprøvet på udvalgte risiko patienter –men der var ikke tilstrækkelig systematisk registrering af den analoge deli alle testgrupperne endnu. Testentyder dog på, at det godt kan kombineres med Ændrings-skemaet til at få systematiserede målinger af vitale værdier og opfølgning på deudsatte borgere.Der er udviklet en tilpasset IT-platform med Ændringskemaet, triage og TOBS til at få plejepersonalet til at lave tidlig opsporing af borgere med begyndende sygdomstegn. Endelig er der lavet et spørgeskema, der kan bruges til at undersøge oplevelsen af forandringer i den sundhedsfaglige praksis i forbindelse med indsatsen for tidlig opsporing og det er pilottestet i to plejegrupper (n=45). Der er ikke fundet tegn på systematisk bortfald på enkelte items, men der var for stort generelt bortfald i den sidste testgruppe til at opnå en fuld repræsentativitet i forhold til deres besvarelser. Konklusion: Tidlig opsporing i primær sektor, kræver enklemetoder tilpasset praksis ogfaggrupperne. Der er testet og fundet et virksomtmetodisk designtil tidlig opsporing i primær sektor, et tilpasset IT-redskabtil at understøtte udførelsen afÆndringsskemaet med triage og TOBS måling af borgere i risikozonen. Endvidere erpilottestet etnytspørgeskematil at undersøge forandringen af den sundhedsfaglige praksis, som den opleves af de involverede fagpersoner / Background.New methods and interventions in the primary sector can increase early disease detection and avoid unnecessary hospitalization. Aim:This study aimed to test a powerful set of early detection methods for vulnerable citizens who exhibit signs of incipient disease or preventable deterioration, including (i) an IT system customized to perform triage, (ii) Timely Observation of Beginning Sickness (TOBS) to measure at-risk citizens, and (iii) a questionaire that assesses change in healthcare practice. Methods. The mixed methods in this study included clinical testing, a triaged changing table, TOBS, risk scoring, and a new IT platform. We also pilot-tested a new questionnaire to investigate change in the healthcare practice. Main Results: After testing the triaged changing table in three healthcare groups (n=105), we registered citizens according to risk. Information boards allowed care groups to identify patients who experienced less loss of function and fewer signs of disease (12.4%); others experienced several major changes and were at risk of deterioration or hospitalization (8.6%). We initiated follow up and preventive measures to care for these citizens. TOBS included measurement of vital signs (i.e., heart and breathing rate, temperature, level of consciousness and systolic blood pressure) in selected risk patients, providing systematic risk scoring and suggestions for actions. Finally, we developed and pilot-tested (in two care groups, n = 45) a simple questionnaire that can prospectively examine change in healthcare practices. There are no signs of systematic errors on single items but in the last test group there was too large a general lapse of answers to achieve a full representation in relation to their responses. Conclusion: Early detection of preventable diseases in the primary sector requires methods that are adapted to the clinical setting and professional groups. Our results suggest that combining TOBS with the changing table may enable systematic measurement in vulnerable citizens detected and a quick follow up with preventive measures to care for these citizens. A well-customized IT platform will help healthcare providers detect early signs of disease. Using data entered during patient visits, the system can perform an online triage, create summaries of categorized citizens, and provide reminders of important follow up / <p>ISBN 978-91-86739-80-5</p>

Bakgrunn: ”Demens i familien” er en intervensjonsstudie hvor psykoedukativ metode ble benyttet for å redusere stress hos pårørende, og for å redusere psykiatriske tilleggssymptomer hos personer med demens. Studien pågikk i Norge fra 2001-2004. Denne MPH- oppgaven er en delstudie av”Demens i familien”. Mål: Undersøke om pårørende opplevde at de hadde hatt nytte av den psykoedukative intervensjonen, og om effekten ble opprettholdt over tid, dette ble målt med et evalueringsskjema. Delmål var å beskrive pårørendes vurdering av eget stress, egen byrde og egen opplevelse av helse, samt sammenligne om det forelå noen forskjell mellom de som hadde fått en kortvarig intervensjon og en kontrollgruppe som hadde fått vanlig behandling. Metode: Evalueringsskjema med 8 spørsmål og en rubrikk for kommentarer var utarbeidet. Skjemaet ble fylt ut av pårørende etter intervensjonen og 7,5 måneder senere (n=45). Spørreskjemaer sommåler stress (RSS), byrde (NPI- byrde) og opplevelse av egen helse (GHQ-30), ble målt hos pårørende, ved baseline, etter intervensjonen og 7,5 måneder senere. Andre fra intervensjonsgruppen (n=47) og kontrollgruppen (n=86), skåret på de samme spørreskjemaene. Grad av demens (MMS), varighet av sykdom, pårørendes alder og kjønn forelå på alle. Resultater: Skårene fra spørreskjemaene RSS, NPI- byrde og GHQ-30 viste ingen signifikant forskjell etter intervensjonen i gruppene eller mellom gruppene. Forskjeller i varighet av sykdommen, pårørendes kjønn og alder var små. Alle opplevde nytte av intervensjonen også over tid. I den åpne rubrikken var det kommentarer fra 36 personer. Konklusjon: Spørreskjemaene viste at pårørende var stresset, belastet og at dette gikk ut overhelsen. Psykoedukative intervensjonsgrupper var nyttige, og pårørende ønsket differensierte grupper med oppfølgingsmøter og egne grupper for personer med demens / Background:”Dementia in the family” is an intervention study where psycho-educative method has been applied aiming to reduce stress for the relatives and reduce psychiatric behavioural symptoms to persons with dementia, carried out in Norway between 2001-2004. The evaluation described below is part is part of “Dementia in the family”study. Aim: Investigate the relative’s perception of the usefulness of the intervention, and if the effect remained. This was assessed with an evaluation questionnaire. An additional aim was to see how relatives assessed their own stress, burden and general health, and if there were any difference between those who received a short intervention and the control group, which received treatment as usual. Method: Aquestionnaire with 8 questions and a section for comments was developed and filled in by the relatives after the intervention and 7,5 months later (n=45). Tests measuring relatives stress (RSS), burden (NPI- burden) and experience of general health (GHQ- 30) was performed at baseline, after the intervention and 7,5 month later. Others in the intervention group (n=47) and control group (n=86) scored the same tests. Level of dementia was measured (MMSE), duration of illness, relative’s gender, relation and age was stated for all participants. Results: The scores from tests showed no significant differences in any of the groups or between the groups. There were small variations in the MMSE score, duration of illness, relative’s gender and age. The questionnaire showed that every relative found the intervention useful and the effect remained. 36 persons filled in on the comments. Conclusion:Results indicated that the relative’s were stressed, burdened and their general health was suffering. It was concluded that the psycho-educative intervention groups were useful, and that the relatives wanted differentiated groups, follow-up meetings and special groups for the persons with dementia. / <p>ISBN 91-7997-144-x</p>

Background: Continuity of care and post-discharge follow-up visits can improve the quality of care and reduce the likelihood of relapse and re-hospitalization in patients with psychotic disorders. Purpose: This study aimed to analyze post-discharge follow-up interventions in patients with psychotic disorders, and to identify measurement instruments for intervention outcomes. Method: The literature review described here used a specific framework, where the follow-up interventions and the measurement instruments were analyzed systematically, to investigate fifteen studies identified through electronic databases such as Pubmed, Psychinfo, ProQuest, Cinahl, Medline, and Scopus. Results: The studies used interventions including psychoeducation, cognitive-behavioral therapy, cognitive behaviorally oriented service, optimal clinical management, relapse prevention plan, software suggested intervention, ambulatory outpatient care, community re-entry module, integrated treatment, and hospital-based community psychiatric service. Additionally these studies used thirty-eight measurement instruments to assess change in psychiatric patients or their relatives, based on psychological, social, and occupational factors as well as specific symptoms and symptom severity. The instruments also measured quality of life, insight, self-esteem, and cognitive function. Further, the studies examined therapeutic alliances and the experience of family members. The most commonly used instruments were the Global Assessment of Functioning and the Positive and Negative Syndrome Scale. Conclusion: The interventions reviewed here emphasize an individualized approach that targets education, illness management, coping strategies, social skills training and relapse prevention, and seeks to alter any harmful understanding of the illness. Although researchers can choose among numerous interventions, psychoeducation was the most appealing follow-up intervention for patients suffering from psychotic disorders. Importantly, evaluation instruments must be relevant to psychological symptoms, treatment, time and resources available, and what questions were being sought to answer. Approximately eleven of the thirty-eight instruments reviewed here showed weak or unclear reliability and validity. The most practical instrument for evaluating the outcome of an intervention for patients suffering from psychotic disorders wasthe Positive and Negative Syndrome Scale. / <p>ISBN 978-91-86739-70-6</p>

Baggrund:Hygiejne er et nyt indsatsområde, som er skrevet ind i Sundhedsaftalerne 2011-2014. Sundhedsaftalen beskriver, at der i kommunerne er stigende behov for infektionshygiejnisk rådgivning i de kommunale institutioner. Formål:Formålet med dette studie var at undersøge, beskrive og analysere, hvordan kommuner på baggrund af Sundhedsaftalen 2011-2014arbejdermed oginterntsamarbejderom udvikling af en hygiejneorganisation. Desuden var formålet at afdække om Sundhedsstyrelsens forebyggelsespakke om hygiejne og netværksdannelsen omkring hospitalerne, havde betydning for udviklingen afhygiejneorganisation. Metode: Studiet er et kvalitativt studie,hvor det empiriske materialeblev indsamlet vedsemistrukturerede interview med medlemmer af hygiejnenetværket med hospitalet.Som analysemetode blev anvendt kvalitativ indholdsanalyse. Den teoretiske ramme for studiet er fokuseret på forskellige former for samarbejde, og styrker og svagheder ved samarbejde. Resultat:Studiet viste, at kommuner i Region Hovedstaden arbejder på forskellig vis medudvikling af en hygiejneorganisation.En afgørende faktorfor arbejdet var ledelsesforankring. Samarbejdet kompliceredes af, at kommunen blev opfattet som en stor, uoverskuelig organisation. Sundhedsaftalen, forebyggelsespakken om hygiejne og samarbejdet med hospitalet blev opfattet, som motiverende faktorer for udvikling af en hygiejneorganisation. Det blev opfattet, som en nødvendighed, at kommunen havde adgang til en hygiejnesygeplejerske, så arbejdet med hygiejne ikke kun blev baseret på interesse, men på kompetencer inden for området. Konklusion:Der er forskellige forhold, som er af afgørende betydning for samarbejde om udvikling af en kommunal hygiejneorganisation. Hygiejneorganiastionen skal være ledelsesforankret, og der skal være ledelsesgodkendte rammer for og ressourcer til arbejdet. Kommunen skal have direkte adgang til specialistviden på hygiejneområdet. / Background:Infection control isa new focus areain the intersectoral health agreements 2011-2014,which statesthat municipalities need guidance regarding infection control. Aim:The present study aimed to investigate, describe and analyze, how municipalitiesin Denmark ́s Capital Region collaborate internally while building an infection control organization. The study also aimed to determinehow hygiene suggestions from the National Board of Health and networking with hospitals affected the development of the infection control organization. Method:The empirical material of this qualitative studyincludedsemi-structured interviews with network members.Data was analyzed with qualitative content analysis. Theories supporting the study were different perspectives on collaboration. Results:The study found that municipalities in the Capital Region collaborate in different ways while developing an infection control organization. Management participationplayeda crucial role.. The municipality was considered a large confusing organization. Motivation factors included the health agreements, hygiene suggestions from the National Board of Health and networking with hospitals. Access to an infection control nurse was considered a necessary element, basing collaboration on competencies, rather than personal interest. Conclusion:Different circumstances are crucial when developing an infection control organization. Management must participate, and also must approve settings and resources. The municipality must have directaccess to expert knowledge about infection control / <p>ISBN 978-91-86739-81-2</p>

Målet med dette arbeidet er å få kunnskaper om lederes mobbing, relatere det til konseptet destruktiv ledelse, og undersøke hvilken betydning makt og verdier kan ha i denne prosessen. Hensikten er å bruke kunnskapen til å bekjempe mobbing. Metode: Dette er en litteraturstudie med et systemteoretisk perspektiv. Mobbingen blir sett på som en dynamisk prosess med interaksjon mellom lederen som mobber, mobbeofferet, arbeidsgruppen og organisasjonen, hvor de alle inngår i et flerdimensjonalt system. Det er lagt stor vekt på å presisere begrepene. Resultater: Det er funnetgode holdepunkter for å hevde at ledere som mobber utøveren meget skadelig form for ledelse. I denne prosessen som har en tendens til å eskalere over tid, spiller makt og verdier en viktig rolle. Ledere med en psykopatisk personlighet kan praktisere ledelse på en måte som får store negative konsekvenser for organisasjonen og de ansatte, og slike personer har en tendens til å misbruke makt. De kan likevel bli ansatt som ledere fordi de har egenskaper som organisasjonen søker og setter pris på. Det er ikke enighet om at mobbing er en uetisk handling. Litteraturen viser at enkelte ledere bruker mobbing strategisk for å oppnå egne fordeler, eller for kontrollere eller straffe de ansatte. Mobbing kan inngå i en bevisst ”organisasjonspolitikk” som blir aksepterti visse organisasjoner. Bedriftsetikk ser i mange sammenhenger ut til å være et begrep uten forpliktende innhold. Det er undersøkt hvordan begrepene managementideologi, instrumentell rasjonalitet og paradokser kan påvirkelederes mobbing. Managementideologien som gjennomsyrer synet på ledelse i store deler av samfunnet, i offentlige organisasjoner i form av New Public Management, er preget av instrumentelle verdier og en utilitaristisk etikk. Dette kan stå i motsetning til den grunnleggende respekt for mennesket som er et fundament i Emmanuel Kants etikk. Konklusjon:Studiet viser atlederes mobbingav ansatte er et meget utbredt og alvorlig problem som er svært ødeleggende for personer og organisasjoner. Det er dermed et betydelig folkehelseproblem. / Objectives: This study aimed to gain insight into the process of leaders bullying their subordinates, relate it to the concept of destructive leadership, and examinethe role of power and values in this process. The overall aim was to provide knowledge about how toreduce bullying. Method: This literature study looked at workplace bullying from the perspective of systems theory. Bullying is seen as a dynamic process characterized by interactions between the perpetrator, the victim, the workgroup, and the organization. The author has given priority toprecision of concept definitions. Results: The literature suggests that leaders who bully practicea very destructive form of leadership. Powerand values play an important rolein the bullying process, which tends to escalate over time.Leaders with a psychopathic personality practicea leadership style that may have serious negative consequences for the organization and its employees. Although psychopathic leaders often misuse power they may retain their leadership role because they seem to have personality traits the organization seeks and appreciates. Interestingly, the author found no agreement about bullying being an immoral act. The literature shows that some leaders use bullying strategically for personal gain or to control or punish employees. Bullying may be part of the organization politics accepted by some organizations,and business ethics often sees to be a concept without areal obligation. An overview discusse show the concepts of management ideology, instrumental rationality and paradoxes may affect leaders ́bullying and harassment. Instrumental values and utilitarian ethics dominate the management ideology that strongly influences leadership in a large part of society, and in public organizations such as New Public Management.This is often in opposition to the fundamental respect for the person that is central to the ethics of Emmanuel Kant. Conclusions: This study shows thatorganization leaders who bully their subordinates representa large and serious problem, with very destructive consequences for persons and organizations. Bullying is thus an important public health problem / <p>ISBN 978-91-86739-83-6</p>

Bakgrunn: Forekomsten av overvekt og fedme er økende i de nordiske landene og iverden forøvrig. Utviklingen er bekymringsfull fordi den bringer med seg uhelse og alvorlig sykdom. Ulike virkemidler er tatt i bruk for å løse problemene forårsaket av overvekt og inaktivitet. Samtidig prøver man å påvirke til endret helseatferd. Det er behov for å utvide kunnskapen om hva som i denne sammenheng er effektive strategier. Hensikt: Studiens hensikt er med kvalitativ metodikk å studere hvordan personer som har lykkes med å endre livsstilsvaner, opplevde og håndterte endringsprosessen. Metode: 14 personer, derav åtte menn, i alderen 23 til 68 år er intervjuet individuelt. Modifisert versjon av Grounded Therory er brukt som metode i innsamling av data og i analyseprosessen. Resultat: Studien viser at deltakernes vellykkede livsstilsendring har forløpt gjennom en rekke sosiale prosesser som kan beskrives ut fra tre hovedkonsepter som her er samlet i følgende kategorier; Motiverer til endring, danner nye vaner og håndterer seg selv. Det som kjennetegner endringsprosessen i sin helhet er hvordan hovedpersonene har utviklet større grad av kontroll og håndterbarhet i egne liv. Konklusjon: Vellykket livsstilsendring er en psykologisk empowermentprosess med vekt på prosesser omkring selvregulering, motivering, psykisk uhelse og det å danne nye vane / The incidence of overweight and obesity is steadily increasing in the Nordic countries and the entire world. This trend is a cause for concern because obesity links directly to many several illnesses, some life-threatening. Various methods have been developed in an effort to manage problems associated with obesity and inactivity. These methods also try to initiate positive lifestyle changes. However, it is necessary to broaden the knowledge base regarding the effectiveness of these strategies. Aim: This study aimed to use qualitative methodology to assess people who have succeeded in making positive lifestyle changes, documenting their experiences and learning how they adapted during the change process. Methodology: A group of 14 people consisting of eight men and six women, all between the ages of 23 and 68 years, were individually interviewed using a modified version of Grounded Theory to collect and analyze the data. Results: The study shows that the participants' positive lifestyle changes have gone through a variety of social processes. These processes comprised three main categories: motivation to change, development of new habits, and self-management. A defining factor in the change process of each candidate was how well that individual developed a greater degree of self-control and management of their own lives. Conclusion: Successful lifestyle change is a psychological empowerment process that emphasizes self-regulation, motivation, mental disorders, and the development of new habits. / <p>ISBN 978-91-86739-44-7</p>

Aim To describe the epidemiology of tuberculosis in the city of Liepaja during the last 27 years and the management of patients with tuberculosis during the period 1993-2002; to identify problems in tuberculosis management relevant to increasing level of morbidity and the registered high levels of drug-resistance. Material and methods The cases were all persons reported with tuberculosis in 1975-2002. The data sources were the yearly Health Statistics books at the Latvian Office of Medical Statistics. The study used data from the available 655 individual patient records from Liepaja Tuberculosis Dispensery and TB Register of 1993 – 2002. Information was extracted selectively and extraction sheets containing the variables of interest were developed. The incidence differences according to sex and age, possible clustering of patients in high-risk living areas of the city, differences in occupation of the patients were studied. The differences of time from disease symptoms to diagnosis, as well as investigation data, treatment regimens, the proportions of treatment outcomes were analysed. Analysis was done using EPI-INFO programme for statistical analysis. Results In the 1980s tuberculosis was under control in Latvia and the incidence was at the European average level. After Latvia had regained independence in 1991, with economical and political disruption and changes in the health care system, TB incidence and mortality in the country increased rapidly as well as in Liepaja. Although not very high compared to global TB rates, there was great concern about TB control in Latvia. In addition, the emergence of drug resistance and multi-drug resistant bacteria made the TB epidemic more serious. The TB incidence increase in children suggested that there was quite a big number of undetected cases of TB. Tuberculosis control and early detection activities were not integrated into the PHC system. Treatment results of TB were quite poor and showed high proportions of interruptions, defaults, relapses. The tuberculosis control Programme in Latvia and Liepaja put much effort into the improvement of the epidemiological situation with TB, focusing on TB control activities and management during the period 1993-2002. The incidence of tuberculosis in Liepaja was higher than in Latvia, particularly in some living areas in the city, and above endemic level. Mortality rate in average was higher as in the whole country. The proportion of socially sensitive groups (children, unemployed, pensioners, disabled) comprised more than 50 % of the tuberculosis incidence. Incidence among medical staff was higher than in general population in the all professional groups. Medical delay of diagnosis decreased, but early detection of tuberculosis was not fully integrated in PHC system. There were quite big differences in numbers of MDR-TB in years 1993-2002. DOTS was introduced in Liepaja five years later than in Latvia –in year 2000 and strategy was not fully successful. The number of positive treatment outcomes increased, but the registered numbers of treatment relapses and defaults were higher than in Latvia . Conclusions The situation with regard to tuberculosis development and tuberculosis management in Liepaja during the period under study was unfavourable. Particularly : the incidence and mortality rates, much variation in the diagnostic process, results of treatment ,a high proportion of MDR-TB , unsatisfactory links between local government, family doctors and medical professionals and multi-sectoral collaboration in TB control activities , the objectives set up by WHO for DOTS treatment were not reached / <p>ISBN 91-7997-139-3</p>