Prior research has found the female athlete triad in both female athletes and female non-athletes. This study consisted of 192 female participants attending Utah State University with 103 collegiate athletes and 89 non-athletes. The instruments used included the EAT-26, menstrual cycle history questionnaire, osteoporosis questionnaire, and time spent in exercise questionnaire. Results from the present study found a statistically significant difference between athletes and non-athletes being at risk for the triad with female athletes having a higher percentage (4.8%, 3.4%). No statistical significant correlation was found between the risk of the triad and excessive amounts of time spent in exercise in athletes (r=.113, p=.256) and non-athletes (r=-.041, p=.706). When athletes were divided into lean and non-lean athletes statistical significance was found with non-lean (17.4%) sport athletes (χ²(1,N=103)=83.971, p<.01) having a higher overall percentage of being at risk of the triad compared to the athletes involved in lean (5%) sports.

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

<p>Globally, injury is a major public health problem. The extent of the problem varies considerably by demographic subgroups, regions and national income. The overall objective of this thesis is to examine the relationship between injury mortality and economic development, and to discuss its role in the changing patterns of mortality as described in health transition theory.</p><p>By cross-sectional analysis between cause-specific injury-related mortality and income per capita, studies included in this thesis indicated that while unintentional injury mortality (UIM) and homicide rates correlated negatively with GNP per capita for total populations with varying patterns for age-specific mortality, suicide rates increased slightly by nations’ income per capita, especially among women. In age- and cause-specific injury mortality differentials between low-income, middle-income and high-income countries, ageing and injury interplay mutually with regard to health transition; declining rates in child UIM by income level contributes to the ageing process, while increasing UIM among the elderly, in combination with ageing populations boosts the absolute number of injury deaths in this segment.</p><p>Between the income-based country groups, both cross-sectional and longitudinal analyses show that injury mortality for all three major causes (i.e. unintentional injury, suicide and homicide) first increase and then decrease with rising income per capita, following an inverted U-shaped curve.</p><p>These results illustrate that injury is not a homogeneous public health phenomenon from a health transition perspective. While child unintentional mortality clearly agrees with ‘diseases of poverty’, unintentional injury in the elderly agrees with ‘diseases of affluence’. Patterns for homicide and suicide are more complex and uncertain. Generally, the strength and direction of injury mortality by economic development vary considerably by age, sex and type of injury.</p><p>Further research on causations, mechanisms, broader indicators and data quality, as well as theoretical developments on health transition taking new findings and parallel frameworks into account, is needed to fully understand the complex relationship between economic development and injury mortality.</p>

Bakgrund: Osteoradionekros är en komplikation till strålbehandling mot huvud-hals-cancer. Personer som drabbasbehandlasiblandmed käkbensrekonstruktion.Mycket lite är känt om hur dessa personer hanterar sin situation. Syfte: Att öka och fördjupa kunskapen om vilka strategier som personer som genomgått käkbensrekonstruktionefter komplikation till cancerbehandling, använder för att hantera sin situation. Metod: Klassisk grounded theory användes vid analysen av 11 kvalitativa intervjuer, som utfördes medöppna frågorutifrån en temaguide.Konsekutivt och teoretiskt urval användes tills saturation uppnåddes.Syftet med metoden är att förutsäga och förklara det studerade fenomenet. Resultat:I analysen framkom kärnkategorin ”att orka bära sitt öde”.Personer som genomgått en käkbensrekonstruktion p.g.a. osteoradionekros använder huvudsakligen fyra strategier för att hantera sin situation. De tar de chanser de får;börjar om på nytt genom att ta en dag i sänder; skaffar sig ett nytt perspektiv på livet;och söker stöd hos andra i alla tillgängliga sfärer. Konklusion/Implikation:Ett ökat stöd behövs riktat till denna grupp av patienter. Att inom hälso-och sjukvården, lära ut dessa aktiva och hälsofrämjande copingstrategier, skulle kunna öka gruppens livskvalitet och empowermen / Background: Mandibular osteoradionecrosis is a complication of radiotherapy for head and neck cancer. Treatment of this condition sometimes involves mandibular reconstruction. Little is known about howpatients handle their situation after a mandibular reconstruction. Aim:This study aimed to increase and gaina deeper knowledge about coping strategies among mandibular reconstruction patients. Method: Classical grounded theory was used to analyze 11 open qualitative interviews with steoradionecrosis patients. Consecutive and theoretical sampling was performed until saturation. This method seeks to predict and explain the studied phenomena Results: Interview analysis revealeda core category “coping to carry one’s fate”. Patients, treated with mandibular reconstruction due to osteoradionecrosis, used four main active coping strategies. They take the chances they get; start over againtaking one day at a time; gain a new perspective on life; and seek support from other people in all available contexts. Conclusion:Patients with osteoradionecrosis need increased support. To increase quality of life and empowerment, health care settings could teach such patients these active health promoting coping strategies / <p>ISBN 978-91-86739-40-9</p>

Bakgrunn: Misbruk av vanedannende legemidler er et viktig folkehelseproblem. Enkelte pasienter går fra lege til lege og driver såkalt legeshopping for å skaffe seg mest mulig av denne typen legemidler. Dette er et problem i forhold til å kunne begrense legemiddelmisbruket i befolkningen. Fastlegeordningen, som ble innført i Norge i 2001, er blant annet ment å skulle begrense mulighetene til legeshopping. Det er ikke tidligere gjort studier som kan kartlegge omfanget av legeshopping i en befolkning, verken i Norge eller andre land. FORMÅL: Kartlegge omfanget av legeshopping i befolkningen i Norge, og forsøke å klarlegge i hvilken grad bruk av flere leger kan skyldes shopping etter legemidler eller andre årsaker. MATERIALE OG METODE: Studere data fra det norske Reseptregisteret (NorPD) for kalenderåret 2004, som blant annet viser antallet leger benyttet, mengde utlevert av det aktuelle legemiddelet og samtidig mengde utlevert av benzodiazepiner og opioider for alle brukere av de vanedannende legemidlene diazepam, karisoprodol og kodein kombinasjoner sammenlignet med alle brukere av de ikke-vanedannende legemidlene esomeprazol, metformin og salbutamol. RESULTATER: De aller fleste pasienter bruker kun en eller to leger for å få utlevert samme legemiddel i løpet av ett kalenderår. Andelen som bruker tre eller flere leger er imidlertid mer enn dobbelt så høy for de vanedannende legemidlene som for de ikke-vanedannende, og for de som bruker fem eller flere leger, er andelen nesten ti ganger større. Med økende antall leger som er benyttet, er dessuten økningen i både utlevert mengde av legemidlet og samtidig mengde utlevert av benzodiazepiner og opioider langt mer uttalt for de vanedannende legemidlene enn for de ikke-vanedannende. KONKLUSJON: Det foregår etter innføringen av fastlegeordningen fortsatt en begrenset, men klar legeshopping blant pasienter som ønsker å få tak i mest mulig av vanedannende legemidler. Dette forhold må tas alvorlig av både de forskrivende legene og helsemyndighetene. / BACKGROUND: Abuse of prescription drugs is an important public health issue. Some patients go from one physician to another in so-called doctor-shopping (or physician-shopping) with the intention to have as much as possible of addictive drugs prescribed. This is a problem when trying to restrict prescription drug abuse in the population. The Regular General Practitioner (RGP) Scheme which was introduced in Norway in 2001 had among other things the intention to counteract doctor-shopping. So far there are no studies in Norway or other countries that have presented estimates of the proportions of patients that practice doctor-shopping. AIM: To explore the extent of doctor-shopping in the population in Norway and try to unveil if the use of several doctors is primarily a prescription drug shopping or if it has other reasons. MATERIAL AND METHODS: Data from The Norwegian Prescription Database (NorPD) for the year of 2004 was studied. The register includes information on the number of doctors used by individual patients and the amount of drug dispensed. There is also information about concomitant use of opioids and benzodiazepines. Users of the addictive drugs diazepam, carisoprodol and codeine combinations were compared to users of the non-addictive drugs esomeprazole, metformin and salbutamol. RESULTS: Most patients use only one or two doctors for prescription of the same drug over a period of one year. However the proportion of patients who uses three or more doctors for the addictive drugs is more than twice the comparable proportion of patients using the non-addictive drugs. For those who uses five or more doctors the proportion is nearly ten times larger. The amount of dispensed drug increases considerably more by increasing number of doctors used for users of the addictive drugs than for the users of the non-addictive drugs, as do the amount of concomitantly dispensed opioids and benzodiazepines. CONCLUSION: Also after the introduction of the Regular General Practitioner (RGP) Scheme in Norway doctor-shopping is still going on to a limited but significant extent by patients who appear to have the intention to get as much as possible of addictive drugs. This is a public health issue that has to be taken seriously by both prescribing doctors and health authorities. / <p>ISBN 978-91-85721-60-3</p>

Bakgrunn:I norske levekårsundersøkelser oppgirinnvandrere at de hardårligere helse enn resten av befolkningen. Et mål i norsk integreringspolitikk er å fremmelevekår for innvandrerbefolkningen. Fysisk aktivitet slik som svømming har en sosial og kulturell verdi i det norske samfunnet,samtidig som det er en forebyggende innsats vedat manglende ferdigheter i svømming bidrar til at innvandrergrupper har høyere risiko for å drukne. Hensikt: Formålet med studien var åutvikle et svømmekurs som en helsefremmende intervensjon for kvinner med innvandrerbakgrunn og undersøke om svømmekurset bidro til økte svømmeferdigheter og sosial integrering. Metode: Å utføre enintervensjon gjennom et svømmekurs med deltagelse fra 16 kvinner fra 6 forskjellige land.Triangulering av metoder med spørreundersøkelser, gruppeintervjuerog observasjoner fra 15.november 2012 til 26. oktober 2013. Forskningsspørsmål har søkt svar innenfor temaene øktesvømmeferdigheter, sosial integrering ogandre faktorer som kunnepåvirke helsetilstanden til kvinner med innvandrerbakgrunn. Kvalitativ innholdsanalyse ble brukt for å analysere det kvalitative datamaterialet. Resultat: Deltagerne visteøkte svømmeferdigheter parallelt med økt trygghetsfølelse i forhold til vann fra kursstart til kurset varavsluttet. Deltagerne viste en kulturell åpenhet og personlig utvikling som ble synlig gjennom utvidet sosialt nettverk på tvers av kulturer og utvidet omfang av sosiale aktiviteter slik sombruk av offentlig basseng. Andre funn var en bedre selvopplevd helse og at deltagernefungerte som rollemodellerfor egen familie og venner med tanke på ålære svømmeferdigheten. Konklusjon: Denne intervensjonen visteat aktivitet tilrettelagt for kvinner med innvandrerbakgrunn fremmet faktorer som haddeen positiv effekt på helsetilstanden, Dette gjennombedring av svømmeferdigheter,og sominngangsport til sosial integrering / Background:Norwegian surveys have reported that the health of immigrants compares negatively with the health of the general population. Norwegian society emphasizes thesocial and cultural value ofphysical activity such as swimming,andintegration policypromotes improved living conditions for immigrants. Moreover, inability to swim heightens the risk of drowning. Purpose: This study aimed to develop swimming instruction as a health-promoting intervention among immigrant women.It also examined whether such swimming lessons improve women's health by increasing skills and social integration. Method: Sixteen women from six different countries participated in swimminglessons between 15 November 2012 and 26 October 2013. This thesis used a triangulation of methods (i.e., surveys, group interviews,and observations)to investigate whether increased swimming skill, social integration, and other factors affect the health of immigrant women. I used qualitative content analysis to evaluate alldata. Results: As immigrant women became better swimmers, their sense of security in the water improved. Additionally, swimming enhanced cultural openness and personal development, and participants’ social networks expanded across cultures. Public swimming pools increasedsocial activity. Finally, as participants’perceptions of their own health improved,they encouraged their family and friends to learn how to swim. Conclusion: This intervention shows that activities organized for immigrant women promote factors that have a positive effect on health, such as improved swimming skills. Swimmingis a gateway to social integration / <p>ISBN 978-91-86739-67-6</p>

No description available.

No description available.

Public health aspects of pharmaceutical prescription patterns: Exemplified by treatments for prevention of cardiovascular disease. Louise Silwer. ISBN: 978-91-85721-18-4 ISSN: 0283-1961Main aim:To study patterns and trends of dispensed prescriptions, to explore what proportion of the population is exposed to some of the more prevalently prescribed pharmaceuticals, and to find possible ways of measuring drug-induced adverse symptoms in the population. Further, to illuminate conditions surrounding prescribing in primary prevention of cardiovascular disease. Methods: In three descriptive studies of prescription patterns, prescription data at aggregate level from a Swedish county were analysed retrospectively, and proportions were calculated. Data from the first ten years of the studies were obtained from a local prescription study, and data from another five years were local data from a national prescription survey. Data from a Danish database (OPED), with data at the individual level, were used for a prescription sequence symmetry analysis, and when Swedish national prescription data at the individual level became accessible, they were used for calculations of drug prevalence in the entire Swedish population. In a qualitative analysis of interview data, a phenomenographic approach was used. Main results: The purchase of pharmaceuticals on prescription almost doubled in the studied county in the period 1988-2002. Some common pharmaceuticals that increased to a great extent among the older part of the population were cardiovascular preventive drugs, such as antihypertensive and lipid modifying agents, and also hormone replacement therapy for women. In 2005, over half of all Swedish citizens, aged 60 or over, purchased antihypertensive or lipid modifying preparations during a six-month period. The different views that were found among GPs, regarding beliefs and practical management of primary prevention of CVD, could be interpreted as a reflection of the complexity of patient counselling in primary prevention in practice. Conclusion: The increase in dispensed prescriptions over the 15 years and the magnitude of the prevalence of the studied pharmaceuticals, such as antihypertensive, lipid modifying and hormonal treatments, which to a great extent are used by ‘healthy’ people, point to the need of following-up both beneficial and harmful consequences on public health. The prevalence of preventive treatments together with the variation in views of administration of primary prevention of cardiovascular disease, also point to the need of clarification of guidelines regarding pharmaceutical primary prevention and encouragement of therapy discussions among GPs.

Bakgrund: Självskadebeteende är ett allvarligt problem som förekommer idag. Under senare år har vårdgivare inom hälso- och sjukvården uppmärksammat en ökning av detta problem som leder till fysiska och psykiska hälsobesvär. Dessa hälsobesvär kan förekomma i form av exempelvis depression, fysiska skador och kan i värsta fall leda till självmord. En form av terapi som visat sig ge goda resultat för att komma till rätta med detta beteende är DBT, dialektisk beteendeterapi. Syfte: Att undersöka om DBT- terapeuters beskrivning av sitt arbete med dialektisk beteendeterapi stämmer överens med litteraturens beskrivning av behandlingen, och därmed uppnå en fördjupning i dialektisk beteendeterapi och självskadebeteende. Metod: En kvalitativ studie med sex stycken semistrukturerade intervjuer med DBT- terapeuter har genomförts. Analysen har utförts med hjälp av kvalitativ innehållsanalys. Resultat: Resultatet har delats upp i två huvudkategorier: arbetsmetod samt terapeuter och andra vårdgivares bemötande av patienter. I resultatet framkommer det hur en DBT- behandling stegvis ser ut samt vikten av ett gott bemötande av patienter. Ett gott bemötande omfattar bland annat ett respektfullt och icke- dömande förhållningssätt. Konklusion: Resultaten i studien bekräftar resultaten från den tidigare forskningen. Dock krävs det mer forskning om DBT som behandlingsmetod för att kunna dra tillförlitligare och säkrare slutsatser. Genom att arbeta med behandling av självskadebeteende kan individers hälsa förbättras, vilket i sin tur även kan leda till minskning av antalet självmord och psykisk ohälsa. / Background: Self- harm behavior is a serious problem that occurs today. In recent years care providers in the health-care have noticed an increase of this problem that leads to physical and mental health- problems. These health- problems can occur, for example, in the form of depression, physical harms and can lead to suicide in worst case. A form of therapy that has been shown to give good results to manage this behavior is DBT, dialectical behavior therapy. Aim: To investigate whether DBT- therapist’s description of their work with dialectical behavior therapy is consistent with the literature’s description of the treatment, and thereby achieve a deepening in dialectical behavior therapy and self- harm behavior. Method: A qualitative research with six semi-structured interviews with DBT- therapists have been implemented. The analysis has been done using a qualitative content analysis. Results: The result has been divided into two main categories: working- method and therapist’s and other care provider’s treatment of patients. It appears in the result how a DBT- treatment looks like, step- by step, and the importance of a good treatment of patients. A good treatment includes a respectful and non- judgemental attitude. Conclusion: The results in the study confirms the results from the recent research. However, more research on DBT as a treatment is necessary, in order to make stronger and more reliable conclusions. People’s health can be improved by working with treatment of self- harm behavior, which also can lead to a reduction in the number of suicide and mental illness.