The main objective of this epidemiological study was to assess the incidence of unintentional non-fatal injuries, together with their determinants and consequences, in a defined Vietnamese population, thus providing a basis for future prevention. A one-year follow-up survey involved four quarterly cross-sectional household injury interviews during 2000. This cohort study was based within a demographic surveillance site in Bavi district, northern Vietnam, which provides detailed, longitudinal information in a continuous and systematic way. Findings relate to three phases of the injury process: before, during and after injury. The study showed that unintentional non-fatal injuries were an important health problem in rural Vietnam. The high incidence rate of 89/1000 pyar reflected almost one tenth of the population being injured every year. Home injuries were found to be most common, often due to a lack of proper kitchens and dangerous surroundings in the home. Road traffic injuries were less common but tended to be more severe, with longer periods of disability and higher unit costs compared with other types of injury. The leading mechanisms of injury were impacts with other objects, falls, cuts and crushing. Males had higher injury incidence rates than females except among the elderly. Elderly females were often injured due to falls in the home. Being male or elderly were significant risk factors for injury. Poverty was a risk factor for injuries in general and specifically for home and work related injuries, but not for road traffic injuries. The middle income group was at higher risk of traffic injuries, possibly due to their greater mobility. Injuries not only affected people’s health, but were also a great financial burden. The cost of an injury, on average, corresponded to approximately 1.3 months of earned income, increasing to 7 months for a severe injury. Ninety percent of the economic burden of injury fell on households, only 8% on government and 2% on health insurance agencies. Self-treatment was the most common way of treating injuries (51.7%), even in some cases of severe injury. There was a low rate of use of public health services (23.2%) among injury patients, similar to private healthcare (22.4%). High cost, long distances, residence in mountains, being female and coming from ethnic minorities were barriers for seeking health services. People with health insurance sought care more, but the coverage of health insurance was very low. Some prevention strategies might include education and raising awareness about the possible dangers of injury and the importance of seeking appropriate care following injury. To avoid household hazards, several strategies could be used: better light in the evening, making gravel paths around the house, clearing moss to avoid slipping, wearing protective clothing when using electrical equipment and improving kitchens. Similarly, improving road surfaces, having separate paths for pedestrians and cyclists and better driver training could reduce road accidents. In Vietnam, and especially in a rural district without any injury register system, a community-based survey of unintentional injuries has been shown to be a feasible approach to injury assessment. It gave more complete results than could have been obtained from facility-based studies and led to the definition of possible prevention strategies.

In this thesis, priority setting to the form of the Swedish parliamental decision on priority setting, 1997, is considered an innovation for implementation in health care. The features of this innovation are investigated. The practical implications of implementation are identified by investigating the user organisation, ie, Swedish health care organisations and management systems. Also, a case of a three-stage process for macro-level priority setting that engaged the entire organisation in the Västerbotten County Council (VCC) is presented. This is done against a background of preceding implementation efforts in the VCC. Four specific research efforts and papers are presented. In Paper I, priority setting is operationalised into a multi-dimensional resource allocation task. On that basis, with the help of interviews (1998) and surveys (2002 and 2005) primarily of VCC health care managers, the impact of implementation is measured by prioritisation structures, processes and decisions. Survey response rates were low. Results were used as qualitative data, internally compared, and interpreted as: a) responses reflected mainly “early adopters’” opinions; b) priority setting is an ambiguous concept; c) indicating limited overall implementation; d) reinterpretation of the prioritisation task occurred over time among respondents; and, e) this group took increasingly personal responsibility as stakeholders in priority setting. Paper II reports a case study intervention of explicit, departmental level priority setting with the aim of improving cost-effectiveness in in vitro fertilization resource use and a rationing of services perceived legitimate by all stakeholders. The intervention combined priority setting and structured quality improvement techniques. Results were: a) improved operational efficiency of diagnostic procedures that allowed resources to be reallocated to treatment; and b) patients were prioritized and treatment resources were rationed based on evidence of treatment effect among subgroups. Evaluation showed that the procedure met stated criteria for legitimacy. In Paper III, a full-format test of the macro level prioritisation process is described and evaluated by participants with the help of surveys after each completed stage. Participants report the need for improvement of elements in the overall process and of procedural specifics. However, overall there was a strong commitment to the initiative and satisfaction with the process and the resulting decisions. In Paper IV, procedural specifics of the prioritisation process are evaluated. They are also compared to the Program Budgeting and Marginal Analysis (PBMA) framework when used for macro level purposes. Procedures provided intended results such as vertical and horizontal priority setting and a consistent process. However, economic targets were not fully achieved in any of the stages. Conclusions include that health care management systems are not prepared for priority setting and need profound restructuring and that the prioritisation process described in Papers III and IV was successful because: a) the process satisfied politicians’ directives; b) participants were satisfied with the procedures and perceived the subsequent reallocation decisions as legitimate; and, c) methods resulted in the intended outcome. Factors suggested as the basis of success include: long-term overall preparations; broad and deep participation; a readiness for change among participants; a stage for horizontal priority setting that added to the quality, feasibility and perceived validity of the knowledge base; a strong process leadership; and politicians determined to protect the process from opportunistic disturbances.

Många personer drabbas årligen av hjärtinfarkt, ofta rekommenderas livsstilsförändringar i rehabiliteringsfasen. Det är en utmaning för hälso- och sjukvårdspersonal att motivera och stödja patienten i deras strävan mot en förbättrad livsstil. Syftet med studien var att belysa de faktorer som underlättar respektive försvårar patientens livsstilsförändringar efter en hjärtinfarkt. Studien genomfördes som en litteraturstudie och baserades på 12 vetenskapliga artiklar. I resultatet framkom sex kategorier. Dessa var socialt stöd, professionellt stöd, rehabiliteringsprogram, självcentrerat perspektiv, existentiellt perspektiv samt miljö. I omvårdnaden är det viktigt att hänsyn tas till den enskilda individen vid livsstilsförändringar, det krävs då både medvetenhet och kunskap från hälso- och sjukvårdspersonal. De sex kategorier som framkom ger kunskap som underlättar arbetet med patienter som drabbats av hjärtinfarkt. Beträffande framtida forskning vore det intressant att se vad som påverkar den eventuella varaktigheten av livsstilsförändringar, då följsamheten är viktig för att undvika att patienten drabbas av ytterligare hjärtinfarkter.

Sammanfattning Syfte och frågeställningar Syftet med uppsatsen är att belysa hur arbetsplatser kan påverka personalens frisknärvaro genom mätning och uppföljning av denna samt av hälsofrämjande insatser. Vilka effekter kan mätningar av närvaro, resultaten av mätningarna samt interventioner/insatser ge? Vilka tänkbara faktorer kan påverka frisktalen vid en arbetsplats? Hur kan man förstå kopplingen mellan frisktal och ekonomisk lönsamhet?   Metod En kvalitativ ansats valdes med tanke på uppsatsens undersökande innehåll och karaktär. Studien bygger på en litteraturgenomgång inom för uppsatsen relevanta områden och en undersökning av ett industriföretag. Resultat Aktuell litteratur och forskning visar på det positiva sambandet mellan medveten mätning, analys och uppföljning, hälsofrämjande arbetsklimat och ökande frisktal samt ekonomisk lönsamhet och stigande produktivitet. Det undersökta företaget arbetar aktivt på detta sätt och har ökat frisknärvaron vilket har resulterat i stora besparingar och välmående och motiverad personal. Ledarskapet, integrationen av hälsofrågor inom samtliga delar av organisationens arbete samt människosynen och kulturen gör det undersökta företaget till en attraktiv och hälsofrämjande arbetsplats - ett företag i tiden. Slutsats Resultatet av den här studien pekar på att mätningar, uppföljningar och insatser kan göra positiv skillnad för ett företags frisktal. Ett engagerat och medvetet ledarskap som bjuder in till delaktighet, integrerar och synliggör hälsofrågor och ger dem en strategisk roll kan skapa en välmående och attraktiv arbetsplats med motiverade medarbetare. Detta i sin tur bidrar till att höja "företagets varumärke" på arbetsmarkanden och öka produktiviteten samt den ekonomiska lönsamheten. / Summary Aims and objectives The aim of this paper is to illustrate how the workplace can affect employee attendance, through evaluation, follow-up and health promoting inputs. To what effect can evaluation of attendance, the results of evaluation and intervention give? What possible factors can affect attendance? How does one understand the connection between attendance and economic viability?   Methodology A qualitative approach was chosen taking because of the papers investigative contents and characteristics. The paper is a study based on a review of relevant literature within the subject plus an industry analysis. Results Current literature and research show a positive connection between deliberate evaluation, analysis and follow-up, increased attendance, advancement of the prevention of ill health, economic viability and a rise in productivity. The business which was analysed is pro-active in these areas and has an improved absence management which has resulted in large economic benefits and a healthier and more motivated personnel. Leadership, integration of health issues within all sections of the business, human outlook and culture have all attributed to an attractive and healthy workplace- a company of the times. Conclusions The results of this study indicate that evaluation, follow-up and input can make a positive change for a businesses employee attendance. A committed and attentive leadership which encourages participation, integrates and addresses health issues by giving them a strategic role can create a prosperous, attractive workplace with motivated employees. This in turn contributes to increased productivity and higher economic benefits.

Inledning/Bakgrund: Alla barn ska ha rätt till fritid, lek, rekreation och vila. Det ser dock annorlunda ut i verkligheten och barn som växer upp i ekonomiskt utsatta hushåll deltar i lägre grad i fritidsaktiviteter än övriga barn. Detta är oroväckande och kan ha negativa effekter på folkhälsan, då det visat sig att fritidsaktiviteter har positiv inverkan på hälsan och välmåendet. Syfte: Denna studie syftar till att undersöka vilka eventuella möjligheter och hinder som verksamhetsföreträdare från Karlskoga kommun anser sig ha för att skapa förutsättningar för fritidsaktiviteter för ekonomiskt utsatta barn i åldrarna 7-18 år. Metod: Intervjustudie med sju verksamhetsföreträdare som erbjuder fritidsaktiviteter för barn i åldrarna 7-18 år i kommunen. Resultat: Resultatet visade att det finns goda möjligheter till ett jämlikt deltagande och en förståelse för ekonomiskt utsatta barn i verksamheterna men även att det är svårt att nå ut till målgruppen. Resultatet lyfter även fram förutsättningar för barnens deltagande men även förutsättningar för verksamheterna. Det framgår också att verksamheterna upplever att de i framtiden skulle kunna utvecklas och erbjuda ytterligare möjligheter till fritidsaktiviteter för ekonomiskt utsatta barn i Karlskoga. Diskussion: Det finns goda förutsättningar till att erbjuda fritidsverksamheter för ekonomiskt utsatta barn såväl på vardagar som på lovdagar. Idag görs inga riktade insatser för att få dessa barn delaktiga i verksamheterna, vilket vi anser bör förändras för att skillnaderna i hälsa mellan barn med olika ekonomisk bakgrund ska minska. Kommunen har också en viktig roll i utvecklingen med att stötta verksamheterna på olika sätt / Titel: Leisure Activities for All? – A Qualitative Study about Opportunities and Obstacles to Leisure Activities for Economically Disadvantaged Children. Introduction/Background: All children should have the right to leisure and play. Unfortunately, things are different in the real world. Children who grow up in economically disadvantaged households participate to a lower degree in leisure activities than other children. This is a disturbing fact that may have negative effects on the public health, because scientific studies show that leisure activities have a positive impact on health and wellbeing. Aim: This study aims to examine possible opportunities and obstacles that representatives from both public sector and non-governmental organisations from the municipality of Karlskoga consider they have to create conditions for leisure activities for economically disadvantaged children aged 7-18 years. Method: Interviews with seven representatives from the public sector and nongovernmental organisations that offer leisure activities for children aged 7-18 years. Result: There are good opportunities for equal participation and an understanding of economically disadvantaged children in leisure activities, but also that it is difficult to reach out and capture the target audience. Furthermore, it shows that representatives from both sectors feel that in the future they could develop and offer additional opportunities for leisure activities for economically disadvantaged children in Karlskoga. Discussion: There is good potential to provide leisure activities for economically disadvantaged children. Today, neither sector specifically target children from economically disadvantaged backgrounds to involve them in the activities. Therefore, we think this is something that should change so that differences in health between children from different economic backgrounds decreases. Finally, the municipality also has an important role in the development of supporting relevant sectors in different ways.

<p>Den fysiska uppsatsen är arkiverad på Akademin för Juridik, Psykologi och Socialt arbete.</p>

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published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Statistics and Actuarial Science / Master / Master of Philosophy