Background South Africa is experiencing a massive HIV epidemic that together with the new epidemic of non-communicable diseases is directly affecting the health and wellbeing of older people. For policy makers, there is a crucial need for information on how this dual epidemic is evolving and how this may affect older people's health, mortality and health care needs. 2. Aims To better understand factors that influence the health, wellbeing and survival of older people, and their need for care in rural South Africa at a time of a growing dual epidemic of chronic diseases (non-communicable and communicable). To provide information which may assist in the planning of health services for older people. 3. Methods Applying the WHO Study on Global Ageing and Adult Health (SAGE) and a study on HIV and non-communicable diseases (NCD), we investigated the health, wellbeing and mortality of the population 50 years and older in the Agincourt sub-district in north-east South Africa which is underpinned by health and demographic surveillance. A random sample of the population 50 years and older was selected for the SAGE survey. A random sample of the population 15 years and older was selected for the HIV and NCD study. All available adults 50 plus were invited to participate in the SAGE module in the 2006 census round. We assessed self-reported health, anthropometric measures, blood pressure and HIV status using dried blood spots. Statistical analysis included simple frequencies, univariate and multivariate analysis and Cox proportional hazard models. 4. Findings The usual pattern of mortality, of increasing death rates with age, is not observed in this population, where those in their 50s have higher mortality compared to older age groups. The high prevalence of HIV in this age group (50 to 59) appears to be the main explanation for the observed pattern. Hypertension affects two thirds of this older population and, although there are no differences by gender, women are more aware of their condition. This is reflected in more women attending primary health care services. Reporting lower quality of life and greater disability are associated with higher likelihood of death. We observed gender differences in the process of ageing with women reporting higher prevalence of mortality risk factors but living longer than men, a phenomenon known as the "survival paradox".

Introdução: A osteoporose (OP) é doença caracterizada pela fragilidade do osso e, consequentemente, pelo incremento do risco de fraturas. É considerada problema de saúde pública na maioria dos países. Evidências epidemiológicas apontam associação entre variáveis sociodemográficas, variáveis de estilo de vida (como a ingestão de alimentos e de bebidas alcoólicas e hábito de fumar), e indicadores antropométricos (como índice de massa corporal -IMC-) e risco de OP e fraturas osteoporóticas. Objetivo: Estimar a incidência de OP e a prevalência de fraturas referidas, em idosos domiciliados no Município de São Paulo e verificar associação com variáveis sociodemográficas, de estilo de vida, e IMC. Método: analisaram-se dados do Estudo SABE (Saúde, Bem-estar e Envelhecimento) 2000 - 2006, o qual é estudo epidemiológico, longitudinal, de base domiciliar, cuja amostra inicial foi composta por 2143 idosos (&#8805;60 anos), de ambos os sexos, residentes habituais de domicílios urbanos no Município de São Paulo, e selecionados por amostragem probabilística, sendo que 829 idosos (39%) constituíram a amostra de estudo, em 2000, para análise da incidência de OP referida, em 2006, e 1072 idosos (50%) foi a amostra de estudo para análise de prevalência de fraturas após 60 anos referidas, em 2006. Investigou-se a associação entre variáveis sociodemográficas (sexo, grupo etário, vida no campo por 5 anos ou mais durante a infância ou adolescência, escolaridade e etnia), de estilo de vida (ingestão referida de leite e produtos lácteos, ovos e leguminosas, carnes, peixes e aves, frutas e verduras, frequência de ingestão de bebidas alcoólicas, e hábito de fumar); e variável antropométrica (IMC), com relação à referência de OP e fraturas após 60 anos, em 2006. Para verificar associação entre as variáveis categóricas e o desfecho, utilizou-se o teste de Rao & Scott (p<0,05) e a análise de regressão logística univariada (IC95%).O programa Stata, versão 10.1 foi usado para realizar os cálculos estatísticos. Resultados: Houve 114 casos novos de OP referida em 2006, sendo que o coeficiente de incidência (CI) de OP referida foi estimado em 13,93/1000 pessoas-ano (IC95%=11,60 16,87). O CI de OP referida em mulheres foi 22,95/1000 pessoas-ano (IC95%: 19,08 27,87), e 3,34/1000 pessoas-ano (IC95%: 1,85 6,73), em homens.A prevalência de fraturas após os 60 anos referidas foi 17,16%. Sexo feminino (OR= 7,69; p=0,000) e ingestão referida de bebidas alcoólicas < 4 vezes/semana (OR= 2,26; p=0,019), foram fatores de risco para referência de OP. Sexo feminino (OR=2,38;p=0,000), idade avançada (&#8805;75 anos)(OR=1,72; p=0,012), ingestão referida de bebidas alcoólicas < 4 vezes/semana (OR=2,45; p=0,016), referência de OP em 2000 (OR=1,75; p=0,048), e referência de OP em 2006 (OR=2,29; p=0,000), foram fatores de risco para referência de fraturas após 60 anos. Conclusões: sexo feminino, idade avançada foram fatores de risco para OP e fraturas após os 60 anos. Dentre as variáveis modificáveis, a ingestão de bebida alcoólica com frequência &#8805; 4 vezes/semana, esteve negativamente associado à referência de OP e fraturas após 60 anos. / Introduction: Osteoporosis (OP) is a disease characterized by bone fragility and increased risk of fractures. It is considered a public health problem worldwide. Epidemiological studies have found association between sociodemographic, lifestyle and anthropometrical variables and increased risk of OP and osteoporotic fractures. Objetive: To estimate incidence of self-reported OP, in 2006, and prevalence of fractures after the age of 60 year-old, on a sample of elderly individuals from the Município de São Paulo, and verify association between selected variables and outcome. Method: based on data from the SABE Study (health, well-being and aging) 2000 - 2006, which is an epidemiological prospective study of a probabilistic household sample of elderly population ((&#8805; 66 y), of both sexes, from São Paulo City, Brazil. Association between sociodemographic (sex, age, life in rural area for 5 year or more during childhood or adolescence, schooling, and race) lifestyle (reported food intake (milk and dairy products, eggs and legumes, meat, fish and poultry, fruit and vegetables), reported alcoholic beverages intake) and smoking habit; and anthropometrics\' variables, such as body mass index (BMI) and self-reported OP and fractures after the age of 60 year-old, in 2006. Rao & Scott Test was used to verify association between the categorical variables and outcome (p<0,05) as well as simple logistic regression (CI95%). Stata software, version 10.1, was used for statistical calculation. Results: There were 114 new cases of self-reported OP in 2006, and an incidence rate of 13,93/1000 persons-year (IC95%=11,60 - 16,87). In women the incidence rate was 22,95/1000 persons-year (CI95%: 19,08 - 27,87), and in men it was 3,34/1000 persons-year (IC95%: 1,85 - 6,73). Prevalence of self reported fractures after de age of 60 y was estimated in 17,16%. Female sex (OR= 7,69; p=0,000) and frequency of reported alcoholic beverages intake < 4 times/week (OR= 2,26; p=0,019), were risk factors for self-reported OP. Female sex (OR=2,38;p=0,000), advanced age (&#8805;75 y) (OR=1,72; p=0,012), frequency of reported alcoholic beverages intake < 4 times/week (OR=2,45; p=0,016), self-reported OP in 2000 (OR=1,75; p=0,048), and self-reported OP in 2006 (OR=2,29; p=0,000), were risk factors for reporting fractures after the age of 60 years-old Conclusions: female sex, advanced age, were risk factors for reported OP and fractures after 60 y. Among modifiable variables, intake of alcoholic beverages as often as > 4 times/week was negatively associated with reported OP and fractures after the age of 60 y.

People living with heart failure (PLHF) should be screened for symptoms at every healthcare visit since they are 3 times more likely to experience ventricular arrhythmias. This quality improvement project (QIP) compared 3 self-administered HF symptoms questionnaires to determine the best screening tool for a tertiary hospital arrhythmia devices clinic. The instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and the Self-Reported Heart Failure Symptoms (SHEFS) questionnaire. For a 30-day period, 76 people were eligible to participate in the QIP, with 55 participants included in the final analysis (72.5% participation). The questionnaires were compared and assessed with the gold standard laboratory test for HF (NT-proBNP) for sensitivity and specificity. For HF, the SHEFS was the most sensitive (83%) compared to the NT-proBNP, but the MLHFQ was most specific (89%). When compared to the MLHFQ as the standard, SHEFS was 71% sensitive, and 73% specific for HF. Similarly, when compared to the KCCQ, the SHEFS was both, 75% specific and sensitive in identifying HF. However, the rate of correlation to a positive or negative NT-proBNP test results was the highest for the SHEFS (87%). All 3 questionnaires were statistically significant in predicting admission to hospital for HF in the past 6 months (p = 0.02 to 0.03). Finally, given the shortest length and simplicity of use, the SHEFS was selected by the stakeholders to be the standard screening tool for the clinic. This project contributes to positive social change by providing the first reported comparison in the literature to implement questionnaires in a clinic to assess symptoms for PLHF attending an arrhythmia devices clinic.

Adolescents spend a large proportion of their everyday life in school, and schooling is vital for future success and well-being. One group that are in risk for reduced school success are children with disabilities or long-term illnesses. The aim of this study is to investigate whether the factors age, gender, self-perceived relationship with teachers, self-perceived relationship with peers and parental bonding can predict school engagement of students with self-reported long term health conditions and impairment. School engagement is defined as having three aspects, behavioral, emotional and cognitive. HBSC (Health behaviors in School Children) data from Sweden is used. The result shows that self-perceived relationship with teachers and age are related to all three components of school engagement, behavioral, emotional and cognitive in this study.  Self-perceived relationship with peers is related to emotional school engagement only. Gender is related to cognitive engagement. Parent bonding cannot predict any of the three aspects of school engagement. This study demonstrated that school environment, especially teachers, is important for the school engagement of students with long-term health condition and impairment. Dispite the inconsistent results with previous reseach which focus on typical functioning students, School and educators should focus on how to maintain and improve and promote school engagement of students with long-term health condition and impairment in mainstream school setting.

ABSTRACT Background and aims: Nutrition is a part of the medical treatment, and also a part of the nursing care. In spite of this, malnutrition is a common problem in the health care sector. Studies show that nurses have too little knowledge about nutrition and malnutrition and that nutrition has low priority in the daily work. The aim with this study was to find out the nurses self-reported knowledge about and their attitudes towards malnutrition, nutrition screening, prevention and treatment of patients with malnutrition. Methods: A questionnaire was handed out to 65 nurses in two different care units and 36 questionnaires were answered. Results: The respondents from the two care units self-reported their knowledge about nutrition and malnutrition low. Most of the respondents stated to have a big need of education about nutrition screening and more than half of the respondents stated that they have a need of education for prevention and treatment of malnutrition. None of the respondents stated that there were good routines to discover and treat malnutrition in their care units. Less than half of the respondents stated that the patient´s nutrition had high priority to them. Conclusion: The self-reported knowledge about nutrition and malnutrition, nutrition screening, prevention and treatment of patients with malnutrition is low among nurses. There is a big need of education about nutrition screening, prevention and treatment of malnutrition. Good and transparent routines and policies for nutrition screening and treatment of malnutrition are missing. Patient´s nutrition has low priority.To educate nurses within nutrition screening, prevention and treatment of malnutrition and to implement clear and simple-to-use nutrition screening instruments seems to be very important for improvement of patient´s nutritional care.

Privacy emerges as a critical issue in an e-commerce environment because of a fundamental tension among corporate, consumer, and government interests. By reviewing prior Internet-privacy research in the fields of information systems, business, and marketing published between 1995 and 2006, we consider the following research questions: 1) how an individual’s privacy behaviour is affected by privacy policy disclosures and by the level of the individual’s involvement regarding the sensitivity of personal information; 2) how companies’ privacy policies vary with respect to regulatory approaches and cultural values; and 3) whether there is a gap between the privacy practices valued by individuals and those emphasized by companies. A three-stage study is conducted to answer these questions. The first two stages, consisting of a Web-based survey and an online ordering experiment with 210 participants, found that individuals are more likely to read the privacy policy statements posted on Web sites and less likely to provide personal information, when they are under a high privacy involved situation as compared to being in a low privacy involved situation. However, the existence of a privacy seal did not affect individuals’ behaviour, regardless of involvement conditions. This study also found a gap between self-reported privacy behaviour and actual privacy behaviour. When individuals were requested to provide personal information, their privacy policy statement reading behaviour was close to their self-report behaviour. However, their personal information providing behaviour was different from their self-reported behaviour. The third stage, which entailed the study of 420 privacy policies spanning six countries and two industries, showed that privacy policies vary across countries, as well as with varying governmental involvement and cultural values in those countries. Finally, the analysis of all the three stages revealed a gap between individuals’ importance ratings of companies’ privacy practices and policies that companies emphasize in their privacy disclosures.

Privacy emerges as a critical issue in an e-commerce environment because of a fundamental tension among corporate, consumer, and government interests. By reviewing prior Internet-privacy research in the fields of information systems, business, and marketing published between 1995 and 2006, we consider the following research questions: 1) how an individual’s privacy behaviour is affected by privacy policy disclosures and by the level of the individual’s involvement regarding the sensitivity of personal information; 2) how companies’ privacy policies vary with respect to regulatory approaches and cultural values; and 3) whether there is a gap between the privacy practices valued by individuals and those emphasized by companies. A three-stage study is conducted to answer these questions. The first two stages, consisting of a Web-based survey and an online ordering experiment with 210 participants, found that individuals are more likely to read the privacy policy statements posted on Web sites and less likely to provide personal information, when they are under a high privacy involved situation as compared to being in a low privacy involved situation. However, the existence of a privacy seal did not affect individuals’ behaviour, regardless of involvement conditions. This study also found a gap between self-reported privacy behaviour and actual privacy behaviour. When individuals were requested to provide personal information, their privacy policy statement reading behaviour was close to their self-report behaviour. However, their personal information providing behaviour was different from their self-reported behaviour. The third stage, which entailed the study of 420 privacy policies spanning six countries and two industries, showed that privacy policies vary across countries, as well as with varying governmental involvement and cultural values in those countries. Finally, the analysis of all the three stages revealed a gap between individuals’ importance ratings of companies’ privacy practices and policies that companies emphasize in their privacy disclosures.

Vest, H. (2012).Möjligheter och hinder för samverkan inom offentlig sektor. Uppsats i pedagogik på kandidatnivå. Högskolan i Gävle, Akademin för utbildning och ekonomi. Denna undersökning syftar till att belysa upplevda möjligheter och hinder för samverkan, i arbetet med ungdomar rörande alkohol, narkotika, doping och tobak (ANDT). Studiesubjekten utgörs av 14 anställda på en kommun i södra Norrland. Metoden som använts i undersökningen är semi-strukturerad enkät med ett fåtal öppna frågor som ger utrymme för respondenterna att uttrycka sina upplevelser. Respondenternas svar har kategoriserats utifrån en analysmodell som belyser inre och yttre möjligheter och hinder för samverkan. Tidigare forskning rörande studieobjektet visar att samverkan har blivit en nödvändighet inom offentlig sektor idag i takt med att verksamheter renodlats och organisatoriskt gått från en centraliserad styrmodell till en decentraliserad. Samtidigt saknas en helhetssyn inom offentlig sektor som gör att individer i behov av hjälp ofta slussas mellan olika myndigheter i takt med att de utfört sitt eget specifika uppdrag. En fungerande samverkan är beroende av en mängd möjligheter och hinder kopplade dels till individer och dels till organisationen och dess struktur. Undersökningen visar att en majoritet av respondenterna besitter inre möjligheter för samverkan, i form av en vilja att samverka och en upplevelse av att samverkan är något positivt som främjar arbetet och gynnar resultatet. En majoritet av respondenterna upplever att de begränsas av yttre hinder kopplade till organisationen, främst faktorer som tid, ledarskap, förankring och strukturer för samverkan.

The objectives of this thesis were to examine (1) associations between primary care type (team-based versus non-team based) and access problems (difficulty in access and self-reported unmet need), and (2) if socioeconomic variations in access problems were less graded for team-based than non-team-based primary care. Data came from a nationally representative cross-sectional survey, the 2008 Canadian Survey of Experiences with Primary Health Care. Using logistic regression, we examined the associations between primary care type and access problems, adjusting for demographic, health status, socioeconomic, and health care supply factors. We then stratified by primary care type to compare steepness of socioeconomic associations with access problems. Primary care type had no statistically significant, independent associations with access problems. No statistically significant socioeconomic gradients in access problems were observed regardless of primary care type, except that difficulty in access was statistically significantly and positively graded by education for non-team-based primary care.

Background: Research points in different directions when looking at possible increases in mental health problems among adolescents. Findings in favor of an increase are questioned due to methodological problems. Aim: Investigating whether mental health problems among young adolescents are increasing over time in Europe and North America. If so, does the trend apply both to mean levels of symptoms and to the proportion of adolescents with substantial problems? Are the time-trends similar over sex and age-categories?                                                                                                    Method: A total of 401 089 adolescents from a total of 38 countries are included in the analysis. Based on the eight health variables on self-rated health provided by the HBSC study, a measurement of mental health problems was created using factor analysis in SPSS. Results: Increases of mental health problems were found in Europe and North America. Increases were found both in terms of mean levels of symptoms and to the proportion of adolescents with substantial problems. Increases were seen in all age groups and among both girls and boys. Conclusion: Reasons behind the discovered increases are not known and should be further investigated as extensive research point to severe consequences of mental health problems in adolescence for later life.       Key words   Adolescents, mental health problems, trends, self-reported health (SRH), psychological health complaints (PHC)