<p>Diss. Umeå : Umeå universitet, 1989</p> / digitalisering@umu

Sedan 2004 har en stor ökning skett av ensamkommande barn i Sverige och år 2014 kom över 7000 barn hit. Ett ensamkommande barn är ett barn som kommer utan sina föräldrar eller någon som företräder föräldrarna. Det vanligaste hälsoproblemet hos ensamkommande barn är psykisk ohälsa, på grund av bland annat traumatiska upplevelser i deras liv. Syftet med denna studie är att beskriva vad omgivande aktörer har för uppfattning om ensamkommande barns förutsättningar för god hälsa. Undersökningarna för studien har gjorts med hjälp av åtta kvalitativa enskilda intervjuer. Intervjupersonerna var människor som på något sätt har kontinuerlig kontakt med ensamkommande barn i en mindre kommun i Mellansverige. Intervjuerna analyserades i en manifest innehållsanalys. De etiska forskningsprinciperna samt kvalitetskriteriet tillförlitlighet har beaktats under undersökningens gång. I resultatet framkom att integrering, stöd och engagemang från samhället, skolan och omgivande aktörer upplevdes som förutsättningar för ensamkommande barns hälsa. Flera faktorer ansågs ha påverkan på ensamkommande barns hälsa, exempelvis trauman, utbildning, sociala relationer och möjlighet till fritidsaktiviteter. De omgivande aktörerna upplevde att dessa faktorer även kunde påverka och vara avgörande för varandra. Slutsatserna blev att det finns vissa faktorer som i större utsträckning upplevs påverka ensamkommande barns förutsättningar för hälsa. Trots att de ensamkommande barnen i viss mån anses ha goda förutsättningar finns det flera sätt att förbättra och öka deras möjligheter till god hälsa. / Since 2004, the amount of unaccompanied children in Sweden has increased and 2014 over 7000 children came here. An unaccompanied child is a child who is coming without its parents or someone who can act in their place. The most common health problem among unaccompanied children is mental illness, for instance because of traumatic incidents in their lives. The aim of this study is to describe the involved persons’ opinions about unaccompanied children’s opportunities for good health. The surveys for the study have been conducted by eight qualitative separate interviews. The persons interviewed were people who in some way have continuous contact with unaccompanied children in a smaller district in the middle of Sweden. The interviews were analyzed in a manifest content analysis. The ethic principles for research and trustworthiness have been observed during the study. The result shows that integration, support and engagement from the community, school and persons involved were experienced as conditions for unaccompanied childrens health. Several factors were considered influence unaccompanied children’s health, for example trauma, education, social relations and the possibility of recreational activities. The persons involved considered that these factors also could influence and be crucial for each other. The conclusions were that there are some factors that to a greater extent are experienced to influence unaccompanied children’s opportunities for good health. Even though the unaccompanied children in some degree are considered to have good opportunities, there are several ways of improving and increasing their possibilities for good health.

This paper investigates the influence of various macroeconomic variables on Japan’s merger and acquisition (M&A) activity, both in terms of total deal value and total number of deals. Looking at monthly data from June 1997 to December 2013, I use econometric time-series analysis to find that: First, total deal value per month is not well explained by our macroeconomic variables, but about half of the variation in number of deals per month can be explained by our dataset. Second, the most important determinant in the total number of deals per month during our period is the level of national debt, and interest rates had the opposite effect from what was originally expected. Third, adding lag variables to our analysis proved to be relatively fruitless. Finally, when taking a look at only the past couple of years to determine the effects of “Abenomics” on M&A activity in Japan, I conclude that there is not enough data, and better results would be obtained in the future.

While previous health research with Aboriginal populations focused almost exclusively on Aboriginal Peoples of First Nations descent living on reserves or in isolated rural communities in Canada, this study focusing on diabetes aimed to engage Aboriginal Peoples of First Nations and Métis descent living in an urban Ontario setting. Type 2 diabetes mellitus is a progressive metabolic disorder that affects Aboriginal Peoples of Métis and First Nations descent disproportionately compared to the rest of the Canadian population. To understand this disparity in diabetes incidence and to address issues with existing diabetes prevention and management strategies, this study: a) explores the perceptions surrounding Type 2 diabetes and its prevention from First Nations and Métis community people and health service providers and policy makers; and b) informs the existing diabetes prevention, management and care strategies in light of these perceived understandings. Primary data was collected through 40 in-depth one-on-one narrative interviews with First Nations and Métis people, health service providers and policy makers. Thematic codes that emerged through the narrative analysis of this data revealed that to fully understand the social determinants of diabetes in an urban First Nations and Métis people’s context required the application of intersectionality theory, since production of First Nations and Métis diabetes is socially determined and deeply intersectional. By combining the concepts of the social determinants of health and intersectional approaches, narrative analysis of the primary data revealed that diversities in socio-economic, cultural, legal and spatial contexts determine First Nations and Métis people’s life choices and have a strong bearing on their health outcomes. First Nations and Métis participants’ narratives revealed that dimensions of marginalization were reflected not only through inadequate material resources, but also through intersections of multiple factors such as colonial legacies, stereotyping, legal statuses, and the pan-Aboriginal nature of government policies and services. First Nations and Métis community members indicated that preventive programming aimed at avoiding or managing diabetes should be grounded in balancing and restoring the positive aspects of physical, mental, spiritual and emotional health and should also balance their diverse needs, lived realities, and social circumstances. The views of health service providers and policy makers captured in this thesis tended to reflect an understanding of diabetes causation grounded in both biomedical and intersecting social determinants of health. At the pragmatic level, however, the solution to this health issue presented by health service providers and policy makers addresses only the measurable individualistic biomedical risk factors of diabetes. Policy makers also discussed the need for developing qualitative indicators of the success of presently implemented health programs. Overall, the results of this study indicated that effective diabetes prevention and management strategies for urban First Nations and Métis people must recognize and address the diversities in their historical, socio-economic, spatial and legal contexts as well as their related entitlement to health services. A comprehensive diabetes prevention strategy should target the social determinants of health that are specific to urban First Nations and Métis people and must build on community strengths.

Courtesy stigma is the public disapproval evoked as a consequence of associating with a stigmatized individual or group. While there are few examples of research applying the concept of courtesy stigma to the professional associates of stigmatized persons, courtesy stigma has been shown to limit the social support and social opportunities available to family members who come to share some of the shame, blame and loss associated with their family member’s stigma(s). Research on the occupational health of persons performing frontline service work examines various sources of workplace demands and rewards, including the availability of public funding for the health and social service sectors, the devaluation of feminized forms of care-oriented work, and the downloading of responsibility for providing care to poorly paid or unpaid workers in the community and home. This research project blends the literatures on courtesy stigma and the occupational health of frontline service workers to understand the work experiences of those providing frontline social services to sex workers. A mixed methods design is used to study the workplace experiences of a small group of workers in a non-profit organization providing support and educational services to sex workers. The findings reveal that courtesy stigma is a discernable experience among this vulnerable group of service workers, affecting their work, community and family contexts. Courtesy stigma played a significant role in staff perceptions of others’ support for themselves and their work activities, leading to diminished opportunities for collaborative relationships, emotional exhaustion, altered service practices, and a low sense of workplace accomplishment. Thus, courtesy stigma forms part of the package of conditions that leads to high turnover, diminished workplace health, and a loss of service capacity in the frontline health and social service sector. The dissertation concludes with a consideration of the implications of the findings for the literatures on courtesy stigma and frontline service work, arguing that courtesy stigma is an underestimated determinant of occupational health for frontline service providers serving socially denigrated groups.

This thesis is a subset of a larger “parent” project under the direction of my supervisor, Dr. Cecilia Benoit. The purpose of the larger project is to seize an unique research opportunity that has emerged with the development and implementation of the HerWay Home (HWH) program, a community-based initiative for pregnant and early parenting women who face substance use and other challenges in the Greater Victoria Area. My research has capitalized on the pre-implementation phase of the HWH program between 2010-2011. Thirteen in-person semi-structured interviews were conducted with women who would likely be clients for the HWH program, based on their pregnancy experiences, substance use concerns and other life challenges. The goal of this research has been to explore these women’s pregnancy and postpartum narratives and investigate what, in their view, should be crucial components of the HWH intervention in the short and longterm. My findings indicate that, consistent with the literature on pregnant and early parenting women facing substance use and other life challenges, a range of complex, intertwined disadvantages exist in their lives that translate into multiple barriers to accessing continuous health and social care during their pregnancy and after the birth of their child. An adapted model of the Health Lifestyle Theory is used to frame the analysis of the data collected from this research. The results from this research support the argument that the life choices of the participants are constrained by structural life chances and socially determined inequities that systematically disadvantage and disempower them. The findings also reveal an implicit sense of agency in the women’s narratives, as well as key specifics about what they view as the main gaps in care and their desired program services. The findings will be relayed to HWH organizers, and used to inform the development and implementation of the program’s services. / Graduate

The aim of this study was to develop, implement and evaluate the effectiveness of a behavior based, theory driven multi-component nutrition education Intervention promoting healthy eating among two (17 to 19 year old) Lebanese adolescent samples from contrasting socioeconomic statuses. The effects of the intervention were examined in a quasi-experimental control design trial among two hundred and nine adolescent males and females from Beirut, Lebanon: one hundred and ten belonged to a high socioeconomic status (HSES) population and ninety nine belonged to a low socioeconomic status (LSES) population of adolescents. There were four study groups: two intervention and two control. The intervention groups received twelve nutrition lessons, one hour each, involving class based teaching, print materials and activities delivered by a dietitian. Intervention Mapping protocol was applied and constructs from the Social Cognitive Theory were used for the development of the intervention. At baseline and after the intervention, food frequency questionnaires (FFQ) were administered and three 24-Hour Dietary Recalls were used to examine dietary practices and nutrient intakes while semistructured interviews were conducted to gain insight to underlying determinants of food choice. Quantitative data were analyzed using Mann Whitney U Test and Chi-Square analysis. Post intervention, adolescents in both the HSES and LSES intervention groups showed a significant improvement (p<0.05) in some dietary practices and nutrient intakes; however, the impact was higher in the HSES group. In both intervention groups, positive changes were observed in some personal determinants of food choice but none were noted for external factors. These results propose that the developed nutrition education intervention is a promising instrument to promote healthy eating among similar groups of Lebanese adolescents; however, further research is needed for interventions that specifically target LSES groups.

There is a growing public health concern over the effects that sedentary lifestyles are having on the health of young people, particularly in relation to overweight and obesity. This thesis presents five studies which examine the prevalence, incidence and determinants of sedentary behaviour among youth. The rationale for eachs tudy derives from a framework of behaviourale. pidemiology applied to physical activity and health. Study I presents four systematic reviews of literature. The first review presents a descriptive epidemiology of youth sedentary behaviour. The second review presents a summary of empirical correlates of television viewing, the most prevalent sedentary behaviour among young people. 'Me third and fourth reviews present quantitative syntheses of empirical relationships between television viewing and body composition (review 3) and sedentary behaviour and physical activity (review 4). Study 2 examines the prevalence and interrelationships among different sedentary behaviours and physical activity in a cross-nationa(l USA & UK) sample of 2,494 youth ages 11-15. Study 3 uses a qualitative strategy to generate a grounded framework from which to understand the choices young people make about how to spend their free-time. Study 4 adopts a micro-behavioural approach for understandingt he incidence and temporal patterning of sedentary behaviour among 162 adolescents (age 13-16). Study 5 presents an evaluation of a behaviour change theory useful for increasing levels of physical activity and reducing sedentary behaviour. Sedentary behaviour and physical activity do not appear to be two sides of the same coin and appear to have different sets of determinants. This is an important finding becausee fforts to increase levels of physical activity may not reduce levels of sedentary behaviour. While television viewing, video games and computer use are consistent referents in the academic and media panic surrounding youth inactivity, it is unlikely that these behaviours play a substantialr ole in epidemiologic trends of adolescent overweight and obesity. Further study should attempt to examine how contemporary lifestyles contribute to the growing prevalence of overweight and obesity among adolescents.

Best Practices: Does it mean the same thing in the Aboriginal community as it does in the Health Authorities when it comes to diabetes care? / Population Health

Entre 1990 y 1994, coincidiendo con el inicio del proceso de transición, tuvo lugar un drástico incremento de la mortalidad en Rusia. Las tasas estandarizadas de mortalidad masculina (por 1000 hab) pasaron de 19,3 en 1990 a 25,7 en 1994. Este incremento se concentró en los hombres de edades medias y no afectó por igual a las diferentes causas de mortalidad ya que, mientras que las defunciones ocasionadas por tumores apenas aumentaron, las ocasionadas por enfermedades cardiovasculares y causas externas (violencia y accidentes) experimentaron un ascenso sin precedentes. Se ha estimado que el exceso de mortalidad respecto a la tendencia observada en las décadas precedentes se sitúa entre 2 y 3 millones de personas.En este trabajo, se analizan las posibles causas del aumento de la mortalidad adulta masculina observado entre 1990 y 1994, con el fin constatar la importancia de los determinantes de tipo psicosocial. A través del análisis de la evolución de la mortalidad por causas y edades así como de las diferentes posibles variables explicativas y partiendo de la multicausalidad del proceso, se argumenta que el proceso de transición específico que tuvo lugar en Rusia generó una situación de "desestructuración social" caracterizada por la aparición de nuevas tensiones de tipo psicosocial y por una reducción de los mecanismos para superarlo. En este contexto, el estrés jugó un papel catalizador del aumento de la mortalidad producido entre 1990 y 1994. Aunque otros determinantes de la salud como el funcionamiento del sistema sanitario, los estilos de vida, el descenso del nivel de ingresos y el deterioro medioambiental son factores que repercuten sobre la vulnerabilidad de la población y contribuyen a explicar el deterioro de algunos indicadores de la salud así como la tendencia descendente de la esperanza de vida observada desde 1965, éstos no ofrecen una explicación satisfactoria al acentuado aumento de la mortalidad que tuvo lugar a principios de los 90. En este trabajo se analiza, en primer lugar, la posible relación existente entre la evolución de la mortalidad y la rapidez e intensidad de las reformas llevadas a cabo en los diferentes PECO y ex-repúblicas soviéticas. El objetivo de dicho análisis es determinar si los procesos de transición han sido, en términos generales, letales. Una vez descartada esta hipótesis se pasa a profundizar en el caso de Rusia a través del análisis de series temporales de mortalidad por grandes grupos de causas, géneros y edades, constatándose que el incremento de la mortalidad se concentró en los hombres de edades medias y estuvo ocasionado fundamentalmente por enfermedades cardiovasculares y causas externas. Posteriormente, se analizan detalladamente cuatro grandes grupos de explicaciones posibles de dicho incremento: la continuación de una tendencia previa, los estilos de vida (tabaco, dieta, ejercicio físico y consumo de alcohol), los determinantes de tipo fundamentalmente material (nivel de ingresos, funcionamiento del sistema sanitario y situación medioambiental) y los determinantes de tipo psicosocial. Éstos últimos se analizarán en el marco de una situación de "desestructuración social" derivada del proceso de transición caracterizada por el deterioro de cuatro pilares fundamentales de la estructura social: la familia, las empresas, la comunidad y el estado. Finalmente se analiza la evolución de diferentes indicadores de la solidez de éstos cuatro pilares durante los primeros años de las reformas y se revisa la literatura existente en el ámbito de la epidemiología con el fin de constatar si la evolución de dichos indicadores puede, efectivamente, tener un impacto sobre la salud de la población, constatándose que dicho impacto puede traducirse a corto plazo en una mayor mortalidad por enfermedades del corazón y causas externas entre los hombres de edades medias. / Between 1990 and 1994, coinciding with the beginning of the transition process, a severe increase of death rates took place in the Russian Federation. The standardised mortality rates (per. 1000 pop.) rose from 19,3 in 1990 to 25,7 in 1994. The aim of this study is to analyse the possible causes of this increase in order to assess the importance of the role played by psychosocial determinats . Through an analysis of the evolution of mortality by age, gender and group of cause, as well as different possible explanatory variables, it will be argued that the specifics of the transition process that took place in the Russian Federation led to a situation of "social disorganisation" characterised by an upsurge of new sources of stress as well as a reduction in the support mechanisms used to overcome it. In this context, stress played a catalysing role in the mortality increase that took place between 1990 and 1994. Although other health determinats such as the state of the health care system, lifestyles, a reduction in incomes and the environmental situation contributed to the increased vulnerability of the population and explain part of the rising trend of death rates observed since 1965 as well as the deterioration of certain health indicators, they do not offer a satisfactory explanation to the short term mortality crisis. The analysis of mortality data reveals that the increase affected mainly middle aged men and was mostly due to heart disease and external causes of death such as violence and accidents, while other causes of death as cancer remained mostly at the same level. Four possible explanations for this increase will be considered: the continuation of a previous tendency, lifestyles, material determinants (income, health care system and environment) and psycho-social determinants. The later will be analysed in a context of "social disorganisation" derived from the transition process and characterised by the erosion of four fundamental pillars of the social structure: family, enterprise, community and state. The existing epidemiological evidence will be revised in order to confirm that the "social disorganisation" indicators which are analysed in this work, can effectively influence the evolution of mortality rates in the short term.