ABSTRACT Wångdahl, J. (2006). Hälsofrämjande budskap i en livsmedelsbutik- kunders uppfattningar. C-uppsats i Folkhälsovetenskap. Örebro, Hälsovetenskapliga institutionen. Obesity and being overweight are on the increase in Sweden which makes work in the area of health promotion very important. Many people are confused by the numerous and varied health messages presented in society as a whole which makes the design and promotion of efficient and effective health messages extremely important. One such example is messages presented in supermarkets. The purpose in this study is to examine customers perceptions and understanding of health promoting messages and the methods used, as they are spread in a supermarket. Individual interviews as well as focus group interviews in a qualitative approach are used to examine as many perceptions as possible. In total, 64 customers participated in the survey. The results from the surveys showed that some participants understood the health messages and the methods as they are spread. Others clearly did not. It also showed that some health messages and methods used to disseminate them were understood more often than others. The participants perceived the health messages and the methods used to disseminate them as something positive to a great extent. Most participants felt that health messages were needed in that they raise awareness and draw attention to healthy products especially when new lines are available. The health messages were also seen as a help and something which improved the atmosphere of a shop, in some cases also influencing them to buy healthier provisions. The designs were felt to be good, with the right quantity and presenting a message which was voluntary. When it came to trustworthiness, many participants thought it was important to be a little bit critical as it is new advice and findings every day. Keywords: Health promoting messages, supermarket, customers perceptions.

När alkoholen kommer närmare - om förändrad alkoholtillgänglighet i en mindre svensk kommun En kvalitativ intervjustudie Ulrika Englund Örebro Universitet, Hälsovetenskapliga institutionen SAMMANFATTNING Denna studie syftar till att undersöka vad som händer i en kommun när alkoholtillgängligheten förändras, och detta med utgångspunkt i kommunens alkoholförebyggande arbete. En specifik tonvikt har lagts vid kommunens etablering av ett Systembolag. Följande perspektiv har studerats; 1) Beskrivningar av förebyggande arbete 2) Exempel på alkoholförebyggande arbete 3) Samverkan 4) Viktiga aktörer 5) Alkoholkällor 6) Möjligheter till tillgänglighetsbegränsning samt 7) Systembolagets betydelse för kommunen. Datainsamling skedde genom nio halvstrukturerade intervjuer med totalt tretton intervjupersoner vilka alla kom i kontakt med alkoholfrågan i sina arbeten. Intervjupersonerna kom att representera socialtjänst, kommun, skola, landsting, polis, Systembolaget, Brottsförebyggande rådet och nattvandrarverksamheten i den studerade kommunen. Insamlad intervjudata bearbetades med meningskoncentrering. Resultatet visar att ett omfattande alkoholförebyggande arbete bedrivs inom kommunen. Huvudsaklig fokus ligger på ungdomar och dess föräldrar och arbetet är ofta praktiskt inriktat på att försöka försena ungdomars alkoholdebut. Samverkan i alkoholrelaterade frågor pågår i stor utsträckning och många viktiga aktörer identifieras. Gruppen föräldrar bedöms vara den allra viktigaste parten i alkoholförebyggande sammanhang. Importerad alkohol beskrivs som vanligast i samband med ungdomars konsumtion och som den mest allvarliga och svårkontrollerade alkoholkällan. Systembolagets etablering i kommunen uppfattas som positiv. Någon konsumtionsökning eller ökad mängd alkoholrelaterade problem på grund av etableringen kan inte urskiljas. Systembolaget utgör ett viktigt led i tillgänglighetsbegränsningen med ålderskontrollen för alkoholinköp som den viktigaste uppgiften. Såväl den hembrända alkoholen som den offentliga ungdomsberusningen bedöms vara mindre förekommande än tidigare. Nyckelord: alkohol, förebyggande, ungdomar, Systembolaget, import, begränsning

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Background: Increasing costs and quantities of orphan drugs within the European market has led to much debate in Sweden on how they should be handled within the existing reimbursement system. Previously, there has been little research looking at local and regional handling of and implications of these issues when it comes to decision-making, financing, and access. This study aims to provide insight into these issues through perspectives and experiences obtained in interviews with representatives working for County Councils in Northern Sweden. Methods: A case study comprised of semi-structured interviews following a qualitative methodology with an inductive approach was used for this study. Five informants from three different work groups engaged with the orphan drug introduction process in Northern Sweden were interviewed. A thematic analysis was performed on the data where common themes were identified through several rounds of coding to allow cross-sectional analysis between data obtained from informants. Results: The thematic analysis identified five major themes surrounding the introduction process for orphan drugs; centralization of processes, methods & standardization, ethical considerations, economics & price setting, and challenges & difficulties. Informants provided insights, opinions, and a deeper understanding of these themes within the introduction process for orphan drugs. Conclusion: This study confirms many of the complexities in establishing a clear and fair process for introducing orphan drugs. In line with existing literature, informants highlighted how centralization and the pooling of resources and expertise is vital in ensuring equal quality and access to care for patients suffering from rare diseases. There is broad agreement how orphan drug legislation and processes should develop, but substantial hurdles concerning the specifics as well as issues with external actors on pricing of orphan drugs. Addressing these issues could potentially have important benefits, not only for healthcare budgets and patients suffering from rare diseases, but also in setting precedents for future processes where costs and ethics will again come to a head.

Human health depends on a well-functioning endocrine system to regulate hormone release for normal bodily functions. Endocrine disrupting chemicals (EDCs) constitutes a group of chemicals, included in many commonly used products, (e.g., PVC flooring), with properties proven or suspected to interact with the natural hormone system in humans and animals. EDCs are manmade compounds (there are also natural compounds with such properties) that can bind to cell receptors and mimic or block the functions of natural hormones potentially resulting in adverse human health effects. One type of widely concerning EDC is phthalates. Since phthalates create weak chemical bonds when they are added into different products, they readily leach into the surrounding environment. Phthalate metabolites can therefore be frequently measured in human biological samples. Major public health concerns regarding EDCs over the past three decades have focused on phthalates. According to the World Health Organization, EDCs are suspected to be associated with altered reproductive function in males and females, increased incidence of breast cancer, abnormal growth patterns and neurodevelopmental delays in children, as well as changes in immune function. The thesis shows that PVC flooring in the home is a source for human uptake of phthalates, that replacement of phthalates in soft PVC products have an impact on human uptake of these chemicals, and that exposure for phthalates in early life increase the risk for airway disorders in children. As we have shown, ongoing regulations on phthalates is of importance for human uptake. Ultimately, individuals can make small changes in their consumer product choices that can lead to changes in uptake of chemicals with endocrine disrupting properties. Philosophically, we all have a responsibility to protect future generations from dangerous chemicals. / Human health depends on a well-functioning endocrine system to regulate hormone release for normal bodily functions. Endocrine disrupting chemicals (EDCs) constitutes a group of chemicals, included in many commonly used products, (e.g., PVC flooring), with properties proven or suspected to interact with the natural hormone system in humans and animals. One type of widely concerning EDC is phthalates. Since phthalates create weak chemical bonds when they are added into different products, they readily leach into the surrounding environment. Phthalate metabolites can therefore be frequently measured in human biological samples. Major public health concerns regarding EDCs over the past three decades have focused on phthalates resulting in implementation of regulations. The thesis shows that PVC flooring in the home is a source for human uptake of phthalates, that replacement of phthalates in soft PVC products have an impact on human uptake of these chemicals, and that exposure for phthalates in early life increase the risk for airway disorders in children. This means that regulation and consumers’ product choices can lead to changes in uptake of EDCs of importance for human health. Philosophically, we all have a responsibility to protect future generations from dangerous chemicals.

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Background: Mental health disorders can be considered a public health problem and affect approximately one in ten people worldwide. It has profound negative effects on both the individual, the workplace and society. In the Swedish adult working population, diagnoses of mental health disorders is the most common reason for sick leaves among both men and women under the age of 50. Of these, depression and stress reactions are the primary diagnoses. Aim: To examine the relationship between sleep behaviour and depressive symptoms in a sample of working adults. Method: A cross-sectional design with data gathered through the use of actimetry, questionnaires and sleep diaries was employed. Analyses of correlation between sleep variables and depressive symptoms, analysis of variance to detect differences between groups and regression analyses to measure the predictive value of variables have been performed. Results: Depressive symptoms are positively associated with self-rated sleep measures. Self-rated sleepiness showed some explanatory value in predicting depressive symptoms but when adjusting for self-rated stress, sleepiness was no longer significant. Conclusion: Self-rated sleepiness only predicts depressive symptoms to a certain extent. Other factors such as self-rated stress seems to be a stronger indicator of depressive symptoms.

Background Air quality in Africa has remained a relatively under-researched field. Most of the African population is dependent on biomass for cooking and heating, with most of the combustion happening in low efficiency stoves in unvented kitchens. The resulting high emissions are compounded by ingress from poor outdoor air in a context of poor emissions controls. The situation is dire in slum households where homes are crowded and space is limited, pushing households to cook in the same room that is used for sleeping. This study assessed the levels of particulate matter with aerodynamic diameter £ 2.5 microns (PM2.5) in slum households and people's perceptions of and attitudes towards air pollution and health risks of exposure in two slum areas, Viwandani and Korogocho, in the Nairobi city. Methods The study employed both qualitative and quantitative methods. For the quantitative study, we used structured questionnaires to collect data about the source of air pollution among adults aged 18 years and above and pregnant women residing in the two study communities. We used the DustTrak™ air samplers to monitor the indoor PM2.5 levels in selected households. We also collected data on community perceptions on air pollution, annoyance and associated health risks. We presented hotspot maps to portray the spatial distribution of perceptions on air pollution in the study areas. For the qualitative study, we conducted focus group discussions with adult community members. Groups were disaggregated by age to account for different languages used to communicate with the younger and older people. We analysed the qualitative data using thematic analysis. Results Household levels of PM2.5 varied widely across households and ranged from 1 to 12,369μg/m3 (SD=287.11). The household levels of PM2.5 levels were likely to exceed the WHO guidelines given the high levels observed in less than 24 hours of monitoring periods (on average 10.4 hours in Viwandani and 11.8 hours in Korogocho). Most of the respondents did not use ventilation use in the evening which coincided with the use of cookstove and lamp, mostly burning kerosene. The levels of PM2.5 varied by the type of fuels, with the highest emissions in households using kerosene for cooking and lighting. The PM2.5 levels spiked in the evenings and during periods of cooking using charcoal/wood. Despite these high levels, residents perceived indoor air to be less polluted compared with the outdoor air, possibly due to the presence of large sources of emissions near the communities such as dumpsites and industries. The community had mixed perceptions on the health impacts of air pollution, with respiratory illnesses perceived as the main consequence while vector or sanitation related diseases such as diarrhoea was also perceived to be related to air pollution. Conclusions With poor housing and reliance on dirty fuels, households in slums face potentially high levels of exposure to PM2.5 with dire implications on health. To address the poor perception on air pollution and knowledge gaps on the health effects of air pollution, education programs need to be developed and tailored. These programs should aim to provide residents with information on air quality and its impact on the health; what they can do as communities as well as empower them to reach out to government/stakeholders for action on outdoor sources of pollution such as emissions from dumpsites or industries. The government has a larger role in addressing some of the key pollution sources through policy formulation and strong implementation/enforcement.

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