<p><em>Syfte</em></p><p>Huvudsyftet med denna studie var att undersöka om det finns ett samband mellan graden av fysisk aktivitet och nedstämdhet/depression bland elever i årskurs 3 på gymnasiet. Vidare syften var att undersöka om nedstämda/deprimerade elever upplever känsla av meningsfullhet, glädje och lycka, lugn och harmoni samt kontroll över sin vardag i samma utsträckning som icke nedstämda eller deprimerade elever. Dessutom är ambitionen att undersöka om den upplevda stressnivån samvarierar med graden av fysisk aktivitet. Slutligen skulle alla dessa aspekter undersökas ur ett genusperspektiv.</p><p><em>Metod</em></p><p>Till denna studie har en kvantitativ enkätmetod använts. Deltagarna i undersökningen bestod av 252 gymnasieelever i årskurs tre från olika gymnasieprogram på två gymnasieskolor. Enkätsvaren behandlades statistiskt med hjälp av SPSS där signifikansnivån var satt till (p<0,05)</p><p><em>Resultat</em></p><p>Resultaten visar att mer än var tredje elev på de aktuella skolorna var nedstämda eller deprimerade, flickorna i högre grad än pojkarna. Den fysiska aktivitetsnivån var låg, 37 % av flickorna och 28 % av pojkarna var fysisk inaktiva. De fysiskt aktiva eleverna hade signifikant lägre CES-D värde dvs. var i betydande lägre grad nedstämda och deprimerade. Resultaten visade att elever med hög fysisk aktivitetsgrad upplever sig ha en betydligt lägre stressnivå än eleverna med lägre eller obefintlig fysisk aktivitetsgrad. De nedstämda och deprimerade eleverna visade i denna studie med god signifikans att såväl flickor som pojkar till mellan 70 % och 90 % sällan eller aldrig upplever följande känslor: Lugn och harmoni, Glädje och/eller lycka, Kontroll över sin vardag samt Meningsfullhet </p><p><em>Slutsats</em></p><p>Resultaten i denna studie tyder på att den fysiska aktiviteten samvarierar med nedstämdhet och depression, men för att undersöka vad som är orsak och verkan måste interventionsstudier och vidare longitudinella studier i frågan utföras. Den fysiska aktiviteten verkar således samvariera med graden av nedstämdhet och depression.</p> / <p><em>The aim</em></p><p>The main aim of this study was to investigate if there is a correlation between the extent of physical activity and low-spiritedness/depression among students in the third year of upper secondary school. Further aims were to investigate if low-spirited or depressed students experienced the feelings of sense of meaning, joy and happiness, calm and harmony, and control of the weekday to the same extent as non low-spirited/depressed students. Moreover to investigate if the experienced level of stress relates to the amount of physical activity. Finally all these aspects where investigated with a gender perspective.</p><p><em>Method</em></p><p>In this study a quantitative questionnaire method was used. The participants were 252 students in the third year of upper secondary school from different study programmes. The questionnaire answers were statistically analyzed with SPSS, and the level of significance was set at p<0, 05.</p><p><em>Results</em></p><p>The results showed that more than a third of the students at the current schools where low-spirited or depressed, the girls to a higher degree than boys. The extent of physical activity was low, 37 % of the girls and 28 % of the boys where physically inactive.  The students who were very physically active had lower CES-D value i.e. they where less low-spirited and depressed. The results also showed that the students who had a higher extent of physical activity experienced a lower level of stress then students with lower extent or non physical activity. Seventy to ninety percent of those in this study who were low-spirited or depressed exhibited, girls as well as boys, that they seldom or never experienced the following feelings: sense of meaning, joy and happiness, calm and harmony, and control of the weekday.</p><p><em>Conclusion</em></p><p>The results from this study indicate that the extent of physical activity has a covariance with low-spiritedness and depression. To investigate what the cause and effect is intervention studies and longitudinal studies of this effect must be done. However, it appears that physical activity covariates with the extent of low spiritedness and depression.</p>

The overall aim of this thesis was to explore the impact of workplace social relations on the implementation of return-to-work interventions. The thesis consists of four separate papers with specific aims. In Paper I, the overall purpose of the study was to analyse how a multi-stakeholder return-to-work programme was implemented and experienced from the perspective of the stakeholders involved, i.e. supervisors, occupational health consultants and a project coordinator. The objective was to identify and analyse how these stakeholders perceived that the programme had been implemented in relation to its intentions. In Paper II, the objective was to explore how workplace actors experience social relations, and how organisational dynamics in workplace-based return-to-work start before and extend beyond the initial return of the sick-listed worker to the workplace. In Paper III, the objective was to explore the meaning of early contact in return-to-work, and how social relational actions and conditions can facilitate or impede early contact among workplace actors. In Paper IV, the objective was to explore the role of co-workers in the return-to-work process, and their contribution to the process, starting from when a colleague falls ill, continuing when he/she subsequently becomes sick-listed and finally when he/she re-enters the workgroup. The general methodological approach to the papers in this thesis has been explorative and interpretive; qualitative methods have been used, involving interviews, group interviews and collection of employer policies on return-to-work. The data material has been analysed through back-and-forth abductive (Paper I), and inductive (Papers II-IV) content analysis. The main findings from Paper I show that discrepancies in the interpretations of policy intentions between key stakeholders (project coordinator, occupational health consultants and supervisors) created barriers for implementing the employer-based return-to-work programme, due to lack of communication, support, coaching and training activities of key stakeholders dedicated to the biopsychosocial intentions of the programme. In Papers II-IV, the workplace actors (re-entering workers, co-workers, supervisors and/or human resources manager) experienced the return-to-work process as phases (time before the sick leave, when on sick leave, when re-entering the workplace, and future sustainability). The findings highlight the importance and relevance of the varied roles of the different workplace actors during the identified phases of the return-to-work process. In particular, the positive contribution of co-workers, and their experience of shifting demands and expectations during each phase, is acknowledged. During the period of time before sick leave the main findings show how workplace actors experience the meaning of early contact within a social relational context, and how early contact is more than an activity that is merely carried out (or not carried out). The findings show how workplace actors experience uncertainties about how and when contact should take place, and the need to balance possible infringement that early contact might cause for the re-entering worker between pressure to return to work and their private health management. The findings in this thesis show how the workplace is a socially complex dynamic setting, which challenges some static models of return-to-work. The biopsychosocial and ecological/case management models and policies for return-to-work have been criticised for neglecting social relations in a return-to-work process at the workplace. This thesis provides increased knowledge and explanations regarding important factors in workplace social relations that facilitate an understanding of what might “make or break” the return-to-work process.

No description available.

Syfte Huvudsyftet med denna studie var att undersöka om det finns ett samband mellan graden av fysisk aktivitet och nedstämdhet/depression bland elever i årskurs 3 på gymnasiet. Vidare syften var att undersöka om nedstämda/deprimerade elever upplever känsla av meningsfullhet, glädje och lycka, lugn och harmoni samt kontroll över sin vardag i samma utsträckning som icke nedstämda eller deprimerade elever. Dessutom är ambitionen att undersöka om den upplevda stressnivån samvarierar med graden av fysisk aktivitet. Slutligen skulle alla dessa aspekter undersökas ur ett genusperspektiv. Metod Till denna studie har en kvantitativ enkätmetod använts. Deltagarna i undersökningen bestod av 252 gymnasieelever i årskurs tre från olika gymnasieprogram på två gymnasieskolor. Enkätsvaren behandlades statistiskt med hjälp av SPSS där signifikansnivån var satt till (p&lt;0,05) Resultat Resultaten visar att mer än var tredje elev på de aktuella skolorna var nedstämda eller deprimerade, flickorna i högre grad än pojkarna. Den fysiska aktivitetsnivån var låg, 37 % av flickorna och 28 % av pojkarna var fysisk inaktiva. De fysiskt aktiva eleverna hade signifikant lägre CES-D värde dvs. var i betydande lägre grad nedstämda och deprimerade. Resultaten visade att elever med hög fysisk aktivitetsgrad upplever sig ha en betydligt lägre stressnivå än eleverna med lägre eller obefintlig fysisk aktivitetsgrad. De nedstämda och deprimerade eleverna visade i denna studie med god signifikans att såväl flickor som pojkar till mellan 70 % och 90 % sällan eller aldrig upplever följande känslor: Lugn och harmoni, Glädje och/eller lycka, Kontroll över sin vardag samt Meningsfullhet  Slutsats Resultaten i denna studie tyder på att den fysiska aktiviteten samvarierar med nedstämdhet och depression, men för att undersöka vad som är orsak och verkan måste interventionsstudier och vidare longitudinella studier i frågan utföras. Den fysiska aktiviteten verkar således samvariera med graden av nedstämdhet och depression. / The aim The main aim of this study was to investigate if there is a correlation between the extent of physical activity and low-spiritedness/depression among students in the third year of upper secondary school. Further aims were to investigate if low-spirited or depressed students experienced the feelings of sense of meaning, joy and happiness, calm and harmony, and control of the weekday to the same extent as non low-spirited/depressed students. Moreover to investigate if the experienced level of stress relates to the amount of physical activity. Finally all these aspects where investigated with a gender perspective. Method In this study a quantitative questionnaire method was used. The participants were 252 students in the third year of upper secondary school from different study programmes. The questionnaire answers were statistically analyzed with SPSS, and the level of significance was set at p&lt;0, 05. Results The results showed that more than a third of the students at the current schools where low-spirited or depressed, the girls to a higher degree than boys. The extent of physical activity was low, 37 % of the girls and 28 % of the boys where physically inactive.  The students who were very physically active had lower CES-D value i.e. they where less low-spirited and depressed. The results also showed that the students who had a higher extent of physical activity experienced a lower level of stress then students with lower extent or non physical activity. Seventy to ninety percent of those in this study who were low-spirited or depressed exhibited, girls as well as boys, that they seldom or never experienced the following feelings: sense of meaning, joy and happiness, calm and harmony, and control of the weekday. Conclusion The results from this study indicate that the extent of physical activity has a covariance with low-spiritedness and depression. To investigate what the cause and effect is intervention studies and longitudinal studies of this effect must be done. However, it appears that physical activity covariates with the extent of low spiritedness and depression.

This thesis presents perspectives of men regarding abortion, contraceptive use and sexuality. Contrary to what we had expected, men expressed anxiety over abortion and contraceptive use, not because the issues concerned women’s health, but rather because men associated them with extramarital sexual activity they thought women were concealing. To understand the meanings of sexuality and factors shaping these meanings appeared to be a necessary step in promoting women’s health. We thus included in the study participants with different characteristics including men, women and adolescents, and used a variety of qualitative methods to explore in-depth these issues. Men’s anxiety over wives’ sexuality seemed to be exacerbated by their separation from the family through labour migration, and their inability to play the expected role of the family breadwinner. The men described using different strategies to ensure their wives did not use contraceptives. Men’s perspectives and the related dynamics seem therefore to be a manifestation of contradictory experiences of gender power within contexts of spousal separation. The thesis also illuminates the paradoxical situation of adolescents and adolescent sexual and reproductive health. As guardians, the men described how they are intolerant to premarital sex and pregnancy, which might threaten the expected bride wealth from the marriage of a daughter or sister. They therefore respond with violence. Ironically, information or service which would enable unmarried girls to prevent pregnancy is also denied. This is so in spite of the great concern by families over premarital pregnancy, and common knowledge that young girls are sexually abused by adult men. The men and boys described the pressure they exert on the girls for sex, but also how they then blame the girls for deliberately becoming pregnant in order to trap them into marriage. The boys are nevertheless anxious about pregnancy also for fear of family violence and the threat of being forced to terminate schooling. The girls expressed feeling trapped between the violence from guardians and partners, a situation which may lead to unsafe abortion. The silence, denial and violence imply the young people generally cannot discuss sexual abuse or abortion with parents, or seek health care when needed. Rather, sexually transmitted infections may be ndured or even self-treated, and abortion sought in silence. Preventive actions such as condom use are similarly difficult for the youth. The knowledge the youth may have about AIDS may also simply become a burden when room for applying it is limited. This thesis challenges public health promotion approaches that assume firstly a universal manifestation of gender power, and secondly ability of individuals to effect behaviour change once provided with information regardless of contextual factors. Whether in AIDS education or involvement of men in sexual and reproductive health, understanding social contexts and dynamics, and identities and experiences within these contexts is crucial.

FOOD HABITS, DIETARY INTAKE AND NUTRITIONAL STATUS DURING ECONOMIC CRISIS AMONG PREGNANT WOMEN IN CENTRAL JAVA, INDONESIA Th. Ninuk Sri Hartini, Epidemiology and Public Health Sciences, Dept. of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Community Health and Nutrition Research Laboratories, Gadjah Mada University, Jogjakarta, Indonesia; Nutrition Academy, Ministry of Health, Jogjakarta, Indonesia ABSTRACT Objectives: The overall objective of this thesis was to study the effect of the economic crisis on food habits, dietary intake and nutritional status among pregnant women in Purworejo District, Central Java, Indonesia. Subjects and methods: Since 1994, the Community Health and Nutrition Research Laboratories (CHN-RL), Gadjah Mada University, Jogjakarta, Indonesia have operated a surveillance system in Purworejo District, Central Java, Indonesia. Between 1996 and 1998, a monthly monitoring of new pregnancies took place within the surveillance system. This project included a detailed evaluation of dietary intake during pregnancy. Each trimester six repeated 24-hour recalls were conducted on 450 pregnant women. Weight and mid-upper arm circumference (MUAC) were measured monthly, height and serum ferritin concentration was measured once. Here, the dietary intake and nutritional status of the women during the second trimester are evaluated in relation to the emergence of the economic crisis, that started in 1997. Women were classified into four socio-economic groups. A computer program (Inafood) was developed to calculate nutrient intake. To support the quantitative results, a qualitative study was carried out between January and June 1999. Focus group discussions were held with four groups of women, in-depth interviews with 16 women, three traditional birth attendants and four midwives, and observations were carried out with four women. Here, food habits and coping strategies in relation to the economic crisis were explored. Results: Before the crisis, more than 80% of the pregnant women had inadequate energy and 40% had inadequate protein and vitamin A intake. All women had inadequate calcium and iron intake. The food intake consisted of rice, nuts and pulses and vegetables, meaning that it was mainly plant-based food. Rice behaved as a strongly inferior good in economic term, meaning that its consumption increased in spite of its price increase. Rice remained an important supplier of energy, protein and carbohydrates also during the crisis. Especially, rural, poor women with access to rice fields increased their rice intake and decreased their intake of non-rice staple foods. Reasons for the continued rice intake included the women had been accustomed to eating rice since they were born and that cooking methods for non-rice staple foods were difficult. The intake of animal food was low initially and decreased further during the economic crisis. Rich women decreased their intake of fat. The intake of nuts and pulses and vegetables increased for most groups. Nuts and pulses were an important supplier of calcium and iron, and vegetables were an important supplier of vitamin A. The rural, poor women with access to rice fields kept their food taboos also during the crisis. Rich women were able to maintain a good nutrient intake during the crisis, although fat intake decreased. Also, urban poor and rural, poor, landless women had an increased intake “during crisis” because relatives and neighbour provided some foods and perhaps also because of the government support programme. Conclusion: Before the crisis, energy and nutrient intake of pregnant women were inadequate. The food pattern of the women was predominately plant-based. Rich women were able to maintain a good nutrient intake during the crisis, although fat intake decreased. Rural poor women with access to rice fields had a higher rice intake than other groups throughout the crisis. Urban poor and rural poor, landless women experienced a decreased intake of most nutrients in the transition period but an increased intake during the crisis, reflecting government intervention and support from relatives and neighbours. The latter, however, is not sustainable. Thus, vulnerable groups are at risk of developing nutritional deficiencies without food support programmes. Key words: Food intake, nutrient intake, nutritional status, food pattern, pregnancy, food habits, coping strategies, economic crisis, Indonesia.

Background: Iron and zinc are difficult to provide in sufficient amounts in complementary foods to infants world-wide, resulting in high prevalence of both iron and zinc deficiency. These deficiency states cause anemia, delayed neurodevelopment, impaired growth, and increased susceptibility to infections such as diarrhea and respiratory infections. Design: Two different intervention strategies; reduction of a possible inhibitor of iron and zinc absorption, i.e. phytate, or supplementation with iron and zinc, were applied to two different populations in order to improve iron and zinc nutrition: In a high-income population (Umeå, Sweden), the amount of phytate in commonly consumed infant cereals was reduced. Healthy, term infants (n=300) were at 6 mo of age randomized to phytate-reduced infant cereals, conventional infant cereals, or infant formula and porridge. In a low income population (Purworejo, Indonesia), daily iron and zinc supplementation was given. Healthy, term infants (n=680) were at 6 mo randomized to supplementation with iron, zinc, a combination of iron and zinc, or placebo. Blood samples, anthropometrical measurements, and data on infant neurodevelopment and morbidity were collected. Also, in the Swedish study, detailed information on the dietary intake was recorded. Results: In the Swedish study, the reduction of phytate had little effect on iron and zinc status, growth, development or incidence of diarrhea or respiratory infections, possibly due to the presence of high contents of ascorbic acid, which may counteract the negative effects of phytate. In the Indonesian study, significant negative interaction between iron and zinc was evident for several of the outcomes; Hb and serum ferritin improved more in the iron only group compared to placebo or the combined iron and zinc group. Further, supplementation with iron alone improved infant psychomotor development and knee-heel length, whereas supplementation with zinc alone improved weight and knee-heel length compared to placebo. Combined iron and zinc supplementation did decrease the prevalence of iron deficiency anemia and low serum zinc, but had no other positive effects. Vomiting was more common in the combined group. Analyses of dietary intake from the Swedish study showed that dietary iron intake in the 6-11 mo period was significantly associated with Hb, but not serum ferritin at 9 and 12 mo, whereas the opposite was true in the 12-17 mo period, i.e. dietary iron intake was significantly associated with serum ferritin, but not Hb at 18 mo. Conclusions: The phytate content of commercial infant cereals does not seem to contribute to poor iron and zinc status of Swedish infants as feared. However, the current definitions of iron and zinc deficiency in infancy may overestimate the problem, and a change in the recommended cutoffs is suggested. These studies also indicate that dietary iron is preferably channeled towards erythropoiesis during infancy, but to an increasing amount channeled towards storage in early childhood. This suggests that in evaluating dietary programs, Hb may be superior in monitoring response to dietary iron in infancy, whereas S-Ft may respond better later in childhood. However, as shown in this study, increasing Hb may not necessarily be an indicator of iron deficiency, as more dietary iron increased Hb regardless of iron status. In the low-income setting combined supplementation with iron and zinc resulted in significant negative interaction. Thus, it is not possible to recommend routine iron-zinc supplementation at the molar concentration and mode used in this study. It is imperative that further research efforts are focused at finding cost-effective strategies to prevent iron and zinc deficiency in low-income populations.

Introduktion: Fysisk inaktivitet och stillasittande beteende är två av de största riskfaktorerna för ohälsa, sjukdom och död i västvärlden idag. Många människor uppfyller inte riktlinjerna kring regelbunden fysisk aktivitet, och studenter är inget undantag. Aktiva studenter var ett projekt på KTHhallen i Stockholm som bedrevs för sjätte året i rad med syftet att få fysiskt inaktiva studenter att bli aktiva. Syfte: Syftet med denna studie var att undersöka varför deltagarna valde att delta i Aktiva studenter, hur de upplevde projektet samt om de upplevde några effekter av sitt deltagande och i så fall på vilket sätt.  Metod: Studien genomfördes som en kvalitativ intervjustudie med sex semistrukturerade intervjuer. Materialet sorterades med hjälp av studiens syfte och diskuterades sedan med hjälp av Deci och Ryans Self-Determination Theory och tidigare forskning inom ämnet. Resultat: Alla deltagare brukade vara fysiskt aktiva när de var yngre, men hade de senaste åren varit inaktiva. De definierade sig ändå som aktiva personer, vilket var en av huvudanledningarna till att de ansökte till Aktiva studenter. De ville återfå sina gamla vanor. Studien visade att Aktiva studenter hade positiva effekter på deltagarnas fysiska aktivitetsvanor. Nästan alla deltagare trodde att de skulle fortsätta med dessa vanor om ett och tio år. Studien visade också att den ökade fysiska aktivitetsnivån hade positiva effekter på deras fysiska och mentala hälsa.  Konklusion: Genom deltagande i Aktiva studenter ökade deltagarnas motivation till fysisk aktivitet, och då främst den yttre motivationen. Studenterna som deltog i studien hade varit aktiva tidigare i livet men var inaktiva vid projektets start. Det är därför inte möjligt att utifrån denna studie säga om och hur studenter som aldrig varit fysiskt aktiva tidigare, och som är fullständigt omotiverade till att bli detta, skulle påverkas av ett liknande projekt då de inte förekom som deltagare i studien, men trots detta kan ha deltagit i projektet.

Stress kan påverka den fysiska och psykiska hälsan när en obalans mellan de krav som ställs och förmågan att hantera dessa sker. Arbetsrelaterad stress är en konsekvens av hög arbetsbelastning i förhållande till individens förmåga. Tandhygienister behandlar många patienter per dag och det ställs höga krav på ekonomiska intäkter. Samtidigt ska hög kvalitativ vård ges till patienter. Därför var syftet med denna litteraturstudie att undersöka om tandhygienister upplevde stress i sitt arbete och hur stress påverkade deras fysiska och psykiska hälsa.   Utifrån sex sökningar i databasen PubMed hittades åtta vetenskapliga artiklar, som ligger till grund för denna litteraturstudie. Metoderna som användes i de inkluderade studierna var: enkätstudier, intervjustudier och fysisk undersökning.   Samtliga artiklar visade att stress påverkade den fysiska och psykiska hälsan negativt. Stress påverkade den fysiska hälsan genom bland annat muskuloskelettala besvär i nacke, axlar, rygg och handleder.  Faktorer som påverkade den fysiska hälsan var, operationsstolar, arbetslivserfarenhet samt antalet patienter som behandlades per dag.   Den psykiska hälsan påverkades genom bristande kontroll över tidbok, social isolering, och dålig återkoppling från chefer. Arbetsrelaterad stress och muskuloskelettala besvär var två anledningar till varför tandhygienister sjukanmälde sig.   Slutsatsen med studien är att arbetsrelaterad stress har en negativ påverkan på tandhygienisternas fysiska och psykiska hälsa. Stress leder till muskuloskelettala besvär i bland annat nacke, axlar, rygg och handleder, samt otrivsel på arbetet och sjukanmälningar.

<p>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.</p>