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Bakgrund: Arbetsmarknaden har förändrats och statistiken över sjukskrivningar på grund av psykisk sjukdom ökar. För att anställda ska hålla sig friska kan hälsopromotion på arbetsplatsen användas som strategi med arbetsmiljön som en stödjande miljö för hälsan. Hälsoinspiratörer finns inom både privat och offentlig sektor och arbetar för att inspirera till en hälsofrämjande arbetsmiljö. Syftet med studien är att skapa en fördjupad förståelse för hur hälsoinspiratörer inom kommunala verksamheter arbetar med hälsa på arbetsplatsen, vad som motiverar dem till att arbeta med hälsa på arbetsplatsen och undersöka hur deras hälsoarbete kan utvecklas. Metoden som används i studien är kvalitativa metoder och sex semistrukturerade intervjuer med hälsoinspiratörer har genomförts. Sedan har materialet transkriberats och analyserats genom en innehållsanalys. Resultatet visar att hälsoinspiratörer arbetar både med den fysiska- och den psykosociala arbetsmiljön. Vad som motiverar hälsoinspiratörerna till att arbeta med hälsa på arbetsplatsen visar resultatet är att de har ett personligt intresse för hälsa och välbefinnande samt att de upplever hälsoarbetet som meningsfullt för dem. Konklusionen är att hälsoarbete som riktar sig mot den psykosociala arbetsmiljön stärker det sociala klimatet på arbetsplatsen och motiverar både anställda i sina arbetsuppgifter och hälsoinspiratören i sitt hälsoarbete. Ett promotivt hälsoarbete riktat mot en god psykosocial arbetsmiljö kan ses som ett processarbete som inte har en början och inget slut, som ständigt bör utvärderas för att utvecklas.   Background: With a developed market on the working field the conditions is also changing with the development. The statistics tells that sick leave because of psychological illness is increasing and a strategi to keeping employees healthy the organizations can use health promotion as a strategy and the working environment can function as an environment that supports and enhances health. A health motivator is an employee whose job is to inspire to a health supporting working environment. The Aim is to create an understanding for how the health motivator in municipal organizations is working with workplace health promotion, what is motivating them in their inspire assignment and look into how their workplace health promoting can devolop. Method: A qualitative method has been used where six semistuctured interviews with health motivators have been done and transcribed. Thereafter analysed with a content analysis, where the data material was organized, coded and abstracted.  Results: The results shows that health motivators workplace health promotion includes both the physical and the psychologial working environment. And that health motivators inspires a motivation in their assignment for a personal interest in health and wellbeing and find the promotion meaningful for them. Conclusion: Health promoting oriented to the psychosocial work environment reinforces the social climate at the workplace and motivate both employees and health motivators in their work. Health enhancing workplace health promotion unto a good psychosocial work environment can be seen as a process of work that does not have a beginning and no end, which should be continuously evaluated to evolve.

<p>Litteraturstudiens syfte var att beskriva om/hur en kvinnas sociala situation och bakgrund inverkar på hennes ohälsosamma alkoholvanor. Datasökningen genomfördes i databasen MedLine (via PubMed). Nio artiklar uppfyllde inklusionskriterierna och bearbetades samt kvalitetsgranskades. Resultatet visade att olika stadier i en kvinnas liv såsom besvärliga uppväxtförhållanden, en tidig alkoholdebut och dåliga relationer i vuxenlivet inverkar negativt på hennes alkoholkonsumtion. Det fanns också ett klass- och genusperspektiv. Resultatet visade att kvinnor som hade en besvärlig uppväxt med våld och övergrepp konsumerade mer alkohol i det vuxna livet än de kvinnor som hade ”normal” uppväxt och vuxenliv. Ohälsosamma alkoholvanor var också relaterat till en tidig alkoholdebut och en tidig alkoholdebut var i sin tur relaterat till flickor som hade en låg självkänsla och ett aggressivt beteende. Kvinnor i relationer där partnern missbrukade, våldtog och misshandlade gjorde att kvinnans alkoholkonsumtion ökade. Klassperspektivet var tydligt sammanlänkat med en högre alkoholkonsumtion hos kvinnor som var skilda eller änkor, kvinnor som hade låg inkomst och låg utbildning, kvinnor som inte hade någon familj eller kvinnor som var deprimerade. Sammanfattningsvis visar resultatet att flera aspekter i en kvinnas liv såsom uppväxtförhållanden och socialsituation inverkar på hennes alkoholvanor. Detta är något som behöver uppmärksammas både i vården och i samhället.</p> / <p>The aim of this literature review was to describe if/how a woman´s social situation and background affects her unhealthy alcohol habits. A search in the Medline database found nine scientific articles. They were thoroughly processed and valued for quality. The results showed that different stages in a woman’s, life, upbringing, age of onset of drinking and relationships in adulthood had a negatively effect on her alcohol consumption. The results also highlighted a class and gender perspective. The results revealed that women, who went through childhood and adulthood with adverse experiences such as, sexually assaulted and abused physically or mentally were more likely to have hazardous high alcohol consumption rates in adulthood. Unhealthy alcohol habits were linked to the age of onset of drinking which also was linked to girls who had an aggressive behavior and a low self-esteem when they grew up. Women who lived in a relationship where the partner abused substance or assaulted her resulted in a more frequent alcohol drinking in more hazardous amounts. The class perspective was strongly associated with a woman’s unhealthy relations’ to alcohol for example; when the woman were widowed, divorced, women with a income around the poverty line, women with low or no education at all, women who had no family or women who were depressed, were more likely to have an high alcohol consumption then women who had a family, a good income and an education. In summary the result showed that several aspects in a woman’s life, upbringing and social situation do affect her alcohol habits. This is knowledge that needs attention both in the health care and in the society.</p>

Psoriatic arthritis (PsA) is an inflammatory joint disease associated with psoriasis. PsA has a heterogeneous pattern, expressed by different manifestations such as mild mono-oligoarthritis or very severe, erosive and destructive polyarthritis. Measurable inflammatory activity is not always prominent. The aetiology is unknown but genetic factors are believed to be of importance. The pattern of inheritance is proposed to be polygenic. The aim of this study was to estimate the prevalence of joint and axial manifestations, characterise the disease in relation to inflammatory and genetic markers, and to identify disease susceptibility gene(s) for PsA in patients from northern Sweden. All patients from the city of Umeå (n=276), selected from a community and hospital based psoriasis register (n=1737) at the Dept of Dermatology, were invited to a prevalence study. Two hundred-two patients were examined and 97 (48%) had inflammatory manifestations such as peripheral arthritis, axial disease, undifferentiated spondylarthropathy (uSpA) and enthesopathies. Of the 67 patients (33 %) with peripheral arthritis and/or axial disease, 30 were not previously diagnosed. The association of clinical manifestations and potential markers of aggressive joint disease with HLA associations were analysed in 88 patients with PsA. We were not able to confirm findings of other groups reporting strong association with several HLA-antigens. The prevalence of HLA-B17, B37 and B62 was increased compared with controls, but the strongest predictive factors among our patients for an aggressive disease, in a multiple logistic analysis, were polyarthritic disease and distal interphalangeal engagement. In order to investigate for disease susceptibility genes, five genetic loci were analysed with microsatellites and single nucleotide polymorphisms in an association study of 120 patients with PsA. There was a significant association with the TNFB locus on chromosome 6p but not with any other loci examined; 1q21 (PSORS4), 3q21 (PSORS5), 8q24 and CTLA4. When stratifying for the TNFB alleles the association was confined to allele 123. In a subgroup of patients who were HLA-typed (n=83), we were not able to verify linkage disequilibrium with the TNFB allele 123 and the HLA antigens; B17, B27, B37, B62 or Cw*0602. The presence of renal abnormalities was evaluated as a manifestation of systemic inflammation in 73 patients with PsA. Renal abnormalities defined as decreased creatinine-clearance (≤ mean - 2SD) and/or urinary albumin &gt;25 mg/24 h was found in 23% of the patients. The predictive factors for renal abnormalities was inflammatory activity (ESR &gt; 25 mm/h and/or CRP &gt;15 mg/L) indicating a systemic effect in some of the patients. In conclusion, we found high prevalence of inflammatory manifestations in patients with psoriasis. There was no strong association between PsA and HLA antigens and predictive factors for aggressive disease were polyarthritic disease and DIP joint engagement. The TNFB locus was associated with PsA and there were no linkage disequilibrium with the HLA antigens B17, B27, B62 or Cw*0602. There were evidence for systemic effects as renal abnormalities in patients with PsA and measurable inflammatory activity.

There is still a debate concerning the evidence base for community interventions. The randomised clinical trial design (RCT) is increasingly challenged as a gold standard for their evaluation. This thesis takes the Norsjö health programme in Västerbotten as the starting point for a discussion about the ethical platform of community interventions and for exploring the role of self-rated health. The specific objectives are: 1) to better understand barriers to community participation and to assess the role of ethical premises among decision-makers, 2) to explore how health related norms and attitudes interact with self-rated health and the risk factor outcome of an intervention and 3) to analyse the gender and socio-cultural interplay of self-rated health with biomedical risk factors for cardiovascular disease. The participation and views of different actors in the planning and implementation phases of the intervention were studied by contrasting information between official documents, interviews with decision makers and professionals and questionnaires to community members. The role of basic values in setting priorities and choosing intervention strategies utilised a questionnaire design with hypothetical scenarios sent to a representative sample of Swedish health care politicians. Qualitative research interviews were used to explore health related norms and attitudes. Health examination measurements and questionnaire data formed the basis for analysis of the development of self-rated health and risk factor load during a 10-year follow-up of the intervention. Access to a stroke registry enabled a case-referent approach for studying the interaction between bio-medical risk factors, socio-demographic factors and self-rated health. Data from the Västerbotten Intervention Programme (VIP) could be utilised for a cross-country comparison with a “sister project” in Otsego, U.S.A. The results point to both strengths and limitations of the efforts made to involve people in the intervention. The problem definition mainly remained with the professionals and participation as a goal in itself, strengthening local democracy was felt to be an exaggerated ambition. However, there was an overall agreement about the seriousness of the health problem, the need to intervene and about the implementation mode. Self-rated health and reported behavioural change were important indicators of participation and young men with bad health seemed to have been least involved. Among Swedish health care politicians there was an overall agreement to allocate resources for prevention directed towards communities when there are serious health problems. The majority preferred an intervention strategy that involved primary health care. The risk of harm by creating some degree of anxiety or stigma was for many considered an acceptable drawback of a successful intervention. The follow-up study revealed a positive risk factor reduction accompanied by a positive development of self-rated health, especially for men. Additional support for an intervention effect was given through a comparison with a reference area. The interaction pattern between risk reduction and self-rated health was more polarised for men than for women, with a corresponding pattern for the lower compared to the higher educated. These results could be linked to a transition in the health related norm system and to “ideal types” representing attitudinal sets towards the intervention. The case-referent analysis suggested an interaction effect between self-rated health and bio-medical risk factor load in predicting stroke that was greater for men than for women. The cross-country comparison revealed a stronger influence of education in the U.S.A. The lower educated, with a high risk load, had a greater risk of self-rated poor health than their Swedish counterparts. The thesis suggests that self-rated health is an unexplored indicator, potentially important for understanding the complexity of community interventions. Self-rated health may predict disease development as well as modify the impact of established risk factors.

The use of hand-held vibrating tools may lead to hand-arm vibration syndrome (HAVS), a condition with vascular, neurological and musculoskeletal symptoms. Vibrating tools are used in several occupations in which women can be found, e.g. by metal- and wood workers, drivers, and dental personnel. The risk of women developing HAVS is hard to estimate, as little research has been done on women exposed to hand-arm vibration. The overall aim of this thesis has been to fill this gap of knowledge. It is based upon one questionnaire study and one interview study on women who have reported an occupational injury related to hand-arm vibration. The thesis also comprises two laboratory studies of female and male subjects exposed to hand-arm vibration from a handle. The questionnaire and the interview study showed that the women had a high prevalence of symptoms, such as numbness, weakness, pain and white fingers. Neurological symptoms were more common and developed after shorter time of exposure compared to vascular symptoms. The symptoms had a considerable impact on all domains of the women’s lives, not only on their physical functioning, such as the ability to work, to participate in leisure activities and to do household activities, but also on their relationships and identity. Forty per cent of the women had retired or retrained due to the injury. Dental personnel had the highest relative risk of vibration injuries. In one of the laboratory studies 12 female and 12 male subjects were exposed to vibration in two vibration directions, (Xh and Zh) and at two vibration levels. The absorbed power was higher in the Zh direction and at the higher vibration level. The volumes of the subjects’ arms affected the power absorption in the Zh direction. There were no indications of a gender difference in the absorption of power. In the other laboratory study, the effect of handle size, vibration level, anthropometric measures and maximal grip force on the ability to perform a precision task was studied in 20 female and 20 male subjects. Ratings of difficulty and discomfort were made after each test round. The results indicate that the male subjects performed better in all the tests, but no gender difference was seen in the ratings. The higher vibration level resulted in higher ratings of discomfort. In the female subjects, the handle size, the anthropometric measures and maximal grip force affected both the performance and the ratings. In conclusion, the studies indicate that vibration injuries are severely disabling and influence many parts of the sufferer’s life. Vibration injuries are preventable, and the extensive consequences found underscore the importance of preventive action. This can be done by informing employees about the risks, and by giving them the opportunity to choose suitable machines and to practice work tasks when starting a new job.

The Arctic mutation in the Amyloid-β (Aβ) domain of the Amyloid-β precursor protein (APP) causes Alzheimer’s disease (AD) and confers unique biochemical characteristics to Aβ peptides. The aims of this thesis were to evaluate a transgenic model with the Arctic mutation, and to use it to gain new insights into the mechanisms of early (pre-plaque) and late-stage Aβ pathogenesis in AD. The Arctic mutation made Aβ more prone to aggregate, to accumulate in intracellular compartments and to form extracellular plaques when the models tg-ArcSwe and tg-Swe were compared. By inhibiting APP processing genetically or pharmacologically, the intraneuronal granular immunoreactivity with antibodies binding the Aβ domain was shown to largely represent Aβ, and not APP or APP-fragments. At two months of age, the intracellularly accumulated Aβ decreased rapidly, likely because it was still accessible to intracellular clearance. Extracellular Aβ deposits emerged at 5-6 months of age and the amyloid fibril structure was more compact than in tg-Swe. Moreover, Aβ deposits in tg-ArcSwe were more resistant to chemical extraction than those of established models carrying the Swedish APP mutation only, e.g. tg-Swe mice. The stability of deposits better reflects the biochemistry of senile plaques in AD. Thus, the tg-ArcSwe model may better predict the outcome of clinical trials, particularly therapies designed to enhance clearance of Aβ aggregates and deposits. Postmortem brain of Arctic mutation carriers contained extensive parenchymal plaque pathology. Differential immunostaining patterns with C- and N-terminal Aβ antibodies revealed a subset of plaques that were unique to the brains of Arctic mutation carriers. Aβ deposits in the cerebral vessel walls were congophilic and mainly composed of full-length Aβ. In contrast, N-terminally truncated Aβ was more prominent in the parenchymal plaques, all of which essentially lacked amyloid cores. A heterogeneous assembly of mutant and wild-type Aβ was shown to favor the formation of diffuse deposits in bitransgenic mice, and such mechanisms may at least partly explain observations of plaques lacking amyloid cores in postmortem Arctic mutant brain. In the bitransgenic mice, a low level of Arctic Aβ was sufficient to facilitate aggregation of wild-type Aβ. This observation, but also our findings of differences in amyloid fibril structure in tg-ArcSwe and tg-Swe, further highlights similarities between AD and prion disorders in which PrPsc refolds PrPc and facilitates fibril formation. / (Faculty of medicine)

SAMMANFATTNING Bakgrund: Livmoderhalscancer orsakas av humant papillomvirus (HPV). De flesta fallen inträffar bland kvinnor som inte deltar i preventionsprogram mot livmoderhalscancer. Syfte: Att undersöka invandrarkvinnors inställning till prevention av livmoderhalscancer. Metod: En explorativ kvalitativ studie. The Health Belief Model har använts som teoretisk modell. Fem fokusgruppintervjuer med 32 kvinnor ålder 18-54 år, som studerade svenska för invandrare. Data analyserades med latent innehållsanalys. Resultat: De temata som kunde urskiljas var svårigheterna med kommunikation med sjukvården, positiva till hälso- kontroll, behov av information för att fatta beslut samt ojämlikhet mellan könen. Kvinnorna i studien var mycket positiva till prevention av livmoderhalscancer och hade hög tilltro till det svenska sjukvårdssystemet. De poängterade i synnerhet kontakten med barnmorska. Deltagarna hade överlag svårigheter med information från sjukvården och saknade kunskap och information om HPV för att kunna fatta beslut om prevention av livmoderhalscancer med HPV- vaccin. Det framkom även att kulturella skillnader och ojämlikhet mellan könen påverkade inställning till prevention av livmoderhalscancer. Slutsats: Informanterna var positiva till prevention av livmoderhalscancer och vill få adekvat kunskap och information om sjukdomen men de har svårigheter med kontakten med sjukvården. Sjukvårdspersonal behöver beakta att kulturella normer påverkar kvinnors inställning till deltagande i det nationella preventionsprogrammet av livmoderhalscancer. / ABSTRACT Background: Cervical cancer is caused by Human papillomavirus (HPV). Most cases occur among women who don’t attend prevention programs. Objective: To explore immigrant women’s attitude towards prevention of cervical cancer. Method: An exploratory qualitative study. The Health Belief Model (HBM) has been used as a theoretical model. Five focus groups interviews with 32 women age 18-54, who studied Swedish for immigrants. Data was analyzed with content analysis. Results: Four main themes were found: difficulties to communicate with healthcare, positive to health control, the need of information to make a decision and inequalities among genders. The informants were positive to prevention of cervical cancer and had high confidence in the Swedish health care system. They appreciated in particular the meeting with the midwife. They had difficulty understanding the information from health care and had inadequate knowledge about HPV to make decisions about prevention of cervical cancer. Cultural differences and inequalities among genders were also related to prevention of cervical cancer. Conclusion: The informants were positive to prevention of cervical cancer and want to have adequate information about the disease. Healthcare professionals should consider that difficulties in contact with healthcare as well as inequalities in gender and cultural aspects have an impact on immigrant women’s attitude to prevention of cervical cancer. / HPV-projektet

Litteraturstudiens syfte var att beskriva om/hur en kvinnas sociala situation och bakgrund inverkar på hennes ohälsosamma alkoholvanor. Datasökningen genomfördes i databasen MedLine (via PubMed). Nio artiklar uppfyllde inklusionskriterierna och bearbetades samt kvalitetsgranskades. Resultatet visade att olika stadier i en kvinnas liv såsom besvärliga uppväxtförhållanden, en tidig alkoholdebut och dåliga relationer i vuxenlivet inverkar negativt på hennes alkoholkonsumtion. Det fanns också ett klass- och genusperspektiv. Resultatet visade att kvinnor som hade en besvärlig uppväxt med våld och övergrepp konsumerade mer alkohol i det vuxna livet än de kvinnor som hade ”normal” uppväxt och vuxenliv. Ohälsosamma alkoholvanor var också relaterat till en tidig alkoholdebut och en tidig alkoholdebut var i sin tur relaterat till flickor som hade en låg självkänsla och ett aggressivt beteende. Kvinnor i relationer där partnern missbrukade, våldtog och misshandlade gjorde att kvinnans alkoholkonsumtion ökade. Klassperspektivet var tydligt sammanlänkat med en högre alkoholkonsumtion hos kvinnor som var skilda eller änkor, kvinnor som hade låg inkomst och låg utbildning, kvinnor som inte hade någon familj eller kvinnor som var deprimerade. Sammanfattningsvis visar resultatet att flera aspekter i en kvinnas liv såsom uppväxtförhållanden och socialsituation inverkar på hennes alkoholvanor. Detta är något som behöver uppmärksammas både i vården och i samhället. / The aim of this literature review was to describe if/how a woman´s social situation and background affects her unhealthy alcohol habits. A search in the Medline database found nine scientific articles. They were thoroughly processed and valued for quality. The results showed that different stages in a woman’s, life, upbringing, age of onset of drinking and relationships in adulthood had a negatively effect on her alcohol consumption. The results also highlighted a class and gender perspective. The results revealed that women, who went through childhood and adulthood with adverse experiences such as, sexually assaulted and abused physically or mentally were more likely to have hazardous high alcohol consumption rates in adulthood. Unhealthy alcohol habits were linked to the age of onset of drinking which also was linked to girls who had an aggressive behavior and a low self-esteem when they grew up. Women who lived in a relationship where the partner abused substance or assaulted her resulted in a more frequent alcohol drinking in more hazardous amounts. The class perspective was strongly associated with a woman’s unhealthy relations’ to alcohol for example; when the woman were widowed, divorced, women with a income around the poverty line, women with low or no education at all, women who had no family or women who were depressed, were more likely to have an high alcohol consumption then women who had a family, a good income and an education. In summary the result showed that several aspects in a woman’s life, upbringing and social situation do affect her alcohol habits. This is knowledge that needs attention both in the health care and in the society.

Det framkommer i studiens bakgrund att föreningsidrotten är en viktig aktör som bidrar till att öka fysisk aktivitet och minska stillasittandet i befolkningen. För att undvika låg fysisk aktivitet och avhopp inom föreningsidrotten krävs det att individen känner sig motiverad till att delta i idrottsföreningar. Syftet med studien var att undersöka motivationsaspekter bland äldre tonårsflickor som deltar i motionsaktiviteter i idrottsföreningar. En kvalitativ intervjustudie användes som metod för studien, med ett strategiskt urval som kom att bli lagidrottande tonårsflickor som motionsidrottar. Materialet analyserades med stöd av en kvalitativ innehållsanalys där nyckelord sorterades ut och kategorier bildades. Resultatet visade på att ett flertal aspekter är viktiga för tonårsflickors motivation för motionsidrott: kärlek till idrott, hälsoaspekter, att vara en del av laget, omgivningens betydelse, förutsättningar och bekräftelse. Självbestämmande och samhörighet visade sig vara viktiga komponenter för skapandet av motivation. Utifrån konklusionen borde dessa två komponenter stå centralt i diskussioner om hur föreningsidrotten bör organiseras för att kunna öka intresset för deltagande i idrottsföreningar. / It emerges in the background of the study that club sports are an important player that has the resources to increase physical activity and reduce sedentary population. To avoid low physical activity and defections in club sports requires that the individual feels motivated to participate in sports. The aim of the study was to investigate motivational aspects of older teenage girls participating in exercise activities in sports clubs. A qualitative study was used as a method in the study, with a strategic choice that resulted in team sports by teenage girls who exercise sports. The material was analyzed through a qualitative content analysis where keywords were sorted out and categories formed. The results showed that several aspects are important for teenage girls' motivation for physical exercise: the love of sport, health aspects, to be part of the team, ambient impact, conditions and confirmation. Self-determination and togetherness proved to be important components for creating motivation and should, on the basis of the conclusion, play a vital role in the discussions about how the club sports could be organised in order to increase interest in participating in sports clubs.