The Sami people are the Natives of northern Scandinavia. The knowledge of the health and living conditions of the Swedish Sami is extremely limited which is in contrast to the large amount of detailed information on health and socioeconomic issues that is available for other circumpolar Natives. The encounter with the western society and the acculturation process has for many native populations had serious health consequences, causing a dramatic increase of lifestyle related diseases such as cancer, diabetes, stroke, obesity and hypertension as well as a dramatic increase of suicide and drug abuse. The overall objective of this thesis was to investigate the health conditions of the Sami population of Sweden using causes of death and incidences of cancer and cardiovascular diseases (CVD) as health indicators, and to evaluate their possible association with acculturative factors such as assimilation, integration, separation and marginalization. A Sami population was identified containing a total of 41 721 individuals. Specific cohorts were selected from this population for the different studies. A four times as large demographically matched non-Sami control population was used for comparisons. A study of causes of death, 1961-2000, showed small differences in overall mortality and life expectancy between the Sami and the non-Sami. However, Sami men showed significantly lower mortality risks for cancers but higher for external cause of injury and Sami women higher risks for diseases of the circulatory system (CVD) and of the respiratory system. An increased risk of dying from subarachnoid haemorrhage (SAH) was observed among both Sami men and women. The increased risk of dying from accidents among male reindeer herders is suggested to be caused by the increased socioeconomic pressure and the extensive use of terrain vehicles. It is concluded that commercial reindeer management is one of the most dangerous occupations in Sweden. In a study of the cancer risk among the reindeer herding Sami between 1961-1997, an overall lower risk to develop cancers, particularly prostate and malignant lymphoma was observed among the reindeer herding Sami. The risk for stomach cancer was significantly higher in relation to their non-Sami neighbours. The Sami and the non-Sami had similar risk factor-patterns for CVD. The main differences were related to working conditions and lifestyle factors of the reindeer herding Sami - the women showed a more unfavourable risk factor pattern than the men. Higher incidences of stroke were observed among Sami men and women compared to their non-Sami neighbours while the mortality rates of stroke were similar. The mortality ratio of AMI was increased for Sami women in spite of similar incidence ratios. A higher risk of SAH was observed among all groups of Sami. According to traditional socioeconomic risk factors, the differences in the levels of income and education observed between the Sami and the non-Sami, were poorely associated with the disparities of CVD. As has been shown, only minor differences in the health indicators were found between the Sami and their non-Sami neighbours. This is in clear contrast to several other native populations for which the health situation is largely unfavourable in comparison with that of the general population. The observed differences between the Sami and the non-Sami probably reflect differences in lifestyle, psychosocial and genetic factors. The relation between these factors and the acculturation process is dicussed, and it is suggested that separation or segregation of the reindeer herding Sami and the assimilation of the other Sami have influenced the health condition of the Sami, but with the largest impact probably prior to 1961 and the earliest start of follow-up for the studies in this thesis. Thus, the similarities in health between the Sami and the non-Sami 1961-2002, are probably a result of centuries of close interaction that has caused similarities in culture, attitudes and lifestyle, as well as equal accessibility to the health care services and the social security systems.

The objectives of the thesis was to explore partner violence during pregnancy in Nicaragua – its prevalence and characteristics, how women perceive, understand and cope with it, its association with specific child outcomes such as low birth weight (LBW), small for gestational age (SGA) and preterm birth, and possible pathways. A cross-sectional community-based study was conducted with 478 pregnant women and for a sub-sample of 147 salivary cortisol was measured. A case-referent hospital-based study was organized including 303 mothers immediately after delivery. In-depth interviews were conducted with women survivors to increase understanding of partner violence during pregnancy. The prevalence of emotional, physical and sexual partner abuse during pregnancy was 32.4%, 13.4% and 6.7% respectively. Seventeen percent of the victims suffered all three types of violence and in two thirds the abuse was severe and repeated. Half of the abused women had experienced punches and kicks directed to the abdomen; however, only 14% had sought health care and very few had disclosed the abuse or contacted police or authorities. Adolescent mothers, unwanted pregnancy and late registration for antenatal care or no check-ups were more likely among victims. The access to social resources facilitated the women’s ability to cope with the abuse, but the pregnancy itself was a barrier to receiving support from family, friends or society. The ability to confront abuse was determined by a complex interplay of factors such as economic independence, severity of abuse, access to social resources, implications for important others (i.e. children), socioeconomic group and a personal ability to cope with social norms. Low social resources, high levels of emotional distress and attempted suicide were associated with violence during pregnancy. Abuse during pregnancy was also found as an independent risk factor for LBW. Sixteen percent of LBW was attributed to physical abuse by a partner during pregnancy. A significant association between abuse during the index pregnancy and SGA was found. Partner violence during the pregnancy, low social resources and emotional distress were associated with higher levels of salivary cortisol. Pregnant women with high cortisol values were significantly more likely to give birth to SGA babies. A substantial decrease of birthweight, 142 grams, was estimated to be associated with increases in cortisol due to violence exposure. Partner violence during pregnancy is a serious social problem that impacts the rights, health and wellbeing of both the woman and her unborn child. The studies call for prioritization of intervention programmes for prevention and detection of violence, treatment and rehabilitation of the victims and the perpetrators, and change of the structural causes producing violence in society.

This thesis presents how humanitarian aid workers were attracted, motivated, recruited, and prepared for fieldwork, and how they reported their work experience directly from the field and when they returned home. Data were derived from interviews with experienced aid workers, focus group discussions with presumptive aid workers, analysis of letters from aid workers in the field on MSFs homepages in Europe, and from interviews with recruitment officers at some of the main humanitarian organisations. Health professionals were attracted by the positive images of humanitarian action. They wished to work in teams with like-minded people, and to make a difference in the world. However, this image was not supported by the recruitment officers, or experienced aid workers, who described a complex reality in humanitarian action. The experienced aid workers instead had realised they learned more than they contributed. The recruitment system for relief workers would benefit from a more holistic approach, where personalities of the aid workers are more in focus. More time must be spent with the applicants, both recruited and returning aid workers, in order to improve the system. A socialisation approach could help identify the right personnel and to motivate current personnel to continue.

Introduktion        Övervikt och fetma (BMI > 25 respektive BMI > 30) ökar i omfattning i hela världen och så även i Sverige. Prevalensen av övervikt/fetma i Sverige är ca 44 % och specifikt i Sandvikens kommun så är drygt hälften av den vuxna befolkningen överviktig/fet vilket ökar risken för ohälsa och sjukdom. Det är angeläget att hitta de personer som löper risk att utveckla alternativt redan har övervikt/fetma för att kunna förebygga och behandla. Med tidig upptäckt och rätt behandling så gynnas förstås patienten i första hand, men även sjukvården och samhället i stort då detta i förlängningen minskar kostnaderna. I denna studie undersöktes hur ett vårdprogram som ska användas för upptäckt och behandling av övervikt/fetma tillämpades på tre hälsocentraler i Sandvikens kommun under två månader hösten 2005. Metod Utgångspunkten för vårdprogrammet med tillhörande flödesschema är att man mäter BMI först. Mätning ska ske på alla patienter som söker vård inom Primärvården Gästrikland – inte bara de patienter som specifikt söker för övervikt eller fetma. Kontroller gjordes först av hur många patienter som fick BMI uppmätt under vald tidsperiod och beroende på resultat av BMI-mätning kontrollerades därefter hur många patienter som fick behandling. Resultat Av totalt antal patienter som besökte hälsocentralerna under vald tidsperiod kontrollerades BMI på 6 %. Av dessa hade 38 % ett BMI som enligt vårdprogrammet skulle leda till erbjudande om behandling. Vid kontroll av behandling så hade i stort sett alla patienter fått någon form av behandling men med utgångspunkt från andra vårdprogram och orsaker än just övervikt och fetma. En femtedel av de 38 % fick behandling pga. sin övervikt/fetma och endast ett fåtal fick diagnos " övervikt/fetma". Konklusion Då så få patienter fick sitt BMI kontrollerat och därefter behandlades enligt vårdprogrammet finns misstanken att undersökt vårdprogram inte används överhuvudtaget. Detta skulle kunna bero på att personalen inte känner till dess existens alternativt inte finner vårdprogrammet användarvänligt. Det är synnerligen viktigt att använda sig av bevisat effektiva metoder för upptäckt och behandling av övervikt/fetma men oavsett metod så gäller förstås att de som ska använda sig av metoderna också känner till dem samt finner metoderna möjliga att använda i dagligt arbete. / Introduction   The number of overweight (BMI > 25) and obese (BMI > 30) people is rising worldwide and also in Sweden where the prevalence is 44 %. In the municipality of Sandviken more than half of the population is overweight or obese and that could lead to poor health and/or sickness. It is important to find the persons in risk of developing overweight/obesity and the people who already are overweight/obese to be able to prevent or to give treatment. Early discovery and correct treatment will of course benefit the patient but it will also lower the costs for the healthcare system. The purpose of this study was to investigate the practical use of a program for identification and treatment of overweight/obesity in three health clinics in the municipality of Sandviken during two months in 2005. Method The starting-point of the program is to measure BMI. BMI should be measured on all patients who seek care and treatment at the health clinic – not just the ones who want help because of overweight or obesity. The first control was therefore to see how many of all the patients who visited the health clinic who got their BMI measured. The second control was to see how many of those patients who got treatment according to the program. Results BMI were measured on 6 % of all the patients who visited the health clinics. Out of these patients, 38 % had a BMI that should lead to an offer of treatment according to the program. Almost all of the 38 % did get treatment but for other reasons and diagnoses than overweight or obesity which only one fifth of the 38 % got. Very few got the diagnose "overweight/obesity".   Conclusions With such low figures of BMI-measuring and treatment according to the program, you could suspect that the program is not in use at all. The reason for this could be that the staff at the health clinics does not know that the program exists or that they do not find the program user-friendly. It is very important to use effective methods for identification and treatment of overweight/obesity, but no matter what method – the most important thing is that the staff who is supposed to adopt these methods is well acquainted with them and also finds them useful in their daily work.

Riksdagen beslutade år 2000 om en nationell handlingsplan för att förbättra tillgängligheten för persoaner med funktionsnedsättning. Hindren skall vara åtgärdade före 2010. Syfte. Att studera hur tillgänglighet i offentlig miljö beskrivs i vetenskapliga artiklar och hur det påverkar delaktigheten i socila aktiviteter för personaer med fysisk funktionsnedsättning. Metod. Systematisk litteraturstudie av artiklar sökta i fyra olika databaser. Resultat. Elva artiklar publicerade 2002-2009 studerades och resultatet visar att tillgänglighet i offentlig miljö har stor betydelse för delaktighet i sociala aktiviteter men också graden av funktionsnedsättning, ålder samt upplevelse av hinder är faktorer som är avgörande. Konklusion. Resultatet styrker vikten av att följa den nationella handlingsplanen från 2000 för att öka möjligheten för personer med funktionsnedsättning att leva enligt sina egna önskemål och inte vara tvingade att acceptera hinder i omgivningen. / The Swedish Parliament decided in 2000 on a national plan to improve the accessibility to people with disability. Environmental barriers should be removed prior to 2010. Purpose. To investigate how accessibility to public environments is described in scientific articles and how it influences participation in social activities for persons with physical functional limitations. Method. Review of scientific articles found in four different databases. Results. Eleven scientific articles published 2002-2009 were studied and the result showed that accessibility to public environments is found to be of great importance for participation in social activities. For persons with physical functional limitations, level of disability, age and experience of environmental barrioers are utmost importance. Conclusion. The result strengthen the necessity of following the national plan from 2000 and thereby increase the possibilities for persons with disability to live according to their own wishes and not be forced to accept environmental barriers.

Syftet med studien var att beskriva erfarenheter som hemtjänstpersonal har av handledning. Metoden var kvalitativ, med enskilda, öppna intervjuer. Sju personer som arbetar i kommunal hemtjänst intervjuades. Intervjumaterialet analyserades med kvalitativ innehållsanalys. Resultatet visar att samarbete mellan arbetsterapeut och hemtjänstpersonal är en förutsättning för att arbetsterapeutens insatser ska komma brukaren till nytta. Resultaten visar vidare att hjälpinsatsens utformning påverkas av om arbetsterapeuten gjort en tidig rehabiliteringsinsats. Det är främst genom dialog med arbetsterapeuten och praktisk handledning i vardagsarbetet som hemtjänstpersonalen får tillgång till den kunskap och information som handledningen har för avsikt att förmedla. Deltagarna förordade praktisk handledning. Den upplevdes ge kunskaper som de direkt kunde tillämpa i sitt arbete, samt skapa förutsättningar för ett enhetligt arbetssätt inom hemtjänstgruppen. Studien synliggör behov av rutiner kring överrapportering. Arbetsterapeuten bör prioritera att snabbt lämna ut information gällande ADL-förmågor. Enligt erfarenheterna var handledning väsentlig kring varje enskild brukare och behöver finnas att tillgå när den efterfrågas av hemtjänstpersonalen. För att arbetsterapeutens handledning skall vara till verklig nytta för brukaren krävs ett gott samarbete mellan samtliga yrkeskategorier i teamet.

Inledning: Sveriges befolkning blir alltmer äldre och det gör att behovet av en välfungerad hälso- och sjukvård blir större. För att vi ska behålla hälsan längre upp i åldrarna behövs åtgärder som är hälsofrämjande, vilket kan vara i form av kulturella aktiviteter. Syfte: Syftet med studien var att undersöka äldre personers beskrivningar av hur kultur kan främja upplevelse av hälsa. Metod: Kvalitativ metod användes i studien med semi-strukturerade intervjuer. Deltagarna valdes ut genom ett strategiskt urval med fokus på givna kriterier, där deltagarna inte skulle ha någon form av demenssjukdom. Kvalitativ innehållsanalys genomfördes för att få fram kategorier med tillhörande subkategorier. Resultat: Utifrån resultatet har tre kategorier tagits fram som var Ett liv med kultur, Kultur som påverkansfaktor för hälsa och Kulturaktiviteter som hälsoarbete. Det övergripande temat Äldreperspektiv på kultur har två underliggande subteman Äldres individperspektiv och Äldres grupperspektiv. Konklusion: Kulturella aktiviteter ökar välbefinnandet och livskvaliteten för äldre, vilket ingår för upplevelse av hälsan. Kulturella aktiviteter ökar även gemenskap och tillhörighet. Det har framkommit att hälsoarbete inom kultur är väsentligt ur både ett individ- och grupperspektiv för upplevelsen av hälsa för äldre. Resultatet i studien kan bidra med förståelse för hur kultur kan främja äldres upplevelser av hälsa. / Introduction: Sweden's population is becoming increasingly older and that makes the need for a well-functioning healthcare more important. If we are going to maintain health in later age it is essential that health promotion is in focus, for example cultural activities. Aim: The aim of the study was to examine descriptions of elderly on how culture can promote their health experience. Method: Qualitative method was used in the study with semi-structured interviews. The participants were selected through a strategic selection with focus on given criteria, were the participants wouldn´t have any form of dementia. Qualitative content analysis was conducted to obtain the categories and related subcategories. Results: Based on the results three categories have been developed which were: A life of culture, Culture as an influence factor for health and Culture activities as health work. The overall theme Elderly perspective on culture has two underlying subthemes: Elderly individual perspective and Elderly group perspective. Conclusion: Cultural activities will improve the wellbeing and quality of life for elderly, which is part of the experience of health. Cultural activities will also increase fellowship and belonging. It has been found that cultural health work is essential from both an individual and group perspective for the experience of health for the elderly. The results of the study may contribute to the understanding of how culture can promote older people's experiences of health.

Bakgrund: Med en fördubbling av antalet anställda, de höga sjukskrivningsdagar samt att arbetet inom restaurang ses som påfrestande är det viktigt och intressant att undersöka den psykosociala arbetsmiljön bland restauranganställda. Syfte: Undersöka restauranganställdas upplevelser av den psykosociala arbetsmiljön i relation till hälsa, välbefinnande och trivsel. Metod: Kvalitativ metod av induktiv karaktär med empiri insamling genom semistrukturerade intervjuer och analys genom kvalitativ innehållsanalys. Resultat/konklusion: Den upplevda psykosociala arbetsmiljön inom restaurang i relation till hälsa, välbefinnande och trivsel påverkas av tre betydelsefulla kategorier: Den betydelsefulla gästen, att känna gemenskap och kärlek till yrket samt systematiskt arbete och kontroll. / Background: With the increasing number of employees, the high sickness absence in the profession and to work in the restaurant seen as stressful it is important and interesting to look into the psychosocial work among restaurant employees. Aim: Investigate restaurant employee perceptions of the psychosocial work environment in relation to health, well-being and job satisfaction. Method: Qualitative method of inductive character with empirical data collection through semi-structured interviews and analysed by qualitative content analysis. Results / conclusion: The perceived psychosocial work environment in a restaurant in relation to health, well-being and job satisfaction is influenced by three major categories: The important guest, feel and love for the profession and systematic work and control.

<p>Inflammation and oxidative stress may be involved in atherogenesis. This thesis describes clinical studies of prostaglandin F_2α (PGF_2α), an inflammatory mediator, and the isoprostane 8-iso-PGF_2α, a reliable indicator of oxidative stress, and cytokine-related inflammatory mediators and indicators in healthy subjects and in a population-based cohort of Swedish men. </p><p>PGF_2α and 8-iso-PGF_2α formation in healthy subjects varied considerably between days with a mean intra-individual coefficient of variation of 41 % and 42 %, respectively. A morning urine sample reflected the basal level of 8-iso-PGF_2α formation as accurately as a 24-hour urine collection, and represents a more practical alternative to the 24-hour urine collection in clinical studies. PGF_2α formation (as measured by urinary 15-keto-dihydro-PGF_2α) was increased in patients with type 2 diabetes and in smokers independent of other cardiovascular risk factors. These results indicated an on-going cyclooxygenase (COX)-mediated inflammatory reaction related to these conditions. Further, an increased formation of isoprostanes (as measured by urinary 8-iso-PGF_2α) was found in patients with type 2 diabetes and in smokers, indicating a high level of oxidative stress in these men. The smokers had also increased levels of the cytokine interleukin-6, indicating an on-going cytokine-related inflammatory reaction. The inflammatory indicators C-reactive protein and serum amyloid A were related to overweight but not independently associated to type 2 diabetes. High levels of serum selenium in middle-aged men predicted reduced formation of PGF_2α and 8-iso-PGF_2α 27 years later.</p><p>In summary, low-grade, chronic COX-mediated and possibly cytokine-related inflammation, and oxidative stress, seem to be joint features of type 2 diabetes and smoking, two major risk factors of atherosclerosis, in elderly men. Inflammation and oxidative stress may represent a possible common pathogenetic link between established risk factors for atherosclerosis and atherogenesis.</p>

Inflammation and oxidative stress may be involved in atherogenesis. This thesis describes clinical studies of prostaglandin F2α (PGF2α), an inflammatory mediator, and the isoprostane 8-iso-PGF2α, a reliable indicator of oxidative stress, and cytokine-related inflammatory mediators and indicators in healthy subjects and in a population-based cohort of Swedish men. PGF2α and 8-iso-PGF2α formation in healthy subjects varied considerably between days with a mean intra-individual coefficient of variation of 41 % and 42 %, respectively. A morning urine sample reflected the basal level of 8-iso-PGF2α formation as accurately as a 24-hour urine collection, and represents a more practical alternative to the 24-hour urine collection in clinical studies. PGF2α formation (as measured by urinary 15-keto-dihydro-PGF2α) was increased in patients with type 2 diabetes and in smokers independent of other cardiovascular risk factors. These results indicated an on-going cyclooxygenase (COX)-mediated inflammatory reaction related to these conditions. Further, an increased formation of isoprostanes (as measured by urinary 8-iso-PGF2α) was found in patients with type 2 diabetes and in smokers, indicating a high level of oxidative stress in these men. The smokers had also increased levels of the cytokine interleukin-6, indicating an on-going cytokine-related inflammatory reaction. The inflammatory indicators C-reactive protein and serum amyloid A were related to overweight but not independently associated to type 2 diabetes. High levels of serum selenium in middle-aged men predicted reduced formation of PGF2α and 8-iso-PGF2α 27 years later. In summary, low-grade, chronic COX-mediated and possibly cytokine-related inflammation, and oxidative stress, seem to be joint features of type 2 diabetes and smoking, two major risk factors of atherosclerosis, in elderly men. Inflammation and oxidative stress may represent a possible common pathogenetic link between established risk factors for atherosclerosis and atherogenesis.