Tuberculosis (TB) has presented a challenge to the public health community in Thailand, especially as regards patient adherence to TB treatment. Direct observed treatment (DOT) is recommended for promoting patient adherence to TB treatment. There is good evidence that DOT can significantly increase the patient adherence to TB treatment. However, the implementation of DOT has complex relationships to socioeconomic factors and Thai context issues.  The overall aim was (1) to obtain a deeper understanding of what happens when the DOT is practised in a local Thai community, and (2) to generate knowledge for improving the implementation of DOT, and thereby improve patient adherence to TB treatment. The empirical data were collected in Trang province, in the southern region of Thailand, between 2013 and 2015. The sample of study I consisted of five District TB Coordinators and five TB clinic staff from the public health sectors in rural and urban areas. Phenomenographic analysis was used. Study II: Five focus group discussions were conducted with 25 village health volunteers and six family members; manifest and latent content analysis was used for the analysis. Study III: Twenty TB patients were interviewed, using grounded theory methodology. Study IV: A mixed-method systematic review was accessed through databases. Data from the selected studies were extracted and synthesized using thematic analysis.  The fear of stigma of TB patients was considered a significant barrier to the practice of DOT and adherence to TB treatment (studies I, II and III). Lack of TB knowledge and skills among DOT observers were revealed as barriers to the practice of DOT (studies I and II). At the same time, social facilitation and TB patients’ positive thinking and self-awareness were considered enablers of patient adherence to TB treatment (studies I and III). Another result is to provide an empowerment approach for DOT observers, who, in turn, will increase the empowerment of TB patients to achieve adherence to TB treatment  (study IV). This thesis contributes a deeper understanding of the perspective of healthcare providers, DOT observers and TB patients when DOT is practised in a local Thai community. A challenge from these results is to provide an empowerment approach towards DOT observers. The results of this thesis will be useful for policy-makers who will consider strategies for improving the implementation of DOT and enabling patient adherence to TB treatment in the Thai context.

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Background: Injuries are one of the most common causes of death in the world. Varying types of injuries dominate in different parts of the world, which also have separate influences mortality. In Scandinavia blunt injuries dominates and the majority of those who die do so pre hospital. Over time different injury pattern may vary and by analyzing this we can assess when, where and how preventive work can be reinforced. The aim of this thesis was to study injury epidemiology in Sweden and assess the contribution of different injury patters on mortality. Method: We used the Swedish cause of death and the national patient registries which have a complete national coverage. ICISS was calculated (based on ICD-10) in the in hospital population. We have chosen to do this investigation with a broad perspective using the term injury, which includes trauma but also other diagnoses like suffocation and drowning. Results: During the study period (1999-2012) the number of deaths because of injury was 1213, 25 388, and 18 332 among children, working age and elderly, respectively. Mortality declined in the children and in the working age but inclined in the elderly. Mortality increased with each age group except between the ages of 15–25 and 26–35 years. One thousand two hundred sixty four (97%) of those who died because of penetrating trauma (sharp objects and firearms) were killed by intentional trauma (assault and intentional self-harm). One thousand and seventeen (83%) of the children died prehospital. In the working age 22 211 (80%) of 25 388 died pre hospital. Nine thousand six hundred and eighteen (53%) of 18 332 of the elderly died prehospital. During 2001- 2011 the risk adjusted in hospital mortality decreased in traffic and assault but not in fall related injuries. Discussion: Largely, the anticipated injury mortality picture was found, with blunt injuries (traffic accidents) dominating in the working age and falls in elderly. Further a significant portion of the deaths occurred pre hospital. The intentional injuries are dominated by intentional selfharm. The decrease in child injury mortality is notable as Sweden already has one of the lowest incidences in child injury mortality in the world. The decrease in injury mortality in the working age also implies that preventive work has had an effect. The incline in injury mortality in elderly on the other hand needs to be further studied. Areas of particular importance for future preventive work is the incline in injury mortality in elderly and intentional injuries among children.

<p>Godkänd datum 171026.</p>

<p>Godkänt datum: 2017-10-26.</p>

<p>Godkänd datum: 2017-10-26.</p>

<p>Godkännande datum 2017-11-26.</p>

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Background It is stated that vital exhaustion (VE) increases the risk of getting cardiovascular disease (CVD) (1), at the moment the leading cause of death globally (2). A factor in life that may be protective against the harmful effect of VE is social support (3) which is also associated with CVD (4). This thesis will investigate if social support can moderate the relationship between VE and CVD outcomes and have a protective effect. It will also exploratively investigate if comorbid depression or self-rated health confound the relationship. Method This thesis uses secondary data from 935 myocardial infarction patients that were included in the Uppsala University Psychosocial Care Programme (U-CARE) Heart Trial conducted in Sweden. To estimate the hazard ratio (HR) for developing CVD outcomes and investigate if the relationship between VE and CVD could be explained by different confounders and moderated by social support, stratified and interaction analyses were conducted, as well as Cox proportional hazard regression model. Results Social support did not moderate the relationship between VE and CVD. No protective effect on the hazard of developing CVD was shown in those with high social support. The effect of VE on CVD was not affected by depression but when self-rated health was included in the model VE lost its unique effect on CVD. Conclusion Social support did not have a protective effect on VE that impacted CVD. Globally, the main focus should be on preventing individuals from getting VE to prevent and reduce the prevalence of CVD.