Introduktion: Kolera är en sjukdom som orsakar akut diarré. Kolera fortsätter att orsaka stor sjukdomsbörda och dödlighet världen över. Vaccin mot kolera kan användas i kombination med WASH åtgärder (wash, sanitation and hygiene) för att stävja utbrott eller som proaktiv åtgärd i områden som anses vara högriskområden för att drabbas av kolera. Trots att WHO (Världshälsorganisationen) sedan 2010 rekommenderar vaccin som en reaktiv åtgärd vid utbrott används det sällan på grund av en global brist av vaccin och bristen på forskning kring vaccinets effekt i verkliga miljöer, särskilt vid pågående kolera utbrott. Det finns fortsatt ett behov att utforska vaccin som en reaktiv åtgärd vid pågående kolera utbrott. Syfte: Syftet med studien var att analysera effekten av vaccin vid pågående kolera utbrott. Metod: En systematisk litteraturöversikt där analysen utfördes genom narrativ syntes. Även en evidensgradering enligt EPPI-center modellen utfördes. Resultat: Resultatet av syntesen antyder att vaccin kan vara effektivt som en reaktiv åtgärd, även i miljöer där befolkningen saknar grundläggande immunitet. Två doser vaccin ger ett skydd som varar i upp till fyra år, effekten av vaccinet varierar inte nämndvärt beroende på hur lång tid som passerat sedan vaccinering. Effekten av vaccinet är högre i endemiska miljöer, skillnaden är dock marginell.Slutsats: Vaccin kan vara en effektiv åtgärd för att kontrollera utbrott av kolera. / Introduction: Cholera is an acute diarrhoeal disease with high morbidity and mortality globally. Oral cholera vaccines can be used in conjunction with improvements of water and sanitation to control cholera outbreaks as well as for prevention in areas known to be in high risk for cholera. Altough WHO has recommended oral cholera vaccines as a reactive measure since 2010 they are not routinely used during cholera outbreaks due to global vaccine shortage and the scarcity of data on the effectiveness of the vaccines in real life settings, especially during a cholera epidemic. As a consequense of this there is a need to explore the effectiveness of reactive use of oral cholera vaccines during cholera outbreaks. Aim: The aim of this study was to analyze the effectiveness of oral cholera vaccines in response to an outbreak. Method: Astructured literature review was performed and analysed trough narrative synthesis. Furthermore an assesment of the overal weight of evidence was conducted using the EPPIaproach. Result: The result of the synthesis suggest that vaccines may be an effective reactive measure during an outbreak, even in areas of little or no recent exposure to cholera. Two doses of oral cholera vaccine provides protection, lasting up to four years. The effectiveness did not wary much depending on the time passed since vaccination. The vaccine effectiveness is higher in endemic settings, altough the difference is only marginal. Conclusion: The findings suggest that vaccine may be effective in controlling cholera outbreaks.

Bakgrund: Statistik visar att narkotikaanvändningen bland tjejer i åk 2 på gymnasiet på Gotland ligger 5% över riksgenomsnittet i Sverige. Mot denna bakgrund tog Region Gotland fram ett medborgarlöfte år 2020 med målet att ta fram ett proaktivt och förebyggande samverkansarbete gällande gymnasietjejers narkotikabruk. Syfte: Studiens syfte var att inom ramen för Region Gotlands utvecklingsarbete undersöka unga kvinnors uppfattning och erfarenhet av narkotikaanvändning på Gotland. Metod: Studiens design var kvalitativ med induktiv ansats. Semi-strukturerade fokusgrupper genomfördes för att samla in data. Tre fokusgrupper genomfördes, där vardera gruppen intervjuades vid två tillfällen, cirka 120 minuter per tillfälle. Sammanlagt deltog 22 tjejer i gymnasieåldern i intervjuerna. Systematisk textkondensering användes för genomförande av analysen som mynnade ut i fyra teman med tillhörande underkategorier: 1) Narkotikan finns överallt och när den träder in förändras spelreglerna, 2) Se oss, hör oss respektera oss, 3) Kille och tjej på olika villkor, 4) Vi bor alla på en liten ö. Resultat: Det sammantagna resultatet visade att tjejerna efterfrågar närvarande vuxna som visar förståelse och engagemang att vilja lära sig om de problem och utmaningar som unga tjejer stöter på i sin vardag. Tjejerna efterfrågade engagemang från vuxna i balanserade samtal om droger, både som föräldrar och i professionella situationer. Slutsats: Tjejerna gav flera förslag för att minska riskfaktorer och öka skyddsfaktorer som i hög grad stämmer överens med de åtgärder som återfinns i den så kallade Islandsmodellen. / Background: Statistics show that drug use among girls in year 2 of Upper Secondary School on Gotland is 5 % above the national average in Sweden. Against this background, Region Gotland made a citizens’ pledge in 2020 with the goal of developing a proactive and preventive collaboration within Region Gotland, regarding high school girls’ drug use. Aim: The purpose of the study was to examine young women’s perceptions and experiences of drug use on Gotland within the framework of Region Gotland’s development work. Method: The design of the study was qualitative with an inductive approach. Semi-structured focus groups were conducted. Each group was interviewed on two occasions, with each session lasting about 120 minutes. Twenty two girls of high school age participated in the interviews. Systematic text condensation was used for the implementation of analysis that resulted in four themes with associated subcategories: 1) Drugs are everywhere and once introduced, the rules of the game change, 2) See us, hear us, respect us, 3) Boys and girls on different terms, 4) We all live on a small island. Results: The overall result showed that girls are actively looking for adults who show an understanding for their situation and who are committed to wanting to learn about the challenges that young girls face in their everyday lives. The girls expressed a call for adults, both parents and professionals, who were willing to engage in balanced conversations about drugs, both as parents and in professional situations. Conclusion: Several proposals on how to reduce risk factors and how to increase protection factors were brought forward by the girls. These were very much in line with the measures found in the so called Icelandic model.

Sömnstörningar och förskrivning av sömnläkemedel är ett ökande problem i världen och Sverige. Arbetet visar på att prevalensen av användning av sömnläkemedel i Sverige har ökat under åren 2006 till 2019. Från 10,3 % hos kvinnor och 5,9% hos män till 11,1% respektive 6,7 %. I Sverige finns det inga nationella riktlinjer för behandling av sömnstörningar, utan bara på regional nivå. Gemensamt för de regionala rekommendationerna är att kognitiv behandlingsterapi alltid ska testas innan läkemedelsbehandling sätts in. Läkemedelsrekommendationerna skiljer sig något åt mellan regionerna, där melatonin tillkommit de senaste åren hos flertalet regioner. En ökning av antalet patienter som använder melatonin sågs också i arbetet från 2015 till 2019, där den största ökningen var hos de unga vuxna. Godkända indikationer för melatonin är dock bara behandling av sömnstörningar hos ungdomar och vuxna 55+ samt kortvarig behandling av jetlag hos vuxna. Därför är Region Stockholms rekommendation 2020 överraskande. Melatonin är förstahandsval till alla åldrar vid farmakologisk behandling av sömnstörningar.  Bensodiazepinder och Bensodiazepinliknadande läkemedel tillhör de narkotikaklassade sömnläkemedel, vilka medför en ökad risk för att utveckla läkemedelsberoende hos patienterna. Bensodiazepinliknande läkemedel har under många år ökat i Sverige, men i detta arbete tyder det på att den trenden har brutits. Användningen och nyförskrivning av de narkotikaklassade läkemedel har minskat från 2015 till 2019. Incidensen för alla narkotikaklassade sömnläkemedel har minskat, från 8,4% hos kvinnor och 6,4% hos män till 4,2% respektive 3,6%.  För att besvara arbetes syfte, ” hur ser nyförskrivning av sömnläkemedel ut till vuxna människor i Sverige under åren 2015 till 2019” samt ” tidstrender i användningen av sömnläkemedel under åren 2006–2019” gjordes en kvantitativ deskriptiv kohortstudie baserad på olika register. Barn och ungdomar under 18 år exkluderades då de farmakologiska rekommendationerna för barn och ungdomar skiljer sig från de vuxna. Även äldre vuxna över 64 år exkluderades från studien då sömnsvårigheter ökar med åldern och det finns ökad bakomliggande sjuklighet.  De sömnläkemedel som har en ökad risk för att utveckla läkemedelsberoende minskar i förskrivning. Dock undersöktes inte långtidsanvändningen av dessa läkemedel, vilket är viktigt för framtida forskning. / Background: Sleep disorders are an increasing problem in the world, and due to this, prescription of hypnotics is also increasing. Patients who are prescribed benzodiazepines and non-benzodiazepines have a high risk of developing drug-dependency. Aim: To study the incidence in new prescriptions of hypnotics to adults in Sweden during 2015-2019, in relation to gender, age, region, season, prescriber, and comorbidity. Also, to study trends in the use of hypnotics during 2006-2019. Methods: A quantitative descriptive cohort-study based on national registers on in- and outpatient specialist care, and dispensed prescription drugs held by the National Board of Health and Welfare and the Swedish eHealth Agency.  Adults between 18-64 years who had received a new prescription of hypnotics were included. Results:  The prevalence of use of hypnotics has increased during 2006-2019 from 10.3% and 5.9% to 11.1% and 6.7% for women and men, respectively. In contrast, the incidence of newly prescribed benzodiazepines and nonbenzodiazepines has instead decreased during 2015-2019 from 8.4% and 6.4% to 4.2% and 3.6% for women and men, respectively. The proportion dispensed hypnotics increases with rising age, except in the case of melatonin, which is more common among younger patients. Conclusions: The incidence in prescription of benzodiazepines and other sedatives with a high risk of causing drugdependency, has been declining in the latest years. Interestingly, melatonin increases mostly in younger adults, even though melatonin is only indicated for sleep disorders in adults aged 55 years and older, and short time treatment of jetlag in adults.

Introduktion: Migration har alltid förekommit i större delar av världen, men har under de senaste 25 åren ökat. Enligt World Migration Report fanns det över 280 miljoner migranter under 2020, varav 90 miljoner befaras vara flyktingar eller asylsökande. Att integrera i ett nytt land kan vara svårt och många migranter möter både interna och externa barriärer vid den vidare bosättningen. För migranten är den digitala utvecklingen vital och kan på många sätt underlätta integrationen i samhället. Syfte: Syftet med studien är att undersöka vilka digitala möjligheter och utmaningar migranter ställs inför i ett nytt land.  Metod: Den metod som applicerades var en strukturerad litteraturstudie, där artiklar samlades in i databaserna CINAHL, Scopus och Web of Science. 11 artiklar inkluderades, och analyserades genom en tematisk analys med induktiv ansats. Resultat: Den tematiska analysen resulterade i identifierandet av sju teman, samt 14 underrubriker. Resultatet påvisade en komplex relation mellan migranters digitala möjligheter och utmaningar. Digitala medel kan gynna integration i samhället, men är också en risk för socialt utanförskap. Slutsats: Digitala möjligheter reflekteras genom olika aspekter som underlättar integrationen i samhället. Likväl, är dessa möjligheter endast befintliga för de individer som har tillgång och kunskap att bruka digitala medel. / Introduction: Migration has always occurred around most parts of the world, but has increased in the past 25 years. According to the World Migration Report there was over 280 million migrants during 2020, which of 90 million was refugees or asylum seekers. To integrate in a new country can be challenging and many migrants face both internal and external barriers during their settlement. For the migrant, the digital development is vital and can aid the integration in the new society. Aim: The aim of this study is to examine what digital opportunities and challenges migrants face when settling in a new location.  Methods: The applied method was a structured literature review, where articles were gathered from the databases CINAHL, Scopus and Web of Science. 11 articles were included and analysed through thematic analysis with an inductive approach. Results: The thematic analysis resulted in the identification of seven themes, and 14 subcategories. The result demonstrated a complex relation between migrants’ digital opportunities and challenges. Digital means can help integration in society, but also pose as a risk for social exclusion.  Conclusion: Digital opportunities is reflected through several aspects which facilitates integration in society. Yet, these are possibilities only for the individuals who has access and knowledge on how to use digital means.

Bakgrund: Arbetsmiljö och delaktighet anses vara viktiga faktorer för individens hälsa. Över tid har sjuksköterskors och undersköterskors arbetsmiljö förändrats vilket gett upphov till mindre delaktighet på arbetet och mindre förtroende för organisationen.   Syfte: Syftet är att undersöka delaktighet på arbetsplatser bland sjuksköterskor och undersköterskor som arbetar på sjukhus. Studien avser även undersöka om det finns några skillnader mellan sjuksköterskors och undersköterskors delaktighet.   Metod: I denna studie användes en kvantitativ metod med tvärsnittsdesign där data samlades in genom en digital enkät. Urvalet bestod av cirka 300 medarbetare på sjukhus och 76 deltog i undersökningen genom att besvara enkäten. Data analyserades i SPSS genom frekvenstabeller och skillnader fastställdes genom Chi-2-test.    Huvudresultat: Både undersköterskor och sjuksköterskor upplevde delaktighet på sina arbetsplatser. Resultatet visade även att undersköterskor upplevde mer delaktighet än sjuksköterskor. Dock saknade resultatet statistisk signifikans.   Slutsatser: I föreliggande studie har det framkommit att delaktighet på arbetsplatser upplevs positivt för målgruppen. Det som däremot var märkbart var att både sjuksköterskor och undersköterskor i högre grad upplevde att de inte kunde påverka arbetstempot. Vidare upplevde undersköterskor en mer rättvis fördelning av arbetsuppgifter i jämförelse med sjuksköterskor och hälften av båda yrkeskategorierna ville ha mer inflytande på arbetsuppgifterna. / Background: Work environment and participation are considered important factors for the individual's health. Over time, nurses' and assistant nurses' work environment has changed, which has given rise to less participation in the work and less trust in the organization. Aim: The purpose is to investigate workplace participation among nurses and assistant nurses who work in hospitals. The study also aims to investigate whether there are any differences between the participation of nurses and assistant nurses. Method: This study used a quantitative method with a cross-sectional design where data was collected using a digital survey. The sample consisted of approximately 300 hospital employees and 76 participated in the survey by answering the questionnaire. Data were analyzed in SPSS by frequency tables and differences were determined by Chi-2 test. Main results: Both assistant nurses and nurses experienced participation in workplaces. The results also showed that assistant nurses experienced more participation than nurses. However, the result lacked statistical significance. Conclusions: In the present study, it has emerged that participation in workplaces is experienced positively by the target group. What was noticeable, however, was that both nurses and assistant nurses felt to a greater degree that they could not influence the pace of work. Furthermore, assistant nurses experienced a fairer distribution of tasks compared to nurses, and half of both professional categories wanted to have more influence on tasks.

Background: In 1946, a proposal was made for a law on national pensions with the aim of reforming the pension system and giving pensioners better finances, which later was implemented at 1948. The theory of the social determinants of health suggests that income is an important factor that has an impact on health. The study aim was therefore to investigate whether the general pension reform implemented in 1948 could account for any differences in death rates for those aged 67 and older, and the research question was to examine if there was change in death rates for those aged 67 and older after 1948 that could be explained by an increase in income from the pension reform  Method: The study design was a quantitative inductive method. Data used in the study was death rates for those aged 67-90 years in Sweden between 1933-1962, as well as statistics from the Statistical Yearbook for Sweden to obtain data on income from the pension system. To investigate whether the pension reform has had any significant effects on the health of people of old ages, an interrupted time series analysis was used to measure changes in death rates for those aged 67-90 years between 1933 and 1962 in Sweden.  Results and conclusion: The results showed that there was an increase in the average pension by 461% for men and 442% for women between the years of 1947 and 1948. The study suggests that for women there was a significant change in death rates since the reform started, but that the reform of 1948 might not have had a significant effect on men’s death rates. Overall my study indicates that the changes in death rates for women in the pension age in 1948 and after could be explained by an increase in income from the pension reform, and that the pension reform seems to be a sustained policy effect that have accumulated over time.

This study aims to discover how self-supported elderly in Finland experience the move towards a digital society and how this change affects their daily lives. As the proportion of the elderly compared to younger generations changes, so does the need for digital services catering to this population group. At the same time, society is digitalising at an accelerated pace, and this growing populace will face a very different society than the one they grew up in. Conducting 11 personal interviews in Tampere, Finland, and phone interviews around Finland, this study presents the elderly in a more nuanced and personal light. Modified Van Kaam analysis brings a comprehensive picture of the emotions and experiences surrounding digitalisation. This study showed that the elderly in the study are managing the use of digital services but were concerned about the skills and coping of others. Lifelong learning is discussed in connection with the results, as is the need for unlearning old habits. Results show that society’s shift into remote healthcare access and limited on-location services cause the elderly concern and uncertainty, decreasing their quality of life. The elderly want to live high-quality life and have an active role in society. This study showed the elderly as quality conscious populace with digital solutions. The inclusivity of the services is essential as the digital society cannot be wholly avoided in modern life. As the study sample is limited to a broad scope, the study’s results guide future research towards more focused research.

Background Each year almost 1 in 3 (27%) of women (15-49y) worldwide experience lifetime physical and/or sexual domestic violence by their husbands/partners; that is almost 736 million women worldwide. According to the PDHS 2017-18, the prevalence of DV is 24% in Pakistan. The higher education level of the husband/partner in Pakistan might act as a protective factor against DV in women. Therefore, this study aimed to explore the association between the husband/partner's level of education and lifetime physical domestic violence against women. Method This quantitative cross-sectional study was based on the secondary data from Pakistan demographic health survey (PDHS) 2017-2018. The Woman's Questionnaire was used for the Data collection, and women (n = 3959) aged 30-49 in Pakistan were included. Descriptive analysis, crosstab chi-squared tests, and logistic regression analyses were performed to describe the background characteristics of the sample and evaluate the association between exposure and outcome of interest.    Results Almost 24% of the women aged 15-49 have experienced lifetime physical domestic violence by their husbands/partners. In addition, 34% of the husbands/partner had secondary education. A secondary education level lowers the odds of physical domestic violence against women (OR=0.65, CI=0.54-0.77).   Conclusion The association between the husband/partner's level of education and lifetime physical domestic violence against women was established in this study. However, improving the husband/partner’s education level might contribute to eradicating DV against women.

Background Diarrhea is a common diseases and each year around 5 billion children suffer from this diseases globally. According to BDHS 2017-18, 21% mothers had no education. Moreover, maternal education might consider to be one of the important aspect which plays a great role to diarrheal incidence. So the aim of this study is to explore the association between level of maternal education and recent episode of diarrhea among under five children in Bangladesh. Method The quantitative cross-sectional study utilized the secondary data from Bangladesh Demography and Health Survey (BDHS) 2017.Data was collected from Women’s Questionnaire and total 8398 mothers having  children aged 0-59 months were selected. Descriptive analysis, crosstab chi-squared tests, and logistic regression analyses were conducted to describe the background characteristics of the participants and explore the association between exposure and outcome of interest. Result Approximately 5% of the children had diarrhea and 17% of the mothers had higher level of education. Children whose mother had higher education had 30% lower risk of having diarrhea (OR=0.70, CI 0.44-1.13) compared to the children having uneducated mother. However, findings revealed that there is no significant association between maternal education and the incidence of diarrhea in the study population.  Conclusion  Based on this study, maternal education has no association with diarrhea among under five children. However, there might be several other factors responsible for the reduction of diarrheal diseases other than maternal education.

The aim of the study was to investigate the perceived factors influencing the possibilities of engaging more children and youth in organized physical activity during their leisure time within the current IOP project. The studys method used semi-structured interviews for data collection. Conventional content analysis was used for data analysis. The results indicate that resources, organizationalstructure and activites, and the interest of children and youth have the greatest impact on their level of engagement in physical activity. Girls, children from different ethnic backgrounds, and those lacking adult role models were considered more challenging to reach. The informants unanimously emphasized the importance of increased collaboration. The conclusion drawn is that access to economic resources, visible organizations, and children and youth's own interest are crucial in promoting their physical activity. The lack of these factors was found to be a hindrance. Challenges were identified in reaching girls, children from different ethnic backgrounds, and those lacking adult role models. The informants emphasized the significance of increased collaboration for promoting physical activity among children and youth.