<p><strong>Inledning: </strong>En vanlig missuppfattning är att feta individer är lata och inte vill försöka uppnå viktkontroll, eller gå ner i vikt. <strong>Syfte:</strong> Identifiera faktorer, vilka respondenterna uppfattar påverkar viktuppgång som upphov till övervikt och fetma hos sig själva samt hos andra individer. <strong>Urval:</strong> Fyra kvinnor och två män i åldrarna 39-50. Ingen respondent har varit överviktig som barn, men har någon gång efter 18 års ålder upplevt fetma. <strong>Metod:</strong> Studien har en kvalitativ forskningsansats där semistrukturerade intervjuer har använts för att ta reda på respondenternas uppfattningar kring fenomenet viktuppgång. Intervjuerna transkriberades och analyserades enligt ett fenomenografiskt - hermeneutiskt perspektiv. <strong>Resultat: </strong>Intervjuerna genererade kategorierna<strong> </strong><em>Emotioner</em>; <em>Fysisk aktivitet</em>; <em>Bristande</em> <em>kunskap</em>; <em>Kosthållning</em>; <em>Socialt stöd</em>; <em>Förnekande</em>; <em>Tidsbrist, prioritering, vanor</em>;<em> Ålder, hormoner, ämnesomsättning</em>; <em>Ekonomi </em>och <em>Kriser.</em> <strong>Slutsats:</strong> Viktökning och förlorad viktkontroll är en konsekvens av samverkande faktorer, och det är omöjligt att särskilja en primär kategori i denna urvalsgrupp. För begynnande viktuppgång, både hos respondenterna själva och gällande deras uppfattningar om andra individer, är kategorierna <em>Fysisk aktivitet</em>, <em>Kosthållning</em> och <em>Tidsbrist, prioritering, vanor</em> de dominerande. <em>Förnekande</em> är en betydande faktor för uppkomsten av fetma, och är bidragande för bristande viktkontroll men kan inte missförstås som lathet bland respondenterna i denna urvalsgrupp.</p>

<p>Why do some anaesthetists perform a better job than others? Why do some trainees grow faster in their professional role than others? These are important questions when the education of anaesthetists is so topical. Research in work pedagogy has shown that competence is related to the way professionals understand their work; the two first interview studies of this thesis are about understanding work. <i>Study I</i> shows that specialist anaesthetists understand work in four different ways, representing four aspects of work. Some of them have a comprehensive understanding, seeing three or all four aspects of work, whereas others have more restricted understandings. In <i>Study II,</i> trainees expressed similar ways of understanding work, some comprehensive, some more restricted. It is important that trainees develop competence in all aspects of work. Therefore, trainees need not only to develop competence by <i>deepening their present understanding</i>, but also by <i>change of understanding</i>, an important but difficult step in competence development.</p><p>Reflection is important in professional training. The reflection process should encompass all aspects of work, to enable trainees to develop a broad competence. However, only anaesthetists with a comprehensive way of understanding work have the prerequisites for facilitating trainees’ reflection in all aspects of work.</p><p><i>Study III, </i>focussing on the learning environment,<i> </i>shows that two important principles of professional training are often violated for trainee anaesthetists: making use of the trainee’s curiosity and reducing trainees’ stress level. Trainees very much need support from well educated mentors. </p><p>Teachers should not only facilitate trainees’ development of competence but also support young trainees to develop into anaesthetists who enjoy work. <i>Study IV</i> shows that some experienced anaesthetists still enjoy work very much after years of practice. Their advice about how to get to terms with work should be shared with young trainees. </p>

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The aim of this thesis was to examine the cost-effectiveness of specific advanced home care and home rehabilitation interventions and to improve economic evaluation methods when applied to advanced home care. This included a comparison of two alternative ways of administering oxygen at home to patients with chronic hypoxaemia, as well as a review of scientific evidence on costs and effects of home rehabilitation after stroke. Also included were studies on prominent methodological issues in advanced home care - the redistribution of care efforts among caregivers and costing of informal care efforts. For patients with chronic hypoxaemia, a randomised, controlled trial showed that mobile liquid oxygen was considerably more costly compared to concentrator treatment. However, the treatment effects showed that liquid oxygen had a better impact on patient quality of life. The literature review revealed that the outcomes and costs of home rehabilitation after stroke are equal to those of alternative treatment strategies. Similar results were obtained in a study comparing hospital-based and home-based stroke rehabilitation, which also showed that there is a considerable redistribution of costs between health care providers and social welfare providers. Studies of patients in advanced home care in the county of Östergötland, Sweden, showed that the cost of informal care constitutes a considerable part of the care effort in all costing approaches used. Also, informal care costs were higher among patients who were men, who were younger, who had their own housing and had a cancer diagnosis. This thesis reveals that advanced home care interventions can differ regarding costs as well as effects, and thus comparisons between alternative home care interventions must also be performed. Further, redistribution effects are important to consider in evaluations. The cost of informal care is substantial in advanced home care. These costs must be included in evaluations with a societal perspective or else the comparisons will be biased.

Why do some anaesthetists perform a better job than others? Why do some trainees grow faster in their professional role than others? These are important questions when the education of anaesthetists is so topical. Research in work pedagogy has shown that competence is related to the way professionals understand their work; the two first interview studies of this thesis are about understanding work. Study I shows that specialist anaesthetists understand work in four different ways, representing four aspects of work. Some of them have a comprehensive understanding, seeing three or all four aspects of work, whereas others have more restricted understandings. In Study II, trainees expressed similar ways of understanding work, some comprehensive, some more restricted. It is important that trainees develop competence in all aspects of work. Therefore, trainees need not only to develop competence by deepening their present understanding, but also by change of understanding, an important but difficult step in competence development. Reflection is important in professional training. The reflection process should encompass all aspects of work, to enable trainees to develop a broad competence. However, only anaesthetists with a comprehensive way of understanding work have the prerequisites for facilitating trainees’ reflection in all aspects of work. Study III, focussing on the learning environment, shows that two important principles of professional training are often violated for trainee anaesthetists: making use of the trainee’s curiosity and reducing trainees’ stress level. Trainees very much need support from well educated mentors. Teachers should not only facilitate trainees’ development of competence but also support young trainees to develop into anaesthetists who enjoy work. Study IV shows that some experienced anaesthetists still enjoy work very much after years of practice. Their advice about how to get to terms with work should be shared with young trainees.

Denna studie syftade till att undersöka vilka behandlingsmetoder som används mot övervikt och fetma. Författarna finner detta område intressant då övervikt och fetma har blivit ett växande folkhälsoproblem i Sverige. I bakgrunden definierades övervikt, fetma, orsaker till övervikt och fetma, läkare och sjukvård samt tidigare studier. Studien var en kvalitativ undersökning och designen var en beskrivande studie. I denna studie genomfördes semistrukturerade intervjuer med två patienter som lider av fetma, en läkare, en dietist, en studentsköterska och en diabetessköterska. Resultatet påvisar att behandlingsmetoder mot övervikt och fetma som används i Sverige är kirurgi, samtalsterapi och medicinering. Samtalsterapi är vanligast, medan kirurgi är mest effektivt. Medicinering används sällan på grund av svåra biverkningar. Majoriteten av yrkespersonalen som intervjuades kompletterade sin metod med övriga för att uppnå bästa möjliga viktnedgång. Slutsatsen för denna studie blev att kirurgi är mest effektiv på kort och lång sikt. Det är dock viktigt att komplettera en operation med samtalsterapi både innan och efter operationen. / Obesity and overweight are growing public health problems in Sweden, which is why the authors find it interesting to investigate which methods of treatment that are used. This descriptive study opens with a review of previous studies and definitions of relevant concepts. Thereafter, the focus question is treated qualitatively through semi structured interviews with six persons: two patients suffering from obesity, a doctor, a dietician, a student nurse and a diabetics nurse. On the basis of the interviews it is concluded that methods of treatment used in Sweden to fight obesity and overweight include cognitive therapy, surgery and medication. It appears that cognitive therapy is the most common, that surgery – in both the short and the long run – is the most effective and that medication is used with caution due to the risk of severe side effects. However, a majority of the interviewed report that they in several cases combine the three methods of treatment; for example, surgery is often both preceeded and followed by cognitive therapy. The study at hand closes with suggestions on ways in which consecutive studies could investigate how the most commonly used method of treatment, cognitive therapy, could be optimized and/or supplemented. The authors propose the hypothesis that cognitive therapy should be executed closely linked to the patient’s behavioural pattern, and suggests a quantitative observational study to test this hypothesis.

Abstract School of Education Växjö University Social Science specialised in Care and Treatment of Juveniles and Substance Abusers C- Essay 10p Titel Benzodiazepines in primary care Authors Taskin Arslan and Mattias Edlund Supervisor Stellan Jeppsson Date March 2006 Number of pages 47 Keyword benzodiazepines, pharmaceutical abuse, tranquillizer, perspective of gender With this essay we have tried to bring up the different causes why there are so many prescriptions of benzodiazepines, the primary cares part in all this and why there are more prescriptions for women than men. The purpose of this study was to increase our knowledge about benzodiazepines, try to find out advantages and disadvantages in case of prescriptions of these preparation and if primary care was aware of these disadvantages in case of prescriptions especially at the matter of prescriptions for women. Some of the questions we asked ourselves were: what kind of risk is connected to benzodiazepines? What kind of responsibility does the doctor have in case of prescriptions of benzodiazepines? How is it that the women constitute the group which receives most prescriptions of benzodiazepines? Our method has been an explorative theoretical study combined with qualitative interviews. In our studies we have found that there is a big awareness about the disadvantages of benzodiazepines prescriptions among the doctors in primary care. And that the conversation between doctor and patient is important for the search of underlying causes. Finally that why women are overrepresented in the matter of benzodiazepine prescription could be due to that women to a greater extent seeks help in non-institutional care than men. / Abstract Institutionen för pedagogik/IKM Växjö universitet Pedagogik med inriktning mot Ungdoms- och missbrukarvård C- Uppsats 10p Titel Bensodiazepins in primary care Författare Taskin Arslan och Mattias Edlund Handledare Stellan Jeppsson Datum Mars 2006 Antal sidor 47 Nyckelord bensodiazepiner, läkemedel, lugnande, genusperspektiv Detta arbete har försökt ta upp de olika orsakerna till varför det föreskrivs så mycket bensodiazepiner, primärvårdens roll i det hela och varför det föreskrivs mer bensodiazepiner till kvinnor än män. Syftet med denna studie var att fördjupa våra kunskaper om bensodiazepiner, försöka ta reda på fördelarna och nackdelarna vid föreskrivning av dessa preparat och om primärvården var medveten om dessa nackdelar speciellt när det gällde föreskrivning till kvinnor. Några av frågorna vi ställde oss var: Vilken risk finns kopplade till bensodiazepiner? Vilken roll respektive vilket ansvar har läkaren vid föreskrivning av bensodiazepiner? Hur kommer det sig att kvinnor utgör den grupp som erhåller flest bensodiazepinförskrivningar? Vår undersökning har varit en explorativ litteraturstudie kombinerad med intervjuer. Det vi har kommit fram till utifrån intervjuerna och litteraturen är att det finns en stor medvetenhet hos läkarna kring riskerna med föreskrivning av bensodiazepiner. Att samtalet mellan läkaren och patienten är viktigt för att utreda de bakomliggande orsakerna och att orsaken till att kvinnor är överrepresenterade vad gäller föreskrivningen av bensodiazepiner kan enligt litteraturen och läkarna vi varit i kontakt med bero på att kvinnor i större utsträckning än män söker hjälp inom vården

The problem of vesico-vagina fistula still remains a ravaging scourge in resource-poor countries of which Nigeria is visibly prominent. A majority of the cases are attributed to prolonged complicated labour due to inaccessibility of adequate and immediate obstetric health care. Complicated labour arises as a result of narrow pelvis bones of victims due to suffering from poor nutrition. While the above factors are noted as the direct cause to the prevalent of VVF, there are other socio-cultural conditions which predispose victims to this disease. Notable among them are the following: poverty; marital age; illiteracy; hazardous traditional practices, such as female circumcision. VVF victims often live an unworthy life. Many of them have been abandoned or divorced by their husbands and become ostracised by families and societies because of their repulsive smell and inability to engage in sexual activity and bear children. VVF victims suffer both physical and social consequences, many of them find it difficult to engage in any economic activity, surviving the hardship is very complicated and pathetic; some victims turn to street begging, while others survive through hawking of “bagged” water and selling firewood. Most studies conducted on the problem of Vesico vaginal fistula are done from the medical perspectives, often neglecting the psycho-social consequences faced by the sufferers. This study, however, discusses the socio-cultural and the psychological consequences of the disease. Locally and internationally, attempts are being made to eradicate the problem of VVF, however, if the Nigerian government does not recognise the incidence of VVF as a major public health issue, it will continue to ravage lives of Nigerian women, hence increasing maternal mortality in the country. This study proffers recommendations to help eradicate or alleviate the problem in Nigeria.

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This study is about age and gender specific HIV morbidity in Nepal. The main objective of the study is to find out the factors that affect the HIV prevalence in Nepali society and the relationships of different existing socio cultural and economic factors that have led females vulnerable to HIV infection especially to housewives. Qualitative and quantitative methods were used for the data collection. Initially, Nepal’s epidemic was driven by sex workers and drug users .Though HIV prevalence was concentrated in these groups for several years, now it has been proved that  the outbreak is not limited among those groups only, the prevalence among housewives , clients of sex workers, migrants and male homosexuals   are stretching up . Moreover findings have shown that the HIV epidemics is taking a devastating tool in women in Nepal, covering the more HIV prevalence number by low risk group housewives among the HIV affected female population. Lack of fully inclusive knowledge of HIV/AIDS; lack of knowledge of proper use of condom, negligence, and risky sexual behavior have compelled maximum risk for HIV contraction in society. Socio economic and cultural structures and the consequences of its correlation aggravated the HIV prevalence among people, especially have affected women. Discrimination of women is entrenched in Nepali society. Due to disparity and discrimination women are not able to get formal education that deprives them from any opportunity for the employment that leads poverty on them. Living under poverty often stems them to engage in high risk situations and likely to adopt risky sexual behaviors which in turn render them vulnerable to HIV infection. The masculinity of the society, and women’s less power for the decision making process have made females heavily dependent on males, and this constraint them from entering into negotiating for protective sex which put them in HIV infection .The study further revealed the triggering effect of powerlessness of housewives and risky sexual behavior of men to HIV infection to low risk group housewives.  If the same trends go on, the time is not so far for the Nepali women to take up the higher number of HIV prevalence, and the low risk group housewives will be highly vulnerable. It is already urgent to activate the plans and intervention program for the prevention of HIV prevalence which is stretching towards women especially to low risk group housewives. Based on the findings, conclusions and recommendations are drawn.