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<p><strong>Background:</strong> Over the past two decades the prevalence of childhood obesity has reached epidemic proportions. In Canada recent population growth has relied heavily on immigration. In some instances, immigrant youth exhibit better health overall and may be at less risk for obesity. There is a paucity of literature on the health of immigrant youth in Canada.</p> <p><strong>Objectives:</strong> The objectives of this study are: (i) to examine differences in body mass index and prevalence of overweight/obesity between immigrant versus non-immigrant youth and (ii) to identify the extent to which (a) lifestyle and (b) socio-demographic factors, account for between-group differences.</p> <p><strong>Methods:</strong> Data for this study was obtained from the Canadian Community Health Survey (CCHS). The associations between standardized BMI score (zBMI) and prevalence of overweight/obesity, immigrant status, socio-demographic and lifestyle covariates were analyzed using multilevel linear and logistic regression, respectively.</p> <p><strong>Results:</strong> The CCHS sample included 63509 participants, aged 12 to 19 years. 6.4% respondents identified themselves as being born outside of Canada. Immigrant youth had a lower zBMI by 0.441 compared to Canadian-born youth (p < 0.001). The odds of being overweight/obese were 34% lower (OR 0.66, 95% confidence interval (CI) 0.45, 0.86) among immigrant versus non-immigrant respondents. Measures of diet, activity level and sedentary behaviour did not account for the differences in body composition between immigrant and Canadian born youth.</p> <p><strong>Conclusion:</strong> Immigrant youth had a lower rate of overweight/obesity and lower zBMI scores compared to Canadian-born youth.</p> / Master of Science (MSc)

Background: Lifestyle diseases are the leading causes of death, disability and healthcare costs worldwide. Despite advances in pharmacological treatment, lifestyle modification remains a primary treatment. For behavioral change, it is of great importance that a patient is motivated, as this helps them maintain interest. Primary care nurses can be the patient's first point of contact, therefore they have the opportunity to identify patients with risk factors before the onset of disease. Nurses' skills in motivating patients to make lifestyle changes are therefore crucial. Aim: The purpose of the literature study was to describe nurses' experiences of motivating patients to make lifestyle changes- in primary care. Methods: The literature study was based on 10 studies with a qualitative approach. Database search was conducted in Cinahl and Psycinfo. The analysis was carried out using Friberg's five-step model. Results: The analysis resulted in four categories and twelve subcategories. The four categories concludes "The nurses’ own prerequisites affect", "The patient’s starting point affects", "The conversation as a tool" and "The organization as a barrier or enabler". Conclusion: Nurses' experiences of motivating patients to make lifestyle changes are perceived to be influenced by both internal factors of the nurse and external factors from the patient and the organization as well as how the conversation is structured. By prioritizing disease prevention, the need for care can be reduced and a sustainable work situation for all healthcare professionals can be created. This could also lead to shorter waiting lists, faster care and a reduction in chronic, fatal diseases in society.

Lifestyle is a popular concept used to understand consumers' behaviors; however, the lifestyle concept rarely has been applied to housing studies. Although renting a multifamily dwelling is a non-normative housing choice in the United States, many people prefer to rent multifamily housing units for reasons other than financial. The purpose of this study is to identify the housing preferences of multifamily housing residents as determined by their lifestyles. The model of influences on housing choice was used as a theoretical framework for the study. Fifty nine housing activity, interest, and opinion (AIO) statements were developed as a lifestyle measurement for this study. A total of 211 responses were collected from residents of nine selected apartment communities in Charlotte, N.C., through two phases of questionnaire surveys. The respondents were represented by young single-person or couple households with high income and college degrees or higher education. Four lifestyle factors (Well-being, Social, Spaces, and Envirotech) were derived from housing interest and opinion items, and the respondents were grouped into four lifestyle clusters (Community Cluster, Basics Cluster, Home Cluster, and Environment Cluster) on the basis of the lifestyle factors. The relationships between the lifestyle clusters and their housing preferences were tested and the model of influences on housing choice was partially supported. Households in the Community Cluster had a strong downtown-orientation and the weakest perception of homeownership, and preferred to have security features. Households in the Basics Cluster had the weakest preferences for apartment home and community features and the second weakest perception of homeownership. Households in the Home Cluster had the strongest perception of homeownership and relatively strong feature preferences, including preferences for upscale interior design features. Households in the Environment Cluster had a strong suburban-orientation and preferred to have outdoor parking spaces in front of the building, plant watering service, and an on-site car care center. The findings from this study can be applied to the design and management of apartment communities and to marketing strategies that are sensitive to lifestyle concepts. Because of the unique sampling framework, the results from this study cannot be generalized. Instead, it is recommended that further research studies test the housing AIO statements with different groups in diverse markets. / Ph. D.

The primary goal of this project was to develop, implement, and evaluate a lifestyle modification intervention that did not require extensive, ongoing personal contact to improve lifestyle behaviors shown to lower blood pressure (BP) in adults with prehypertension (N=23, mean age=54, mean BP=126.7/75.1). Incorporating clinical practices and psychological approaches to behavior change, this intervention used primarily the DASH Eating Plan, coupled with a low-sodium diet and a walking program; it applied social cognitive theory to health behavior change, specifically self-regulation for self-monitoring and management of BP, diet, exericse, and weight. The study compared two conditions, the DASH 2 Wellness Only standard of care condition to the DASH 2 Wellness Plus treatment condition on the primary outcome measures of fruit and vegetable (servings/day), sodium consumption (milligrams/day), physical activity (steps/day), weight (kgs), and blood pressure (primarily systolic BP). Consistent with hypotheses, MANOVAs detected significant differences between the conditions with D2W Plus evidencing a larger increase in change of total daily steps (M= 2900.14, SD= 1903.83) than D2W Only, (M= 636.39, SD= 1653.26), a larger decrease in systolic BP change (MMHG) (M= 15.14, SD= 4.33) than D2W Only, (M= 4.61, SD= 8.28), and a larger decrease in weight change (kg) (M= 4.78, SD= 3.81) than D2W Only, (M= 1.47, SD= 2.57). While conditions did not significantly differ on daily sodium reduction or fruit and vegetable increase, D2W Plus evidenced a larger decrease in sodium (mg) (M= 932.22, SD= 1019.22) than D2W Only, (M= 423.64, SD= 749.15) and larger increase in fruit and vegetable increase, (M= 2.10, SD= 1.73) than D2W Only, (M= 1.02, SD= 2.24). It was also hypothesized that the D2W Plus condition would show greater improvements in nutrition-specific and PA-specific health beliefs of self-regulation, social support, self-efficacy, social support, and outcome-expectancy compared to those in the D2W Only condition. A MANOVA revealed significant group differences in PA-specific health beliefs primarily attributable to increased PA self-regulation in D2W Plus compared to D2W Only, (M= 1.78, SD= 0.75) and (M= 0.55, SD= 0.57), respectively. While no overall significant group differences were found for nutrition-specific health beliefs, analyses showed meaningful differences in nutrition-specific health beliefs attributable to increased nutrition self-regulation strategies in D2W Plus compared to D2W Only. Results provide preliminary support for the efficacy of an electronic delivery of an intervention aimed at improving lifestyle behaviors and lowering BP in middle-aged individuals with prehypertension. / Ph. D.

Övervikt har idag blivit den största kroniska sjukdomen världen över och anses vara den näst största behandlingsbara dödsorsaken. Patienter som blir medvetna om sin övervikt kan i större utsträckning gå ner i vikt än de som inte upplyses. Primärvården anses vara den enhet som har störst möjlighet att förmedla kunskap om levnadsvanor. Det är viktigt att med hjälp av livsstilsrådgivning stödja människor, distriktssköterskor anses vara den mest passande professionen för denna uppgift. Genom livsstilsrådgivning kan människor få en ökad kunskap och förståelse för hur vår livsstil påverkar vår hälsa. Initiativ till att ställa frågor och diskutera om levnadsvanor bör tas även när det inte finns en nära koppling till de besvär eller den sjukdom patienten söker för. Trots detta finns risk att livsstilsrådgivning utförs i bristande omfattning. Syftet med studien var att belysa distriktssköterskors erfarenheter av livsstilsrådgivning med överviktiga vuxna som söker vårdcentral för andra besvär. Metoden var kvalitativ och genomfördes med ett semistrukturerat frågeformulär. Det väsentliga resultatet var att distriktssköterskorna upplevde livsstilsrådgivning som deras ansvar men att det var ett känsligt område. Trots detta upplevde flertalet av patienterna samtal om levnadsvanor som positivt. Livsstilsrådgivning beskrevs vara nedprioriterat av arbetsgivaren, trots primärvårdens preventiva ansvar. En önskan om förändring på arbetsplatsen var tydlig. Förändringarna som beskrevs var att livsstilsrådgivning skulle prioriteras av arbetsgivaren. Riktlinjer behövdes och utbildning krävdes för ett optimalt omhändertagande av överviktiga vuxna. Vidare önskades mer tid avsatt för området så att undersökningar och livsstilsrådgivning kunde möjliggöras. Ett behov av samarbete med andra professioner sågs också. Studien diskuterar hur livsstilsrådgivning skulle kunna hanteras med aktuella resurser utan förändring på arbetsplatsen men även arbetsgivarens ansvar för att distriktssköterskorna ska kunna bedriva en hälsofrämjande vård. Vidare diskuteras förslag på implementering av bland annat en modell för viktkontroll. Förslagen skulle sannolikt kunna bidra till ett förbättrat preventivt arbete inom primärvården. Distriktssköterskorna ansåg att livsstilsrådgivning var viktigt och kunde se flera fördelar med att prioritera det hälsofrämjande arbetet. / Overweight has now become the largest chronic disease worldwide and is considered the second largest treatable cause of death. Patients that become aware of their overweight may increasingly lose weight than those who are not informed. Primary care is considered to be the unit that has the best opportunity to mediate knowledge about living habits. It is important that by using lifestyle counseling support people, primary care nurses are considered the most suitable profession for this task. Through lifestyle counseling people can get a better knowledge and understanding of how our lifestyle affects our health. Initiative to ask questions and discuss about living habits should be taken even when there isn´t a close link to the symptoms or disease the patient searching for. Despite this, there is a risk that lifestyle counseling performed in the lack of scope. The purpose of the study was to lighten primary care nurses experiences of lifestyle counseling to overweight adults who seek health center for other conditions. The method was qualitative and was conducted using a semi-structured questionnaire. The important outcome was that the primary care nurses experienced lifestyle counseling as their responsibility but that it was a sensitive area. Despite this, most of the patient experienced talk about lifestyle habits as positive. Lifestyle counseling was described to be given lower priority by the employer, even though the primary cares preventive responsibility. A desire for change in the workplace was clear. The changes described were that lifestyle counseling would be given priority by the employer. Guidelines were needed and education required for optimal treatment of overweight adults. Further, there was a desire of more time set aside so that screening and lifestyle counseling could be made possible. A need for collaboration with other professions was also seen. The study discusses how lifestyle counseling could be dealt with current resources without change in the workplace, but also the employer´s responsibility to primary care nurses so they can conduct health care. Proposals on the implementation of including a model for weight management are also discussed. The proposals would likely contribute to an improved preventive work in primary care. Primary care nurses felt that lifestyle counseling was important and could see several benefits to prioritize health promotion.

The purpose of this study was to explore patients' perception and knowledge regarding hypertension and hypertensive guidelines on sodium intake and lifestyle modifications in a work environment in the Republic of Panama. Hypertension is important not only because of its high prevalence but also because it is a major modifiable risk factor for cardiovascular diseases. In Panama the prevalence of hypertension is about 38.7% and uncontrolled hypertension is almost 50%.This number may translate into complications for the general population. For instance 52.8% of the population has had an ischemic disease and death by ischemic disease climbed from third place to second place from 2009 to 2010. This qualitative study used an exploratory approach and semi-structured in-depth interviews to answer the research questions. A purposive sample included woman with a hypertension diagnosis, between 30 to 59 years of age, and working in a single organization. A constant comparative analysis was used to search for themes grounded in the data. Emerging themes illustrated that participants perspectives of hypertension had become their drives towards the management of their disease and throughout their daily lives constant different factors played the role of motivating or discouraging their non-pharmacological treatment. Participants had also provided a list of barriers and coping strategies which were redundant on the need of practical knowledge, obtainable goals and policy changes of their environment in order for them to keep their disease management. Further research at a population level may aid to generalize this finding and to provide a better understanding of patients' compliance to non-pharmacological treatment.

Bakgrund: Ohälsosamma levnadsvanor är ett folkhälsoproblem och står för en femtedel av den totala sjukdomsbördan i Sverige. Var annan kvinna och var tredje man i åldrarna 16-84 år rapporterar att de inte har några ohälsosamma levnadsvanor. (Socialstyrelsen, 2011; Folkhälsomyndigheten, 2014). De flesta distriktssköterskor och sjuksköterskor i den svenska primärvården tycker att det är viktigt att arbeta med patienternas levnadsvanor, de tycker även att arbetet behöver utvecklas (Kardakis, Weinehall, Jerdén, Nyström &amp; Johansson, 2013). Syfte: Att undersöka i vilken utsträckning distriktssköterskor och sjuksköterskor arbetar med rådgivning om levnadsvanor till patienter i primärvården. Syftet är också att undersöka hur de skulle vilja arbeta, vilken kunskap de tycker sig ha och om de anser att de behöver ytterligare kunskap om rådgivning kring levnadsvanor. Metod: En totalundersökning gjordes där samtliga distriktssköterskor och sjuksköterskor verksamma inom primärvårdens vårdcentraler i föreliggande landsting inkluderades i studien. Data samlades in med hjälp av en webbenkät. Resultat: Resultatet visade att de flesta respondenterna ansåg att arbetet med levnadsvanor var mycket eller ganska viktigt och att de flesta arbetade med rådgivning om levnadsvanor i ganska stor utsträckning. Det fanns inga signifikanta skillnader mellan specialistutbildade och grundutbildande sjuksköterskor. Slutsats: Distriktssköterskor och sjuksköterskor i primärvården i föreliggande landsting anser att arbetet med rådgivning om levnadsvanor är mycket viktigt. De arbetar också mycket med detta och anser sig ha kunskaper inom området, men de vill ändå arbeta mer med rådgivning om levnadsvanor och utveckla sin kompetens.  Det är tydligt att distriktssköterskor och sjuksköterskor i primärvården är en underutnyttjad resurs i arbetet med levnadsvanor. / Background: Unhealthy lifestyle behaviour is a public health problem, accounting for a fifth of the total burden of disease in Sweden. Every second woman and every third man aged 16-84 years report that they do not have any unhealthy lifestyle behaviours. (Socialstyrelsen, 2011; Folkhälsomyndigheten, 2014). Most district nurses and registered nurses in Swedish primary health care think it is important to work with lifestyle behaviours, they also think there is need for improvement (Kardakis, Weinehall, Jerdén, Nystrom &amp; Johansson, 2013). Aim: To examine the extent to which district nurses and nurses are working with counseling patients on lifestyle behaviours in primary health care. The aim is also to examine how they would like to work, what knowledge they think they have and if they feel they need additional knowledge of counseling on lifestyle behaviours. Method: A comprehensive survey was made in which all district nurses and registered nurses working in primary health care centers in the present county were included in the study. Data were collected using an online survey. Results: The results showed that most respondents felt that the work with lifestyle behaviours was very or quite important. Most of the respondents were working quite widely with counseling on lifestyle behaviours. There were no significant differences between nurses with specialist education and registered nurses. Conclusion: District nurses and registered nurses in primary health care in this county believe that counseling on lifestyle behavior is very important. They also work a lot with this and claim to have knowledge about lifestyle behaviours. Still they want to work more with counseling on lifestyle behaviours and develop their skills. It is clear that district nurses and registered nurses in primary health care is an underutilized resource in the work with lifestyle behaviours.