Bakgrund Klimakteriet är en naturlig process nästan alla kvinnor går igenom och inträffar vanligtvis vid 45–55 års ålder. Processen pågår i flera år och det sker en gradvis minskning av östrogennivåer i blodet vilket till slut leder till kvinnans sista menstruation, menopaus.Klimakteriet medför kroppsliga förändringar och olika symtom som kan inverka på det fysiska, psykiska och sociala välmåendet. Egenvård är en viktig faktor vid behandling av klimakterierelaterade symtom. Det handlar om en individs förmåga att vårda sig själv med hjälp av kunskap och medvetenhet. Syfte Syftet är att belysa olika egenvårdsinsatser som kan lindra klimakterierelaterade symtom. Metod En icke systematisk litteraturöversikt utfördes. Artikelsökningarna utfördes i databaserna PubMed, CINAHL och Web of Science med relevanta sökord för syftet. Artiklarnas kvalitet granskades och en integrerad dataanalys genomfördes. Resultat 17 vetenskapliga originalartiklar inkluderades. 16 vetenskapliga artiklar var av kvantitativ design och en var av designen mixad metod. Identifierade huvudkategorier var: Levnadsvanor och Behandlingsinsatser. Fyra underkategorier utformades och beskrev olika egenvårdsinsatser vid klimakterierelaterade symtom. Egenvårdsinsatserna var fysisk aktivitet, hälsosamma kostvanor, knipövningar, användning av glidmedel samt relaxations-och andningsövningar. Dessa påvisades ha effekt för vasomotoriska symtom, sömnproblematik, stressreducering samt för det psykiska och sexuella välmåendet. Slutsats Det finns effektiva icke medicinska egenvårdsinsatser för att minska klimakterierelaterade symtom. Det är viktigt för hälso- och sjukvårdspersonal att ha kunskap kring klimakteriet som process, samt vilka egenvårdsinsatser som finns för att stötta kvinnorna i samband med upplevda besvär. Mer forskning bör bedrivas för att utveckla hur egenvårdsinsatser kan individualiseras och nyttjas kliniskt. / Background Menopause is a naturally occurring process that nearly all women go through at the age of 45–55. The process extends over several years and there is a gradual decrease in blood eostrogen levels which results in the womans last menstruation. The menopause comes with bodily changes and several different symptoms that can interfere with the physical, psychological and social wellbeing. Self-care is an important factor in treating menopause related symptoms and can be described as an individual's ability to care for themselves with knowledge and awareness.  Aim The aim is to highlight different self-care measures to treat menopause related symptoms.  Method A non-systematic literature review was conducted. The article searches were carried out in the databases PubMed, CINAHL and Web of Science, using relevant keywords for the aim of the review. The quality of the articles were analysed and an integrated data analysis was conducted. Results 17 original research articles were included. 16 articles were of quantitative design, and one was mixed method. The identified main headings were: lifestyle habits and treatment measures. Four subcategories were established and described different self-care measures for menopause related symptoms. Self-care measures were physical activity, a healthy diet, Kegel exercises, use of lubricant gel and relaxation/breathing techniques. These measures were shown to have effect on vasomotor symptoms, sleep problems, stress reduction and for the psychological and sexual wellbeing.  Conclusions There are several effective, non-medical self-care measures to reduce menopause related symptoms. It’s important for healthcare professionals to have knowledge about the process of menopause and which self-care measures are available to support women in their experience with problematic symptoms. More research is needed to develop how self-care measures can be individualised and used in practice.

Cluster randomized controlled trials are increasingly used to assess the effectiveness of life-style interventions in improvement of health services or prevention of disease. However, statistical methods in the analysis of cluster randomized controlled trials are not well established especially for analyzing binary outcomes. This project is motivated by the Community Hypertension Assessment Trial (CHAT) to assess the effectiveness of a 12-month community-based blood pressure management program in improving the management and monitoring of high blood pressure (BP) among older people. The study is a paired cluster randomized controlled trial, where the family physicians' practices are the clusters randomly allocated to CHAT intervention or usual practice, and a random sample of 55 patients 65 years and older were selected from the 14 practices in each study arm for health record review. The primary outcome was controlled BP over 12 months defined as systolic BP c:; 140 and diastolic BP c:; 90 for patients without diabetes or target organ damage or systolic BP c:; 130 and diastolic BP c:; 80 for patients with diabetes or target organ damage. Secondary outcomes include frequency of BP monitoring and average BP over a 12 month period. The clinical objective of this project is to evaluate the effectiveness of the CHAT intervention. The statistical objective is to compare Bayesian and classical methods of analyzing cluster-randomized trials using CHAT study as an example. We compared the results of different cluster-level analysis methods: i) un-weighted regression, ii) weighted regression, iii) random-effects meta-analytic approach, and different individual-level analyses: i) standard logistic regression, ii) robust standard errors approach, iii) generalized estimating equations, iv) random-effect logistic regression, v) Bayesian random-effect regression. We find that there is no sufficient evidence in support of the effectiveness of the CHAT intervention on all outcomes. For BP control, odds ratio (95% confidence interval) is 1.14 (0.72, 1.80) from generalized estimating equations. This result remains robust under different methods. We also find that the results from different statistical methods are different. The results from cluster-level analysis methods are quite different, while the results from the individual-level analysis methods are similar. We conclude that using various methods to analyze the trial provide good sensitivity analyses to help in interpreting the results of cluster randomized trials. Extensive simulation studies comparing the statistical powers of the different methods in different situations are required. / Thesis / Master of Science (MS)

Women’s journey through and out of a criminal lifestyle is often neglected in different research about individuals living a criminal lifestyle and therefore automatically also about why and how they leave said lifestyle (Sarnecki, 2014, s. 228). This has been done not only by analysing past research in the subject but also see what pulls and, especially, pushes the women in question to this kind of lifestyle. This has been done through analysing eight separate interviews of women in different age groups where they are asked about their journey through and out of a criminal lifestyle. The result shows that three factors are crucial to exiting a life of crime, 1) a will to leave, 2) a motivation to leave, and 3) support to leave.

Bakgrund: Personer som drabbas av diabetes utgör ett stort hälsoproblem världen över och förekomsten ökar. En stor del av anledningen till den globala diabetesepidemin är förändrade livsstilsfaktorer, framför allt avseende människors kost och motionsvanor som leder till övervikt. En tidig upptäckt av personer som är i riskzon och även att påbörja livsstilsbehandling kan både fördröja och förebygga att personer utvecklar diabetes typ 2 samt kardiovaskulär sjukdom. Vinsten är både att minska mänskligt lidande och ekonomiska besparingar.Syfte: Syfte med litteraturöversikten var att belysa patienter och personals erfarenheter av hindrande och främjande faktorer avseende livsstilsförändringar hos patienter med prediabetes i primärvården.Metod: Studien genomfördes som en litteraturöversikt genom en systematisk, metodisk och kritisk granskning av 16 vetenskapliga artiklar. Databaserna PubMed och Cinahl har använts för datainsamling. Artiklarna analyserades i en trestegsmetod.Resultat: Utifrån analysen av resultaten i de granskade artiklarna framkom fyra huvudteman: Erfarenheter och upplevelser av att få en prediabetesdiagnos med undertema Information, Livsstilsförändringar med underteman motivation, ekonomi och fysisk aktivitet, Socialt stöd med undertema matkultur och Vårdpersonalens roll med undertema olika hanteringar och stöd som påverkade patienternas hindrande och främjande faktorer till livsstilsförändringar. Främjande faktorer för att göra livsstilsförändringar var att få information om diagnosen och om vilka livsstilsförändringar som behövs utföras för att undvika att utveckla diabetes typ 2 samt stöd både från närstående och vårdpersonalen. Hindrande faktorer för att göra livsstilsförändringar var brist på att ta diagnosen på allvar, oförmåga att ha ekonomi för hälsosam kost, möjlighet till fysisk aktivitet, kulturella matpreferenser samt brist på stöd från både närstående och vårdpersonal.Slutsats: Genom att hälso- och sjukvårdspersonal blir medvetna om vilka hinder och främjande faktorer som finns kan detta ligga till grund för hur man bemöter och upprättar en relation i enlighet med Travelbees omvårdnadsteori till en patient med prediabetes i primärvård. Förhoppningsvis kan studien användas som en kunskapskälla för hälso- och sjukvårdspersonal vid önskvärda livsstilsförändringar. Nyckelord: Prediabetes, motivation, livsstilsförändringar, distriktssköterska, primärvård / Background: People suffering from diabetes constitute a major health problem worldwide and the incidence is increasing. A large part of the reason for the global diabetes epidemic is changed lifestyle factors, above all regarding people's diet and exercise habits that lead to obesity. An early detection of people who are at risk and also starting lifestyle treatment can both delay and prevent people from developing type 2 diabetes and cardiovascular disease.The benefit is both a reduction in human suffering and financial savings.Purpose: The purpose of the literature study was to shed light on patients' and staff's experiences of hindering and promoting factors regarding lifestyle changes in patients with prediabetes in primary care.Method: The study was conducted as a literature review through a systematic, methodical and critical review of 16 scientific articles. The databases PubMed and Cinahl have been used for data collection. The articles were analyzed in a three-step method.Results: Based on the analysis of the results in the reviewed articles, four main themes emerged: Experiences and experiences of receiving a prediabetes diagnosis with the subtheme Information, Lifestyle changes with the sub-theme motivation, finances and physical activity, social support with the sub-theme food culture and the role of the healthcare staff with the sub-theme different handling and support which affected the patients' hindering and promoting factors to lifestyle changes.Conclusion: Promoting factors for making lifestyle changes were getting information about the diagnosis and about which lifestyle changes need to be made to avoid developing diabetes type 2, as well as support both from relatives and the healthcare staff. Obstructing factors for making lifestyle changes were lack of taking the diagnosis seriously, inability to have finances for a healthy diet, opportunity for physical activity, cultural food preferences and lack of support from both relatives and healthcare professionals. By making healthcare professionals aware of the barriers and promoting factors that exist, this can form the basis of how to treat and establish a relationship in accordance with Travelbee's nursing theory with a patient with prediabetes in primary care. Hopefully, the study can be used as a source of knowledge for healthcare professionals in the case of desirable lifestyle changes.Key words: Prediabetes, motivation, lifestyle changes, district nurse, primary care.

Background: Type 2 diabetes (T2D) is increasing in young people. Reporting on the processes used when developing prevention interventions is needed. We present the development of a family-based interactive lifestyle intervention for adolescents with risk factors for T2D in the future. Method: A multidisciplinary team in the UK site led the intervention development process with sites in Portugal, Greece, Germany and Spain. Potential programme topics and underpinning theory were gathered from literature and stakeholders. A theoretical framework based on self-efficacy theory and the COM-B (capability, opportunity, motivation, behaviour) model was developed. Sessions and supporting resources were developed and refined via two iterative cycles of session and resource piloting, feedback, reflection and refinement. Decision on delivery and content were made by stakeholders (young people, teachers, parents, paediatricians) and all sites. Materials were translated to local languages. Site-specific adaptations to the language, content and supporting resources were made. Results: The “PRE-STARt” programme is eight 90-min interactive sessions with supporting curriculum and resources. Iterative development work provided valuable feedback on programme content and delivery. Conclusion: Reporting on the intervention development process, which includes stakeholder input, could yield a flexible approach for use in this emerging ‘at risk’ groups and their families.

Bone-derived osteocalcin has been suggested to be a metabolic regulator. To scrutinize the relation between osteocalcin and peripheral insulin sensitivity, we analyzed changes in serum osteocalcin relative to changes in insulin sensitivity, low-grade inflammation, and bone mineral density following lifestyle-induced weight loss in individuals with metabolic syndrome (MetS). Participants with MetS were randomized to a weight loss program or to a control group. Before and after the 6-month intervention period, clinical and laboratory parameters and serum osteocalcin levels were determined. Changes in body composition were analyzed by dual-energy X-ray absorptiometry (DXA). In participants of the intervention group, weight loss resulted in improved insulin sensitivity and amelioration of inflammation. Increased serum levels of osteocalcin correlated inversely with BMI (r = −0.63; p < 0.001), total fat mass (r = −0.58, p < 0.001), total lean mass (r = −0.45, p < 0.001), C-reactive protein (CRP) (r = −0.37; p < 0.01), insulin (r = −0.4; p < 0.001), leptin (r = −0.53; p < 0.001), triglycerides (r = −0.42; p < 0.001), and alanine aminotransferase (ALAT) (r = −0.52; p < 0.001). Regression analysis revealed that osteocalcin was independently associated with changes in CRP but not with changes in insulin concentration, fat mass, or bone mineral density, suggesting that weight loss-induced higher serum osteocalcin is primarily associated with reduced inflammation.

Bakgrund Övervikt och fetma är ett stort folkhälsoproblem som kan orsaka olika sjukdomar. Dessutom leder övervikt och fetma till minskad autonomi och nedsatt arbetsförmåga som förorsakar stora samhälleliga kostnader för samhället. Sjuksköterskans ansvarar är att hjälpa personer med övervikt och fetma förändra sina ohälsosamma levnadsvanor, förebygga ohälsa, få kunskap om egenvård samt stöd och hjälp vilket är väsentligt och avgörande under livsstilsförändringar. Syfte Syftet var att beskriva vuxna personers upplevelser av livsstilsförändringar vid fetma Metod En litteraturöversikt med nio vetenskapliga varav åtta var kvalitativa, en kvantitativ genomfördes enligt Fribergs metodbeskrivning. Databaserna Cinahl Complete och PubMed användes för att söka fram artiklarna som analyserades och tematiserades under olika rubriker enligt Fribergs metod. Resultat Två huvudteman identifierades i resultatet: Upplevda hinder och utmaningar för livsstilsförändringar samt Underlättande och stödjande vid livsstilsförändringar. Under första temat identifierades två undertemat Oförmåga samt Psykisk lidande. Under andra temat identifierades två underteman, Stöd av andra samt Acceptans och Mindfullnessövningar Slutsats Resultatet i denna litteraturöversikt visade att personer som hade övervikt och fetma behövde vårdpersonalens stöd och hjälp för att förbättra sina levnadsvanor, förstärka sin autonomi och genomföra egenvårdsinsatser för att uppnå hälsosammare livstillförändringar. / Background Overweight and obesity are a major public health problem that can cause various diseases. Moreover, overweight and obesity could lead to reduced autonomy and impaired working ability, which cause large social costs for society. The nurse`s responsibility is to help people with overweight and obesity to change their lifestyles, prevent ill-health, gain knowledge about self-care as well as support and help, which is essential and decisive during life changes. Aim The aim was to describe the experiences of adult's lifestyle changes in obesity. Method A literature review with nine scientific articles, eight which were qualitative, one quantitative, was carried out according to Friberg`s method description. The databases Cinahl Complete and Pubmed were used to search for the articles that were analyzed and thematized under different headings according to Friberg`s method. Results Two main themes were identified in the results: Perceived obstacles and challenges for lifestyle changes and facilitating and supporting lifestyle changes. Under the first theme, two sub-themes Inability and Mental suffering were identified. Under the second theme, two subthemes were identified, Support from others and Acceptance and Mindfulness exercises.   Conclusion The results of this literature review showed that people who were overweight and obese needed the support and help of healthcare professionals to improve their lifestyle habits, strengthen their autonomy and implement self-care efforts to achieve healthier lifestyle changes.

BACKGROUND: Pregnancy-induced hypertension (PIH) and gestational diabetes mellitus (GDM) are among the leading causes of disability and death for women and their babies. Identifying risk factors for these pregnancy-related complications is essential to their prevention. Studies identifying preventive models for PIH and GDM are few. OBJECTIVES: This study was designed to evaluate lifestyle and personal predictors of PIH and GDM in a cohort of nearly 20,000 pregnant women. METHODS: The exposure data for the study were derived from a combination of a telephone interview and a questionnaire completed approximately 2 months after conception during the period from 1984 to 1987. The initial questionnaires asked for information on three periods: 3 months before conception, at conception, and 2 months after conception. Subjects included 19,312 women, aged 18-<45 years, who did not have excessive intakes of alcohol or food, were neither underweight (BMI >18.5) nor extremely overweight (BMI <40), and did not use illegal drugs during the first trimester of pregnancy. Outcome data on the mother and baby were collected approximately one year after the expected data of delivery. Logistic regression models were used to estimate the odds ratios (OR), and 95% confidence intervals (CI), as well as receiver operating characteristic (ROC) curves predicting PIH and GDM. Akaike Information Criteria (AIC) were used to select the best predictors of these two outcomes. Factors found not to affect PIH or GDM (based on a two-unit decrease in the AIC) were excluded from the final models. RESULTS: Based on the outcome data collected, there were 204 PIH cases, 358 GDM cases, and 538 who had PIH and/or GDM. After selecting the outcome predictors using AIC values, we identified three predictive models—one each for PIH, GDM, and either PIH or GDM. Factors found to predict PIH included age, previous hypertension or type 1 or 2 diabetes, pre-pregnancy BMI, parity, exercise, red meat consumption, margarine consumption, cigarette smoking, and weight change at 2 months. The final AIC value for PIH was 2084.12 and the AUC value was 0.76. GDM was predicted by age, previous GDM (in an earlier pregnancy), pre-pregnant BMI, height, exercise, race, dairy consumption, and cigarette smoking, with an AIC value of 3288.74 and an AUC value of 0.70. The combined model (predicting either PIH or GDM) was best predicted by age, history of GDM in a previous pregnancy, pre-pregnant BMI, previous history of hypertension, height, exercise, dairy consumption, red meat consumption, parity numbers, cigarette smoking, and weight change at 2 months with an AIC value of 3288.74 and an AUC value of 0.71. CONCLUSIONS: In these analyses, separate models predicting PIH and GDM were better than a combined model predicting PIH or GDM. These final models indicate that we can reasonably identify women who are at increased risk for adverse maternal outcomes associated with hypertensive disorders or diabetes during pregnancy.

Today, more people have the opportunity to travel which means that more places need to raise awareness that they exist. In the global world that we live in today, competition among places are growing. This means that places need to work on their marketing to create a unique and special image that reaches out through all the noise. This study aims to investigate why a special image is chosen, in this case why the destination Swedish Lapland have chosen to market a region in north of Sweden as an artic destination. The study also aims to investigate what is included in the concept of an artic destination and what is comprehended in an artic lifestyle, which also is a theme that is used in the marketing of the region. Are there any challenges by using the artic and artic lifestyle concept in the marketing and what consequences can it entail? To answer these questions interviews where made with informants that have a professional work connection to the area. The result showed that the arctic region is complex phenomena to define also for those who use the expression in marketing. What is included in the artic concept and the lifestyle is connected to a lot of conceptions of the nature, culture, climate and experiences. The informants gave different viewpoints about challenges when marketing a large region and the consequences that can be registered. The hope with this study was to get a deeper understanding about the area and especially why a specific theme as the artic was used in marketing purpose for a region in north of Sweden.

Despite scientific research indicating that women have unique pathways both into, and out of crime, they are still quite often an overlooked group in regards to criminal research. For society to continue supporting these women in the most optimal way, it is important to both acknowledge and dive further into the complicated factors that affect women’s processes of reformation from a criminal lifestyle. The purpose of this study was to both create an understanding of the challenges women face when wanting to put their criminal past behind them and to cement the importance of social work in this exit process. Using the exit process and gender contract as our theoretical frames we have analyzed ten semi-structured interviews with five former female criminals. The results show that motherhood is a significant factor in a woman's desistance. KRIS, a volunteer support organization, is also a crucial system in a woman’s decision to leave a criminal lifestyle. Additionally, we have found that multiple traditional expectations involved with being a woman, and a mother, are significant factors in a desire for reformation. Finally, the results indicate that engaging in activities that involve helping others is a key factor in women's journey to desistance. / Kvinnor är en ofta förbisedd målgrupp inom forskning gällande kriminalitet. Detta trots att studier pekar på att kvinnor i många fall har unika ingångar till kriminalitet och därmed följer unika vägar ut ur den. Det är viktigt att erkänna och förstå de komplexa faktorerna som påverkar deras exitprocess från brottslighet så att samhället kan hjälpa och stödja dessa kvinnor på ett fördelaktigt sätt. Syftet med denna uppsats har varit att skapa en förståelse för de utmaningar som kvinnor, vilka har haft kriminalitet som livsstil, kan stå inför när de vill avsluta sin kriminella livsstil och på vilket sätt det sociala arbetet har en roll i en sådan exitprocess. Vi har med hjälp av teorierna om exitprocessen och genuskontraktet analyserat material från tio semistrukturerade intervjuer med fem kvinnor som tidigare levt i livsstilskriminalitet. Resultatet visar att moderskap är betydelsefullt i en kvinnas avhållsamhet, likaså har den frivilliga stödorganisationen KRIS många gånger varit ett avgörande stöd. Av resultatet kan vi även utläsa att det finns föreställningar på en kvinna och än mer på mödrar som gjort att kvinnorna försökt eller helt avhållit sig från kriminalitet. Slutligen visar resultaten att kvinnorna i studien idag jobbar med att hjälpa, vilket är viktigt för deras avhållsamhet.