<p>In this dissertation I argue that the currency of the childhood obesity “epidemic” as a health crisis is derived largely from processes of representation and reproduction through which fatness has been re-calibrated as something pathogenic. I develop the position that the “childhood obesity epidemic”—influenced as it is by neoliberal notions of what constitutes a healthy individual and a vital body politic—risks exacerbating, rather than mitigating, the vulnerability of children.</p> <p>The methodology of this project uses the example of lifestyle to illustrate how consensus about the presence of an “obesity epidemic” has been built, the concept of lifestyle being read as representative of how particular constellations of anxiety regulate what counts as true in the developing body of social knowledge concerning childhood obesity. I contend that the problem of lifestyle captures the complexities of the “childhood obesity epidemic” because children are presupposed, in obesity discourses, to be more vulnerable to the sweeping set of social trends brought under the rubric of the “obesity epidemic” than adults.</p> <p>In what follows, I investigate the rationale for anti-obesity through an investigation of a series of analogous clusters, cases of persuasive ideas borne out of the moral panics subtending childhood obesity. I ask what it means that the child’s diminished capacity for autonomous decision-making is considered to be especially critical in the face of popular culture’s media “bombardment.” More broadly, I focus on the delimiting effect that anti-obesity’s politicization of lifestyle has had on recent attempts to think through the articulation of health, consumerism, environment, and the government of risk.</p> / Doctor of Philosophy (PhD)

Around 10% of women in fertile age have endometriosis, despite this there is little known about its origin. It can take years from the first experienced symptoms to an established diagnosis, which is done using invasive methods. A database from the Lucy application containing 11720 questionnaires with up to 41 questions each was examined for signs of associations between lifestyle factors and health indicators with endometriosis. The database was restructured and unusable questionnaires were pruned, leaving 5719 questionnaires for analysis. Questionnaires were assigned a label depending on whether the respondent had an endometriosis diagnosis, some other diagnosis or no diagnosis. Histograms were created for 36 questions to visualize answer distributions among the labels while wordclouds were created for 3 questions to determine commonly used words. Pearson’s chi-square test was performed on 24 questions to determine whether there were statistically significant differences in how respondents answered with regards to their diagnosis. Then, 26 questions were divided between seven question groups based on their similarities. The relative prevalence of endometriosis for every answer alternative was determined and compared withthe average for that group. This was then followed up by a multi-correspondence analysis for every question group. It was found that there are associations between endometriosis and 12 health indicators. These being: affected by infertility, always being tired, regarding own health as bad, having more than 100 birthmarks, severe chronic pelvic pain, dysmenorrhea, regularly whole-body pain, muscle stiffness, neck and shoulder tension, forgetfulness, concentration difficulties, regularly experiencing that stress worsens physical symptoms. No statistically significant association between lifestyle factors and endometriosis could be found in the survey database. There were findings of socioeconomic differences between respondents with endometriosis and those without a diagnosis which may have affected the result. / Runt 10% av kvinnor i fertil ålder har endometrios, trots detta är lite känt om dess ursprung. Det kan gå flera år från första upplevda symptom till en etablerad diagnos, som kräver invasiva metoder. En databas från Lucy applikationen med 11 720 enkäter upp till 41 frågor vardera undersöktes efter tecken på kopplingar mellan livsstilsfaktorer och hälsoindikatorer med endometrios. Som ett första steg omstrukturerades databasen och oanvändbara enkäter sållades bort, vilket lämnar 5719 enkäter för analys. Enkäterna blev tilldelad en etikett baserad på huruvida respondenten hade en endometriosdiagnos, någon annan diagnos eller ingen diagnos. Histogram skapades för 36 frågor för att visualisera svarsfördelningen mellan etiketter medan ordmoln skapades för 3 frågor för att bestämma vanligt förekommande ord. Pearsons chi-kvadrattest utfördes på 24 frågor för att bestämma huruvida det fanns signifikanta statistiska skillnader i hur respondenter svarade med avseende på deras diagnos. 26 frågor blev uppdelade i 7 olika grupper baserade på deras liknelser och den relativa utbredningen av endometrios bestämdes för varje grupp och jämfördes med snittet i varje grupp. Slutligen följdes detta upp med multikorrespondensanalys för varje grupp av frågor. Det hittades associationer mellan endometrios och 12 hälsofaktorer. Dessa var: infertilitet, alltid vara trött, betrakta sin egna hälsa som dålig, ha fler än 100 födelsemärken, uppleva allvarlig kronisk bäckensmärta, dysmenorré, regelbunden helkroppssmärta, muskelstelhet, spändhet i nacke och axlar, glömskhet, koncentrationssvårigheter, regelbundet uppleva att stress förvärrar fysiska symptom. Ingen statistisk signifikant association kunde hittas mellan livsstilsfaktorer och endometrios från undersökningsdatabasen. Det hittades socioekonomiska skillnader mellan respondenter med endometrios och de utan diagnos vilket kan ha påverkat resultatet. / FEMaLe

Due to urbanization, Sweden’s municipalities have adapted their cities for population growth as peoples’ desire to live closer to service, jobs, and city activities have increased. This has left the rural areas with population decline as the focus have swifted towards the city areas and place attractiveness and service in the rural have decreased. Municipalities need to aim focus on rural areas again to enhance an attractive living environment for its residents, but also to increase population growth again. However, there is a problem on how profitable it is to invest new buildings and infrastructure in those areas.  This study focuses on Sundsvall municipality and its largest rural area, Indals- liden. It investigates opinions of current and recent residents on how the area can increase in attractiveness. The study points out what actions that three types of migrants (immigrants, emigrants, and home returners) want the municipality to prioritize in order to increase attractiveness and attract new residents, but also sustain a pleasant surrounding for existing residents. A rural coordinator explains the prioritized points, that have been analyzed in relative to the lifestyle migrant’s perspective. The results presents both similarities and differences between different groups of migrants on how to increase place attractiveness, but also differences and similarities between push- and pull factors that have driven them to move. Further, there are differences and similarities between the rural coordinator’s opinions and prioritized agenda, and the migrants. This study therefore concludes the importance of using the narrative of residents to ensure that the area stays attractive and have necessary service and infrastructure in order to attract new residents and provide a good living environment for current residents.

In the United States, low-income, ethnic/racial minorities and rural populations are at increased risk for poorer health outcomes compared to higher income, non-minorities, and urban populations. Two key determinants that influence rural health disparities are health literacy and social capital. Health literacy can be described as an individual-level factor and defined as, "the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions." Social capital is a concept that accounts for the role of collective social functioning and has been defined as, "the features of social structures, such as levels of interpersonal trust and norms of reciprocity and mutual aid" which act as resources for individuals to facilitate collective action." The overarching goal of this research is to explore factors influencing health disparities, including health literacy, social capital in two rural regions of Virginia. The first study is embedded in Talking Health, a larger 2-arm RCT targeting adults in rural Southwest Virginia and examined participants' perceptions of and satisfaction with components of a behavioral intervention designed using health literacy concepts to decrease sugary beverage intake in rural, low-health literacy participants. The second study is also embedded in the Talking Health trial, yet focused on the maintenance of behavior 12-months after the intervention concluded. Guided by RE-AIM, this study examined the reach, effectiveness and implementation of a 12-month randomized extended care intervention aimed at enhancing long-term maintenance of behavior change and study retention when compared to a control condition. The last study is part of a larger telephone surveillance survey conducted in the Dan River Region located in south central Virginia. This study described current levels of social capital in the Dan River Region and examined the influence of social capital on FV consumption, physical activity, sugary beverage intake and BMI on a sample of rural and urban adults. / Ph. D.

Syfte: Studiens syfte var att studera munhygien- och kostvanor hos individer som arbetar natt inom vården. Metod: En kvantitativ tvärsnittsstudie med pappersenkäter som datainsamlingsverktyg genomfördes. Urvalet var nattarbetare inom vård- och omsorgssektorn på sju arbetsplatser i södra Sverige. Analys av materialet genomfördes i form av deskriptiv statistik som redovisas i text och tabeller. Resultat: Totalt deltog 73 nattarbetare. Studien visade att majoriteten borstade tänderna två gånger om dagen i två minuter med fluoridtandkräm. Cirka hälften av deltagarna (n=36, 49,3%) använde sig av extra fluoridtillskott, och 69,9% (n=51) utförde regelbundet approximal rengöring. Gällande kostvanorna visade resultatet en hög konsumtion av småätande mellan måltider och intag av sötade drycker. Dessutom missade en majoritet dagligen frukost, middag eller lunch. Slutsats: Studien visar att nattarbetare har goda munhygienvanor, men missar huvudmåltider vilket ger upphov till frekvent småätande som kan vara en risk för den orala hälsan. Det visar också behovet av ytterligare forskning för att förstå de underliggande faktorerna bakom nattarbetares hälsobeteenden. / Purpose: The aim of the study was to examine oral hygiene and dietary habits among individuals working night shifts in healthcare. Method: A quantitative cross-sectional study utilizing paper surveys as data collection instrument was conducted. The sample consisted of night-shift workers in the healthcare and social care sector at seven workplaces in southern Sweden. The material was analyzed using descriptive statistics, presented in text and tables. Results: A total of 73 night shift workers participated. The study showed that the majority brushed their teeth twice a day for two minutes using fluoride toothpaste. Approximately half of the participants (n=36, 49,3%) used additional fluoride supplements, and 69,9% (n=51) performed regular interdental cleaning. Regarding the dietary habits the results showed a high consumption of snacks between meals and intake of sweet beverages. Additionally, a majority missed breakfast, dinner or lunch daily. Conclusion: The study demonstrates that night-shift workers have good oral hygiene habits but tend to miss main meals, leading to frequent snacking, which may pose a risk to their oral health. It also highlights the need for further research to understand the underlying factors behind the health behaviors of night-shift workers.

Bakgrund: Många personer drabbas av hjärtinfarkt i Sverige varje år. En hjärtinfarkt uppstår när hjärtat får syrebrist genom en tilltäppning i något av de blodkärl som förser hjärtat med syre. En hjärtinfarkt är en dödlig sjukdom som kan upplevas som ett trauma av den som överlevt. Detta medföljande trauma kan vara svårhanterligt utan rätt kunskap eller resurser. Sjuksköterskan har som uppgift att genom sina kärnkompetenser nå ut till patienter för att främja hälsa. Kliniskt arbetande sjuksköterskor behöver en ökad förståelse av hjärtinfarkt patienters upplevelser för att bättre kunna vårda, uppmärksamma, motivera och behandla dessa patienter med mål att så goda resultat som möjligt skall uppnås. Syfte: Belysa patienters upplevelser av livet efter en hjärtinfarkt i Sverige. Metod: En kvalitativ litteraturstudie baserad på 13 kvalitativa artiklar om patienters upplevelse efter en hjärtinfarkt. Resultat: I studien kunde 6 teman identifieras. “Förändrad livsvärld”. ”Hantera en livsomställning”, “Samspel med vården”, “Stöd från närstående”, “Information och kunskap”, och “En andra chans”. Konklusion: Patienter upplevde svårigheter med att anpassa sig till livsstilsförändringar de blivit rekommenderade till av sjukvårdspersonal och den nya vardagen som följer efter sin hjärtinfarkt. Faktorer som påverkade patienter positivt efter en hjärtinfarkt var copingstrategier, ett bra samspel med vården och stöd och förståelse från närstående. / Background: In Sweden, many people develop a myocardial infarction each year. A myocardial infarction occurs when the heart suddenly experience oxygen deprivation due to a blockage in one of the main oxygen supplying blood vessels. A myocardial infarction is a deadly disease that can be experienced as a trauma for the person surviving it. This coherent trauma can be difficult to handle without the right knowledge or resources. A nurse's task is to use their core competences to reach out to patients and promote health. Clinical nurses need an enhanced understanding of the experiences of patients with myocardial infarction to be able to better care for, pay attention to, motivate and treat these patients with the goal of achieving the best possible results. Purpose: Elucidate patients experiences of life after a myocardial infarction in Sweden. Method: A qualitative literature study based on 13 qualitative articles about patients’ experience after a myocardial infarction. Results: 6 themes were identified in this study. "Change of life-world". "Managing a life adjustment", "Interaction with professional healthcare", "Support from close relatives","Information and knowledge", "A second chance". Conclusion: Patients experienced difficulties adapting to the lifestyle changes, they had been recommended to pursue by healthcare professionals, and to the new everyday life after their myocardial infarction. Factors that affected patients positively after a myocardial infarction were coping strategies, good interaction with professional healthcare, and the support and understanding from their close relatives.

Bakgrund: I Sverige insjuknar varje år flera tusen människor i hjärtinfarkt. Fler män än kvinnor drabbas. Att förändra ohälsosamma levnadsvanor kan minimera risken att återinsjukna. Livsstilsförändringar beskrivs som komplexa och att stödja personer till förändring behöver förstås ur en bredare kontext.  Syfte: Syftet var att beskriva erfarenheter av livsstilsförändring efter att ha drabbats av hjärtinfarkt. Metod: Litteraturstudien baserades på åtta vetenskapliga studier som genomförts med kvalitativ metod. Sökningarna gjordes i databaserna Cinahl och Pubmed. Efter kvalitetsgranskning analyserades studierna med hjälp av Fribergs femstegsmodell. Resultat: Resultatet sammanställdes i tre teman: “Vårdrelaterade erfarenheter”, “Emotionella erfarenheter” och “Omgivningsrelaterade erfarenheter” samt sju subteman som beskriver olika erfarenheter av livsstilsförändring efter hjärtinfarkt.  Konklusion: För att främja hälsa och lindra lidande efter en hjärtinfarkt är personcentrerad eftervård av betydelse. Människor är unika med unika erfarenheter och behov vilket behöver beaktas för att uppnå en bestående och ändamålsenlig vård. Genom att belysa personers erfarenheter av livsstilsförändring efter hjärtinfarkt kan vården förbättras och vidareutvecklas för en patientsäker och personcentrerad vård. / Background: Every year thousands of people suffer from myocardial infarction in Sweden, men are more likely to be affected than women. A changed lifestyle is one way to reduce the risk of getting a recurrent myocardial infarction. Lifestyle changes can be complex, thus, in order to support lifestyle changes after a myocardial infarction this must be understood in a wider perspective. Aim: The aim was to describe experiences of lifestyle changes following myocardial infarction. Methods: Literature study based on eight qualitative studies. Database search was conducted in Cinahl and Pubmed. After a quality review, the studies were analysed using a five-stage model according to Friberg. Results: The result was composed of three main themes: “Health care-related experiences”, “Emotional experiences” and “Context-related experiences” and also seven sub themes which describes different experiences of lifestyle change after a myocardial infarction. Conclusion: A person-centered cardiac rehabilitation after myocardial infarction is of importance in order to support health and to avoid continued suffering. Human beings are unique with unique experiences and needs, these needs should be taken into account in the formation of cardiac rehabilitation in order to achieve and in particular sustain the aftercare. By research into individuals’ experiences of lifestyle changes after myocardial infarction the healthcare-system can find areas of improvement and continue to develop in order to ensure a person- safe and centered care.

Yes / In recent years, lifestyle products have emerged to help improve people’s physical and mental performance. The Internet plays a major role in the spread of these products. However, the literature has reported issues regarding the authenticity of medicines purchased from the Internet and the impact of counterfeit medicines on public health. Little or no data are available on the authenticity of lifestyle products and actual toxicity associated with their use and misuse. Our aim was to investigate consumer and patient attitudes toward the purchase of lifestyle products from the Internet, their knowledge of product authenticity and toxicity, and their experiences with counterfeit lifestyle products. A Web-based study was performed between May 2014 and May 2015. Uniform collection of data was performed through an anonymous online questionnaire. Participants were invited worldwide via email, social media, or personal communication to complete the online questionnaire. A total of 320 participants completed the questionnaire. The results of the questionnaire showed that 208 (65.0%) participants purchased lifestyle products from the Internet mainly due to convenience and reduced cost. More than half (55.6%, 178/320) of participants purchased cosmetic products, whereas only a minority purchased medicinal products. Yet, 62.8% (201/320) of participants were aware of the presence of counterfeit lifestyle products from the Internet, and 11.9% (38/320) experienced counterfeit products. In only 0.9% (3/320) of those cases were counterfeit lifestyle products reported to authorities. Moreover, 7.2% (23/320) of the participants experienced adverse effects due to counterfeit lifestyle products. In summary, patients experienced counterfeit lifestyle products that resulted in adverse effects on their health. Although certain adverse effects were reported in this study, counterfeit products were underreported to authorities. Further public awareness campaigns and patient education are needed.

Alfred Adler's Individual Psychology emphasizes the uniqueness of individuals and describes the life style, or personality, as the unique and characteristic pattern of coping with and solving problems and interacting with other people. The purpose of this study was the development of a similar instrument that would quantitatively identify life styles in children.

Bakgrund:  Motiverande samtal (MI) fokuserar på att främja patienters egen motivation och har visats vara gynnsam i syfte att främja beteendeförändringar. Diabetes är en snabbt växande folkhälsosjukdom och livsstilsförändringar har en positiv påverkan på sjukdomsförloppet. Trots befintlig kunskap om livsstilsförändringar finns svårigheter att uppfylla rekommendationerna och förändringarna upplevs ofta svåra att bibehålla över en längre tid. Syfte:  Beskriva patienters upplevelser av motiverande samtal för att främja livsstilsförändringar vid diabetes.  Metod:  Litteraturstudien inkluderade åtta kvalitativa studier från databaserna Cinahl, PubMed, PsycInfo och Scopus. Därefter kvalitetsgranskades valda studier utifrån Olsson &amp; Sörensens bedömningsmall för kvalitativa studier och analysen utfördes utifrån Fribergs femstegsmodell.  Resultat:  Litteraturstudien resulterade i fyra kategorier med två subkategorier vardera. Följande kategorier identifierades; ”utveckla en vårdrelation som främjar livsstilsförändringar”, ”stöd att genomföra livsstilsförändringar”, ”hjälp att balansera livet vid livsstilsförändringar” och ”stärka det egna ansvaret vid livsstilsförändringar”. Konklusion:  Patienterna upplevde att MI var en metod som främjade och underlättade genomförandet av livsstilsförändringar. Mer forskning och utbildning inom området kan bidra till att MI används i större utsträckning i den kliniska verksamheten. / Background:  Motivational interviewing (MI) has the focus to promote patients own motivation and has been proven successful in promoting behavior changes. Diabetes are diseases growing fast in the society and lifestyle changes are considered to have a positive impact on the development of the disease. Regardless of existing knowledge about the positive effects of lifestyle change, the majority of people with the diagnosis do not meet the recommended goal and changes are often hard to maintain over a longer period.  Aim:  To describe patients experience of motivational interviewing to promote lifestyle changes in diabetes.  Methods:  A qualitative literature study was made with eight qualitative studies. The studies included was found through the databases Cinahl, PubMed, PsycInfo and Scopus. The studies was quality reviewed from Olssens and Sörensens model for qualitative studies and the analysis was made from Fribergs five step model.  Results: The literature study resulted in four categories with two subcategories each. Following categories where identified; ”developing a nursing relationship that promotes lifestyle changes”, ”support in the lifestyle changes”, ”help to balance the everyday life in the lifestyle changes” and ”reinforces the responsibility in the lifestyle changes”. Conclusion:  The patients experienced that MI was a method that promoted and facilitated the implementation of lifestyle changes. More research and education in the area could lead to an increased use of MI in the clinical situation.