Syfte Studiens övergripande syfte var att undersöka vilka skäl som finns till att avstå från hälsotester genomförda inom företagshälsovård. För att synliggöra och öka förståelsen för dessa skäl, var studiens delsyften att undersöka bortfallsgruppens inställning till hälsotesteroch hälsosatsningar, där hälsotester ingår som en del. Metod Genom kontakt med Liv&Lust AB och Preem Petroleum AB gavs möjlighet attgenomföra en studie av bortfallsgruppen, dvs. de individer som arbetar på Preem, Huvudkontoret på Gärdet i Stockholm, och som avstått från att, på frivillig basis, deltaga i Liv&Lust Första Hälsoplantest under 2002-2003. En kvalitativ intervju genomfördes med nio personer ur bortfallsgruppen under våren 2003 på Preem:s huvudkontor. Intervjuerna var halvstrukturerade och deras längd varierade mellan cirka 35 till cirka 60 minuter.  Resultaten kategoriserades först efter meningsbärande utsagor och analyserades därefter utifrån Antonovskys KASAM-modell innehållande de tre komponenterna: meningsfullhet, begriplighet och hanterbarhet. Resultat En vanlig orsak som uppgavs som skäl till att avstå från Hälsoplantest var tidsbristpga. arbetsbelastning. Diffusa negativa känslor uttalades i samband med skälen och ibland även en osäkerhetskänsla inför företagets roll i sammanhanget. Uttryck gavs för en medvetenhet kring den egna kroppsstatusen, både positiv och negativ. Ett Hälsoplantest ansågs därmed innebära en onödig bekräftelse. Då den egna kroppsstatusen beskrevs som mindre positiv sammankopplades testet med ett negativt tillrättavisade budskap. Åsikten att man klarade sig själv, utan hälsotester, framfördes och kunde även den kopplas till medvetenheten kring den egna kroppsstatusen. Inställningen till Hälsoplantest och Preem:s beslut att genomföra dessa var positiv trots att man själv avstått från att deltaga. Inom samtliga kategorier saknades den motivationsskapande KASAM-komponenten meningsfullhet. Slutsats När bortfallsgruppen beskrev den egna kroppsstatusen i mindre positiva termerförknippades  hälsoplantestet med en negativ bekräftelse och ett negativt tillrättavisande budskap, vilka tolkades som styrande faktorer bakom skälet till att avstå. / Bilagorna saknas i pdfen.

Syftet med denna studie var att göra en kartläggning av ungdomars motiv till deltagande respektive icke deltagande i projektet Idrottslyftet och annan organiserad respektive icke-organiserad fysisk aktivitet. Ett pilotprojekt med Idrottslyftet - som har till syfte att få fler barn och ungdomar att börja idrotta och få fler att idrotta längre upp i åldrarna -genomfördes på elprogrammet vid en gymnasieskola. En enkätstudie genomfördes för att få fram svar på frågor som varför ungdomarna är fysiskt aktiva, vilka motiv som finns för att hoppa av och att sluta vara fysiskt aktiv i någon form av organiserad fysisk aktivitet och hur de ser på sin hälsa. Resultatet visade att två tredjedelar av eleverna deltog i projektet och en tredjedel deltog inte. De elever som deltog i projektet var mer fysiskt aktiva på sin fritid. Vilken form av fysisk aktivitet som utövades (i en förening, utanför en förening eller inte alls) påverkade hur eleverna upplevde sitt hälsotillstånd. De som var aktiva i en förening var också de som uppgav bäst hälsotillstånd. Ungdomarna rangordnade att må bättre och att det var roligt högst som anledningar att vara fysiskt aktiv. Rangordningen av motiv för att sluta vara fysiskt aktiv i någon organiserad form av fysisk aktivitet på fritiden var först att det inte var roligt längre och att de inte hade tid.

This thesis reviewed recent hospital mergers in Gothenburg, Sweden, and Reykjavik, Iceland, and describes, analyzes, compares, and assesses those mergers. The study focused on the underlying reasons for the mergers, examining both the methods used in the merging process and the merger outcomes. Background information includes organizational theory regarding mergers, hospitals as professional bureaucracies, organizational change and communication, and quality and efficiency in organizations. The study is based on secondary data derived mainly from official documents, evaluations, and research reports. While the study determined similar reasons—mainly economic—underpinning both mergers, the processes differed. The Swedish merger was much better prepared, more radical, and invested more time and money in its process compared to the Icelandic merger, which was less radical and characterized by decisions from the top. Interestingly, the Icelandic merger, which sought to curtail the growth of expenditures but did not demand savings, achieved outcomes that reflected its main goals. Conversely, the Swedish merger sought unrealistic savings in its goals and the savings demands made it impossible for the management team to gain other objectives of the merger, like better service, quality and more competent institution. / <p>ISBN 978-91-85721-56-6</p>

Bakgrunn: Intrauterin fosterdød er en hendelse som har ringvirkninger langt utover den rammede kvinnen og hennes familie. Det handler i sin ytterste mening om kvinner og barns helse og likhet i helse for alle. Utviklingen mot et flerkulturelt samfunn innebærer andre utfordringer enn tidligere i forhold til kultur, kommunikasjon, kvinne-og familieperspektiv, livsstil og medisinske problemstillinger. Formål: Denne studiens formål har vært å kartlegge forekomsten av intrauterin fosterdød (IUFD) hos innvandrerkvinner sammenlignet med svenske kvinner, og å undersøke faktorer som kan være assosiert med IUFD. Materiale og metode: Registerdata på 904 646 fødte og deres mødre i perioden 1992-2001 ble undersøkt med bivariate analyser. Det ble også gjort en systematisk litteraturgjennomgang av relevant nasjonal og internasjonal forskning på feltet. Resultat: Analysen viser en økt risiko for IUFD hos innvandrerkvinnene sammenlignet med svenske kvinner. IUFD forekommer oftere hos de ikke-europeiske innvandrerkvinnene;OR:1,45(95% CI 1,28-1,63). Litteraturgjennomgangen viser at ikke-europeiske innvandrerkvinner har 2-3 ganger så høy risiko for IUFD sammenlignet med totalpopulasjonen, men også at lav sosio-økonomisk status (SøS), alder, inngifte, røyking, reduksjon av medisinske risikofaktorer og kvaliteten på den antenatale omsorgen påvirker den perinatale dødeligheten. Konklusjon: En forbedret folkehelse i Norden de siste tiårene har bidratt til en reduksjon av den perinatale dødeligheten. Men ikke alle befolkningsgrupper har fått tatt del av denne utviklingen. De ikke-europeiske innvandrerkvinnene har signifikant høyere odds for IUFD. De har ofte lav SøS, hvilket i seg selv er assosiert med IUFD. Kunnskap om ulikheter i helse og sykdom blant ulike kategorier mennesker i samfunnet vårt er viktig og kan bidra til en mer tilpasset omsorg og en bedre medisinsk behandling. Det er behov for videre forskning fra flere fagområder for å kunne kartlegge livsstil, levekår og effekten av språkbarrierene og for å få en oppfatning om hvordan ulikheter i helse kan utjevnes. / Background: Stillbirths or intrauterine fetal death have wide effects on families. This is  about women’s and children’s health as well as equity in health for all. As Sweden becomes more multicultural, new challenges in equity on women’s and children’s health develope related to culture, communication, women –and family matters, lifestyle and medical issues. Aim: The aim of this study was to assess the occurence of stillbirths in immigrant women compared to Swedish women and investigate factors related to stillbirths. Method: Data from 904 646 newborns and their mothers during the period 1992-2001 was analysed using bivariat analyses. A literature study was undertaken with a systematic appraisal of relevant national and international research in the field. Results: The analyses showed that stillbirth was more common in non-European immigrant women. OR: 1,45 (95% CI 1,28-1,63). Non-European immigrant women in Sweden had higher odds of stillbirths compared to the background population. The litterature showed that non-European immigrant women have 2-3 times the risk of stillbirths, and the risk of stillbirths is also increased in women of lower socioeconomic status (SES). Other risk factors indicated to be important are age, consanguinity, smoking and the quality of perinatal care. Conclusions: Non-European immigrant women in Sweden have higher odds of stillbirths compared to the background population. These women also have an increased risk of low SES, which is itself a riskfactor of stillbirth. Appropriate knowledge of difference in health needs in different groups in the community is important for filling the health care needs and improving the medical treatments. Further research is needed from different sectors to assess the importance of lifestyle, language limitations and how these women are treated by the health care system. / <p>ISBN 978-91-85721-30-6</p>

Hensikten med undersøkelsen er å få mer kunnskap om arbeidsrelatert stress blant anestesi-sykepleiere. Det er anvendt kvalitativ metode etter beskrivelse av Kvale. Studien har to forskningsspørsmål: Hva opplever anestesisykepleiere som stressfylt i sitt arbeid, og hvordan påvirker dette dem? Det er benyttet en semistrukturert intervjuguide for å besvare forskningsspørsmålene. Ti anestesisykepleiere fra tre ulike sykehus var respondenter. Resultatene viser at anestesisykepleiere opplever stress på fem områder: stress i pasientarbeidet, i forhold til medarbeidere, i forholdet til ledelse og administrasjon, stress som senior og i det fysiske arbeidsmiljøet. Stressende hendelser i pasientarbeidet og i samarbeidet med andre medarbeidere har ofte en temporær natur som påvirker anestesisykepleiernes helse lite hvis det er tid og anledning til å bearbeide opplevelsene. God sosial støtte er viktig for å redusere stress. Mangel på tid og redusert faglig oppdatering samtidig med økt personlig ansvar og økte ytre krav skaper en opplevelse av at man er under stadig sterkere press. Anestesisykepleierne opplever at de har lite innflytelse på de politiske, økonomiske og administrative rammene for arbeidet. / The aim of this study is to explore work-related stress among nurse anaesthetists. This qualitative study is conducted as described by Kvale. Two research questions were posed: What do nurse anaesthetists experience as stressful in their work, and how does this affect them? A semi-structured interview-guide was used to find answers to these questions. Ten nurse anaesthetists from three different hospitals participated in the study. The results show that nurse anaesthetists experienced stress in five areas: stress in situations of patient care, stress related to co-workers, stress related to leadership and administration, stress as a senior nurse anaesthetist and stress-factors in the environment. Stress related to situations in patient care and to co-workers seems to be of a temporary nature if the nurse anaesthetists are able to find time and opportunity to accommodate their experiences. Social support is important to reduce stress. Lack of time and reduced professional update together with increased personal responsibility and increasing demands from the surroundings creates an experience of being under ever increasing pressure. Nurse anaesthetists experience little influence on the political, economical and administrative frames of their work situation. / <p>ISBN 978-91-85721-21-4</p>

The Nordic countries have been assisting the Baltic countries in their public health (PH) development from early nineties. The study describes PH development in Lithuania alongside with the BRIMHEALTH PH training programme. The study aimed at a qualitative assessment of the programme’s implications in Lithuanian partner institutions. The grounded theory method was used in the analysis of the focus group interview and nine in-depth interviews. The subjective meaning attributed to the programme by its participants was summarized in the following five descriptive categories: international postgraduate students feel welcome in BRIMHEALTH (as the core category); providing assistance; building partnerships; being an experimental programme; BRIMHEALTH as a model. The core category focussed on the student, as the main actor. Each category is related to several subcategories. A constant comparative approach was applied to describe the thoughts and values of the participants. The concepts and categories were validated in the data. It was concluded that the study evaluates the impact of the BRIMHEALTH training programme, proving that PH training was connected to training abroad and international collaboration; the importance of the programme is assessed from a number of perspectives and can be helpful for further research. / <p>ISBN 978-91-85721-12-2</p>

Introduction: The aim of this study was to assess the patient, practice and practice management related factors contributing to non-adherence of type 2 diabetes mellitus clinical practice guideline in Estonia.Methods: Descriptive postal survey using a self-administered questionnaire. Results: Of the 354 doctors who received the questionnaire 46% (n=163) responded. 76% of them have type 2 diabetes guidelines. Low awareness of diabetes and its complications among patients as well as their low motivation to change their lifestyle were considered to be the biggest difficulties in managing individual patients. In addition to the most often listed problems, non-compliance with medical regimen, patients’ financial problems and their non-attendance were mentioned. The greatest health care systems related barriers to practices providing desirable care wereinadequate number of patients` educational materials, the lack of special diabetes education for nurses and underfunding. The patient related issues were regarded as problems in 96% of the cases and health care system related factors were mentioned in 79% of the cases. / <p>ISBN 91-7997-114-8</p>

Bakgrunn: Økning i BMI og immigrasjon til Norge medfører nye utfordringer og det må settes fokus på å bekjempe ulikheter innen helse for mor og barn. I dag utgjør pakistanske immigranter en av de største minoritetsgruppene i Norge. Målet for denne studien er å undersøke forekomst av pregravid body mass index (BMI) og noen sosiodemografiske faktorers påvirkning på operative forløsninger (keisersnitt, vakuum, og tang) blant Norske og Pakistanske førstegangsfødende kvinner i Groruddalen, Norge. Metode: Populasjonsbasert kohort undersøkelse av 146 norske og 39 pakistanske kvinner som går til svangerskapskontroll på helsestasjoneri Groruddalen og deres fødsler ved Oslo universitetssykehusHF, Ullevål og Akershus universitetssykehus HF i Norge. Resultat: Pakistanske kvinner haddelavere pre-gravid BMI enn norske kvinner (22.1 og 24.6, p &lt;0.05). En lavere andel pakistanske kvinner hadde utdannelse&gt; 9år (79.5%) enn norske kvinner (96.6%, p&lt;0.05) og en lavere andel arbeidet utenfor hjemmet, 66.5 % kontra 95.2%, p&lt;0.05. I tillegg var pakistanske kvinneryngre (M=26.4, SD=4.0 år) sammenlignet med norske kvinner(M=29.7, SD=4.4 år, p&lt;0.05). Nyfødte barn av pakistanske kvinnerveide 339 gram mindre, med en gjennomsnittlig fødselsvekt på 3181 gram,i forhold til de norske nyfødte på 3520 gram (p &lt;0.05). Det varingen signifikant forskjell i operative forløsninger blant pakistanske kvinner med 31.6% og norske kvinnermed 27.9 %, p=0.805. Uavhengig av etnisitet hadde variabelen mors alder OR=1.106 (CI95:1.017 til 1.203) og svangerskapets lengde i dager OR= 0.951 (CI95:0.908 til 0.997) sammenheng med operative forløsninger i denne studien. Detnyfødte barnets vekt OR=1.001 (CI95:1.000 til 1.002) varmuligens et grensetilfelle. Konklusjon: Studien viser sosiodemografiske forskjeller mellom norske og pakistanske kvinner i Groruddalen, Norge. Pakistanske kvinner haddelavere BMI, lavere utdanningslengde, færrearbeidet utenfor hjemmet, de varyngre når de fødte sitt første barn og de fødtebarn med lavere vektenn norske kvinner. Det varikke forskjell i andel operative forløsninger mellom norske og pakistanske kvinner. Uavhengig av etnisitet haddekvinnenes alder og svangerskapets lengde påvirkning på operativ forløsning / Background: Elevated body mass index(BMI) and increased immigration pose challenges that demand a new focus on health inequalities for mothers and children. Currently, Pakistani immigrants are among the largest minority groups in Norway.This study aimed to determine the prevalence of pre-pregnancy BMI and the impact of different sociodemographic factors on operative (caesarean section, vacuum and forceps) deliveries among Norwegian and Pakistani nulliparous women in Groruddalen, Norway. Methods: This population-based cohort study included 146 Norwegian and 39 Pakistani women attending Child Health Clinics in Groruddalen and delivering at Oslo University Hospital and Ullevål and Akershus University Hospital, Norway. Results: Compared to Norwegian women, pre-pregnancy BMI was lower in Pakistani women (24.6 and 22.1, respectively; p &lt; .05). Further, education level was &gt; 9 years lower in Pakistani versus Norwegian women (79.5 % and 96.6 %, respectively; p &lt; .05) and fewer Pakistani women work outside the home (66.5 % and 95.2 %, respectively; p &lt; .05). Compared to Norwegian women (M = 29.7 years, SD = 4.4 years, p &lt;.05), Pakistani women were younger (M = 26.4 years, SD = 4.0 years) when they delivered their first child. Moreover, Pakistani infants weighed 339 g less (average birth-weight = 3181 g) compared to Norwegian infants (3520 g; p&lt; 0.05). We observed no significant difference in operative delivery among the Pakistaniversus Norwegian women (31.6 % and 27.9 %, respectively; p = 0.805). Regardless of ethnicity, variable maternal age (OR=1.106 [CI 95: 1.017 to 1.203]) and gestational age (OR=0.951 [CI 95: 0.908 to 0.997]) associated with operative delivery in this study.Newborn weight (OR=1.001 [CI 95: 1.000 to 1.002]) was considered borderline. Conclusion: This study revealedsociodemographic differences between Norwegian and Pakistani women undergoing operative delivery in Groruddalen, Norway. Compared to Norwegian women, Pakistani women had lower BMI and lower educational attainment. Fewer Pakistani women worked outside the home and they were younger when they delivered theirfirst child. Additionally, the birth weight of Pakistani babies delivered was lower than Norwegian newborns. We observed no difference in the proportion of operative deliveries between Norwegian and Pakistani women. Regardless of ethnicity, women’s chronological and gestational age affect operative delivery. / <p>ISBN 978-91-86739-64-5</p>

Objectives: The overall aim was to investigate determinants and consequences of global non-comparative self-ratings of health (SRH). Concerning determinants, the aim was more specifically to investigate the association between age, year of investigation, stress-theory based psychobiological variables, and SRH. Materials and methods: Papers I and IV were based on eight ongoing population-based cohort studies, with sampling performed 1973-2003. The study-population consisted of 11,880 men and women, aged 25-99 years, providing 14,470 observations. Papers II and III were based on a longitudinal study of 212 adult, healthy, women and men. Results: In women, SRH declined linearly with age and year of investigation, after adjustment for influence of covariates, while in men the association was based on a third degree polynomial function. The most important covariates were complaint score, sick-leave or disability pension, and leisure time physical activity. The final model explained 76.2% of the variance in women and 74.5% in men. SRH was directly associated with psychological resources and inversely associated with psychological strain, in healthy, adult, women and men. In men with SRH which decreased to fair or poor, higher levels of prolactin and lower levels of testosterone were observed at follow-up as compared to baseline. There were no associations between endocrine variables and SRH in women. There was a significant inverse association between SRH and mortality, disability pension, and sick-leave during follow-up, in women and men, adjusted for covariates. Associations between SRH and mortality were robust during the follow-up period. Conclusions: Age and year of investigation were associated with SRH, but differently in women and men. Psychological resources and psychological strain were consistently associated with SRH, but there were no robust associations between endocrine measures and SRH. SRH was associated with mortality, disability pension, and sick-leave, during follow-up. The association between SRH and mortality was robust during the follow-up period

<p>Nyckelord: hälsofrämjande, hälsoutvecklare, folkhälsovetenskap, utbildning, arbetsmarknad, upplevelser</p><p>Titel: ”Så mycket mer än bara morötter och joggingdress…” En kvalitativ studie som belyser hur utexaminerade hälsoutvecklare vid Örebro Universitet upplevde sin utbildning och mötet med arbetsmarknaden.</p><p>Bakgrund: Det folkhälsovetenskapliga arbetsfältet är en relativt ny vetenskaplig disciplin. Antalet studier som belyser folkhälsovetarnas villkor på arbetsmarknaden är få och merparten av dessa är av kvantitativ art.</p><p>Syfte: Syftet med denna studie var att belysa hur hälsoutvecklare vid Örebro Universitet som utexaminerats mellan åren 2004-2007 upplevde sin 3-åriga utbildning på Hälsoutvecklarprogrammet samt deras upplevelser av mötet med arbetsmarknadens villkor.</p><p>Frågeställningar: Vilka upplevelser har hälsoutvecklare av mötet med arbetsmarknaden? Vilka upplevelser har hälsoutvecklare av bemötandet av det hälsofrämjande perspektivet på arbetsmarknaden? Vilka upplevelser har hälsoutvecklare av sin utbildning?</p><p>Metod: För att hitta nyanser och ett ökat djup i forskningsfrågan genomfördes kvalitativa intervjuer med respondenter från Hälsoutvecklarprogrammet som examinerats mellan 2004-2007. Intervjuerna transkriberades och därefter genomfördes en innehållsanalys där teman, kategorier och subkategorier utformades.</p><p>Resultat: Respondenterna upplever att en bred utbildning försvårar möjligheten att professionalisera sig på arbetsmarknaden där det finns en del legitimitetssvårigheter. Förklaringen till legitimitetssvårigheterna sammankopplas med respondenternas känsla av att vara missuppfattad, känna en låg status, en känsla av okunskap utan någon spetskompetens samt ett arbeta med ett svårgenomslaget hälsofrämjande perspektiv. För att få arbete inom det hälsofrämjande arbetsområdet behöver hälsoutvecklaren nätverka med andra människor. Nyckelfaktorerna är att ha många kontakter och att vara utåtriktad och driven för att kunna få arbete i en svår bransch där det är tuff konkurrens om få arbeten. Alla respondenter trivs i sitt arbete vilket förklaras i att de känner att de arbetar med betydelsefulla uppgifter, att de har ett bra arbetsklimat samt att de bär med sig en utbildningsstolthet.</p><p>Slutsatser: Det skulle finnas fördelar med att återinföra mentorskap, utveckla praktiken, verklighetsanpassa examinationsuppgifterna och att införa mer hälsoekonomi i utbildningen. Detta för att öka hälsoutvecklarstudenternas anställningsbarhet samt för att få en ännu mer konkurrenskraftig utbildning vid Örebro Universitet.</p> / <p>Keyword: health promotion, public health worker, public health science, education, labour market, experiences</p><p>Title: “So much more than just carrots and training clothes..” A qualitative study that examines how graduated public health workers at the University of Örebro experienced their education and the conditions of the labour market.</p><p>Background: The labour market of public health workers is a rather new discipline. The numbers of studies that examine the conditions of the labour market for examined public health workers are few and most of them have a quantitative approach.</p><p>Purpose: The purpose of this study was to examine how graduated public health workers at the University of Örebro, between the years of 2004 and 2007, experienced their three-year education and the conditions of the labour market.</p><p>Method: In an attempt to obtain an in-depth and more profound understanding, qualitative method was required and therefore, interviews with graduated public health workers were performed. The interviewes were transcribed, and followed by a content analysis where the data were divided into different patterns forming themes, categories and sub categories.</p><p>Result: The respondents experienced a wide and broad education complicates the ability to be more professional in the labour market, where there tend to be difficulties for the respondents to be legitimated. These experiences connect with the respondents feelings of being misunderstood, not having a high-status profession job, having a feeling of poor knowledge and working with the health promotion perspective which tent to have a low impact. To get a job in the health promoting working field after the education the public health workers need to have a wide network with people in the working field. The key factors for an employment is to have many and good social contacts and to be outgoing and to be the prime mover. All of the respondents´ satisfaction by their occupation could be explained by them having feelings about important tasks and assignments. A good working climate and the feeling of being proud of their education are also factors that explain the job satisfaction.</p><p>Conclusion: The education of public health would benefit from reintroducing mentorship and developing the job practice experience during the studies. Other benefits would be to adapt and adjust the examinations of diffrent modules to be more linked to the labour markets requirement, and to introduce more health economics in the education. This, in return would increase the numbers of employments of public health workers and also create an even more competitive education of public health at the University of Örebro.</p>