During the last ten years, the adverse health effects in upper respiratory system and irritation symptoms have become increasingly evident in residents living in moisture damaged houses with dampness and mould growth. In the mid of 1995, Finnish environmental health authorities faced the problem with an increasing demand for investigations to verify the microbial growth in suspected buildings and thereby taking appropriate control measures to protect the health of occupants. As an extension of an earlier relatively onerous method for quantification of microbial growth on surfaces, the Food Laboratory in Porvoo developed an applied direct streak method (DSM) aiming at a facilitation of the method verifying the presence of mould growth. The method was established in close collaboration with health inspectors. The DSM was compared to the original culture method (CM) and repeatability and reproducibility were good or very good. The DSM is a semi-quantitative method and enables the health inspectors to take surface samples without breaking the building structures and without being restricted to stiff surfaces. The results can demonstrate that the material is damaged by active viable mould growth. The DSM provides a powerful and useful tool for health inspectors to verify mould growth in buildings and it supports them to make decisions that are needed to protect the health of occupants. The cost of DSM is about one fourth of that of the more elaborate CM. The DSM is being increasingly used in Finland. / <p>ISBN 91-7997-123-7</p>

The aims of this study were to determine the effects of smoking on the incidence and prognosis of erectile dysfunction (ED) and that of ED on smoking behavior, and to find out whether smoking either directly or through vascular diseases causes ED. The target population comprised of all men born in 1924, 1934 or 1944 and residing in the city of Tampere or 11 adjacent municipalities in Finland. Questionnaires were mailed to 3,143 men in 1994, to 2,864 in 1999 and to 2,510 men in 2004. The response rates were 70%, 75% and 75% respectively. ED was assessed using two questions on subjects’ erectile capacity. Logistic and Poisson regression models were used in the multivariable analyses. Current smoking was associated with ED (Adjusted prevalence odds ratio (POR) = 1.7, 95% CI 1.2-2.4), but not with ex smoking. The incidence of ED non-significantly increased (incidence density ratio (IDR)=1.4) and that of ED recovery reduced (IDR=0.7) with current smoking. A dose-response relationship was found between smoking and ED. Although the relative risks estimates were not statistically significant, probably due to small numbers. Only heavy smokers were significantly at higher risk of ED. Compared with non-smokers, confounder-adjusted IDR was 1.6 (95% CI 1.0-2.6) for men who smoked 21 cigarettes or more daily. Both quitting (IDR=1.7) and starting smoking (IDR=1.9) were rare and higher in men with ED. However, the IDRs estimates were not statistically significant. Current smokers at baseline (1994) who developed vascular disease during 1994-1999 were three times (Confounder-adjusted IDR=3.1, 95% CI 1.3-7.5) at higher risk of ED during 1999-2004 compared with never or ex smokers who did not develop vascular diseases. On the other hand, current smokers who did not develop vascular diseases were not at higher risk of ED (IDR=1.0). There were two bi-directional relations between smoking and ED. Smoking caused ED though vascular diseases and ED caused smoking. The recovery from ED was less in smokers than in non-smokers, and current smokers with ED were more likely to stop smoking compared with men free from ED. / <p>ISBN 91-7997-124-5</p>

Demografisk udvikling peger i retning af en signifikant øgning i antallet af ældre og gamle mennesker. Dette skaber ifølge WHO en udfordring for regeringerne for at opstille en politik, der øger menneskers mulighed for at forblive aktive op i alderdommen. Opfattelsen er, at der bør være mere vægt på sundhedsfremme. Dette er en kvalitativ studie af, hvilken betydning naturen har for ældre (60+) menneskers oplevelse af velvære, og hvilket nærmiljø de foretrækker. Ved analyse af 12 semi-strukturerede interviews, viser fund, at naturens værdi er meget høj blandt informanterne, og at naturoplevelser medvirker til deres følelse af velvære. De opfatter deres nærmiljø som en del af naturen, og de foretrækker især deres have og terrasse. Et nyt fund i denne studie er, at informanterne specielt understreger lysets betydning for deres velvære. Perspektivet i studien er, at det bør overvejes at udnytte natur som en ressource i sundhedspolitik. / Demographic development points to a significant increase in elderly and old people, which according to WHO is creating challenges for governments to make policies, that increase the opportunities for people to stay active as they age. The point is that there should be more emphasis on health promotion. This is a qualitative study on what impact nature has on elderly (60+) peoples experience of well-being, and what kind of nearby environment they prefer. Analysing 12 semi-structured interviews, the findings are, that the value of nature is very high amongst the informants and that nature tributes to their well-being. To them, their nearby environment is part of nature, and they particularly prefer garden and terraces. New findings in this study are, that the informants emphasis especially how much nature’s light means to them. The perspectives of this study suggest that health policies consider nature as a resource in health promotion / <p>ISBN 91-7997-129-6</p>

Bakgrund: Inom förskolan finns det många aktivitetersom utsätter både barnoch personal för risken att bli drabbad av smittsam sjukdom. Detta påverkar inte bara deras hälsa utan även spridningen av infektioner i samhället. Barn i förskola löper två till tre gånger högre risk för att få infektioner än barn som inte vistas på förskola. Tidigare studier visart.ex. att enkla förändringar på förskolan som skrivna riktlinjer för hygienrutiner, följsamhet till hand-och blöjbyteshygien och utbildning av personal och föräldrarkan minska sjukfrånvaron och risken förspridning av smitta. Syfte: 1) Att kartlägga grundläggande kunskaper hos förskolans personal,om hur sjukdomar sprids och hur man kan minska smittspridning. 2) Att undersöka inställningen hos föräldrartill de befintliga hygienrutinerna i förskolan. Metod: 123personal och 104 föräldrar från förskolor inom Kiruna kommun, Sverige svarade på en webb -baserad enkät. Resultat: Resultatet visade på avsaknad avfortbildning, för få skriftliga rutiner, bristande kunskap om hur smitta sprids och begränsad vetskap om informationskällor angående smittsamma sjukdomar. Föräldrar önskar mer information om de hygienrutiner som finns och personal önskar mer kunskap hur de kan informera föräldragruppen. Tillgång till material som handskar, handsprit och pappershanddukar för att kunna följa rekommenderade hygienrutiner fanns på alla förskolor. Både personal och barn reser mycket utanför Sverige, vilket tillsammans med de identifierade bristerna på förskoskolorna bidrar till ökad risk för spridning av smitta. Konklusion:Personalen på förskolorna är inte sjukvårdsutbildade och deras främsta uppgift är att bedriva pedagogisk verksamhet.Trots detta måste förskolor erbjuda en god omsorg till alla barn oavsett hälsostatus. Egenkontroll och dokumentation av förskolans hygienarbete är ett lagstadgat krav och avsaknad av rutiner är en allvarlig brist. Det är av vikt att fokusera på riktlinjer som kan förbättra hygienarbetet. Kan personal och föräldrar hjälpa till att minska risken för smittsamma sjukdomar är det av stor betydelse. För detta krävs god kunskap, samarbetepå olika nivåer, ändamålsenliga lokaler och rätt utrustning / Background: Activities in preschool expose children, staff members, and society at large to com-municable diseases. The risk of infection among preschool children is 2-to 3-fold higher compared to children cared for at home.Recent studies show that simple changes in preschool e.g.written hy-giene guidelines,-and adherence to recommended hygiene practices for changing diapers, improved hand-washing technique, and parental education can prevent infection-based illness and decrease the spread of communicable diseases. Aims: This study aimed to (i)survey the knowledge of preschool staff regarding the spread and pre-ventionof contagious diseases and (ii) investigate the attitude of parents toward current guidelines in preschools. Methods: 123 staff members and 104 parents at preschools in Kiruna,Sweden completed an inter-net-based questionnaire. Results: Our results identified a lack of continuing education for staff members, the absence of writ-ten guidelines at preschools, inadequate understanding of how infection is spreads, and limited knowledge of information sources for communicable diseases. Parents wanted information about current hygiene guidelines, whereas the staff members requested more education to help them better inform parents about the guidelines.The supply of protective gloves, alcohol-based handdisinfect-ants,and paper towels was available at all preschools in accordance with the recommended hygiene practices. We also determined that it was common to travel abroad both among the staff members and the children which, together with the other identified shortcomings at the preschools contributes to an increased risk of spreading infections. Conclusion: Because preschool staff members mainly perform pedagogical activities, they currently lack formal education about health care. However, preschools must offer excellent care to all chil-dren, regardless of health status.Although government regulations require preschools to control hy-giene internally, including documentation, the absence of routines and guidelines is serious. There-fore, preschools should focus on guidelines that improve hygiene. Importantly, preschool staff can both work to prevent communicable diseases.This requires skilled staff, collaboration on different levels, and suitable and well-equipped facilities / <p>978-91-86739-59-1</p>

Background: Insufficient physical activity is a public health problem. Nordic healthcare professionals use physical activity on prescription (PaP) to increase physical activity. Purpose: This study aimed to evaluate the effectiveness of PaP that includes organized exercise. Method: Prospective data was obtained from four Swedish counties during fall 2009 and spring 2010. The study population comprised 98 patients whose healthcare professional prescribed PaP to prevent or treat disease. Questionnaires administered at baseline, three and six months after initiating PaP evaluated self-reported physical activity levels, adherence, factors influencing adherence, and experience of PaP. Results: Although the majority of patients receiving PaP including organized exercise are middle-age women, there are a wide distribution regarding e.g., age, socioeconomic status and reason of receiving PaP. Most participants received initial support from healthcare providers and activity organizers, and most were satisfied with the support they got. Approximately 70% participated in several activities at all measuring points. Although PaP including organized exercise increased activity levels only marginally, sedentary behavior decreased significantly. Six months after initiating PaP including organized exercise, 68% adhered to the prescribed physical activity level. Most participants deemed PaP including organized exercise a good method for becoming physically active. However, there is a need for regularly and longer support. Importantly, individualized instruction, adjusted exercise regimens, and support from other participants provide positive reinforcement. On the other hand, PaP with organized exercise imposes additional costs and decreases flexibility including both time commitment and scheduling constraints. Conclusion: Adherence levels to PaP with organized exercise are similar to those achieved by other chronic disease treatments. PaP including organized exercise can decrease sedentary behavior, an important factor in promoting public health in the Nordic countries. / <p>ISBN 978-91-86739-16-4</p>

The study was user survey method based, performed to get the overview of use and perceptions of health caremanagers towards Lithuanian computerized health information system as a tool for decision – making. Aims of the study were to describe LCHIS, its inputs and potential use; to account for a surveyofpotential users, health care administrators; to discuss the need for improvement of the system and itsuse. Methods. User survey method was applied. Literature search was performed and the questionnaire was constructed after interview with four respondents and clarification of questions. Totally 100 ofrespondents from different health care institutions were interviewed. Data was analysed using normal statistical methods, using MS Excel 2000 and statistical package SPSS 10.0 as tools. Main results. Concerning the awareness about the existing of LCHIS, 68% of the respondents saidtheyhave heard about it and 15% said theyhave been using this system daily. As many as 68% of respondents didn’t really take care about the existence of LCHIS, while the size of respondents being satisfied and not was pretty the same. The number of satisfied with the structure was rather small ifcomparing with those partially satisfied. As many as 76% of the respondents said they haven’t been using the system at all. 24% of the respondents were satisfied with the certain groups of healthindicators within the system. Group of morbidity indicators and group of hospital activity indicatorswere among the mostly used (17% together). Almost 20% of the respondents said it was easy for them to use LCHIS; the same number of health care administrators trusted the information comingfrom LCHISand they have experienced the situation, where they have used LCHIS for planning ormanagement in current situation. As many as 82% of health care managers agreed heads or administrative staff of hospitals supposed to be the key members, who must encourage them to use the system. Conclusions. About two thirds of health care administrators interviewed knew about LCHIS and the rest had been or were users. In the comments this group claimed they were supporting their decisions by using the systemand indicators in it. As many as 96% of the respondents stated there was a needfor statistical information and skills for dailydecision - making and managerial activities. The respondents, who used LCHIS, trusted the information in the system and found it useful in their dailywork as health managers. The main comments, why respondents didn’t use the system or didn’tknow about it, was lack of information technologies in work place, lack of computer skills and lackof support from hospital authorities / <p>ISBN 91-7997-097-4</p>

Objectives – To ascertain the annual number of users who were discharged home after visits to the emergency department, grouped by age, gender and number of visits during the calendar year, and to assess whether an increasing number of visits to the department predicted a higher mortality. Methods – This is a retrospective cohort study, at the emergency department of Landspitali University Hospital, Reykjavik capital city area, Iceland. During the years of 1995 to 2001 19259 users visited the emergency department, and were discharged home and they were follow-up for cause specific mortality through a national registry. Standardised mortality ratio, with expected number based on national mortality rates was calculated and hazard ratios according to number of visits per calendar year using time dependent multivariate regression analysis were computed. Results – The annual increase of visits to the emergency department among the patients discharged home was seven to 14 per cent per age group during the period 1995 to 2001, with a highest increase among older men. The most common discharge diagnosis was the category Symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified. When emergency department users were compared with the general population, the standardised mortality ratio was 1.81 for men and 1.93 for women. Among those attending the emergency department two times, and three or more times in a calendar year, the mortality rate was higher than among those coming only once in a year. The causes of death which led to the highest mortality among frequent users of the emergency department were neoplasm, ischemic heart diseases, and the category external causes, particularly drug intoxication, suicides and probable suicides. Conclusions – The mortality of users of the emergency department who had been discharged home turned out to be higher than that of the general population. Frequent users of the emergency department had a higher mortality than those visiting the department no more than once in a year. Since the emergency department serves general medicine and surgery patients, not injuries, the high mortality due to drug intoxication, suicide and probable suicide is notable. Further studies are needed into the diagnosis at discharge of those frequently using emergency departments, in an attempt to understand and possibly prevent this mortality / <p>ISBN 91-7997-128-8</p>

Baggrunden er de mange forebyggelige indlæggelser, der kan mindskes ved tidlig opsporing og intervention i primær sektor Formål:Atafprøve udvalgte værktøjer i et design, som vil udgøre en effektiv metode til at lave tidlig opsporing af udsatte borgere i primær sektor, der viser tegn på begyndende sygdom som kan forebygges. Dernæstatudvikle og testeet IT-system til attriagere og risikovurderedisse borgere, samt et nyt spørgeskemaredskab til at vurdere forandringenaf den sundhedsfagligepraksis. Metode: Mikset metodologi anvendesfor atbesvare forskningsspørgsmåleneog formålet. Først testesi klinisk praksiset nyt sæt af metoder til tidligopsporing med efterfølgende triage og risiko-scoring af borgerne og dernæst afprøves en nyudviklet IT-platformhertil.Metoderne som afprøves er: Ændrings-skemaet med triage og TOBS (Tidlig Opsporingaf Begyndende Sygdom). Endeligpilottestes et nyt spørge-skema til at undersøge forandringen i den sundhedsfaglige praksis. Hovedresultater: Det er lykkedes at afprøve Ændringsskemaet med triage i trepleje-grupper (n=105)–således at alle borgeres habitualtilstand registreres og triageres. Alle borgere var ved testperiodens slutning monitoreret påoversigtstavler i plejegrupperne. Man havde fundet de kategorier som havde mindrefunktionstab og sygdomstegn(12,4%)og dem som var i risiko for forværring eller indlæggelse(8,6%). Der var iværksat opfølgende handling og forebyggende indsatser i forholdtil disse borgere.TOBS måling af vitale værdier (Puls, vejrtrækningsfrekvens, temperatur, bevidsthedsniveau og systolisk blodtryk) er introduceret og afprøvet på udvalgte risiko patienter –men der var ikke tilstrækkelig systematisk registrering af den analoge deli alle testgrupperne endnu. Testentyder dog på, at det godt kan kombineres med Ændrings-skemaet til at få systematiserede målinger af vitale værdier og opfølgning på deudsatte borgere.Der er udviklet en tilpasset IT-platform med Ændringskemaet, triage og TOBS til at få plejepersonalet til at lave tidlig opsporing af borgere med begyndende sygdomstegn. Endelig er der lavet et spørgeskema, der kan bruges til at undersøge oplevelsen af forandringer i den sundhedsfaglige praksis i forbindelse med indsatsen for tidlig opsporing og det er pilottestet i to plejegrupper (n=45). Der er ikke fundet tegn på systematisk bortfald på enkelte items, men der var for stort generelt bortfald i den sidste testgruppe til at opnå en fuld repræsentativitet i forhold til deres besvarelser. Konklusion: Tidlig opsporing i primær sektor, kræver enklemetoder tilpasset praksis ogfaggrupperne. Der er testet og fundet et virksomtmetodisk designtil tidlig opsporing i primær sektor, et tilpasset IT-redskabtil at understøtte udførelsen afÆndringsskemaet med triage og TOBS måling af borgere i risikozonen. Endvidere erpilottestet etnytspørgeskematil at undersøge forandringen af den sundhedsfaglige praksis, som den opleves af de involverede fagpersoner / Background.New methods and interventions in the primary sector can increase early disease detection and avoid unnecessary hospitalization. Aim:This study aimed to test a powerful set of early detection methods for vulnerable citizens who exhibit signs of incipient disease or preventable deterioration, including (i) an IT system customized to perform triage, (ii) Timely Observation of Beginning Sickness (TOBS) to measure at-risk citizens, and (iii) a questionaire that assesses change in healthcare practice. Methods. The mixed methods in this study included clinical testing, a triaged changing table, TOBS, risk scoring, and a new IT platform. We also pilot-tested a new questionnaire to investigate change in the healthcare practice. Main Results: After testing the triaged changing table in three healthcare groups (n=105), we registered citizens according to risk. Information boards allowed care groups to identify patients who experienced less loss of function and fewer signs of disease (12.4%); others experienced several major changes and were at risk of deterioration or hospitalization (8.6%). We initiated follow up and preventive measures to care for these citizens. TOBS included measurement of vital signs (i.e., heart and breathing rate, temperature, level of consciousness and systolic blood pressure) in selected risk patients, providing systematic risk scoring and suggestions for actions. Finally, we developed and pilot-tested (in two care groups, n = 45) a simple questionnaire that can prospectively examine change in healthcare practices. There are no signs of systematic errors on single items but in the last test group there was too large a general lapse of answers to achieve a full representation in relation to their responses. Conclusion: Early detection of preventable diseases in the primary sector requires methods that are adapted to the clinical setting and professional groups. Our results suggest that combining TOBS with the changing table may enable systematic measurement in vulnerable citizens detected and a quick follow up with preventive measures to care for these citizens. A well-customized IT platform will help healthcare providers detect early signs of disease. Using data entered during patient visits, the system can perform an online triage, create summaries of categorized citizens, and provide reminders of important follow up / <p>ISBN 978-91-86739-80-5</p>

Bakgrunn: ”Demens i familien” er en intervensjonsstudie hvor psykoedukativ metode ble benyttet for å redusere stress hos pårørende, og for å redusere psykiatriske tilleggssymptomer hos personer med demens. Studien pågikk i Norge fra 2001-2004. Denne MPH- oppgaven er en delstudie av”Demens i familien”. Mål: Undersøke om pårørende opplevde at de hadde hatt nytte av den psykoedukative intervensjonen, og om effekten ble opprettholdt over tid, dette ble målt med et evalueringsskjema. Delmål var å beskrive pårørendes vurdering av eget stress, egen byrde og egen opplevelse av helse, samt sammenligne om det forelå noen forskjell mellom de som hadde fått en kortvarig intervensjon og en kontrollgruppe som hadde fått vanlig behandling. Metode: Evalueringsskjema med 8 spørsmål og en rubrikk for kommentarer var utarbeidet. Skjemaet ble fylt ut av pårørende etter intervensjonen og 7,5 måneder senere (n=45). Spørreskjemaer sommåler stress (RSS), byrde (NPI- byrde) og opplevelse av egen helse (GHQ-30), ble målt hos pårørende, ved baseline, etter intervensjonen og 7,5 måneder senere. Andre fra intervensjonsgruppen (n=47) og kontrollgruppen (n=86), skåret på de samme spørreskjemaene. Grad av demens (MMS), varighet av sykdom, pårørendes alder og kjønn forelå på alle. Resultater: Skårene fra spørreskjemaene RSS, NPI- byrde og GHQ-30 viste ingen signifikant forskjell etter intervensjonen i gruppene eller mellom gruppene. Forskjeller i varighet av sykdommen, pårørendes kjønn og alder var små. Alle opplevde nytte av intervensjonen også over tid. I den åpne rubrikken var det kommentarer fra 36 personer. Konklusjon: Spørreskjemaene viste at pårørende var stresset, belastet og at dette gikk ut overhelsen. Psykoedukative intervensjonsgrupper var nyttige, og pårørende ønsket differensierte grupper med oppfølgingsmøter og egne grupper for personer med demens / Background:”Dementia in the family” is an intervention study where psycho-educative method has been applied aiming to reduce stress for the relatives and reduce psychiatric behavioural symptoms to persons with dementia, carried out in Norway between 2001-2004. The evaluation described below is part is part of “Dementia in the family”study. Aim: Investigate the relative’s perception of the usefulness of the intervention, and if the effect remained. This was assessed with an evaluation questionnaire. An additional aim was to see how relatives assessed their own stress, burden and general health, and if there were any difference between those who received a short intervention and the control group, which received treatment as usual. Method: Aquestionnaire with 8 questions and a section for comments was developed and filled in by the relatives after the intervention and 7,5 months later (n=45). Tests measuring relatives stress (RSS), burden (NPI- burden) and experience of general health (GHQ- 30) was performed at baseline, after the intervention and 7,5 month later. Others in the intervention group (n=47) and control group (n=86) scored the same tests. Level of dementia was measured (MMSE), duration of illness, relative’s gender, relation and age was stated for all participants. Results: The scores from tests showed no significant differences in any of the groups or between the groups. There were small variations in the MMSE score, duration of illness, relative’s gender and age. The questionnaire showed that every relative found the intervention useful and the effect remained. 36 persons filled in on the comments. Conclusion:Results indicated that the relative’s were stressed, burdened and their general health was suffering. It was concluded that the psycho-educative intervention groups were useful, and that the relatives wanted differentiated groups, follow-up meetings and special groups for the persons with dementia. / <p>ISBN 91-7997-144-x</p>

Background: Continuity of care and post-discharge follow-up visits can improve the quality of care and reduce the likelihood of relapse and re-hospitalization in patients with psychotic disorders. Purpose: This study aimed to analyze post-discharge follow-up interventions in patients with psychotic disorders, and to identify measurement instruments for intervention outcomes. Method: The literature review described here used a specific framework, where the follow-up interventions and the measurement instruments were analyzed systematically, to investigate fifteen studies identified through electronic databases such as Pubmed, Psychinfo, ProQuest, Cinahl, Medline, and Scopus. Results: The studies used interventions including psychoeducation, cognitive-behavioral therapy, cognitive behaviorally oriented service, optimal clinical management, relapse prevention plan, software suggested intervention, ambulatory outpatient care, community re-entry module, integrated treatment, and hospital-based community psychiatric service. Additionally these studies used thirty-eight measurement instruments to assess change in psychiatric patients or their relatives, based on psychological, social, and occupational factors as well as specific symptoms and symptom severity. The instruments also measured quality of life, insight, self-esteem, and cognitive function. Further, the studies examined therapeutic alliances and the experience of family members. The most commonly used instruments were the Global Assessment of Functioning and the Positive and Negative Syndrome Scale. Conclusion: The interventions reviewed here emphasize an individualized approach that targets education, illness management, coping strategies, social skills training and relapse prevention, and seeks to alter any harmful understanding of the illness. Although researchers can choose among numerous interventions, psychoeducation was the most appealing follow-up intervention for patients suffering from psychotic disorders. Importantly, evaluation instruments must be relevant to psychological symptoms, treatment, time and resources available, and what questions were being sought to answer. Approximately eleven of the thirty-eight instruments reviewed here showed weak or unclear reliability and validity. The most practical instrument for evaluating the outcome of an intervention for patients suffering from psychotic disorders wasthe Positive and Negative Syndrome Scale. / <p>ISBN 978-91-86739-70-6</p>