Bakgrunn: Misbruk av vanedannende legemidler er et viktig folkehelseproblem. Enkelte pasienter går fra lege til lege og driver såkalt legeshopping for å skaffe seg mest mulig av denne typen legemidler. Dette er et problem i forhold til å kunne begrense legemiddelmisbruket i befolkningen. Fastlegeordningen, som ble innført i Norge i 2001, er blant annet ment å skulle begrense mulighetene til legeshopping. Det er ikke tidligere gjort studier som kan kartlegge omfanget av legeshopping i en befolkning, verken i Norge eller andre land. FORMÅL: Kartlegge omfanget av legeshopping i befolkningen i Norge, og forsøke å klarlegge i hvilken grad bruk av flere leger kan skyldes shopping etter legemidler eller andre årsaker. MATERIALE OG METODE: Studere data fra det norske Reseptregisteret (NorPD) for kalenderåret 2004, som blant annet viser antallet leger benyttet, mengde utlevert av det aktuelle legemiddelet og samtidig mengde utlevert av benzodiazepiner og opioider for alle brukere av de vanedannende legemidlene diazepam, karisoprodol og kodein kombinasjoner sammenlignet med alle brukere av de ikke-vanedannende legemidlene esomeprazol, metformin og salbutamol. RESULTATER: De aller fleste pasienter bruker kun en eller to leger for å få utlevert samme legemiddel i løpet av ett kalenderår. Andelen som bruker tre eller flere leger er imidlertid mer enn dobbelt så høy for de vanedannende legemidlene som for de ikke-vanedannende, og for de som bruker fem eller flere leger, er andelen nesten ti ganger større. Med økende antall leger som er benyttet, er dessuten økningen i både utlevert mengde av legemidlet og samtidig mengde utlevert av benzodiazepiner og opioider langt mer uttalt for de vanedannende legemidlene enn for de ikke-vanedannende. KONKLUSJON: Det foregår etter innføringen av fastlegeordningen fortsatt en begrenset, men klar legeshopping blant pasienter som ønsker å få tak i mest mulig av vanedannende legemidler. Dette forhold må tas alvorlig av både de forskrivende legene og helsemyndighetene. / BACKGROUND: Abuse of prescription drugs is an important public health issue. Some patients go from one physician to another in so-called doctor-shopping (or physician-shopping) with the intention to have as much as possible of addictive drugs prescribed. This is a problem when trying to restrict prescription drug abuse in the population. The Regular General Practitioner (RGP) Scheme which was introduced in Norway in 2001 had among other things the intention to counteract doctor-shopping. So far there are no studies in Norway or other countries that have presented estimates of the proportions of patients that practice doctor-shopping. AIM: To explore the extent of doctor-shopping in the population in Norway and try to unveil if the use of several doctors is primarily a prescription drug shopping or if it has other reasons. MATERIAL AND METHODS: Data from The Norwegian Prescription Database (NorPD) for the year of 2004 was studied. The register includes information on the number of doctors used by individual patients and the amount of drug dispensed. There is also information about concomitant use of opioids and benzodiazepines. Users of the addictive drugs diazepam, carisoprodol and codeine combinations were compared to users of the non-addictive drugs esomeprazole, metformin and salbutamol. RESULTS: Most patients use only one or two doctors for prescription of the same drug over a period of one year. However the proportion of patients who uses three or more doctors for the addictive drugs is more than twice the comparable proportion of patients using the non-addictive drugs. For those who uses five or more doctors the proportion is nearly ten times larger. The amount of dispensed drug increases considerably more by increasing number of doctors used for users of the addictive drugs than for the users of the non-addictive drugs, as do the amount of concomitantly dispensed opioids and benzodiazepines. CONCLUSION: Also after the introduction of the Regular General Practitioner (RGP) Scheme in Norway doctor-shopping is still going on to a limited but significant extent by patients who appear to have the intention to get as much as possible of addictive drugs. This is a public health issue that has to be taken seriously by both prescribing doctors and health authorities. / <p>ISBN 978-91-85721-60-3</p>

Bakgrunn:I norske levekårsundersøkelser oppgirinnvandrere at de hardårligere helse enn resten av befolkningen. Et mål i norsk integreringspolitikk er å fremmelevekår for innvandrerbefolkningen. Fysisk aktivitet slik som svømming har en sosial og kulturell verdi i det norske samfunnet,samtidig som det er en forebyggende innsats vedat manglende ferdigheter i svømming bidrar til at innvandrergrupper har høyere risiko for å drukne. Hensikt: Formålet med studien var åutvikle et svømmekurs som en helsefremmende intervensjon for kvinner med innvandrerbakgrunn og undersøke om svømmekurset bidro til økte svømmeferdigheter og sosial integrering. Metode: Å utføre enintervensjon gjennom et svømmekurs med deltagelse fra 16 kvinner fra 6 forskjellige land.Triangulering av metoder med spørreundersøkelser, gruppeintervjuerog observasjoner fra 15.november 2012 til 26. oktober 2013. Forskningsspørsmål har søkt svar innenfor temaene øktesvømmeferdigheter, sosial integrering ogandre faktorer som kunnepåvirke helsetilstanden til kvinner med innvandrerbakgrunn. Kvalitativ innholdsanalyse ble brukt for å analysere det kvalitative datamaterialet. Resultat: Deltagerne visteøkte svømmeferdigheter parallelt med økt trygghetsfølelse i forhold til vann fra kursstart til kurset varavsluttet. Deltagerne viste en kulturell åpenhet og personlig utvikling som ble synlig gjennom utvidet sosialt nettverk på tvers av kulturer og utvidet omfang av sosiale aktiviteter slik sombruk av offentlig basseng. Andre funn var en bedre selvopplevd helse og at deltagernefungerte som rollemodellerfor egen familie og venner med tanke på ålære svømmeferdigheten. Konklusjon: Denne intervensjonen visteat aktivitet tilrettelagt for kvinner med innvandrerbakgrunn fremmet faktorer som haddeen positiv effekt på helsetilstanden, Dette gjennombedring av svømmeferdigheter,og sominngangsport til sosial integrering / Background:Norwegian surveys have reported that the health of immigrants compares negatively with the health of the general population. Norwegian society emphasizes thesocial and cultural value ofphysical activity such as swimming,andintegration policypromotes improved living conditions for immigrants. Moreover, inability to swim heightens the risk of drowning. Purpose: This study aimed to develop swimming instruction as a health-promoting intervention among immigrant women.It also examined whether such swimming lessons improve women's health by increasing skills and social integration. Method: Sixteen women from six different countries participated in swimminglessons between 15 November 2012 and 26 October 2013. This thesis used a triangulation of methods (i.e., surveys, group interviews,and observations)to investigate whether increased swimming skill, social integration, and other factors affect the health of immigrant women. I used qualitative content analysis to evaluate alldata. Results: As immigrant women became better swimmers, their sense of security in the water improved. Additionally, swimming enhanced cultural openness and personal development, and participants’ social networks expanded across cultures. Public swimming pools increasedsocial activity. Finally, as participants’perceptions of their own health improved,they encouraged their family and friends to learn how to swim. Conclusion: This intervention shows that activities organized for immigrant women promote factors that have a positive effect on health, such as improved swimming skills. Swimmingis a gateway to social integration / <p>ISBN 978-91-86739-67-6</p>

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Public health aspects of pharmaceutical prescription patterns: Exemplified by treatments for prevention of cardiovascular disease. Louise Silwer. ISBN: 978-91-85721-18-4 ISSN: 0283-1961Main aim:To study patterns and trends of dispensed prescriptions, to explore what proportion of the population is exposed to some of the more prevalently prescribed pharmaceuticals, and to find possible ways of measuring drug-induced adverse symptoms in the population. Further, to illuminate conditions surrounding prescribing in primary prevention of cardiovascular disease. Methods: In three descriptive studies of prescription patterns, prescription data at aggregate level from a Swedish county were analysed retrospectively, and proportions were calculated. Data from the first ten years of the studies were obtained from a local prescription study, and data from another five years were local data from a national prescription survey. Data from a Danish database (OPED), with data at the individual level, were used for a prescription sequence symmetry analysis, and when Swedish national prescription data at the individual level became accessible, they were used for calculations of drug prevalence in the entire Swedish population. In a qualitative analysis of interview data, a phenomenographic approach was used. Main results: The purchase of pharmaceuticals on prescription almost doubled in the studied county in the period 1988-2002. Some common pharmaceuticals that increased to a great extent among the older part of the population were cardiovascular preventive drugs, such as antihypertensive and lipid modifying agents, and also hormone replacement therapy for women. In 2005, over half of all Swedish citizens, aged 60 or over, purchased antihypertensive or lipid modifying preparations during a six-month period. The different views that were found among GPs, regarding beliefs and practical management of primary prevention of CVD, could be interpreted as a reflection of the complexity of patient counselling in primary prevention in practice. Conclusion: The increase in dispensed prescriptions over the 15 years and the magnitude of the prevalence of the studied pharmaceuticals, such as antihypertensive, lipid modifying and hormonal treatments, which to a great extent are used by ‘healthy’ people, point to the need of following-up both beneficial and harmful consequences on public health. The prevalence of preventive treatments together with the variation in views of administration of primary prevention of cardiovascular disease, also point to the need of clarification of guidelines regarding pharmaceutical primary prevention and encouragement of therapy discussions among GPs.

Bakgrund: Självskadebeteende är ett allvarligt problem som förekommer idag. Under senare år har vårdgivare inom hälso- och sjukvården uppmärksammat en ökning av detta problem som leder till fysiska och psykiska hälsobesvär. Dessa hälsobesvär kan förekomma i form av exempelvis depression, fysiska skador och kan i värsta fall leda till självmord. En form av terapi som visat sig ge goda resultat för att komma till rätta med detta beteende är DBT, dialektisk beteendeterapi. Syfte: Att undersöka om DBT- terapeuters beskrivning av sitt arbete med dialektisk beteendeterapi stämmer överens med litteraturens beskrivning av behandlingen, och därmed uppnå en fördjupning i dialektisk beteendeterapi och självskadebeteende. Metod: En kvalitativ studie med sex stycken semistrukturerade intervjuer med DBT- terapeuter har genomförts. Analysen har utförts med hjälp av kvalitativ innehållsanalys. Resultat: Resultatet har delats upp i två huvudkategorier: arbetsmetod samt terapeuter och andra vårdgivares bemötande av patienter. I resultatet framkommer det hur en DBT- behandling stegvis ser ut samt vikten av ett gott bemötande av patienter. Ett gott bemötande omfattar bland annat ett respektfullt och icke- dömande förhållningssätt. Konklusion: Resultaten i studien bekräftar resultaten från den tidigare forskningen. Dock krävs det mer forskning om DBT som behandlingsmetod för att kunna dra tillförlitligare och säkrare slutsatser. Genom att arbeta med behandling av självskadebeteende kan individers hälsa förbättras, vilket i sin tur även kan leda till minskning av antalet självmord och psykisk ohälsa. / Background: Self- harm behavior is a serious problem that occurs today. In recent years care providers in the health-care have noticed an increase of this problem that leads to physical and mental health- problems. These health- problems can occur, for example, in the form of depression, physical harms and can lead to suicide in worst case. A form of therapy that has been shown to give good results to manage this behavior is DBT, dialectical behavior therapy. Aim: To investigate whether DBT- therapist’s description of their work with dialectical behavior therapy is consistent with the literature’s description of the treatment, and thereby achieve a deepening in dialectical behavior therapy and self- harm behavior. Method: A qualitative research with six semi-structured interviews with DBT- therapists have been implemented. The analysis has been done using a qualitative content analysis. Results: The result has been divided into two main categories: working- method and therapist’s and other care provider’s treatment of patients. It appears in the result how a DBT- treatment looks like, step- by step, and the importance of a good treatment of patients. A good treatment includes a respectful and non- judgemental attitude. Conclusion: The results in the study confirms the results from the recent research. However, more research on DBT as a treatment is necessary, in order to make stronger and more reliable conclusions. People’s health can be improved by working with treatment of self- harm behavior, which also can lead to a reduction in the number of suicide and mental illness.

<p>Bakgrunden till undersökningen är att arbetsplatsen är en viktig arena att arbeta hälsofrämjande på, eftersom en stor del av befolkningen nås via denna och olika hälsobeteenden kan påverkas innan ohälsa uppstår. En framgångsrik strategi för att skapa hälsosammare arbetsplatser är att arbeta med friskvård. Om människor ska kunna leva hälsosamt krävs att de får möjlighet att göra det även på arbetsplatsen, då hälsa bör ses ur ett helhetsperspektiv. EduTainer har utarbetat en metod för att arbeta med friskvård på företag. Ett företag som arbetat efter denna metod, med gott resultat, är Måleriproduktion AB. Syftet med uppsatsen är att undersöka vilka faktorer som underlättar respektive försvårar för friskvårdsarbete på Måleriproduktion AB samt att studera vilka faktorer som är viktiga hos den externa aktören för att uppnå ett framgångsrikt friskvårdsarbete på arbetsplatsen. Undersökningen baseras på kvalitativ metod och intervjuer har genomförts med åtta deltagare i friskvårdsarbetet. Resultatet och slutsatserna visar att faktorer som underlättar för friskvårdsarbete är inställning, socialt stöd, motivation, förändrade rutiner och en extern aktör. Faktorer som försvårar för friskvårdsarbete är tidsbrist, brist på gemensamma aktiviteter och andra faktorer på själva arbetsplatsen. Viktiga faktorer hos den externa aktören är att den förmedlar bred information samt att upplägget är varierande med föreläsningar, individuell rådgivning, tester och uppföljning.</p> / <p>The background for the study is that the workplace is an important arena to work with health promotion, since a large amount of the population can be reached by the workplace and different health behaviors can be affected before ill health appears. A successful strategy for creating healthy workplaces is to work with preventive health care. If people are going to be able to live healthy lives, they need to get the opportunity to live healthy even at the workplace, because health is supposed to be seen from a holistic point of view. EduTainer has created a method, used for companies, to work with preventive health care. A company which has adopted this method, with good results, is Måleriproduktion AB. The aim of this study is to examine what factors that simplify respectively complicate working with preventive health care at Måleriproduktion AB and to study what factors that are important for the external operator to achieve a successful preventive health care-work at the workplace. The study is based on qualitative method and interviews have been made with eight participants of the preventive health care-work. The result and the conclusions show that the factors that simplify working with preventive health care-work are attitude, social support, motivation, a change of routines and an external operator. Factors that complicate working with preventive health care are lack of time, lack of common activities and other factors at the workplace itself. Important factors for the external operator are that the information is widely mediated and that the framing is varied with lectures, individual counselling, tests and follow up.</p>

<p>In community health promotion intersectoral collaboration is essential. Important actors are the governmental health system, the civil society and Non-Governmental organisations (NGOs). The aim of this qualitative thesis was to examine what kind of cooperation existed in a rural community in Mozambique and to describe the actor’s experiences of collaboration and how it can be improved. This was done by conducting interviews. The result of the study showed that different ways of cooperation existed, intersectoral as well as side by side and intrasectoral. The extent of intersectoral collaboration was fairly loose, such as networks, alliances or partnership. All the informants were positive to collaboration, they had experienced that people had been helped and their knowledge in health issues was improved as an effect of joint efforts. The experience among the actors was that the collaboration had improved and that they had become closer together over the years. Problems to cooperation that were mentioned concerned dropouts and financial issues. The informants were unanimous that it was necessary to broaden the collaboration. They were concerned over the sustainability in the different projects as well as the sustainability in cooperation itself.</p> / <p>Para a promoção da saúde em comunidade a colaboração intersetorial é essencial. O sistema público de saúde, a sociedade civil e as organisações não governamentais (ONGs) são importantes agentes. O objetivo desta tese qualitativa foi examinar qual tipo de cooperação existiu em uma comunidade rural em Moçambique e descrever as experiências de colaboração dos agentes e como ela pode ser melhorada. Isto foi feito através de entrevistas. O resultado do estudo mostrou que existiram diferentes modos de colaboração: intersetorial assim como intrasetorial de forma paralela. O nível da colaboração intersetorial foi relativamente informal assim como redes de contato, alianças e parcerias. Todos os entrevistados foram positivos a colaborar e experienciaram que as pessoas tinham sido auxiliadas e que seus conhecimentos acerca de assuntos de saúde foi melhorado como resultado da união de esforços. A experiência entre os agentes foi de que a colaboração foi melhorada e que eles se tornaram mais próximos através dos anos. Problemas acerca de colaboração que foram mencionados foram devidos a desistências e questões financeiras. Os entrevistados foram unânimes sobre a necessidade de aumento do nível de colaboração. Eles estavam preocupados sobre a sustentabilidade de diferentes projetos assim como a sustentabilidade da cooperação em sí própria.</p>

<p><p><p><strong>Bakgrund</strong><strong>:</strong> Studier visar att ungas upplevda- och psykiska hälsa samt deras hälsorelaterade levnadsvanor försämras med åldern. Elevers trivsel och påverkansmöjligheter i skolan minskar också med stigande ålder. Hälsofrämjande arbete i skolan kan därför vara värdefullt för att förbättra ungas hälsa. Det kan exempelvis ske genom Korpen Svenska Motionsidrottsförbundets koncept: Hälsodiplomerad gymnasieskola. I Västerås är Carlforsska gymnasiet en hälsodiplomerad skola. <strong>Syfte</strong>: Att studera om den hälsodiplomerade skolans hälsofrämjande arbete medfört någon förändring gällande elevers hälsa i årskurs två mellan åren 2004 och 2008. <strong>Metod</strong>: En resultatutvärdering genomfördes innefattande; en kvalitativ och en kvantitativ metod. Kvalitativ studie omfattade fyra intervjuer med skolpersonal. Underlag för den kvantitativa studien var ett insamlat material från undersökningen "Liv- och hälsa- Ung i Västmanland". <strong>Resultat</strong>: Skolpersonal upplevde att förbättringar skett gällande elevers hälsorelaterade levnadsvanor och ökad trivsel i skolan. Båda könen rapporterade förbättrad psykisk hälsa avseende minskad nervositet och ökad skoltrivsel. Pojkar hade också förbättrade resultat gällande; livskvalitet, irritation, stress, alkoholintag och snusvanor. Flickor rapporterade förbättrade resultat rörande; fysisk aktivitet, frukostintag och utökad arbetsro i skolan. <strong>Slutsatser</strong>: Skolans hälsofrämjande arbete har troligtvis bidragit till att förbättra elevers hälsa. Det är ett långsiktigt arbete och fler studier inom området behövs för att utläsa dess egentliga effekter på hälsa.</p></p></p> / <p><p><p><strong>Background</strong><strong>:</strong> Studies have shown that young people's experienced- and psychological health and their health related habits declines with age. Student's comfort and influence opportunities in school also weaken with age. Health promotion work in school might therefore be valuable to increase young people's health. This could for instance be achieved through Korpen - the Swedish exercise union's concept: Health certified school. Västerås, a city in the county of Västmanland, has one health certified high school, Carlforsska. <strong>Aim</strong>: To study if the health certified school's health promotion work has resulted in any change concerning the second grade student's health, between the years 2004 and 2008. <strong>Method</strong>: A outcome evaluation has been conducted including both qualitative and quantitative method. The qualitative method included four interviews with school staff. The foundation for the quantitative study was a collected material from a survey called "Liv och hälsa- Ung in Västmanland". <strong>Result</strong>: School staff experienced improvements concerning student's health related habits and increased comfort in school. Both boys and girls reported improved psychological health such as lower feelings of nervousness and improved comfort in school. Boys had also improved results in; self reported quality of life, irritation, stress and alcoholand snuff use. Girls improved their results in; physical activity, breakfast habits and improved feelings of better working conditions in school. <strong>Conclusion</strong>: The school's health promotive work has probably contributed to the student's improved health results. Working with health in school is a longterm process and more studies are needed to assure the detailed influence by health promotive work on young people's health.</p></p></p>

<p><strong>Bakgrund: </strong>Den största delen av den vuxna befolkningen befinner sig i arbetslivet och därför är arbetsplatsen en viktig arena i arbetet med att förbättra folkets hälsa. I verksamheters systematiska arbetsmiljöarbete finns verktyget medarbetarsamtal som syftar till att öka förståelsen för organisationens uppgift samt att ge medarbetaren ett större handlingsutrymme. <strong>Syfte: </strong>Att studera chefers och medarbetares upplevelser av hur arbetsmiljö och livsstilsfrågor diskuteras och behandlas i medarbetarsamtalet. <strong>Metod: </strong>Fyra fokusgrupper genomfördes med chefer och medarbetare från proAros olika verksamheter. <strong>Resultat: </strong>Mål, strategier, utveckling samt en enad riktning av verksamheten diskuterades som viktiga delar i medarbetarsamtalet. Tydligt ledarskap, stöd och uppmuntran, delaktighet, det egna ansvaret samt hur mål och krav är anpassade för den rådande situationen var faktorer som upplevdes påverka medarbetarsamtalet. Gällande arbetsmiljö diskuterades främst hur trivseln i arbetslaget var och hur samarbetet fungerade. Gällande livsstilsfrågor diskuterades friskvård, det egna ansvaret för sin hälsa samt balansen mellan arbetsliv och privatliv. <strong>Slutsats: </strong>Den fysiska arbetsmiljön är fortfarande av betydelse för de anställdas hälsa då proAros verksamheter till större delen består av människobehandlande yrken med påfrestande arbetsbelastningar. Frågan om att hitta balans är viktig för den arbetsrelaterade hälsan och bör därför göras mer medveten. Det promotiva hälsoarbetet bör därför integreras även i medarbetarsamtal.</p> / <p><strong>Background: </strong>The majority of the adult population is present in working life and the workplace is therefore an important setting in the efforts to improve public health. In the organizations’ day-to-day work to improve the work environment it is possible to use performance appraisal that aims to increase the understanding for the organization’s commissions and to increase the employees’ participation. <strong>Aim: </strong>To study directors and coworkers experiences about how work environment and lifestyle are discussed and managed during performance appraisal. <strong>Method: </strong>Four focus groups where performed with directors and co-workers from different units at proAros. <strong>Result: </strong>Objectives, strategies, development, and a united direction in the organization were discussed as important for performance appraisals. Leadership, support and encouragement, participation, the own responsibility and how objectives, demands are adjusted to the existing situation were factors that were experienced to influence performance appraisal. Concerning the work environment was the comfort in the team and how the cooperation worked the foremost subjects that were discussed. Concerning lifestyle were the organisation’s health work, the responsibility for your own health and the balance between working life and leisure time discussed. <strong>Conclusion: </strong>The physical work environment is still important for the employees’ health as the units of proAros to a great extent consist of human services with a high workload. The question of how to find a balance is important for the work related health and therefore should the awareness of it be enlarged. The health promoting work should therefore also be integrated in performance appraisals.</p>