Introduktion: Suicid är ett folkhälsoproblem som ser olika ut på olika platser runt om i Sverige, vissa kommuner såsom Grums kommun har under en tid drabbats mycket och speciellt bland ungdomar. Ett samarbete i Grums har startats där deltagarna består av aktörer som arbetar med ungdomars hälsa i någon form. Syftet är att förbättra samarbetet och förbättra förutsättningarna för Grums ungdomar att leva ett liv med god hälsa. Syftet med studien är att kartlägga det suicidpreventiva arbetet som aktörerna gör i sina respektive verksamheter och utifrån en socialekologisk modell sätts dessa i relation till olika nivåer i samhället där verksamheten befinner sig i relation till ungdomarna. För att arbetet ska ge resultat måste de metoder och arbetssätt som används grundas i den evidensbaserade forskningen. Metod: En workshop hölls i Grums där aktörernas diverse roller fastslogs för en bättre förståelse över det stöd som erbjuds ungdomarna och hur målgruppen faktiskt upplever sin situation i Grums utifrån aktörernas erfarenheter. Telefonintervjuer av 3 aktörer om deras arbetssätt gentemot målgruppen i Grums kompletterade workshopen. Materialet analyserades utifrån en socialekologisk modell. En systematisk litteraturöversikt gjorde grundjobbet med att finna de metoder och arbetssätt som har visat sig ha evidens. Resultat: De olika aktörernas roller i det suicidpreventiva och hälsofrämjande arbetet med Grums ungdomar klargörs. Vidare påvisas hur de olika verksamheternas arbete i vissa fall sker flexibelt utanför de satta ramarna för den specifika aktören. Mycket av arbetet sker överlappande genom olika kategorier och faser i ungdomarnas liv. Risk- och skyddsfaktorer inom olika områden identifierades. Av de totalt 25 studierna som sållades fram blev det 9 som uppfyllde kriterierna. Slutsats: Det är inte enbart viktigt för de olika aktörerna att förstå inte sin egen verksamhet utan även vad andra aktörer gör och har för resurser. Även för målgruppen är det viktigt att veta vad som görs och hur det arbetas. Då individer slutligen själva väljer att söka och använda det stöd som finns är det viktigt att sänka de trösklar som finns. Det finns en rad olika evidensbaserade sätt att arbeta med suicidprevention utifrån Grums kommuns förutsättningar. / Introduction: Suicide is a public health problem with different characteristics in different places in Sweden, some municipalities like Grums have had some difficulties amongst their youth. Grums has started a cooperation with the organizations that works with the target groups health in some way with the aim to improve the collaboration between the organizations and also improve the conditions for teens. The purpose of the study is to map the participants work with suicide prevention and put them in relation to different levels in society and the target group in a socio-ecological model. For the work to give positive results the methods must be evidence-based. Method: A workshop in Grums was held where the different participants work was established and mapped to create a better mutual understanding over the services provided to the teens. Interviews over the phone with 3 of the participants about their work with teens In Grums was used to complement the workshop. The material was analyzed with a socio-ecological model. A systematic review did the groundwork in finding the evidence-based methods presented. Results: The role of the different organizations in the work with suicide prevention among teens in Grums is mapped. It shows that the work of the different organizations in some cases is flexible and extends outside of the borders of the specific organization. A lot of the work is overlapping through different categories and phases in a teens life. Risk factors and protective factors where identified. Of the 25 studies that where found it was merely 9 that fulfilled the criteria. Conclusion: It is not only important for the different organizations to understand not only their own operation but also the other work made by others and the resources they have but it is also important for the target group to know what is being done and how. Because individuals choose to seek help and to use the support that’s eligible it is important to lower the threshold to do so. There are some different evidence-based ways to work with suicide prevention with the conditions in Grums municipality.

Syfte Syftet med studien var dels att kartlägga stillasittandet hos högskoleanställda lärare under arbetsdagen. Vidare syftade studien till att undersöka faktorer som bidrog till att vara stillasittande. Metod I studien användes en blandad metodansats. Datainsamling genomfördes via 4 enskilda intervjuer samt en enkät med 49 lärare på Högskolan Dalarna. Resultat Medelvärdet för deltagarnas tid i stillasittande per arbetsdag var 6,62 (±1,97) timmar och antal avbrott i stillasittandet var i genomsnitt 1,6 (±0,89) per timme. Det fanns ingen statistiskt signifikant skillnad i stillasittande tid ( p= 0,22) eller antal avbrott i stillasittandet (p= 0,21) under arbetsdagen mellan kvinnor och män. Relationsvärdet (r= -0,34) indikerade att det fanns ett svagt samband som visade att deltagare som var mer stillasittande också gjorde färre avbrott i sitt stillasittande. Den främsta anledning som angavs till att sitta ner var att stillasittandet förbättrade koncentrationsförmågan vid arbetsuppgifter som krävde mycket fokus. Andra framträdande faktorer som påverkade ett intagande av stillasittande var tidspress och hög arbetsbelastning. Individen själv uppgavs vara det största hindret för att minska sitt eget stillasittande, där det invanda beteendet att sitta vid vissa arbetsmoment hade stor påverkan. Deltagarnas kunskap kring stillasittandets konsekvenser var bristfällig och det var inte heller ett samtalsämne som diskuterades i större utsträckning på arbetsplatsen. Slutsatser Högskoleanställda lärare är en riskgrupp för stillasittandets negativa hälsoeffekter. Engagemang och ökad kunskap på individ-, interpersonell- och organisationsnivå krävs för att uppnå förändringar i det stillasittande beteendet. / Purpose The purpose of the study was to map the sedentary behavior of college-faculty teachers during the working day. Furthermore, the study aimed at investigating factors that contributed to being sedentary. Method The study used a mixed method approach. Data collection was conducted through 4 individual interviews and a questionnaire with 49 teachers at Högskolan Dalarna. Results The average of the participants' sedentary time per working day was 6,62 (±1.97) hours. The number of interruptions from being sedentary was in average 1,6 (±0.89) per hour. There was no statistically significant difference in sedentary time (p= 0,22) or number of interruptions (p= 0,21) during the working day between men and women. Relationship value (r= -0,34) indicated that there was a weak relationship that showed that participants who were more sedentary also made fewer interruptions in their sitting time. The main reason for being sedentary was that sitting improved the ability to concentrate on tasks requiring a lot of focus. Other prominent factors that affected the intake of sedentary behavior were time pressure and high workload. The individual himself was said to be the biggest obstacle to reducing his own sedentary behavior, where the habitual behavior of sitting when doing certain tasks in the workplace had a major impact. Participants' knowledge of sedentary behavior and consequences was inadequate, and it was not a discussion topic that was discussed in greater detail at the workplace. Conclusions Higher education teachers are a risk group for negative health effects caused by sedentary behavior. Engagement and increased knowledge at individual, interpersonal and organizational levels are required to achieve changes in sedentary behavior.

Active school transport (AST; e.g. the use of non-motorized modes such as walking and cycling to travel to/from school) is an inexpensive, accessible and environmentally-friendly source of physical activity (PA). This dissertation addresses two overarching objectives: 1) to measure the relationships of AST with PA and health-related outcomes; and 2) to examine the correlates of AST immediately before and after the transition from primary to secondary school (the “school transition”). First, a systematic review revealed increasing evidence showing that AST is associated with greater daily PA levels, and that cycling to/from school is associated with higher cardiovascular fitness. Cycling for transportation (not only for school trips) was also associated with lower values for total cholesterol and total cholesterol/HDL cholesterol ratio in the nationally-representative 2007-2009 Canadian Health Measures Survey. Moreover, the present dissertation provides preliminary evidence suggesting that AST may help attenuate the decline in PA across the school transition. However, the relationship between AST and body composition indicators remains unclear. With respect to the correlates of AST, distance was the strongest barrier to AST at both time points, but several road safety concerns, and the perception of having too much stuff to carry were also associated with engagement in motorized travel. At follow-up, AST was more common in children whose parents owned less than 2 cars. In contrast, children were more likely to engage in AST if their parents reported that they chose to live in their current neighbourhood so that their children could walk or bike to school. The associations of neighbourhood walkability (as measured with the Walk Score® application) with AST and PA were generally stronger after the school transition. While AST may improve health among children and youth, an ecological approach targeting multiple levels of influence will likely be needed to alleviate current barriers to AST.

No description available.

Sustainable and equitable fisheries are central for addressing the challenges of the UN Sustainable Development Goal 14: Life Below Water. International trade, once presented by Walrasian economists as a panacea for fisheries development, has not markedly decreased poverty and has been related to the overexploitation of marine species. In this light the consequences of a continued expansion of seafood trade are highly uncertain and problematic. Two competing theoretical hypotheses predict either overexploitation or recovery of marine species when connected to international trade, respectively. The empirical literature finds trade relationships and connections of local fisheries to a large-volume market critical factors for social-ecological outcomes. Here, I combine these insights to show that multi-level links, between fishers & different markets (market manuscript) and marine species & trade relationships (squid manuscript), are critical to explain diverging social-ecological outcomes. In the market manuscript we model the transition from local, to multi-level (both local and global), to global markets in a two species fishery. We find this transition is non-linear, leading to fluctuations in species abundance as a result of abrupt switches between target species. Critical fluctuations of species abundance driven by new market connections are a result of large shifts in prices for one species and high asymmetries in expected income between the two species. The squid manuscript provides empirical and modeling evidence that cyclical changes in the ocean can drive social-ecological systems outcomes through changing interactions at multiple levels. The interactions between squid population and fishers and squid distribution and trading structures determines benefit distributions in the fishery. The lack of consideration of multi-level interactions related to trade in models for fisheries management is likely associated with a lack of processes for integrating the empirical and theoretical insights of two disciplines at the core of fisheries science. Social-ecological system scholars study more often empirical and fishery economics the theoretical aspects of interactions between trade and fisheries. One process suggested in this thesis to bridge insights from both disciplines in fishery models is the careful study of the important interactions in the empirical case. Comparison of these interactions with observed empirical interactions in other systems informs the model conceptualization that is then embedded in a theoretical framework. This leads to the development of models of intermediate complexity  that integrate insights on regular structures and patterns observed in real social-ecological systems. The squid manuscript exemplifies this integration. We integrate observed multi-level links in a standard fishery model between the squid population fishers and traders, and thus better represent the empirical system.  A continuous dialogue between empirics and theorycan help build models of intermediate complexity. To capture the complex elements of these social-ecological systems, in this young field of study, next to a continuous dialogue priority observed empirical dynamics can help question theoretical assumptions. This study seeks to contribute to the development of fisheries management models more suitable to face contemporary challenges of fisheries management by focusing on how multi-level interactions between fisheries and trade shape sustainable and equitable outcomes.

Svenskarnas matkonsumtion är inte hållbar utifrån ett klimatperspektiv. För en mer hållbar konsumtion krävs en minskning av animaliska livsmedel. Tidigare studier visar att det är möjligt att äta klimatsmart och fortfarande nå upp till näringsrekommendationerna. Syftet med studien är att undersöka vilken klimatpåverkan och näringsinnehåll studenters matvanor har och skillnader mellan olika kosthållningar och kön. Studien har genomförts utifrån en kvantitativ ansats med en tvärsnittsdesign genom semistrukturerade intervjuer. Urvalet bestod av 21 högskolestudenter, elva män och tio kvinnor med en fördelning på sju deltagare inom varje kosthållning. Metoden som använts är retrospektiva 24-timmarsintervjuer för att få en bild av en grupps matvanor. Resultatet visar att lunch är den måltidsform med högst klimatpåverkan och näringsinnehåll. Lunch har närmare tre gånger så hög klimatpåverkan jämfört med frukost. Allätare har högst klimatpåverkan och proteinintag, medan veganer har högre kolhydrats- och energiintag samt lägst klimatpåverkan. Vegetarianer och veganer har högst intag av vitamin C. Mäns måltider bidrar med högst klimatpåverkan och de har högst intag av protein, energi och kolhydrater, medan kvinnor har ett högre intag av vitamin C. Det teoretiska perspektivet som användes för att diskutera resultatet är social-ekologiska modellen. / The food consumption of Swedish people is not sustainable from a climate perspective. For more sustainable consumption it requires a reduction of meat and dairy products. Previous studies show that it is possible to eat climate smart but still reach nutrition recommendations. The aim of this study is to investigate the students´ eating habits, nutritional content, impact on the climate, and study if there are differences between diets and between men and women. The study is based on quantitative approach with a cross sectional study through semi-structured interviews. The used method is retrospective 24-hour recall interviews to get at picture of the groups eating habits. The participants comprised of 21 students from Mälardalen University, eleven men and ten women with a distribution of seven participants in each diet. The result shows that lunch is the meal with the highest climate impact and nutritional content and that lunch has almost three times higher climate impact compared to breakfast. Individuals who eat both meat and dairy have the highest climate impact and protein intake, while vegans have the lowest climate impact and highest carbohydrate and energy intake. Vegetarians and vegans have the highest intake of vitamin C. Mens´ meals have the highest climate impact and nutritional content of protein, energy and carbohydrate, while women have a higher intake of vitamin C. The social ecological model is the theoretical perspective used to discuss the result.

Background: On 1 January 2020, the UNCRC was incorporated into the Swedish national law. The Convention argues that all children have the right to health, life, survival and development. The Articles of the UNCRC require higher authorities, health facilities and parents to act in the best interest of children, and to do everything to secure children’s rights. Interpreting the Convention, it is possible to conclude that all children have the right to safe and effective vaccines. Even though vaccines are accessible and free of charge to all children in Sweden, vaccination coverage for multiple vaccine-preventable diseases in Sweden has dropped. As one of the reasons for this drop in vaccination coverage is proposed vaccination hesitancy. To fulfil children’s rights as proposed in the UNCRC, vaccination hesitancy needs to be understood and addressed.  Aim: The objective of the study is to understand causes of vaccination hesitancy among parents living in Stockholm, Sweden and to examine how healthcare professionals in Stockholm County are working to eliminate vaccination hesitancy, in goal to promote children’s rights to health, life, survival and development after the UNCRC became a Swedish law on 1 January 2020. Additionally, to analyze if strategies applied by Stockholm County are truly addressing identified causes of vaccination hesitancy among parents living in Stockholm, Sweden and in that way increasing vaccination rates this year. Method: This study used a qualitative research strategy. Vaccination hesitancy in Sweden was studied using 20 semi-structured interviews with parents living in Stockholm, while effect of the UNCRC incorporation into Swedish law on vaccination hesitancy was studied using a semi-structured interview with one health professional working in Stockholm County. The gathered data was summarized, categorized and analyzed according to the proposed themes of two theories. The theoretical framework consisted of the Health Belief Model and Social-Ecological Model. Conclusion: It was possible to conclude that the choice of immunization among parents is shaped by; 1) sources and type of the received information on vaccines, vaccination and vaccine-preventable diseases included in the general Swedish child vaccination program, 2) their views on vaccine quality, safety, effectiveness and necessity for satisfying children’s rights to health, life, survival and development, 3) the level of knowledge of epidemiological concepts, mechanisms, infectious diseases and vaccines included in the vaccination program, and 4) the level of trust in the Swedish Government and healthcare, and belief if they are acting in the best interest of children. After the UNCRC incorporation into Swedish law, there have not been observed any changes in the strategic work of Stockholm County against vaccination hesitancy. For the past ten years, they are applying methods at the individual- and interpersonal level, which are not quite reaching vaccine hesitant parents living in Stockholm. Other methods at the community- and public policy level are needed. Due to unclear implications of the UNCRC entrance as a national law and COVID-19 pandemic, it is not possible to estimate if there are any changes in the vaccination rates this year.

No description available.

<p><b>Background:</b> Shared decision-making (SDM) increases patients’ involvement in their healthcare, extending the goal of patient-centered care provision. However, SDM is underexplored in women’s reproductive health, where choices about contraception and pregnancy are frequently value and lifestyle-dependent. Furthermore, limited research exists on SDM outside of the patient-physician dyad, preventing insight into how non-physician community-based healthcare professionals (HCPs) engage women in practice. Finally, little research takes a social-ecological approach to SDM, despite interaction of multiple levels of influence in women’s reproductive healthcare decision-making. Therefore, the purpose of this study was to explore women’s and HCPs’ experiences with SDM, including the various factors associated with how women make their reproductive healthcare choices.</p><p> </p><p><b>Methods: </b>This study consisted of three distinct, but interconnected phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 living in Indiana who sought community-based or private healthcare for women’s reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician HCPs (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women’s reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes in both phases. Phase 3 consisted of an online survey. Women (18-45 years) living in Indiana who sought reproductive healthcare completed the survey (N=432). Multiple linear regression, chi-square analyses, and structural equation modeling were utilized to identify ecological factors associated with pregnancy and contraceptive shared decision-making.</p><p> </p><p><b>Results:</b><i> Phase 1)</i> Participants (n=22) wanted to be invited into healthcare discussions. Additionally, they wanted conversations to proceed organically, where HCPs listened to their needs, and supported and validated their choices. Though these behaviors did not always occur, they provided recommendations to enhance these experiences. Additionally, participants described quality of time was more important than quantity of time during appointments. Prior negative healthcare experiences specifically tied to HCP-interactions decreased women’s healthcare engagement. Additionally, social support system experiences were influential on women’s choices. Race also emerged as impactful toward decision-making, including Black women feeling less respected in care and making choices about their reproductive healthcare to ensure their voices were heard, such as enlisting Black doulas. <i>Phase 2)</i> HCPs noted patient-centered care was important to community-based care. They also noted the importance of contextualized decision-making approaches to ensure they could meet women’s varied needs. Results identified that outcome-oriented SDM concepts, including patient buy-in and investigative listening, were important for increasing SDM. HCPs suggested SDM improved healthcare experience beyond one visit. <i>Phase 3) </i>Structural equation modeling revealed access, social support, and patient-HCP relationship had significant relationships with contraceptive and pregnancy SDM. These models demonstrated good global and component fit, suggesting the importance of context in women’s health choices. Further, regression results demonstrated SDM was associated with higher reproductive healthcare quality. Additionally, utilizing community-based healthcare for reproductive health was associated with decreased contraceptive SDM scores.</p><p> </p><p><b>Conclusion: </b>Findings from this study provide practical considerations for extending SDM work in women’s reproductive health. In particular, results supported shifting SDM beyond the patient-physician dyad to include non-physician HCPs and HCPs in community-based healthcare settings. Women frequently access these services when seeking reproductive healthcare; thus, findings improve our understanding of the practical considerations researchers, policy-makers, and HCPs must make when promoting SDM in these settings. Furthermore, results revealed SDM use across multiple touchpoints, including community-based services, is imperative for women to achieve partnership in their healthcare. Thus, SDM provides a broader opportunity to enhance patient involvement across the spectrum of women’s reproductive healthcare. Incorporating women’s contextual needs and preferences improves HCPs’ insight into women’s experiences to further personalize care. Findings emphasize the importance of decisional space that include the various factors, agents, healthcare settings, and options that exist in reproductive health decision-making as these can shape women’s choices, and, subsequently, their SDM experiences. This mixed methods study allowed thorough insight into multiple stakeholder groups engaged in healthcare decision-making; thus, the results offer guidance on the verbiage, resources, and strategies to engage in SDM and strengthen patient involvement reflective of women’s lifestyle needs and HCPs’ existing workflow. Findings drive SDM practice into community-based healthcare and position it as the standard of care across healthcare settings.</p><br>

No description available.