Abstract   Hansson, A. (2017). The experience of demands, control and social support among a group of health care providers in Central Sweden - a cross sectional study. Bachelor thesis in Public Health Science. Department of Occupational and Public Health Science. Faculty of Health and Occupational Studies. University of Gävle, Sweden. Background: In Sweden, employees who work within health and social care is the largest occupational group and is also the group which accounts for the highest number of illness cases. Work in health care often means a variety of psychosocial workloads such as high demands, low control and lack of social support. Aim: The aim of the study was to examine the experiences and/or presence of demands, control and social support among nurses and home care workers in their daily work in health care in a municipality in central Sweden. Method: The study included 44 participants, 12 nurses and 32 home care workers. In a quantitative cross-sectional study, data was collected by use of a questionnaire designed by the author for the aim of the study. Participants reported their age, gender, working years and working hours, and answered questions about the experience and/or presence of demands, control and social support in their daily work. Results: The majority of the respondents experienced social support at their workplace. However, respondents 44 years or younger, did rarely/did not experience high work demands from managers or colleagues. Employees who worked more irregular hours experienced more often that they achieved expectations of what should be done from the care takers and their relatives. Respondents who had worked as caregivers 10 years or more, felt that their working hours were governed by the needs of care taker. Conclusion: The results show that an inadequate psychosocial work environment, with high demands, low control and lack of social support, was not experienced and/or a present problem among the majority of the respondents. Further research and knowledge is needed on how the perception of demands, control and social support at work has an impact on the self-perceived health of municipal employees within the health care sector since the work leave due to illness in this sector in Sweden continues to rise. Keywords: Demand, control and support, Public Health, Psychosocial Working Environment.

Parents experience many stressful situations when their child is ill and needs medical care, irrespective of the child’s age, diagnosis or the severity of the illness. Poor sleep quality and negative mood decrease the parents’ ability to sustain attention and focus, to care for their ill child, and to cope with the challenges they face. The overall aim of this thesis was to evaluate sleep, mood, cortisol response, and sense of coherence (SOC) in parents caring for children in need of medical care, and to identify factors that may influence parents’ sleep. This thesis includes four original studies; two of these are quantitative, prospective, descriptive and comparative studies including parents (n=82) accommodated in six pediatric wards with their ill child, using questionnaires and sleep logs to measure sleep, mood and SOC, and saliva cortisol to measure cortisol response. A follow-up was performed four weeks later at home, after hospital discharge. The other two studies are qualitative, inductive and explorative interview studies, including parents (n=12) staying overnight with their preterm and/or ill infant in three neonatal intensive care units, and parents (n=15) with a child receiving hospital-based home care in two pediatric outpatient clinics. The interviews were analyzed with a phenomenographic method. Being together with one’s family seems beneficial for sleep and may decrease stress. The ability to stay with the child, in the hospital or at home, was highly appreciated by the parents. When caring for a child with illness, parents’ sleep quality was sufficient in the hospital; however, sleep quality improved further (p&lt;0.05) at home after discharge. The parents reported frequent nocturnal awakenings in the hospital caused by the child, medical treatment and hospital staff. Concern and anxiety about the child’s health, and uncertainty about the future were stressors affecting the parents’ sleep and mood negatively. The parents had lower (p=0.01) morning awakening cortisol levels in the pediatric ward compared to at home, and parents accommodated for more than one night had lower (p&lt;0.05) post-awakening cortisol levels compared to parents staying their first night. The findings of this thesis conclude that being together as a family is important for the parents’ sleep. The ability to be accommodated in the hospital and gather the family around the child may have given the parents time for relaxation and recovery, that in turn may lead to a less stressful hospital stay. When it is beneficial for the child, the whole family should be included in the pediatric care. Moreover, pediatric nurses must acknowledge parents’ sleep, in hospital and at home. Medical treatment and care at night should be scheduled and sleep promoted for the parents in order to maintain health and well-being in the family. / <p>The electronic version of the thesis is a corrected version of the printed thesis.</p><p>This thesis has also been funded by <em>Barnklinikens 60-årsfond, Filip SchelinsStiftelse, Riksföreningen för barnsjuksköterskor</em> and <em>Synskadades Riksförbund (Lyckopenningen)</em>.</p>

Background: Hereditary angioedema (HAE) due to C1-inhibitor deficiency, type I and II, is a rare disease with an estimated prevalence of 1/50,000. Angioedema in the larynx can be life threatening and angioedema in the abdomen and skin can give severe and disabling pain. Data on patients with HAE in Sweden were scarce before our study. Aim: To study the prevalence of HAE, and to investigate clinical manifestations, treatments, and Health-Related Quality of Life (HR-QoL) in adults and children in Sweden. Method: In studies, I and II, all patients received a written questionnaire followed by a phone interview with questions about clinical manifestations, medication, sick leave and QoL. In study III the patients completed EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) questionnaires for both the attack-free state (EQ5D today), and the last HAE attack (EQ5D attack). Questions were also asked about sick-leave. In study IV all adults received questionnaires with EQ-5D-5L and RAND-36, Angioedema Quality of Life instrument (AE-QoL), and Angioedema Activity Score (AAS) form, and questionnaires on sick leave and prophylactic medication. Results: We identified 146 patients, 110 adults and 36 children with HAE, type I (n=136) or II (n=10), giving a minimal HAE prevalence of 1.54/100,000. For adults, the median age at onset of symptoms was 12 years and median age at diagnosis was 22 years. Median age at onset of symptoms for children was 4 years and at diagnosis 3 years. During the previous year, 47% of adults experienced at least 12 attacks, 21% 4-11 attacks, 11% 1-3 attacks, while 22% were asymptomatic. For children, the corresponding figures were about the same. The median number of attacks in those having attacks was 14 in adults and 6 in children last year. Adult females reported on average 19 attacks the previous year versus nine for males. Irrespective of location nine out of 10 reported pain. Trigger factors were experienced in 95 % of adults and 74 % of children. Plasma-derived C1-inhibitor concentrate (pdC1INH) had a very good effect on acute attacks. Long-term prophylaxis with androgens and pdC1INH reduced the annual attack frequency by more than 50 %. Of the children’s parents, 73% had been on parental leave to care for the child due to HAE symptoms. Health and QoL were generally rated as good. In study III 103 of 139 responded and reported an EQ5D today score that was significantly higher than the EQ5D attack score. Attack frequency had a negative effect on EQ5D today. Children had significantly higher EQ-5D-5L than adults. Forty four percent had been absent from work or school during the latest attack. In study IV 64 of 133 adults responded. The most affected HR-QoL dimensions in EQ-5D-5L were pain/discomfort and anxiety/depression, in RAND-36 energy/fatigue, general health, health transition, pain, and in AE-QoL fears/shame and fatigue/mood. Females had significantly lower HR-QoL in RAND-36 for general health and energy/fatigue. There was an association between AAS and EQ-5D-5L/RAND-36 (except physical function) /AEQoL. There was no significant difference in HR-QoL in patients with and without prophylactic medication. Conclusion: The minimal prevalence of HAE type I and II in Sweden is 1.54/100,000. Median age at onset was 12 years. Adult females had twice as many attacks as males, adults had also twice as many attacks as children. For acute treatment, pdC1INH had a very good effect. For long term prophylaxis, androgens and pdC1INH had good effect. The most affected HR-QoL dimensions in EQ-5D-5L were pain/discomfort and anxiety/ depression, in RAND-36 energy/fatigue, general health, health transition and pain, and in AE-QoL fears/shame and fatigue/mood. Children reported better HR-QoL than adults. AE-QoL is more disease-specific in HAE than the generic instruments EQ-5D-5L and RAND-36. However, the latter highlights the pain aspect, whereas AE-QoL does not. Patients with high disease activity should thus be considered for more intensive treatment to improve their HR-QoL.

Bakgrund: HIV är en obotlig virussjukdom som främst smittar via oskyddat samlag, blod och orena nålar. Dagens läkemedelsbehandlingar har gjort att allt fler överlever och kan leva ett normalt liv. Trots bättre sjukdomsprognos så visar studier att den psykiska ohälsan bland HIV-positiva män ökar. Samhällets stigmatiseringar skapar hinder i vardagen vilket gör det svårt för männen att acceptera sig själva. Självföraktet leder till negativa självuppfattningar som blir till ett psykiskt lidande som männen har svårt att hantera.  Syfte: Syftet med studien var att belysa HIV-positiva mäns psykiska upplevelser av att bära på en obotlig sjukdom och deras kamp med att acceptera sin situation.  Metod: Studien var en kvalitativ litteraturstudie baserad på fem självbiografier skrivna av män. En manifest innehållsanalys användes vid analys av data. Resultat: Männen upplevde både psykiskt lidande och välbefinnande av sjukdomen. Lidandet beskrivs genom svårigheter med att acceptera sig själv men även genom negativt bemötande och attityder från omgivningen. Välbefinnande kunde männen känna genom positivt stöd från omgivningen, men den viktigaste faktorn var att de accepterade sig själva. Genom självacceptans så kunde männen lämna sitt tidigare destruktiva liv och istället våga se framåt och hjälpa andra.  Slutsats: Lidandet som männen kände var förknippat med negativa tankar om sjukdomen, men även genom fördomar och förakt från omgivningen. Det bidrog till känslor av rädslor, ångest och hat mot sjukdomen. För att kunna känna välbefinnande krävdes det att männen fick positivt stöd från omgivningen men det viktigaste var självacceptans. Genom självacceptans så infann sig känslor av befrielse, trygghet och livskraft inför framtiden. Det är viktigt att som sjuksköterska ha ett öppet och följsamt förhållningssätt där männens livsvärld och livssituation tas i bejakande för att kunna bidra till känslor av hälsa och välbefinnande.

Sammanfattning Bakgrund: Behovet av tolk vid vårdrelaterade besök har ökat i samband med den ökade migrationen till Europa. Drygt en miljon människor på flykt ifrån krig och förföljelser beräknades år 2015 passera inom ramarna av Europa, vilket är den genom tiden största migrationen till Europa dokumenterad. Detta innebär att dagens sjuksköterskor kommer att ställas inför allt fler sammanhang där det finns ett behov av en tolk. Enligt ICN:s etiska kod för sjuksköterskor bär sjuksköterskor på ett ansvar att förmedla begriplig information till patienten vilket gör att tolkar behöver bokas in vid vårdmöten där ett tolkbehov finns. Brister kommunikationen mellan sjuksköterskan och patienten hotas patientsäkerheten och vårdkvaliteten. Syfte: Syftet med studien var att undersöka sjuksköterskors upplevelser av att använda sig av en tolk inom hälso- och sjukvården. Metod: Denna litteraturstudie gjordes med en kvalitativ ansats som baserades på 9 vetenskapliga artiklar. Vid kvalitetsgranskningen av dessa artiklar användes CASP mallen som används som mall för kvalitativa studier. Analysen gjordes med Graneheim och Lundmans beskrivning av en kvalitativ innehållsanalys. Resultat: Resultatet presenteras i 2 huvudkategorier och 7 underkategorier. De 2 huvudkategorierna är Behovet av att använda en tolk samt Problematik kring tolkanvändning. Slutsats: För att kunna kommunicera med och förmedla information till en patient som inte talar samma språk som sjuksköterskan behövs en tolk. Utan en tolk vid vårdmötet där behovet finns kan sjuksköterskan inte verifiera patientens tillstånd och försäkra sig om att patienten förstått vad som sagts under vårdmötet. Trots nödvändigheten och behovet att ha med en tolk finns det begränsningar och problem kring tolkanvändning som missförstånd, feltolkning av tolken samt brist på tolktillgänglighet. Sammanställningen av studien kan bidra till en ökad förståelse för tolkens betydelse för kommunikationen och kommunikationens betydelse för vårdkvaliteten. Vidare forskning kring ämnet kan vara att belysa om utbildning i tolkanvändning har någon inverkan på vårdmötet när en tolk nyttjas.

Background The Hepatitis B Virus (HBV) is a blood-borne infection affecting around 2 billion people at any given time and is commonly transmitted through Mother to Child Transmission (MTCT). Preventative measures include vaccinations, particularly the timely Birth Dose (TBD) given within 24 hours of birth. Timing is crucial for the efficacy of the TBD, and is influenced by various factors. São Tomé and Príncipe is one of seven sub-Saharan African countries with a TBD policy. This study aims to observe the different proportions of children receiving adequate or inadequate vaccinations against HBV, as well as to analyse the risk factors that may lead to inadequate vaccination. Methods Secondary data from the São Tomé and Príncipe Demographic Health Survey from 2008-2009 was analysed in this study. Dose delays for all children and those at risk were described. An associative analysis looked at the potential risk factors for inadequate TBD vaccination. Results A high coverage rate for vaccinations was found (&gt;85%), however, the majority were delayed, with only 1% and 4% on time, and mean a TBD administration of 2(SD±2) months after birth, in all children, versus children at risk. Children born to mothers with positive HBV status and low wealth were significantly more likely to receive the TBD on time. Conclusion The majority of vaccinations, including the TBD were inadequately administered, denoting a concern of transmission to children born at risk. Additionally, socioeconomic factors were found to be factors influencing the provision of the TBD

Introduction and Aim Stress and how individuals cope with environmental stressors is an essential issue in urban settings, where expanding and densely developed artificial environments have negative effects on the psychosocial health of the urban population. The aim of this thesis was therefore to explore and identify environmental stressors and coping strategies among young adults.   Method Collection of data was made through five focus group discussions with four to five university students, between 20 to 30 years of age in Tokyo, Japan. The data was then further analyzed with thematic analysis.   Findings Three themes with sub-themes were identified from the thematic analysis, highlighting exposure of external pressures and stressors that threatens young adult’s capability in coping with these stressors on a daily basis. The study identified the urban environment, including transportation and crowds as main sources of stress. Furthermore, young adults in Tokyo expressed interpersonal relationships as a significant factor when coping with environmental stressors.   Conclusion The present study identifies several different and similar perceived stressful threats and coping strategies among young adults in Tokyo. Where potential stressful threats were created by person-environment transactions that determines how one can adapt and cope with these stressors. Further research on the subject of environmental stressors will be needed to further outline the relationship and influence of environmental stressors on individuals wellbeing and health.

Syfte och frågeställning Syftet med denna studie var att undersöka om det finns skillnader i upplevd hälsorelaterad livskvalitet, antalet sjukdagar samt fysisk aktivitet på fritiden mellan två olika yrkesroller med olika fysiska aktivitetsnivåer. Våra frågeställningar inför denna studie löd: -          Hur skiljer sig den hälsorelaterade livskvaliteten mellan individer med ett fysisk aktivt arbete och individer med ett fysiskt inaktivt arbete? -          Hur skiljer sig antalet sjukdagar år 2009 mellan individer med ett fysiskt aktivt arbete och individer med ett fysiskt inaktivt arbete? -          Hur skiljer sig mängden fysisk aktivitet på fritiden mellan individer med ett fysiskt aktivt arbete och individer med ett fysiskt inaktivt arbete?   Metod Vi använde oss av enkätundersökning för att besvara våra frågeställningar. Denna bestod SF-12 som är en sedan tidigare beprövad och validerad enkät och ett egenkomponerat frågeformulär med kompletterande bakgrundsfrågor. Materialet delades ut till 92 respondenter och besvarades av 79 av dessa, bortfallet blev 14 procent. Enkäterna hanterades anonymt, sammanställdes i Excel och bearbetades i SPSS. Som teoretisk utgångspunkt valdes KASAM.   Resultat De viktigaste resultaten visar inte något signifikant resultat men en indikation på att det finns ett samband mellan den hälsorelaterade livskvaliteten och yrkesroll, i detta fall en högre hälsorelaterad livskvalitet hos de med administrativ tjänst. En skillnad mellan yrkesrollerna sågs även när det gäller antalet sjukdagar under år 2009. Majoriteten av respondenterna med administrativ tjänst hade 0 sjukdagar jämfört med 1-7 dagar hos orderexpeditörerna.   Slutsats Undersökningen visade att det inte förekom några signifikanta skillnader mellan de två yrkesrollerna som vi valde att grunda vår studie på. Vi trodde att skillnaderna i den hälsorelaterade livskvaliteten, antalet sjukdagar samt mängden fysisk aktivitet på fritiden skulle vara större än vad de visade sig att vara. Vad skillnaderna kan bero på är svårt att säga då det förekommer många olika faktorer som kan påverka individerna.

Background and Aim: Street harassment is an international and trans-cultural phenomenon that has short and long-term negative effects on its individual targets impacting millions of people, mostly women and young girls, everyday. Most studies on the subject have been focused on defining the problem from a law point of view leaving a knowledge gap on how social structures and the various political, economic, and cultural means interact to (re)produce and perpetuate this social phenomenon. This study aims to explore the thoughts of young men in Iran in order to discover possible underlying mechanisms reinforcing street harassment.   Methods: A qualitative study consisted of four focus group discussions, with male university students, was conducted in Tehran, Iran. Thematic analysis was used to analyze the data with social constructionism as the theoretical lens.   Results: Two candidate themes were developed: “Normalization and trivialization of the problem” and “Socio-cultural and political silence”. The first theme represents the discussions about street harassment as normal, inevitable, and harmless. The second theme embodies the systematic silence around the subject of sexual harassment. Both normalization and the silence construct street harassment as an invisible problem not only to men who are not directly harmed by it, but also to the society as a whole which led to developing the overarching theme describing street harassment as “an invisible gender-based violence” in Iran. Conclusion: The participants were unaware of the relation between power, gender inequality, and the concept of patriarchy, which in itself is a sign of an androcentric culture. Street harassment was conceptualized as normal and invisible since it doesn’t concern them. However, most participants were eager to discuss the topic developing their arguments as the discussion went on and stating that this topic needs to be discussed and studied which confirms that just providing a safe space and the opportunity for discussions can raise people’s awareness of this social problem.     Key words: Street harassment, male university student, conceptualization, Iran

Ohälsan i arbetslivet ökar bland annat på grund av psykosociala orsaker samtidigt som arbetslivet förväntas pågå under längre tid innan pensionsavgång. Det hållbara arbetslivet handlar om att arbeta långsiktigt för att anställda ska må bra och ha möjligheten att delta ett helt arbetsliv. Syftet med detta examensarbete var att undersöka hur HR-chefer (personalchefer) i kommunal verksamhet arbetar med den psykosociala arbetsmiljön för att uppnå en bra hälsa hos kommunens anställda. För att besvara frågeställningarna valdes en kvalitativ metod där HR-cheferna blev intervjuade. Det var fyra kvinnor och en man som deltog och alla tillhörde olika kommuner i Mellansverige. Ett målinriktat urval har använts för att besvara frågeställningarna. Datainsamlingen skedde med hjälp av semistrukturerade intervjuer och analyserades sedan med kvalitativ innehållsanalys. Resultat visar att HR-chefer använder sig av kompetensutveckling av ledarskapet, fackliga organisationer och medarbetare för att uppnå en god psykosocial arbetsmiljö. Faktorer som påverkar den psykosociala arbetsmiljön kan vara bristande engagemang, för stora arbetsgrupper för cheferna och hur kommunerna skapar delaktighet genom arbetsplatsträffar.  Att ha modet att arbeta med frågor som kan vara svåra samt att det finns tid för att arbeta med den psykosociala arbetsmiljön är förutsättningar för att lyckas.