Background: About 800,000 people are risky drinkers in Sweden and the alcohol consumption has increased around 30% during the last 6 years. In order to counteract the negative effects of drinking there is a need to implement preventive measures at various levels in society. One place where risky drinkers could be identified is the healthcare setting. More than 10% of the visits at emergency departments and 20% of the injuries have been found to be alcohol‐related. So far, very few risky drinkers attending emergency departments receive advice about sensible drinking although there is good research evidence of the efficacy of such advice. Aim: The main aim was to explore the effects of a simple alcohol preventive routine in emergency care on staffs´ attitudes towards alcohol prevention and injury patients´ drinking pattern. Material and methods: A screening and simple advice routine was introduced at the emergency department of Motala County hospital. The staffs´ attitudes were explored by interviews with 12 staff members before the introduction and in 6 follow‐up interviews after a year. All the triage staffs´ attitudes were also measured by a questionnaire before the start of the routine and after 6 months. During the first 6 months of the routine 878 injury patients between 16 and 70 completed an alcohol screening questionnaire. During the next 6 months 647 patients received written advice about sensible drinking after having completed the screening questionnaire. A total of 619 patients included in the 12 months study period were followed‐up by telephone interview and changes in drinking pattern were analyzed. After a further 6 months of intervention a total of 2151 patients had been completing the questionnaire during the total study period of 18 months. The association between drinking pattern and different injury variables was analyzed in order to identify special risk groups and situations. Results: The staff was generally positive to alcohol prevention before the routine started and it was completed as intended. After 6 months of screening the staffs´ role legitimacy and perceived skills had increased. Despite of a further positive change in attitudes towards alcohol prevention the staff was uncertain after the study period whether emergency departments are appropriate settings for alcohol prevention. A total of 9% of the women and 31% of the men attending the emergency department for an injury were defined as risky drinkers. One single item in the questionnaire, concerning frequency of heavy episodic drinking, identified the majority of risky drinkers. In the cohort of patients,who was only screened, 34% was no longer engaged in heavy episodic drinking after 6 months and in the cohort that received written advice in addition to the screening the proportion was 25%. The latter group also increased readiness to change by 14%. The proportion of risky drinkers was higher among injury patients, 21% compared to 15% in the general population in the cathment area. This was mostly explained by a higher proportion of young men in the study group. When drinking pattern was compared, both risky and non‐risky drinkers proved to be significantly more likely than abstainers to be injured in amusement locations, parks, lakes or seas and during play or other recreational activities, when controlling for age and sex. Nine percent of the injury patients reported that they believed that their injury was related to alcohol. Half of this group was non risky‐drinkers. Conclusions: The triage staff performed the intervention as agreed, and in some aspects, which could facilitate further development of alcohol preventive measures, their attitudes changed positively. However, it appears difficult to expect alcohol preventive measures to involve more of the staff’s time than the routine tried, and other practical solutions have to be evaluated. A question about frequency of heavy episodic drinking identified the majority of risky drinkers and could be used as a single screening question. There was a reasonable reduction in heavy episodic drinking among the injury patients. The lack of a control group makes it difficult to fully explain whether this change is a result of the injury per se, the screening and the written advice procedure or a natural fluctuation in the patients´ drinking pattern. More studies are needed in order to establish the minimal levels of intervention in routine care that is accepted by the staff, and has a reasonable effect on risky drinkers’ alcohol consumption.

The aims of this thesis were to study the incidence, severity and pattern of injury in male and female elite football players; to study time trends in injury risk; to identify risk factors for injury; and to test the effectiveness of an intervention programme aimed at preventing re-injury. All studies followed a prospective design using standardised definitions and data collection forms. Individual training and match exposure was registered for all players participating. Time loss injuries were documented by each team’s medical staff. The amount of training increased by 68% between the 1982 and 2001 Swedish top male division seasons, reflecting the shift from semi-professionalism to full professionalism. No difference in injury incidence or injury severity was found between seasons. The injury incidence was 4.6 vs. 5.2/1000 training hours and 20.6 vs. 25.9/1000 match hours. The incidence of severe injury (absence >4 weeks) was 0.8/1000 hours in both seasons. The Swedish and Danish top male divisions were followed during the spring season of 2001. A higher risk for training injury (11.8 vs. 6.0/1000 hours, p<0.01) and severe injury (1.8 vs. 0.7/1000 hours, p=0.002) was observed among the Danish players. Re-injury accounted for 30% and 24% of injuries in Denmark and Sweden respectively. The Swedish top male division was studied over two consecutive seasons, 2001 and 2002, and comparison of training and match injury incidences between seasons showed similar results. Players who were injured in the 2001 season were at greater risk for injury in the following season compared to non-injured players (relative risk 2.7; 95% CI 1.7-4.3). Players with a previous hamstring injury, groin injury and knee joint trauma were two to three times more likely to suffer an identical injury to the same limb in the following season, but no such relationship was found for ankle sprain. Age was not associated with an increased injury risk. The effectiveness of a coach-controlled rehabilitation programme on the rate of re-injury was studied in a randomised controlled trial at amateur male level. In the control group, 23 of 79 injured players suffered a recurrence during the season compared to 10 of 90 players in the intervention group. There was a 75% lower re-injury risk in the intervention group for lower limb injuries (relative risk 0.25; 95% CI 0.11-0.57). The preventive effect was greatest during the first weeks after return to play. Both the male and female Swedish top divisions were followed during the 2005 season. Male elite players had a higher risk for training injury (4.7 vs. 3.8/1000 hours, p<0.05) and match injury (28.1 vs. 16.1/1000 hours, p<0.001) than women. However, no difference was observed in the rate of severe injury (0.7/1000 hours in both groups). The thigh was the most common site of injury in both men and women, while injury to the hip/groin was more frequent in men and to the knee in women. Knee sprain accounted for 31% and 37% of the time lost from training and match play in men and women respectively. / Serienumret i serien Linköping University medical dissertation är fel. Det korrkta numret är 988. The serial number in the series Linköping University medical dissertation is incorrect. The correct number is 988.

Det är allt färre barn och ungdomar idag som når upp till den rekommenderade mängden fysisk aktivitet. Antalet barn som promenerar eller cyklar till skolan har drastiskt sjunkit de senaste årtiondena. Därför är det viktigt att undersöka hur elever upplever aktiva skoltransporter. Syftet med studien var att undersöka elevers upplevelser av att delta i en empowermentinspirerad studie för att främja aktiva skoltransporter under vintern. Genom en kvalitativ metod genomfördes fyra fokusgrupper där upplevelsen av aktiva skoltransporter under vintern diskuterades med photovoice som metod. Resultatet analyserades genom en latent innehållsanalys. Studien var en del av ett treårigt forskningsprojekt som pågår i norra Sverige kring aktiva skoltransporter där flertalet skolor medverkar. I detta projekt medverkade två klasser från årskurs 6. Resultatet visar att barns upplevelse av aktiva skoltransporter på vintern inte är särskilt annorlunda än vad de är på sommaren om förutsättningarna med bra däck och plogade vägar fungerar. Barnen upplevde att de känt sig piggare, har haft bättre koncentration i skolan samt en ökad gemenskap under projektet. Av resultatet bildades tre underteman; “yttre faktorer påverkar barnens sätt att ta sig till skolan”, “delaktighet och gemenskap genom processen är viktig”, “aktiva skoltransporter innebär många fördelar” som sedan bildade ett huvudtema; “omgivning, samhörighet och upplevda fördelar avgör elevers uppfattning av aktiva skoltransporter”. / There are fewer children and adolescents today who reach the recommended amount of physical activity. The number of children walking or cycling to school has drastically fallen in recent decades. Therefore, it is important to investigate how students experience active school transport. The aim of the study was to investigate students experiences of participating in an empowerment-inspired study to promote active school transport during the winter. Through a qualitative method, four focus groups were conducted, where the experience of active school transport during the winter was discussed with photovoice as a method. The result was analyzed by a latent content analysis. The study was part of a three-year research project in northern Sweden about active school transport where several schools participate. In this project, two classes participated from grade 6. The results show that children's experiences of active school transport in winter are not very different from what they are in the summer if the conditions of good tires and plowed roads exist. The children expressed that they felt more alert, had better concentration in school and a sense of community during the project. From the result, three sub themes were formed; “external factors affect children's ways of getting to school”, “participation and sense of community throughout the process are important”, “active school transport has many advantages” that then formed a main theme; “surroundings, togetherness and perceived benefits determine pupils' perception of active school transport”.

Background: Due to the effective antiretrovirals are people living with HIV expected live up to 70 years of age. Approximately half of the people living with HIV in Sweden are above 50 years old and estimated to become enrolled into the Swedish elderly care system. Concern about the Swedish elderly care preparedness for greeting people living with HIV is growing, based on previous experiences of stigma in the general society, many are feeling anxious that they will become victims of stigmatization and discrimination in the Swedish elderly care system.   Method: A collective case study was conducted of three nursing homes with different organizational background in Nacka municipality, Stockholm. Interviews with superintendents from each nursing home was performed and 95 health care workers at the nursing homes completed a questionnaire. Collected data was entered to Excel for descriptive analysis and all statistical analysis was performed in R: The R project for statistical computing. Pearson´s Chi-squared test was used to analyze categorial data, e.g., to find potential statistical significance between the variables and Pearson’s correlation coefficient was used to examine if the variables fluctuate together. Result: The general knowledge about HIV was not more than average among the participating health care workers and many stated concern towards HIV, which might impact on their attitudes and their practical performance when attending a person living with HIV. One of the nursing homes had experience of attending a person living with HIV and showed less feelings of concern compared to the other participating nursing homes. This support the idea that experience of attending a person living with HIV minimizes feelings of concern and negative attitudes to HIV. Like previous studies, this study highlights the relationship between higher degree of education and less negative attitudes towards HIV. However, none of the mentioned results showed a statistically significance outcome possibly due to the small sample size. To reduce risk of HIV stigma and feelings of concern among health care workers must HIV be discussed and prioritized in the Swedish elderly care system, as well as in municipalities.

Ensamhet bland äldre är ett aktuellt ämne då medellivslängden i Sverige ökar drastiskt och med det uppstår vissa utmaningar. Hälsan bland äldre är i flera avseenden sämre än bland yngre. Ensamheten bland äldre är ett folkhälsoproblem då tidigare studier visar att ensamheten ökar med åldern samt att det finns en trend som visar att ensamheten bland äldre kommer att öka med åren. Utifrån de hälsoutmaningar som finns i den åldrande befolkningen är förhoppningen att denna studie ska bidra till kunskap gällande sambandet mellan ensamhet och ohälsa bland äldre. Syftet med studien är att undersöka prevalensen av ensamhet bland äldre, det vill säga 70 år och äldre, samt undersöka sambandet mellan ensamhet och hälsoutfall i form av psykiska- och fysiska besvär, riskkonsumtion av alkohol samt rökning. Studien är en tvärsnittsstudie och använder data från Region Västmanlands enkätundersökning, Liv och hälsa, där 2 239 individer i ålder 70 år och äldre har besvarat enkäten. Studiens resultat visar att drygt var femte äldre i Västmanland ibland eller ofta upplever ensamhet (5,6 procent). Ensamhet ökade sannolikheten för psykiska besvär i form av nedstämdhet och ängslan/oro/ångest men inte för fysiska besvär eller riskkonsumtion av alkohol och rökning. Socialt stöd används som teoretiskt ramverk för att tolka resultaten då en avsaknad av socialt stöd är relaterat till ensamhet. Nyckelord: Ensamhet, fysiska besvär, äldre, levnadsvanor, Liv och hälsa, psykiska besvär, Socialt stöd / Loneliness among elderly is an important topic because the life expectancy in Sweden increases radically and causes a lot of challenges for health issues. Illness among elderly is more common than among younger people. Previous studies show that loneliness increase with age, therefore loneliness among elderly is a public health topic. It is also a pattern that loneliness among elderly will increase over the years. Based on the health challenges that exist in the aging population, the expectation is that this study will contribute to knowledge about the correlation between loneliness and illness among elderly. The aim of this study is to analyze the prevalence of elderly peoples, 70 years and older, loneliness and to analyze the correlation between loneliness and health outcomes like mental- and physical symptoms and habits in terms of risk consumption of alcohol and smoking. This study is a cross sectional study based on a survey from Region Västmanlands study, Liv och hälsa. The survey where answered by 2 239 people of the age 70 years and older. The result of this study shows that one of five of Västmanlands elderly population rarely or often experiencing loneliness (5,6 percent). Loneliness increased the probability of mental symptoms as depression and anxiety but with physical symptoms and risk consumptions of alcohol and smoking no correlation was found. Social support was a theoretical framework used to analyze the results of this study, because lack of social support is related to loneliness. Keywords: elderly, Liv och hälsa, loneliness, mental symptoms, physical symptoms, Social support

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Aim: To compare risk of death and hospitalization due to car accidents among foreign-born individuals to Swedish-born.Method: The study cohort (2,404,710 individuals; 11% foreign-born) established by linkage between Swedish national registers. The main exposure was migration status, and duration of residence and age at migration considered as secondary exposures. The cohort was 18-39 years old and followed from 2005-2012. Hazard ratios (HR) with 95% confidence intervals (CI) adjusted for birth year, gender, family income, area of residence, and country of birth were calculated by Cox proportional hazard model.Results: 588 death (8% among foreign-born) and 17,969 hospitalization (11% among foreign-born) due to car accidents recorded. While, adjusted risk of hospitalization was higher among foreign-born than that among Swedish-born individuals, we found lower risk (HR: 0.92; CI: 0.85-0.996) among females and higher risk (HR: 1.17; CI: 1.10-1.24) among males. Risk of hospitalization was higher among foreign-born individuals who immigrated to Sweden at ages younger than 18 years or lived in Sweden 5 years or longer.Conclusions: Gender is acting as an effect modifier for the risk of hospitalization due to car accidents. We recommend further research to examine factors underlying excess risk impact of duration of residence in host country.

<p>Betygdatum i Ladok: 2018-10-18.</p>

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