Background This work in child population medicine describes child health problems, increases knowledge of health services, systems, and wider determinants, and makes recommendations for improvements. Aims To explore trends in UK child health and health service quality and highlight policy lessons from the UK and other European countries To study child health and health services in western Europe and derive lessons from different approaches to common challenges To enhance knowledge on child to adult transition care To describe trends in UK and EU15+ child and adolescent mortality and seek explanations for deteriorating UK health system performance, and make recommendations for improving survival Methods Population level measures of health status and system performance; primary and secondary research on policies and practice for health system assessments. Quantitative: mortality rate trends, excess deaths, DALYs, healthcare processes Qualitative: case reports, system descriptions, analyses  Results European child survival has improved, but variably between countries. The UK has not matched recent EU mortality gains. There are 6,000 excess deaths annually in children under 15 years in EU14 countries. There are child survival inequities; countries investing in social protection have lower mortality. Children in the UK, compared with other EU countries, are more likely to be poor than adults. Non-communicable diseases are now dominant causes of child death, disease, and disability. Mortality, processes, and outcomes of healthcare amenable conditions varies between countries. Better outcomes seem to be associated with flexible health care models promoting cooperation, team working, and transition. Conclusions Child health in Europe is improving, but unevenly. Child health systems are not adapting sufficiently to meet needs. Recommendations are made for improving health systems and services. / How do European countries compare when it comes to child health statistics? How do different child health services, systems, and wider determinants impact long term influences for good or harm? Why do some countries seem to do better than others in safeguarding their children’s and young people’s health and wellbeing? And what can we  do to make things better for children? This thesis explores some of these difficult but important issues, and despite describing some serious signals of concern about child health, offers recommendations and clear ways forward for countries to ensure healthier futures for children.

Inledning - Vegetarianer har gjort ett livsstilsbeslut att inte äta kött och har ett kostmönster med endast vegetabiliska produkter. Syfte - Syftet med denna litteraturstudie är att lyfta fram hur en vegetarisk kost påverkar individens hälsa ur ett hälsofrämjande- och sjukdomsperspektiv.   Metod - En systematisk litteraturstudie gjort på 11 vetenskapliga artiklar som är granskade ur ett positivt samt negativt synsätt av en vegetarisk diet. Resultat - Vegetarisk kost ger både positiva samt negativa effekter på individens hälsa samt sjukdomsrisk, då det finns hälsofrämjande effekter men även risk för näringsbrist vid okunskap, både vid kortsiktig och långsiktig diet. Diskussion - Forskningen visar att en vegetarisk diet inte är ett väl forskat ämne och mer vetenskaplig forskning krävs. Man hittar både hälsofrämjande och sjukdomsrisk effekter av den vegetariska dieten. Hälsofrämjande visar den vegetariska dieten att risk för hjärt- och kärlsjukdomar minskar. Dock ökar risken att drabbas av näringsbrist när man utesluter animaliska produkter ur sin kost vid okunskap. / Background: Vegetarians have made a lifechanging decision to not eat meat and therefore have an eating pattern consisting of vegetable products. Purpose: The systematic literature overview examines how a vegetarian diet affect health from a health promoting and disease perspectives. Method: A systematic literature overview based on 11 scientific articles that have been examined from a positive and negative approach of a vegetarian diet. Results: A vegetarian diet can both be positive and negative to a persons health. The study shows a positive health for the participants with risk of diseases because there are health promoting effects as well as risks for malnutrition caused by lack of knowledge both regarding short term and long-term diets. Discussion: The research shows that the area regarding vegetarian diets is not a wellresearched area and more research is needed. Both negative and positive effects with this diet can be found. The health promoting effect are reduced risk of cardiovascular disease, and the negative effects are the risk of malnutrition when animal products are excluded from the diet with a lack of knowledge regarding the subject.

Inledning: Samhället utvecklas och ställer allt högre krav på den enskilde individen som kan leda till ökad stressnivå. Långvarig stress kan leda till allvarliga folkhälsosjukdomar såsom utmattningssyndrom och depression. För att kunna påverka stressens negativa betydelse för hälsan är det viktigt att belysa behandlingsalternativ såsom meditation/mindfulness som kan inkluderas i vardagen. Syfte: Syftet med den här litteraturstudien är att undersöka vilka vetenskapliga belägg som finns om hur meditation/mindfulness kan hjälpa individer att hantera och reducera stress och på så sätt öka välbefinnandet och hälsan. Metod: Metoden är en litteraturstudie vilket innebär att artiklarna som ingår i studien har kritiskt granskats i en litteraturgenomgång. Tio artiklar ingår i studien som delats in i fyra teman som redovisas i resultatet. Resultat: Meditation/mindfulness kan vara effektiva metoder att hantera och reducera stress med, men alla studier var inte lika övertygande. Resultatet är indelat i fyra olika teman, positivt med meditation/mindfulness, tvivel om meditation/mindfulness effektivitet, mindfulness-based stress reduction (MBSR) och onlineprogram. Gällande meditation/mindfulness antydde några studier att det kan öka välbefinnandet och minska stress. Medan andra var mer osäkra på dess fördelar. Mindfulness-based stress reduction (MBSR) visade på tydligare resultat gällande stressreduceringsprogram och likaså onlineprogram. MBSR kan användas av både sjuka och friska människor. Onlineprogram är effektiva både kostnadsmässigt och att individen kan nå programmen var som helst. Diskussion: Det fanns inte lika tydliga belägg för meditation/mindfulness effektivitet vid stresshantering som förväntat. Alla studier var inte överens om att det hade någon effekt men trots tvivel vill de forska mer innan de utesluter det som en bra metod. Hur effektivt det är för en individ kan variera för att programmen kräver träning, förståelse och förtroende. Meditation/mindfulness hjälper inte alla individer att hantera sin stress, men för vissa gör den det och för andra kan vara en bra metod i väntan på att få professionell hjälp. / Introduction: The society develops and sets high standards on individuals and that make the stress increase. Long-term stress can lead to public health diseases such exhaustion syndrome and depression. To provide stress’s negative effect on health there is a need of reducing programs and interventions such meditation/mindfulness that can be included in the everyday life. Aim: The aim of this literature study is to investigate what scientific evidence exists about how meditation / mindfulness can help individuals manage and reduce stress, and then increase well-being and health. Methods: The method is a literature study, which means that the articles that are included in the study have been critically reviewed in a literature review. Ten articles are included in this study and they are divided into four themes that are reported in the result. Results: Meditation / mindfulness can be effective methods of managing and reducing stress, but all studies were not assured. The result is divided into four different themes, positive with meditation / mindfulness, doubts about meditation / mindfulness efficiency, mindfulness-based stress reduction (MBSR) and online programs. Some studies suggested that it could increase well-being and reduce stress. While others were uncertain of its benefits. Mindfulness-based stress reduction (MBSR) showed clearer results about stress reduction programs and online programs. MBSR can be used by both sick and healthy people. Online programs are effective both cost-effectively and that the individual can reach the programs from home. Discussion: There was not as clear evidence of meditation/mindfulness effectiveness in stress management as expected. All studies did not agree that it had any effect but in spite of doubt, more research is needed before ruling out as a good method. How effective it is for an individual may vary because the programs require training, understanding and trust. Meditation/mindfulness doesn’t help every individuals to manage their stress, but for some it does and for some it may be a good method while waiting for professional help.

Sammanfattning   Bakgrund: Den lätta åtkomsten till sociala medier och fokus kring de manliga och kvinnliga kroppsidealen som framställs i media kan leda till depressioner, ångest och fysisk inaktivitet. Utifrån ett folkhälsoperspektiv är vikten av en djupare kunskap kring detta fenomen väsentlig bland unga kvinnor och män och tidigare studier kring detta bland unga män är få. Syfte: Syftet med studien var att studera unga mäns erfarenheter och uppfattningar om sin hälsa och kroppsideal som framställs på sociala medier. Metod: Studiens genomfördes med en induktiv ansats med semistrukturerade intervjuer som datainsamlingsmetod. Urvalet bestod av sex personer i åldrarna 18–25 år som tränade minst två gånger i veckan. En tematisk analys användes vid analys av materialet. Resultat: Analysen resulterade i ett huvudtema: Sociala media, hälsa och kroppsideal, en växelverkan. Detta huvudtema resulterade i fyra underteman: Hälsa som resurs, ohälsa som hinder, kroppsideal och vägar dit, samt media som påverkansfaktor. I dessa underteman hittades koder som samtliga har en relation till huvudtemat. Slutsats: Hälsa är ett omfattande begrepp som innefattar fler faktorer som bidrar till en hälsosam livsstil. Massmedias framställning av hälsa uppfattas av denna grupp som en fixering av de kroppsliga idealen kontra den subjektiva hälsan. För dessa deltagare är upplevelsen av vilseledande hälsoinformation lättillgänglig medan den korrekta hälsoinformationen uppfattas som svårare att nå. / Abstract   Background: The easy access to social media and a focus on male and female body ideals that are presented in social media can lead to depression, anxiety and physical inactivity. From a public health perspective, the importance of a deeper knowledge of this phenomenon is essential for young women and men, and past studies of this subject among young men are few Aim: The purpose of this study was to study young men’s experiences and perceptions of their own health and body ideals in relation to health and body ideals presented on social media. Method: The study was conducted with an inductive approach with semi-structed interviews as data collection method. The sample consisted of six people between the ages of 18-25 who exercised at least twice a week. The material was analyzed using a thematic analysis. Results: The analysis of the results led to a main theme: Social media, health and body ideals – an interaction. The main theme consists of four sub-themes: Health as a resource, ill health as an obstacle, body ideals and ways to reach them, and media as an impact factor. In these sub-themes, codes were found, each of which relate to the main theme. Conclusion: Health is a comprehensive concept that includes many factors that contribute to a healthy lifestyle. The mass media’s production of health images is perceived by interviewed in this study as a fixation of the body ideals versus subjective health. For these participants, the experience of misleading health information is readily available while the correct health information is perceived as more difficult to get ahold of.

Abstract Björklund, M. (2017). Is the use of Instagram a new self-harm behaviour? A cross-sectional study of Instagram users’ reflections. Bachelor thesis in Public Health Science. Department of Occupational and Public Health Science. Faculty of Health and Occupational Studies. University of Gävle, Sweden.   The aim of the study was to investigate the use of Instagram among Swedish internet users. A further aim was to investigate whether there was an association between the increased use of Instagram and mental health. The method used was a cross-sectional study with questionnaires. Both quantitative and qualitative questions were included in the survey, which were presented as descriptive statistics as well as thematic analysis with quotes. The selection was a convenience selection and snowball selection, where the surveys were disseminated via the author Facebook. The result showed that the majority used Instagram several times a day and many of them were found to be in the risk group of mental illness. Many users found that the images exposed in Instagram contributed to comparisons between themselves and the photos resulting in body dissatisfaction. The conclusion was that the use of Instagram several times a day was associated with a decreased level of well-being. The majority of the Instagram users compared themselves with other people and more thought of their appearance, when they were exposed to the images in Instagram. / Idag använder ca 55 % av Sveriges befolkning i åldrarna 12–55 år tjänsten Instagram. De senaste åren har användandet ökat med 12 % varje år. Under år 2016 har den psykiska ohälsan i Sverige ökat kraftigt, särskilt i åldersgruppen 16–29 år. Denna grupp är också stora användare av Instagram. Tidigare studier visar att exponeringen av bilder bidrar till att de exponerade jämför sig med andra, vill förändra sig själva och funderar mer över sitt utseende. Dessa beteenden kan också bidra till diagnoser som depression och ätstörningar och bli en typ av ett självskadebeteende.   Syftet med studien var att undersöka hur användandet av Instagram ser ut bland svenska internetanvändare. Ytterligare ett syfte var att undersöka om det finns en association mellan det ökade Instagram-användandet och den psykiska hälsan.   Metoden som används var en tvärsnittsstudie med enkäter, med både kvantitativa och kvalitativa frågor. Detta presenterades som beskrivande statistik samt tematisk analys med citat. Urvalet var ett bekvämlighetsurval och snöbollsurval, där enkäterna delades ut via författarens Facebook.   Resultatet visade att många använde Instagram flera gånger om dagen och många av dem visade sig vara i riskgruppen för att drabbas av psykisk ohälsa. Många upplevde att bilderna man exponeras för på Instagram bidrar till att man jämför sig själv vilket skapar ett missnöje med den egna kroppen. Det fanns ett samband mellan att använda Instagram flera gånger per dag och att uppleva missnöjdhet, osäkerhet, att inte räcka till, samt att man jämförde sig med andra och tänkte mer på sitt utseende. Slutsatsen blev att det som använder Instagram flera gånger per dag upplever ett minskat psykiskt välbefinnande och är i riskgruppen för att drabbas av psykisk ohälsa. Många användare av Instagram jämförde sig med andra och tänkte mer på sitt utseende när de exponerades för bilder på Instagram.

The purpose of this study was to investigate if the environment at home could affect the pupils breakfast intake; what they choose to eat, if the eat and why they eat breakfast. A quantitative method was used and the data was collected by a questionnaire. In total 64 pupils from ninth grade in public school participated in the study. The result showed that most of the pupils ate breakfast regularly and often ate alone at the kitchen table. Though some of them ate very little and a meager breakfast. Most of the pupils were positive to being served breakfast at school because they often were too tired to eat at home and can eat in the company of friends. The conclusion was that most pupils ate breakfast often and a few ate rarely. The kitchen table was the preferred place to eat breakfast and they often ate alone. Popular choices for breakfast were oatmeal, sandwiches or soured milk/yoghurt with cereals. / Matvanor har en stor betydelse för folkhälsan och vad barn erbjuds för mat under uppväxten har en extra stor betydelse. Frukost ger en bra start på dagen. Den ger en den ork och energi som behövs under morgonen före lunch. Energin efter frukosten behövs för att behålla fokus under skolarbetet och för att orka vara fysisk aktiv under skoltid samt fritid. Syftet med studien var att undersöka om miljön i hemmet påverkade niondeklassarnas frukostvanor och hur dessa vanor såg ut. För att besvara syftet så användes kvantitativ metod med tvärsnittsdesign och för insamling av dess data valdes enkäter. Urvalet bestod av elever i årskurs 9 från två skolor i en kommun. Totalt deltog 64 elever i studien. Resultatet visade att majoriteten av eleverna åt frukost ofta och en liten del av dem åt lite eller inget till frukost. De åt frukost vid köksbordet och det gjorde de utan sällskap. Många elever var positiva till att bli serverade frukost i skolan på grund av att få möjlighet att få äta frukost med sällskap. En annan fördel de nämnde med frukost i skolan var att de blev hungriga när de kom till skolan för att de fick vakna till ordentligt och bli piggare. Slutsatsen var att majoriteten av eleverna åt frukost varje dag eller hoppade över frukosten några gånger i veckan. Eleverna bestämde själva vad de ville äta till frukost och de åt oftast ensamma. Köksbordet var den plats i hemmet som var populärast att äta vid. De valde att äta havregrynsgröt, en smörgås med pålägg eller fil/yoghurt med flingor/müsli. Favoritdryckerna var O’boy och te.

Advances and integration of information and communication technologies into healthcare systems offer new opportunities to improve public health worldwide. In Sweden, there are already unique possibilities for epidemiological research from registers because of a long tradition of centralized data collection into population-based registers and their allowance for linkage. The growing efficiency of automated digital storage provides growing volumes of archived data that increases the potential of analyses further. The purpose of this thesis can be divided into two parallel themes: illustrations and discussions of the use and usefulness of population-based registers on the one hand, and specific research questions in epidemiology and healthcare research on the other. The research questions are addressed in separate papers. From the Swedish Cancer Registry, 25 years of incidence data on testicular cancer was extracted for a large cohort. Record linkage to survey data on serum cholesterol showed a highly significant positive association, suggesting that elevated serum cholesterol concentration is a risk factor for testicular cancer. Since the finding is the first of its kind and because of wide confidence intervals further studies are needed to confirm the association. Östergötland County council’s administra-tive database (the Care Data Warehouse in Östergötland (CDWÖ)) provided data for preva-lence estimations of four common chronic diseases. The prevalence rate agreed very well with previous estimates for diabetes and fairly well with those for asthma. For hypertension and chronic obstructive pulmonary disease, the observed rates were lower than previous prevalence estimates. Data on several consecutive years covering all healthcare levels are needed to achieve valid prevalence estimates. CDWÖ data was also used to analyse the impact of diabetes on the prevalence of ischemic heart disease. Women had higher diabetes/non-diabetes prevalence rate ratios across all ages. The relative gender difference remained up to the age of 65 years and thereafter decreased considerably. The age-specific direct healthcare cost of diabetes was explored using data from the CDWÖ, the county council’s Cost Per Patient database and the Swedish Prescribed Drug Register. The cost per patient and the relative magnitude of different cost components varied considerably by age, which is important to consider in the future planning of diabetes management. The Cancer Registry was established mainly as a basis for epidemiological surveillance and research, exemplified in this thesis by a study on testicular cancer. In contrast, the newly established and planned healthcare databases in different Swedish counties are mainly for managerial purposes. As is shown in this thesis, these new databases may also be used to address problems in epidemiology and healthcare research.

Traffic fatalities and injuries among young drivers as a result of road crashes constitute a serious public health problem. The ultimate goal of traffic safety work in Sweden has been formulated in Vision Zero, which includes an image of a future in which no one will be killed or seriously injured in traffic crashes. Therefore, it is unacceptable that young learner and novice drivers are involved in road crashes that result in fatalities or severe injuries. Driver education is an important tool to increase the probability that young drivers actually take their share of the responsibility for Vision Zero by obeying traffic rules and driving as safely as possible. The general aim of the work underlying this thesis was to determine the potential of driver education to reduce road traffic crashes involving young drivers, particularly in Sweden. Paper I examined the relationship between the way in which the education is carried out and the outcome of the driving test. Paper II explored whether there are any gender‐related differences regarding driving practicing, the outcome of the license tests, and involvement in crashes during the first year of licensure. Paper III evaluated the reform that made it possible for learner drivers to start practicing from 16 years of age in terms of its effects on crashes involving young novice drivers. In paper IV, the focus was on investigating crashes during practice and comparing the results with the corresponding situation for novice divers during their first two years of licensure. Paper V assessed an insight‐based educational approach aimed at inducing young drivers to make better use of vehicle‐related safety equipment. The findings of two of the studies (papers III and IV) showed that, in Sweden, taking advantage of the possibility to start practicing behind the wheel from the age of 16 years had a beneficial effect seen as reduced crash involvement among those young drivers. In paper V, it was revealed that using an insight‐based educational approach can have a positive influence on learner drivers’ knowledge of and attitudes towards the use of car safety equipment (e.g., safety belts). In paper I, it was found that it is difficult to explain why 18–24‐year‐olds pass or fail the driving test on the basis of background variables and information concerning how they had practiced driving. Paper II showed that, for females, training pursued in a more structured manner did not seem to be beneficial for the outcome of the license tests, and that males aged 18–24 were involved in 1.9 more injury crashes per 1,000 drivers than females during their first year of licensed driving. Suggestions are given that can be used to develop the Swedish licensing system in a way that will increase the potential of driver education to reduce traffic crashes among young drivers. These ideas comprise aspects such as the following: persuading the youngest learner driver population to start practicing as early and as much as possible; the learning period should be better organized, which includes improved agreement between the goals of the national curriculum, the content/process of driver education, and the design of the license tests; professional instruction of learners in both the theory and the practice of driving should be a more prominent component of driver education; and parts of the Swedish licensing system should be made mandatory to help solve the problems of young drivers and to fulfil he goals of the national curriculum. / <p>On the date of the defence the status of article II was: In press.</p>

Syftet med studien var att utforska elevernas upplevelser av skolmiljön och hur den påverkar deras upplevda välbefinnande. Som metod användes semistrukturerade intervjuer med en intervjuguide som mall. Urvalet innefattade sex elever i åldern 11-13 år från en och samma mellanstadieklass. Resultatet visade bland annat att flera av eleverna kände sig trygga på skolan och beskrev trygghet som att känna sig välkommen eller att få vara sig själv. Eleverna uttryckte att de fick det stöd de behövde från lärare, elever och föräldrar. Något skolan bör förbättra enligt eleverna var de små lyhörda lokalerna inomhus, den tråkiga skolgården samt att det ibland skulle behövas fler rastvakter utomhus. Slutsatsen av denna studie var att skolmiljön kan påverka elevernas välbefinnande samt att en liten skola kan ha både för- och nackdelar för skolmiljön. Fler kvalitativa studier kan ge en ökad förståelse för skolmiljöns påverkan på eleverna. / The purpose of this paper was to explore the students experiences of the school climate and how it affects their well-being. Semi-structured interviews with an interview guide were used as a method. The sample was of six students in the age of 11-13 from one middle school class. The results showed among other things that almost everyone felt safe at school and expressed different definitions of safety such as feeling welcome and feeling like they can be themselves. The students felt supported by the teachers, other students and also their parents. Some things the school should change according to the students were the classrooms which were too small and with inefficient soundproofing, the school yard which was boring, and the fact that the students sometimes wanted more adult supervision during school breaks. The conclusion is that the school climate can affect student’s well-being and that a small school can have both pros and cons regarding the school climate. More qualitative research may result in a better understanding of the way the school climate affects the students.

The purpose of this study was to investigate how nurses describe their meals at work, and how meals at work was described as a possibility to recover. The method had a qualitative approach with semi-structured interviews. Five nurses participate and were recruited through a snowball sampling. The interviews were recorded and then transcribed. To analyze the data a manifest content analysis was used. The result showed that the four categories content and meaning for meals at work, environment for the meal at work, time to eat and social relations at the dining table summarized the nurses' descriptions of meals at work. The meal at work was described as one way to recover, but many other things also helped recovering. The conclusion was that nurses in this study described that meals at work can improve through enough length of the break, lower noise level, less stress while eating, enough room for eating and preparing food as well as nutritional food shall be available. The result of the study shows that meals are described as a chance to recover but also that the nurses associate recovery with night sleep, socialize with the family, perform physical activity or just gather your thoughts. / Sjuksköterskor är en utsatt yrkesgrupp och efterfrågan på sjuksköterskor ökar. Arbetsgivare inom vård och omsorg bedömer en brist på sjuksköterskor. En avgörande faktor till bristen är att sjuksköterskor avslutar sjuksköterskeyrket för bristande arbetsvillkor och arbetsmiljön.  Syftet med studien var att undersöka på hur sjuksköterskor beskriver sina arbetsmåltider och arbetsmåltiden som en möjlighet till återhämtning. Metoden som användes till studien var en kvalitativ ansats med semistrukturerade intervjuer. Urvalet bestod av fem sjuksköterskorna som alla arbetade på samma hälsocentral och åt arbetsmåltider. Rekryteringen av sjuksköterskorna skedde via ett snöbollsurval. Intervjuerna genomfördes på informanternas egna arbetskontor och spelades in och transkriberades sedan. För att analysera datamaterialet från intervjuerna användes en manifest innehållsanalys. Resultatet visade att de fyra kategorierna arbetsmåltidens innehåll och mening, miljö för arbetsmåltiden, tiden för att äta och sociala relationer vid matbordet sammanfattade sjuksköterskornas beskrivningar av arbetsmåltider. Arbetsmåltiden beskrivs som en möjlighet till återhämtning men även att återhämtning är mycket mer än måltider som ger energi. Slutsatsen är att sjuksköterskor i denna studie ansåg att arbetsmåltiderna kan förbättras genom tillräckligt långa raster, lägre ljudnivå i måltidsmiljön, mindre stress under måltider, tillräckligt med utrymmen för att äta och tillreda mat samt genom ett utbud av näringsrik kost på arbetsplatsen. Studiens resultat visar att arbetsmåltiden beskrivs som en möjlighet till återhämtning men att sjuksköterskor associerar återhämtning även till nattsömn, umgås med familjen, utföra fysisk aktivitet eller bara att få samla upp sina tankar som de anser ger dem energi.