Introduction: Infection control in animal health care is, as in human health care, most important to prevent and fight antibiotic resistance. Animal health can also influence public health. Basic hygiene routines; hand hygiene, routines for proper attire, and routines for personal protective equipment (PPE), such as protective aprons and gloves, represent the simplest and most important infection control and prevention measures. High compliance to these routines is important to achieve. However, due to few scientific publications in the animal health care arena, customized and efficient efforts have not been fully identified for this environment. Therefore, optimal oversight and compliance assessments are difficult to achieve. Similar to human health care, several infection control and prevention measures and responsibilities are addressed by nurses. Objectives: To study compliance to basic hygiene routines and assess whether compliance differs between different animal health care professions, such as nurses versus veterinarians. Method: A quantitative web-based survey about basic hygiene routines, was used to investigate compliance to basic hygiene routines among animal healthcare providers. The eligible respondent sample was comprised of 360-2600 providers. Difference in compliance among professions within animal health care was estimated using SPSS statistical analysis software. Results: Of a possible 360-2600 possible respondents, 313 animal healthcare providers responded to our web-based survey. Significant differences in compliance among professions were not found (between veterinarians and veterinary nurses with a degree, and veterinarians versus nurses without a degree). Higher compliance was observed at larger animal hospitals and among personnel educated at their work place in basic hygiene routines. Hand disinfectant use before contact with patients was most often missed, as well as not wearing a protective apron or coat if risk for contact with body fluids was evident. Conclusion: In contrast to previous practical experience and reports, our results showed no significant difference in compliance between animal healthcare veterinarians and nurses. Given our null findings, more studies are needed to identify hidden factors influencing compliance among animal health care workers, as well as attention to representative sampling. Even so, based on our results, potential interventions include enhanced work-based education programs on infection control and prevention, with attention to smaller (small to medium sized) animal health care clinics. Focus for such interventions should also address hand disinfection before contact with patients. In addition, more effective monitoring is required. / Introduktion: Vårdhygien inom djursjukvården är liksom inom sjukvården viktigt för att förebygga och motverka utvecklingen av antibiotikaresistens vilken kan påverka folkhälsan. Basala hygienrutiner är en av de viktigaste vårdhygieniska åtgärderna för att förhindra smitta inom sjukvården och djursjukvården. En god följsamhet till basala hygienrutiner är mycket viktig att uppnå men på grund av liten kunskap om hur det förhåller sig inom djursjukvården är det svårt att skräddarsy insatser. Traditionellt riktas många vårdhygieniska insatser och ansvar till sköterskor i djursjukvården. Syfte: Undersöka om följsamheten till basala hygienrutiner skiljer sig mellan olika yrkeskategorier inom djursjukvården. Metod: Genom kvantitativ ansats utifrån 313 svar på en webenkät med ett utskick på 360-2600 enkäter om basala hygienrutiner undersöka självskattad följsamhet och med hjälp av statistikprogrammet SPSS beräkna om skillnader finns mellan olika yrkeskategorier inom djursjukvården. Resultat: Signifikanta skillnader i följsamhet till basala hygienrutiner mellan yrkeskategorierna veterinärer och sköterskor (djurvårdare och djursjukskötare) fanns inte. Bättre följsamhet sågs på större arbetsplatser samt om personalen fått utbildning på arbetsplatsen. Handdesinfektion före patientkontakt var svårast att följa samt användning av skyddsförkläde/rock vid risk för kontakt med kroppsvätskor. Slutsats: I motsats till tidigare praktisk erfarenhet visade resultaten att signifikant skillnad i följsamhet mellan veterinärer och djurvårdare eller mellan veterinärer och djursjukskötare inte kunde ses. Därmed kan konstateras att fler studier behövs för att identifiera dolda faktorer som påverkar följsamheten bland djursjukvårdens personal. Utifrån resultaten kan dock konstateras att interventioner som innebär förbättrade utbildningsprogram i vårdhygien på arbetsplatsen, särskilt på små till medelstora kliniker, bör genomföras. Dessa bör fokusera på handdesinfektion före patientkontakt. Mer effektiv övervakning behövs.

The transition from adolescence to adulthood can bring with it mental health problems, resulting in reduced mental well-being among young women and an increasing public health issue. Perceived mental health problems can be a major obstacle to personal development and opportunities for becoming established in society. Thus, promotive interventions are needed. The overall aim of this thesis was to explore women’s experience of mentoring relationships as health promotion from the perspectives of both parties in the dyad: the young woman transitioning from adolescence to adulthood (the protégé), and her ten-year-older female mentor. This thesis used a practice-based approach to investigate a group of participants involved in a Swedish non-governmental organization, the Girls Zone. Data collection was conducted including interviews (n = 5) and surveys (n = 52) with female protégés, and interviews with female mentors (n = 12). Study I explored the characteristics of the female protégés and the development of the mentoring relationship, and used mixed methods. Study II, which investigated mentors’ initial motives and the organizational context which enabled the mentors’ engagement, used an explorative qualitative method. This thesis showed that female mentoring relationships seem to have potential to be a health-promoting intervention. A variety of young women were attracted to the mentoring program, and mentorships in line with the perspectives of relational-cultural theory could meet the relationship needs expressed by the female protégés. Further, mentors’ motivations for engaging as mentors were linked to the fulfillment of basic psychological needs for autonomy, competence, and relatedness, in accordance with the perspective of self-determination theory.

Introduktion: Vårdrelaterade infektioner (VRI) har negativ inverkan på folkhälsan med påverkan på mortalitet, morbiditet och livskvalitet. Inom hälso- och sjukvården är VRI en stor utmaning. Den vanligaste VRI i Sverige är vårdrelaterade urinvägsinfektioner (VUVI). För att förebygga VRI är regelbundna mätningar och återkopplingar viktigt. Mätinstrument som idag används på lokal och nationell nivå för att mäta incidens av VRI är bl.a. Markörbaserad journalgranskning och Infektionsverktyget. Syfte: Validera Infektionsverktyget och jämföra incidens av VUVI från Infektionsverktyget mot manuell journalgranskning och Markörbaserad journalgranskning samt studera förekomsten av urinkateter i samband med VUVI. Metod: Under 2017 samlades data in från 143 slumpmässigt utvalda journaler i slutenvården på Södra Älvsborgs sjukhus. Diagnostiserad VUVI och samhällsförvärvad urinvägsinfektion (SUVI) i Infektionsverktyget validerades mot manuell journalgranskning. Incidensen av VUVI i Infektionsverktyget jämfördes även mot VUVI i markörbaserad journalgranskning. Resultat: Incidens av VUVI innan validering var 1.5 % medan den uppskattade incidensen efter manuell journalgranskning och validering var 3.6 %. Markörbaserad journalgranskning visade en incidens på 1.1 %. I 65.6 % av fallen med VUVI fanns en koppling till urinkateter. Den mest förekommande orsaken till inkorrekt registreringen av VUVI var att patienter med urinkateter bedömdes som SUVI. Slutsats: Den rapporterade incidensen av VUVI skiljer sig mellan de mätinstrument som används idag och incidensen är troligtvis högre än vad som idag rapporteras. För att få bra kvalitet på övervakningsdata krävs kunskap och granskning av hög kvalitet. Dock begränsas resultatet från denna studie av att studiepopulationen var relativt liten och därmed begränsar generaliserbarheten. / Introduction: Health care associated infections (HCAIs) have a negative impact on public health, with an impact on mortality, morbidity and quality of life. The most common HCAIs in Sweden are health care associated urinary tract infections (UTI). One important component in preventing HCAIs are regular measurements and feedback to these. Instruments that are currently used for measuring HCAIs at a local and national level in Sweden are marker-based journal review and the Anti-Infection Tool (AIT). Aim:  The aim of this study was to validate the AIT and compare the incidence of health care associated UTI measured with the AIT against both manual journal review and marker-based journal review. The aim was also to study the presence of urinary catheters in conjunction with a healthcare associated UTI. Methods: In 2017, data was collected from 143 records from a random sample of patients admitted to somatic wards at Södra Älvsborg's Hospital. From the AIT, diagnosed health care associated UTI and community-acquired UTI were studied and validated against manual journal review. Also, the incidence of health care associated UTI in the AIT was compared with that found in marker-based journal review. Results: Incidence of health care associated UTI before the validation was 1.5% while the estimated incidence after manual journal review and validation was 3.6%. Marker-based journal review showed an incidence of 1.1%. In 65.6 % of the cases with health care associated UTI, the patient was equipped with urinary catheter. The most common cause of incorrect registration of health care associated UTI was that patients with urinary catheters were assessed as community-acquired UTI.   Conclusion:  The reported incidence of health care associated UTI differs greatly between these instruments. The incidence is probably much higher than what is currently reported using these instruments. To obtain good quality of monitoring data, knowledge and journal reviews of high quality are required. However, the generalizability of the result of this study is limited, due to the relatively small study sample.

Inledning: Mäns våld mot kvinnor i nära relationer är ett utbrett folkhälsoproblem vilket hindrar utvecklingen av ett jämställt samhälle och bidrar till allvarliga hälsoproblem för många kvinnor i form av både kort- och långsiktig fysisk och psykisk ohälsa. Våldet påverkar även våldsutsatta kvinnors möjlighet till delaktighet och inflytande i samhället, vilket ytterligare gör det till en viktig folkhälsofråga. Syfte: Syftet med litteraturstudien var att beskriva riskfaktorer för mäns våld mot kvinnor nära relationer. Metod: Utifrån tjugofem vetenskapliga artiklar vilka analyserades med en tematisk analysmetod identifierades fem huvudsakliga teman: ”Uppväxtvillkor”, ”Individuella faktorer hos mannen”, ”Förhållandekontext”, ”Socioekonomiska och demografiska faktorer” samt ”Normer”. Även fyra subteman identifierades: ”Personlighetsdrag”, ”Alkohol och droger”, ”Konflikter” samt ”Graviditet och barn”. Resultat: Resultatets nyckelfynd var negativa barndomsupplevelser, impulskontroll, alkoholpåverkan, ekonomiska resurser och maskulinitetsnormer. Diskussion: Resultaten har delvis diskuterats utifrån en ekologisk modell och avslutas med implikationer och förslag på utveckling av ämnet. Litteraturstudien belyser vikten av att utveckla förebyggande och behandlande strategier på flera olika nivåer för att motverka mäns våld mot kvinnor i nära relationer. / Introduction: Men’s perpetration of intimate partner violence against women is a widespread public health problem that prevents the development of an equal society and contributes to serious health problems for many women in terms of both short and long term physical and mental health. The violence also affects the victimized women's opportunity for participation and influence in the society, which further makes it an important public health issue. Aim: The aim of the literature review was to describe risk factors for men’s perpetration of intimate partner violence against women. Methods: Based on twenty-five scientific articles analyzed by a thematic analysis method, five main themes were identified: "Conditions during childhood”, "Individual factors of the man", "Relationship context", "Socio-economic and Demographic factors" and "Standards." Four sub-themes were also identified: "Personality traits", "Alcohol and drugs", "Conflicts" and "Pregnancy and children". Results: The key findings of the results were negative childhood experiences, impulse control, alcohol impact, financial resources and masculinity standards. Discussion: The results have been discussed partly based on an ecological model and concluded with implications and suggestions on the development of the subject. The literature study highlights the importance of developing prevention and treatment strategies at several levels to counter men’s perpetration of intimate partner violence against women

Introduction: Emergence of resistance to artemisinin-based combination therapy (ACT) is a major threat to combat Plasmodium falciparum malaria. Regular therapeutic studies to monitor treatment efficacy is essential, and genotyping of molecular makers is useful for mapping development and spread of resistance. Aims: The study aims are to assess efficacy of artesunate-amodiquine (ASAQ) and prevalence of molecular markers of drug resistance in Zanzibar in 2017. Methods: Treatment efficacy of the clinical trial conducted in 2017 was compared with efficacies in 2002 and 2005. A total of 142 samples were genotyped for single nucleotide polymorphisms (SNPs) in the P. falciparum chloroquine resistance transporter gene (pfcrt) gene, the P. falciparum multi drug resistance 1 (pfmdr1) gene, and in the P. falciparum Kelch 13 (PfK13) propeller region. Prevalence of SNPs were assessed during the period 2002-2017. Results: Cure rate was 100% in 2017, compared to 94% and 96%, in 2002-2003 and 2005, respectively. Day 3 fever clearance rate were also high 93% (2002-3), 99% (2005) and 98% (2017) in all studies. Prevalence of pfcrt 76T, pfmdr1 86Y, 184Y and 1246Y and pfmdr1 (86Y, 184Y and 1246Y) YYY haplotypes were significantly decreased between 2002-3 and 2017 (p &lt; 0.001). No SNP in the PfK13 gene related to artemisinin resistance was identified. Conclusion: Efficacy of ASAQ remains high after fourteen years as first-line treatment, despite the wide-scale use of ASAQ, and there is no evidence of selection of resistance markers in Zanzibar. Continuous monitoring of drug efficacy and resistance markers is recommended. / <p>This master thesis is a collaboration project between Institutionen för kvinnors och barns hälsa, Department of Women's and Children's Health, Uppsala Universtiy and Anders Björkman group, Department of Microbiology, Tumor and Cell Biology (MTC), C1, Karolinska Institutet. Laboratory examinations were mainly conducted at MTC house, Karolinska Institutet.</p>

Background: Previous research has shown that body image can have an impact on wellbeing. A negative body image can increase psychological suffering and have physical implications on health. A positive body image can provide protection against external factors that could lead to a negative body image. Aim: The aim of the study is to explore high school students body image and which situations and environments that has an impact on their body image. Method: The study was conducted through a qualitative method with semi structured interviews, the high school students was in the age range of 15-18. The data was gathered without any pre decided codes for analyzing. Result: The study showed that body image was not static within the high school students, body image could change from day to day and from situation, often depending on the mood. Negative body image could have effect on wellbeing overall, like thinking less of themselves, and also limit the high school students in their everyday life. Most high school students felt strongly that the body is something that you can control, with the right amount of motivation, physical activity and limited food intake, everybody could achieve their dream body. Social media had a negative impact on many of the high school students but could, for some work as a way of controlling what images they meet by unfollowing accounts that made them feel bad about themselves. Conclusion: The result of this study shows that body image can be fluid and strongly affected on the situation. Further research, focusing on what influences body image in this specific target group, could have a great impact on future interventions to improve body image. / Bakgrund: Tidigare forskning visar att kroppsuppfattning kan påverka välmående. En negativ kroppsuppfattning kan medföra psykiskt lidande och fysiska konsekvenser för hälsan. En positiv kroppsuppfattning kan medföra ett skydd mot yttre påverkansfaktorer som skulle kunna leda till en negativ kroppsuppfattning. Syfte: Studiens syfte är att undersöka gymnasieelevers kroppsuppfattning samt vilka situationer och miljöer som har en påverkan på deras kroppsuppfattning. Metod: Studien har genomförts med kvalitativ metod i form av semistrukturerade intervjuer där 10 gymnasieelever i åldersgruppen 15–18 fått representera resultatet. Analys skedde löpande under insamling av data enligt induktiv ansats där koderna tog form under arbetets gång. Resultat: Sammanfattningsvis visar resultatet att gymnasieeleverna kunde känna både positiva och negativa känslor inför den egna kroppen, där kroppsuppfattning kunde variera beroende på situation, dagsform samt umgänge. En negativ kroppsuppfattning kunde begränsa i vardagen genom undvikande beteende men det kunde även påverka tankemönster och däri skapa lidande. Kroppen ansågs vara något som kan kontrolleras och förändras med rätt motivation, träning och mat. Sociala medier påverkade negativt i stor utsträckning men kunde även fungera som ett skydd där gymnasieeleverna tog aktiva val om att avfölja konton som påverkade negativt och följa konton med normbrytande kroppar. Konklusion: Resultatet visar att kroppsuppfattning inte är något statiskt utan varierar kraftigt mellan individer och tillfällen. Vidare forskning rörande påverkansfaktorer hos målgruppen skulle kunna förbättra utsikten för framgångsrika interventioner för att förbättra kroppsuppfattningen.

Background and aims: Constipation for patients in palliative care is common and described with variations in prevalence. Side -effects from opioid- treatment, is considered to be one of the main factors leading to constipation. The overall aim of the thesis was to study constipation among patients admitted to specialized palliative care- settings in Sweden. The specific aims of the thesis were 1) To describe and explore the prevalence, definition and symptom distress of constipation by applying different definitions of constipation, in patients admitted to specialized palliative care settings in Sweden. 2) To identify factors related to constipation in patients in specialized palliative care and comparing these factors for patients with different types of constipation to patients without constipation. Methods: A literature- search were conducted where prevalence of- and factors related to constipation was explored and included in a questionnaire, developed for this thesis. Data was collected in a cross- sectional design with a response rate of 50% and analysed with logistic regression. Results: A total of 485 patients from 38 specialized palliative care- units in Sweden participated. Prevalence of constipation for patients in specialized palliative care varied between 7- 43 % depending on definition used. Two different constipation- groups were identified: Medical constipation- group 23% (MCG) and Perceived constipation- group 35% (PCG). Three sub- groups was also identified: patients with i) only ≤ 3 defecations/week, 7%, ii) only perception of being constipated, 19%, and iii) patients with both ≤ 3 defecations/ week and perception of being constipated,16%. Several factors were found to be related to constipation as hospitalisation, absence of laxative- treatment, haemorrhoids, poor appetite, hard stool form and opioids. Conclusions: Prevalence of constipation may differ depending on definitions used. Distress from constipation and other factors related to constipation, than opioids, needs to be incorporated into the clinical constipation- assessment. Validated constipation assessment tool needs to be developed. / <p>The series name <em>Linköping University, Studies in Health Sciences, Thesis</em> in the Licentiate thesis is incorrect. The correct name is <em>Linköping Studies in Health Sciences. Thesis</em>.</p>

Background: Older people are faced with special physical and mental health challenges associated with ageing. Over 20% of adults aged 60 and over suffer from a mental or neurological disorder. It is known, and has been shown in previous studies, that physical activity can enhance physical and mental health. Meditative martial arts such as Tai Chi are, in most cases, low-intensity mind-body exercises that involve very graceful movements, which are performed in a slow, rhythmical, and well-controlled manner. This makes the practice suitable for older adults. Study aim: To investigate and assess the impact of different types of martial arts on mental health, health-related quality of life (HRQOL) and wellbeing among older adults, who are healthy or suffer from a mild cognitive impairment. Methods: This study focused on experimental studies with interventions of martial arts on older adults. Nine original articles gathered from Web of Science (n=1) and PubMed (n=8) were reviewed, compared and summarized. Keywords used were; “martial arts” AND “mental health” in both databases respectively. Results: The practice of martial arts is associated with positive results of both physical and mental health aspects. Tai Chi can lead to improvements of mental ability, health-related quality of life (HRQOL) and improve the physical ability of older adults. Conclusion: Martial arts as a means of intervention may be beneficial for the wellbeing and overall quality of life in older adults and should be recommended. However, nine original articles are not sufficient for stating the significance of martial arts on mental health among older adults. Further research is therefore required.

Alla människor vill gå till arbetet utan att känna oro och ängslan samt kunna gå hem från arbetet med en positiv känsla i kroppen. Vissa människor går till arbetet med en klump i magen och kommer hem med minnen om en skrämmande och hotfull situation som uppstod under dagen. Dagens lärare utsätts för kränkningar, hot och våld i sitt yrkesutövande något som är en direkt påverkan på deras person och arbetsmiljö. Nummer tre av de åtta folkhälsopolitiska målsättningarna tar bland annat upp ökad hälsa i arbetslivet, något som vissa lärare möjligtvis går miste om. Syftet med studien var att undersöka i vilken omfattning högstadielärare utsätts för, kränkningar, hot och våld och om detta hade ett samband med sjukskrivningar hos lärare. Kvantitativa data samlades in via enkäter ställda till lärare för högstadieelever i klass 7–9. Data analyserades både deskriptivt och analytiskt för att kunna besvara frågeställningarna i syftet. Ur resultaten framkom att majoriteten av respondenterna utsatts för kränkningar hot och/eller våld samt att nästan hälften av respondenterna uppfattar att elevers bemötande påverkar dem negativt samt att elevers beteende var bättre förr. Lärares utsatthet för kränkningar, hot och våld kunde dock inte kopplas till sjukskrivning. Slutsatsen är att lärare är en utsatt yrkesgrupp som behöver få stöd inom sin yrkesroll och erbjudas funktionella verktyg för att kunna utföra sitt yrke, förslagsvis med Krav- kontroll-stödmodellen, samt att skolan som arena behöver ses över och göras säkrare. / Everyone wishes to be able to go to work without anxiety and to being able to leave work with a positive feeling. Some people go to work feeling troubled and return to their homes with memories of a frightening and threatening situation that arose during the day. Teachers are subjected to violations, threats and violence in their occupation, which affects them both personally and within their work environment. Number three of the eight Public Health policy objectives include, among other things, increased health at work something that some teachers may miss out on. The purpose of the study was to investigate the extent to which high school teachers are exposed, violations, threats and violence and whether this had any connection with teacher’s sick leave. Quantitative data were collected through surveys that were filled in by teachers in 7th and 9th grade at primary-schools. Analysis regarding both descriptive and analytic forms were presented to answer the questions included in the studies aim. The results showed that the majority of respondents were subjected to violations, threats and /or violence and that almost half of the respondents perceived that pupils' treatment affected them negatively and that student behavior was better in the past. However, teachers' exposure to violations, threats and violence, could not be linked to sick leave. The conclusion is that teachers are a vulnerable professional group who need to be strengthened and offered functional tools to be able to carry out their profession with the Requirements Control support model and that the school as an arena needs to be reviewed and made safer.

Inledning: Antibiotikaresistens är ett av de största hoten mot global folkhälsa. Meticillinresistent Staphylococcus aureus, tidigare främst associerat med sjukhusvård, överförs nu mellan individer i samhället (samhällsförvärvad meticillinresistent staphylococcus aureus). Att identifiera riskfaktorer är centralt för att kunna bedriva effektivt preventivt arbete mot smittöverföring. Syfte: Syftet med uppsatsen var att identifiera och beskriva riskfaktorer associerade med förekomst av samhällsförvärvad meticillinresistent staphylococcus aureus. Metod: Litteraturstudie baserad på 20 internationella artiklar. Huvudfynden i artiklarna kategoriserades i teman. Resultat: Riskfaktorer på samhälls-, hushålls- och individnivå kunde identifieras, bland annat rörande klimat, tidigare antibiotikaanvändning och samsjuklighet.  Diskussion: Ett fåtal enkelt påverkbara riskfaktorer kunde identifieras. Av de identifierade riskfaktorerna är troligen inte alla generaliserbara till en svensk kontext. I flera tidigare studier framhålls att samhällsförvärvad meticillinresistent staphylococcus aureus främst drabbar individer som sedan tidigare är friska, vilket fynden i föreliggande uppsats delvis motsäger då samsjuklighet i exempelvis HIV, diabetes och fetma identifierades som riskfaktorer associerade med samhällsförvärvad meticillinresistent staphylococcus aureus. / Introduction: Antibiotic resistance a threat to global public health. Methicillin resistant staphylococcus aureus, previously primarily associated with hospital care, is now being transmitted in the community (community acquired methicillin resistant staphylococcus aureus). Identifying risk factors is central to enable effective preventive efforts against transmission of community acquired methicillin resistant staphylococcus aureus.   Aim: The aim of this essay was to identify and describe risk factors associated with occurrence of community acquired methicillin resistant staphylococcus aureus.    Methods: Literature study based on 20 international studies. The main results from the articles were categorized into themes. Results: Risk factors at community-, household- and individual level could be identified, for instance concerning climate, previous antibiotic treatment and comorbidity. Discussion: A few easily affectable risk factors could be identified. Perhaps not all of the identified risk factors are generalizable to a Swedish context. Previous research demonstrates that community acquired methicillin resistant staphylococcus aureus usually affects healthy individuals, which the findings in this essay partly contradict: comorbidity, for instance with HIV, diabetes or obesity, is a risk factor associated with community acquired methicillin resistant staphylococcus aureus.