<p>Godkänt datum: 2017-10-26.</p>

<p>Godkänd datum: 2017-10-26.</p>

<p>Godkännande datum 2017-11-26.</p>

No description available.

Background It is stated that vital exhaustion (VE) increases the risk of getting cardiovascular disease (CVD) (1), at the moment the leading cause of death globally (2). A factor in life that may be protective against the harmful effect of VE is social support (3) which is also associated with CVD (4). This thesis will investigate if social support can moderate the relationship between VE and CVD outcomes and have a protective effect. It will also exploratively investigate if comorbid depression or self-rated health confound the relationship. Method This thesis uses secondary data from 935 myocardial infarction patients that were included in the Uppsala University Psychosocial Care Programme (U-CARE) Heart Trial conducted in Sweden. To estimate the hazard ratio (HR) for developing CVD outcomes and investigate if the relationship between VE and CVD could be explained by different confounders and moderated by social support, stratified and interaction analyses were conducted, as well as Cox proportional hazard regression model. Results Social support did not moderate the relationship between VE and CVD. No protective effect on the hazard of developing CVD was shown in those with high social support. The effect of VE on CVD was not affected by depression but when self-rated health was included in the model VE lost its unique effect on CVD. Conclusion Social support did not have a protective effect on VE that impacted CVD. Globally, the main focus should be on preventing individuals from getting VE to prevent and reduce the prevalence of CVD.

Bullying is a serious problem affecting millions of people worldwide. In a report from the Public Health Authority, 6-15 percent of students from compulsory school and upper secondary school in Sweden stated that they are constantly subjected to bullying. The incidence of bullying among students is expected to increase. In order to achieve the national public health goal that aims to create societal conditions for good and equal health in the population, it is vital that schools establish effective anti-bullying strategies. Although schools in Sweden are obligated to prevent bullying, the performance of bullying in Swedish schools among girls and boys is increasing. Efforts aimed to prevent bullying in schools have been shown to have different effects depending on gender. Previous studies have shown that girls more often perform social bullying while boys more often perform physical bullying. Bullying contributes to several consequences that can affect individuals in adolescence but also in adulthood. Consequences of bullying include mental illness, poor school performance and in the worst case, bullying can lead to suicide attempts. Therefore, bullying is a significant public health issue.

Bakgrund: Familjecentraler finns till för att hjälpa och stötta familjer som är i behov av stöd. Det görs genom hälsofrämjande och sjukdomsförebyggande insatser. Två teoretiska ansatser har kopplats till ämnesområdet, dessa är SESAME modellen och stödjande miljöer som används i hälsofrämjande arbeten. Syfte: Syftet var att undersöka vilka upplevelser personal vid familjecentraler har gällande arbetet för att främja barns möjlighet till fysisk aktivitet. Metod: En kvalitativ studie har genomförts med hjälp av semistrukturerade intervjuer. Ett målstyrt urval har använts och består av fem pedagoger, en BVC-sköterska och en kurator från fyra olika familjecentraler i Örebro län. Materialet har analyserats med hjälp av en manifest innehållsanalys. Resultat: Familjecentraler har bra kontroll över begreppet att främja fysisk aktivitet bland barnen. Bland annat har personalen fokus på samtal och information till vårdnadshavare, då det är de som har den avgörande rollen i arbetet. För att underlätta arbetet är det viktigt med en god samverkan med andra aktörer och arenor. Slutsats: Arbetet med att främja barns fysiska aktivitet är en viktig del i det hälsofrämjande arbetet. Det kan därför behövas ännu mer resurser från personalen till föräldrarna, för att ge föräldrarna ett utökat stöd för att lättare kunna främja barns fysiska aktivitet i hemmet. Nyckelord: Fysisk aktivitet, Familjecentral, Hälsofrämjande arbete, SESAME, Sjukdomsförebyggande insatser, Stödjande miljöer. / Background: Family centers are available to help and support families in need of support. This is done through health promotion and disease prevention efforts. Two theoretical Approachers have been linked to the subject area, these being the SESAME model and supportive environments used in health promotion work. Aim: The aim of the study is to investigate how family centers in Örebro County work to promote children's physical activity. Method: A qualitative study has been conducted through semi-structured interviews. A convenience selection has been used and consists of five educators, one BVC nurse and one curator from four different family centers in Örebro county. The material has been analyzed using a manifest content analysis. Results: Family centers have good control over the concept of promoting physical activity among children. Among other things, the staff focuses on conversations and information for custodians, though they play the crucial role in the work with their children. In order to facilitate the work, it is important to have good cooperation with other actors and arenas. Conclusion: The work of promoting children's physical activity is an important part of the health promotion work. Therefore, even more resources may be needed towards the parents, in order for them to be able to demonstrate to the children what physical activity is considered to be. Keywords: Disease prevention work, Family center, Health promotion, Physical Activity, SESAME, Supportive environments.

Aim: This study aims to investigate the experience of Indonesian community health workers (CHW) particularly in the aspect of motivation, advantages gained, obstacles and challenges related to the implementation of Saving Next Generation Institute (SNGI) program in Garut, Indonesia Methods: This study is a qualitative study. Semi-structured interviews were conducted with ten (10) community health workers who were enrolled in the program. Data were analyzed by using thematic analysis. Findings: The study reveals that the participating CHWs have positive experiences with the program. Respondents were motivated to gain comprehensive knowledge and skills from joining the program to serve their community better. Also, the CHWs acknowledged their getting more empowerment, skill-building, positive communication, self-satisfaction, and recognition from the program compared to the state program. Conflicts among the CHWs, the sustainability of the program, and the types of incentives such as transport fees and material incentives were mentioned to be the challenges in the program. Conclusion: This study substantiates what CHWs’ consider points of importance from the program. Points included are sharing synchronous common goals between CHWs and the program, having identified and appropriate program which meets the CHWs’ needs, having positive communication with all stakeholders and having suitable incentives. Findings from this study should be considered an insight for both non-state actors and the Indonesian government to ensure future improvement and program upscaling. Future research might expand to analyzing the dynamics of state and non-state interaction and organizational behavior which highlights communication among stakeholders in the program.

Background: The increase in the prevalence of cardiovascular risk factors (CVRFs) is considered one of the most important public health problems worldwide and especially in Latin American (LA) countries. Although the systematic surveillance of chronic diseases and their risk factors has been recommended, Bolivia has not yet implemented a national strategy to collect and monitor CVRF information. Evidence from previous studies in Bolivia and other Latin American countries has suggested that CVRFs affect women more than men and mestizos more than indigenous people. However, a more accurate and comprehensive picture of the CVRF situation and how ethnicity and gender intersect to affect CVRFs is dearly needed to support the development of health policies to improve population health and reduce inequalities. Objective: to estimate the distribution of CVRFs and to examine intersectional in equalities in Cochabamba – Bolivia in order to provide useful information for public health practice and decision making. The specific objectives are: i) to estimate the prevalence of preventable risk factors associated with CVDs and ii) to assess and explain obesity inequalities in the intersectional spaces of ethnicity and gender. Methods: The data collection procedure was based on the Pan-American version (V2.0) of the WHO STEPS approach adapted to the Bolivian context. Between 2015 and 2016, 10,754 individuals aged over 18 years old were surveyed. The two first stages of the STEPS approach were conducted: a) Step 1 consisted of the application of a questionnaire to collect demographic and lifestyle data; b) Step 2 involved taking measurements of height, weight, blood pressure, and waist circumference of the participants. To achieve objective 1, the prevalence of relevant behavioural risk factors and anthropometric measures were calculated, and then odds ratios/prevalence ratios were estimated for each CVRF, both with crude and adjusted regression models. Regarding objective 2, an intersectionality approach based on the method suggested by Jackson et al. (67) was used to analyse the ethnic and gender inequalities in obesity. Gender and ethnicity information were combined to form four mutually exclusive intersectional positions: i) the dually disadvantaged group of indigenous women; ii) the dually advantaged group of mestizo men; and the singly disadvantaged groups of iii) indigenous men and iv) mestizo women. Joint and excess intersectional disparities in abdominal obesity were estimated as absolute prevalence differences between binary groups, using binomial regression models. The Oaxaca-Blinder decomposition was applied to estimate the contributions of explanatory factors underlying the observed intersectional disparities. Main findings: Our findings revealed that Cochabamba had a high prevalence of CVRFs, with significant variations among the different socio-demographic groups. Indigenous populations and those living in the Andean region showed, in general, a lower prevalence for most of the risk factors evaluated. The prevalence of behavioural risk factors were: current smoking (11.6%); current alcohol consumption (42.76%); low consumption of fruits and vegetables (76.73%); and low level of physical activity (64.77%). The prevalence of metabolic risk factors evaluated were: being overweight (35.84%); obesity (20.49%); abdominal obesity (54.13%); and raised blood pressure (17.5%). It is important to highlight that 40.7% of participants had four or more CVRFs simultaneously. Dually and singly disadvantaged groups (indigenous women, indigenous men, and mestizo women) were less obese than the dually advantaged group (mestizomen). The joint disparity showed that the obesity prevalence was 7.26 percentage points higher in the doubly advantaged mestizo men (MM) than in the doubly disadvantaged indigenous women (IW). Mestizo men (MM) had an obesity prevalence of 4.30 percentage points higher than mestizo women (MW) and 9.18 percentage points higher than indigenous men (IM). The resulting excess intersectional disparity was 6.22 percentage points, representing -86 percentage points of the joint disparity. The lower prevalence of obesity in the doubly disadvantaged group of indigenous women (7.26 percentage points) was mainly due to ethnic differences alone. However, they had higher obesity than expected when considering both genders alone and ethnicity alone. Health behaviours were important factors in explaining the intersectional inequalities, while differences in socioeconomic and demographic factors played less important roles. Conclusion: The prevalence of all CVRFs in Cochabamba was high, and nearly two-thirds of the population reported two or more risk factors simultaneously. The intersectional disparities illustrate that abdominal obesity is not distributed according to expected patterns of structural disadvantages in the intersectional spaces of ethnicity and gender in Bolivia. A high social advantage was related to higher rates of abdominal obesity, with health behaviours as the most important factors explaining the observed inequalities. The information generated by this study provides evidence for health policymakers at the regional level and a baseline data for department-wide action plans to carry out specific interventionsin the population and on individual levels.

The aim of the study was to evaluate experiences of working with delinquent adolescents among supportive actors in Västmanland. A qualitative method and semi-structured interviews were used to collect data for the analysis. A convenience sampling method in combination with a purposive sampling method were used to choose the participants for the study. The study included six participants distributed among three different support actors in Västmanland. The participants operate in the undertaking of delinquent adolescents within social services, non-institutional care and institutional care. Interviews were transcribed verbatim and analyzed by a manifest content analysis. Three categories were found in the analysis as ”Views of working with delinquent adolescents”, ”Obstacles in the undertaking of delinquent adolescents” and ”Possibilities in the undertaking of delinquent adolescents”. The results showed that support actors had positive experiences of working with delinquent adolescents, both when it comes to achieved results but also in terms of relationships between staff and adolescents. Education and personal characteristics were explained as crucial factors to handle the supportive work of delinquent adolescents. In addition, the results showed that support actors are hindered in their work with delinquent adolescents due to secrecy and a perceived lack of consensus between professionals such as personnel within social services, the police and schools. Increased cooperation between professionals and various actors was shown as an opportunity when it comes to achieve behavioural change for delinquent adolescents. Keywords: Juvenile delinquency, Obstacles, Possibilities, Propensity for violence, Youth violence