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Sökning: AMNE:(MEDICIN) AMNE:(Socialmedicin) AMNE:(Folkhälsomedicinska forskningsområden)

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1.
  • Larsson, Matz, et al. (författare)
  • Exposure to environmental tobacco smoke and health effects among hospitality workers in Sweden : before and after the implementation of a smoke-free law
  • 2008
  • Ingår i: Scandinavian Journal of Work, Environment and Health. - Helsingfors : Institutet för arbetshygien. - 0355-3140 .- 1795-990X. ; 34:4, s. 267-277
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives This study attempted to identify changes in exposure to environmental tobacco smoke, as well as symptoms and attitudes among hospitality workers after the introduction of extended smoke-free workplace legislation.Methods A total of 37 volunteers working in bingo halls and casinos (gaming workers) and 54 bars and restaurant employees (other workers) in nine Swedish communities participated in the study. Altogether 71 of 91 persons (14 daily smokers and 57 nonsmokers) participated in both the preban baseline survey and the follow-up 12 months after the ban. Exposure to environmental tobacco smoke, smoking habits, respiratory and sensory symptoms, and attitudes towards the ban were recorded, and spirometry was carried out.Results The frequency of reported respiratory and sensory symptoms was approximately halved among the nonsmokers in both occupational groups after the introduction of the ban. Initially 87% had exposure to environmental tobacco smoke that was over the nicotine cut-off level chosen to identify possible health risk (<0.5 µg/m3), while, after the ban, it was only 22%, a relative risk of 0.25 (95% confidence interval 0.15–0.41). The risk decreased in both occupational groups, but gaming workers experienced the highest preban exposure levels. Attitudes towards the legislation were largely positive, particularly after the ban. However, there was no notable change in lung function, and there was no notable reduction in the number of cigarettes consumed by smokers.Conclusions The introduction of smoke-free legislation was associated with a substantial reduction in respiratory and sensory symptoms, as well as reduced exposure to environmental tobacco smoke at work, particularly among gaming workers.
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2.
  • Westman, Anders, 1946- (författare)
  • Musculoskeletal pain in primary health care : a biopsychosocial perspective for assessment and  treatment
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Long-term musculoskeletal pain is a large public health problem with serious consequences for both the individual and society. Psychosocial factors have been shown to be good predictors of long-term disability and play an important role in the transition from acute to chronic pain. Early identification and intervention of those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering. The overall aim of this thesis was to assess a biopsychosocial approach to the assessment and management of musculoskeletal pain patients in primary health care. To this end, biopsychosocial assessment and treatment methods were tested in two different populations of primary care patients suffering pain. Results indicated that improvements in quality of life and work capacity one year after early multimodal rehabilitation were basically maintained after five years. The most salient prognostic factors determining return to work were educational level and the individual’s perceived health (Study I). Psychosocial factors as measured by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) were related to disability and perceived health three years after treatment for non-acute pain problems (Study II). The experimental group in the controlled multimodal pain rehabilitation programme had lower health care utilization and a reduced risk of using large amounts of medication after three years compared with the participants in the control group. However, there were no significant differences between the groups on variables such as work capacity, function, catastrophizing and pain (Study III). Distinct profiles of catastrophizing, fear-avoidance beliefs, and distress were extracted and meaningfully related to future sick leave and dysfunction (Study IV). Our findings provide support for the biopsychosocial model and highlight the importance of psychosocial factors in long-term outcome. The results underscore the need for early identification of patients at risk. Further, multimodal treatment that covers not only biological but also psychosocial factors seems to be a key to successful treatment, and ideally this intervention should be matched to the patients' needs.
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3.
  • Hult, Carl, 1953-, et al. (författare)
  • Timing of retirement and mortality : A cohort study of Swedish construction workers
  • 2010
  • Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 70:10, s. 1480-1486
  • Tidskriftsartikel (refereegranskat)abstract
    • Recent studies indicate that early retirement per se may have a negative effect on health to such an extent that it increases mortality risk. One type of early retirement often referred to in these studies is retirement with disability pension/benefit. Given the overall objective of disability benefit programmes - to help the disabled live socially and economically satisfactory lives, freed from exposure to employment health hazards and thus avoid further declines in health - the finding is challenging. This paper examined the relationship between timing of retirement and mortality using a cohort of Swedish construction workers. The mortality risk of disability pensioners - excluding those with diagnoses normally connected to increased mortality - was compared with the risk of those continuing to work. Although initial indications were in line with earlier results, it became obvious that the increased mortality risk of disability pensioners did not depend on early retirement per se but on poor health before early retirement not explicitly recognized in the diagnosis on which the disability pension rested. The results indicate that there are no general differences in mortality depending on timing of retirement. Future studies of mortality differences arising from working or not working must sufficiently control for health selection effects into the studied retirement paths.
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4.
  • Sandström, Agneta, 1959- (författare)
  • Neurocognitive and endocrine dysfunction in women with exhaustion syndrome
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Stress has emerged as one of the most important factors to consider in psychiatric diagnoses and has become a common reason for long-term sick leave (LTSL). Roughly 50% of LTSL due to psychiatric diseases are thought to be associated with work-related stress. The demarcation towards major depression is disputed, and no international consensus exists for how to diagnose and rehabilitate these individuals. The Swedish National Board of Health has suggested the term “exhaustion syndrome” to integrate these individuals into stress-related disorders. Prominent features of this syndrome are fatigue, sleeping disorders, and cognitive dysfunction. The cognitive dysfunction may be due to an interaction between personality features, environmental factors, the biological effects of stress hormones, and dysfunction in key brain areas, notably the hippocampus and prefrontal cortex. A consistent feature of chronic stress is activation of the cortisol, or hypothalamic-pituitary-adrenal, axis, which may be linked to cognitive dysfunction. Increased glucocorticoid levels, mainly cortisol in humans, are known to impair memory performance. The aim of this thesis was to investigate whether patients with exhaustion syndrome exhibit specific alterations in an extensive set of biological, psychological and immunological variables. Patients in Study 1 had significant cognitive impairment for specific tasks assumed to tap frontal lobe functioning. In Study 2 anxiety prone, worrying, pessimistic individuals with low executive drive and a persistent personality type were more likely to develop exhaustion syndrome. Decreased reactivity was found on the pituitary level after corticotropin releasing hormone (CRH) in exhaustion syndrome patients. The cortisol/adrenocorticotropic hormone response to CRH was slightly higher in patients compared to controls, indicating increased sensitivity at the adrenal cortex level. No differences were found in hippocampal volume. In Study 3, functional imaging revealed a different pattern of brain activation in working memory tests in patients with exhaustion syndrome compared to healthy individuals and patients with depression. In summary, our data suggests an intimate link between personality and wellbeing, cognitive performance and neuroendocrine dysfunction, in exhaustion syndrome. We thus find similarities with major depression but also distinct differences between the exhaustion syndrome and major depression.
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6.
  • Bjerneld, Magdalena (författare)
  • Images, Motives, and Challenges for Western Health Workers in Humanitarian Aid
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis presents how humanitarian aid workers were attracted, motivated, recruited, and prepared for fieldwork, and how they reported their work experience directly from the field and when they returned home. Data were derived from interviews with experienced aid workers, focus group discussions with presumptive aid workers, analysis of letters from aid workers in the field on MSFs homepages in Europe, and from interviews with recruitment officers at some of the main humanitarian organisations. Health professionals were attracted by the positive images of humanitarian action. They wished to work in teams with like-minded people, and to make a difference in the world. However, this image was not supported by the recruitment officers, or experienced aid workers, who described a complex reality in humanitarian action. The experienced aid workers instead had realised they learned more than they contributed. The recruitment system for relief workers would benefit from a more holistic approach, where personalities of the aid workers are more in focus. More time must be spent with the applicants, both recruited and returning aid workers, in order to improve the system. A socialisation approach could help identify the right personnel and to motivate current personnel to continue.
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7.
  • Bjerneld, Magdalena, 1950-, et al. (författare)
  • Socialisation of humanitarian aid workers : Interviews with recruitment officers
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • International organisations employ thousands of aid workers for humanitarian aid around the world. One of the problems identified in earlier research is the high turnover of personnel.This article is part of a broader research project investigating how humanitarian organisations attract, recruit and prepare expatriate health professionals for field work and how these professionals are utilized in order to identify possible improvements in the human resource management system. The current study describes how recruitment officers in selected large humanitarian organisations perceive humanitarian aid work, how they recruit, prepare, and support their staff in order to achieve high retention, and what concerns and recommendations they have for future work. For the analysis of the interviews content analysis was used.The recruitment officers identified the importance of flexibility and diplomacy in complex realities. They confirmed the findings of earlier studies that team work often is a source of frustrations and sometimes disappointment. Their main concern was lack of time to find the right person for the right job, often a person with broad expertise in public health. Another difficulty was to find persons who could take responsibility as leaders and trainers. In order to socialize the newcomers into the organisation short courses and debriefing sessions were used. Persons, who stay too long in the field of humanitarian action and sometimes become cynical to the difficult situation they work in was also discussed as being problematic. This finding contradicts the otherwise frequently discussed question about the high turnover of personnel in humanitarian action. This article argues for the use of socialization theory in order to find sustainable solution to identified problems.
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8.
  • Brunnberg, Elinor, et al. (författare)
  • Att ha minst en förälder som missbrukar alkohol : om psykisk ohälsa och utvärderade interventioner
  • 2007
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • En riskfaktor för psykisk ohälsa bland barn och ungdomar är alkoholmissbruk i familjen.Barnen och ungdomarna kan indelas i tre grupper, de som mår bra, de som befinner sig i en gråzon, och de som far illa. I denna rapport fokuseras på de barn som far illa. I Sverige finns ca 200 000 barn som lever med minst en förälder som missbrukar alkohol. Studier från andra länder visar också höga siffror och det innebär att det finns två till åtta barn i varje grupp om 25 barn som växer upp i en familj med dessa problem. En amerikansk studie har visat att det är nästan vart tredje barn som är barn till alkoholiserade föräldrar. Livet i en alkoholistfamilj kan vara kaotiskt och oförutsägbart, men också mycket varierat mellan olika familjer.Syftet med denna systematiska kunskapsöversikt är att beskriva vilken kunskap som idag finns om psykisk hälsa och ohälsa hos barn med en alkoholiserad förälder alternativt båda föräldrarna samt vilka risker barnen utsätts för. I översikten kommer även vilket stöd och skydd dessa barn behöver och kan få i Sverige idag att presenteras. Kunskapsöversikten kommer dessutom att granska vilka interventioner som utvärderats och presenterats i svensk och internationell forskning Systematisk litteratursökning har gjorts i flera databaser för att hitta vetenskapliga publikationer inom området och en genomgång av samtliga avhandlingar i socialt arbete som skrivits vid fem universitet i Sverige har gjorts. Även andra vetenskapliga rapporter finns med i kunskapsgenomgången. Dessa har hittats mera slumpmässigt vid genomgång av referenslistor, sökning på olika myndigheters databaser, tips från andra forskare m.m.I resultatet presenteras den utsatthet barn till alkoholmissbrukare har ökad risk för. Det kan vara emotionella svårigheter, anpassnings- och beteendeproblem, skolproblem med svårigheter i kamratkontakter och kognitiva problem, samt risk för en ökad alkoholkonsumtion. De skyddsfaktorer som redovisas är faktorer inom barnet själv, stöd till föräldrar och därigenom ett indirekt stöd till barnen, direkt stöd till barnen, t.ex. i form av signifikanta vuxna, samt kritiska händelser som kan fungera skyddande. I Sverige stöder regeringen gruppstödsverksamheter för barn till alkoholiserade föräldrar. I den aktuella kunskapsgenomgången redovisas forskning på interventioner för barn till alkoholiserade föräldrar. Det finns få rapporterade interventioner som också är utvärderade. Trots kritiken mot att så få utvärderade interventionsstudier gjorts, förordas fortsatt gruppstödsverksamhet för barn till alkoholiserade föräldrar samt att individuella och familjebaserade interventionsprogramn utvecklas och utvärderas.
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9.
  • Brunnberg, Elinor, 1948-, et al. (författare)
  • Att höra eller nästan inte höra : Liv & hälsa ung 2005 och 2007 i Örebro län
  • 2009
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • I linje med FN:s barnkonvention och Konventionen om rättigheter förpersoner med funktionshinder ska ungdomars röst göras hörd. Den härrapporten bygger helt på ungdomars uppgifter om sin verklighet.Studierna Liv & hälsa ung 2005 och 2007 visar att i den reguljära skolanupplever drygt fem procent av eleverna att de har ett funktionshinder närdet gäller hörseln och de rapporterar ofta en utsatt situation. Det finns även hörselskadade ungdomar på specialskolan/riksgymnasiet för döva och hörselskadade. De hörselskadade ungdomarna är en grupp som rapporterar en mängd hälsorelaterade problem, många känner sig mobbade av kamrater eller kränkta av vuxna i skolan. Det är också en grupp som förhållandevis ofta rapporterar bruk av alkohol, tobak och narkotika. De kan även ha andra funktionsnedsättningar eller tinnitus. De hörselskadade ungdomarna är en högriskgrupp som behöver uppmärksammas och få ett bättre anpassat stöd. Det behövs fördjupade studier hur stödet kan utformas på ett relevant sätt, speciellt gäller det dem med flera funktionshinder. För att göra detta är det viktigt att ungdomarna själva involveras i arbetet. Fördjupade studier behövs också om hur hörselskadade ungdomars delaktighet i den reguljära skolan kan förbättras samt om vad som skapar exempelvis stress, trötthet och olyckor. Det behövs åtgärder för att minska den mobbning som sker och inte minst minska det ungdomar rapporterar om kränkning från vuxna. Det behövs riktade insatser för att öka de hörselskadade ungdomarnas simkunnighet och fysiska aktivitet. Det är också av stor betydelse för de hörselskadade och döva ungdomarna att det finns kompetent tvåspråkig (svenska och teckenspråk) personal på ungdomsmottagningar och barnahus.
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10.
  • Burén, Jonas, 1972- (författare)
  • Glucose and lipid metabolism in insulin resistance : an experimental study in fat cells
  • 2003
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Type 2 diabetes is usually caused by a combination of pancreatic β-cell failure and insulin resistance in target tissues like liver, muscle and fat. Insulin resistance is characterised by an impaired effect of insulin to reduce hepatic glucose production and to promote glucose uptake in peripheral tissues. The focus of this study was to further elucidate cellular mechanisms for insulin resistance that may be of relevance for type 2 diabetes in humans. We used rat and human adipocytes as an established model of insulin’s target cells. Glucocorticoids, e.g. cortisol, can induce insulin resistance in vivo. In the present study, pretreatment of rat adipocytes in vitro for 24 h with the cortisol analogue dexamethasone produced a downregulation of glucose uptake capacity as well as a marked depletion of cellular insulin receptor substrate 1 (IRS-1) and protein kinase B (PKB), two proteins suggested to play a critical role in the intracellular signal transduction pathway of insulin. The amount of phosphorylated PKB in response to acute insulin treatment was decreased in parallel to total PKB content. The basal rate of lipolysis was enhanced, but insulin’s antilipolytic effect was not consistently altered following dexamethasone pretreatment. Alterations in blood glucose as well as insulin levels may be of great importance for cellular as well as whole-body insulin resistance. High glucose (≥15 mM) for 24 h induced a decrease in glucose uptake capacity in rat adipocytes and IRS-1 content was reduced whereas IRS-2 was increased. Long-term pretreatment with a high insulin concentration downregulated insulin binding capacity and when combined with high glucose, it produced a pronounced reduction of cellular IRS-1 and 2 content together with insensitivity to insulin’s effect to activate PKB and a decrease in glucose uptake capacity. A common denominator for a decrease in glucose uptake capacity in our rat adipocyte studies seems to be a decrease in IRS-1 content. Adipocytes from type 2 diabetes patients are insulin-resistant, but in our work the insulin resistance could be reversed by incubation of the cells at a physiological glucose level for 24 h. Insulin resistance in fresh adipocytes from type 2 diabetes patients was associated with in vivo insulin resistance and glycemic level and with adipocyte cell size and waist-hip ratio (WHR). As a potential mechanism for postprandial dyslipidemia in type 2 diabetes, we examined the nutritional regulation of subcutaneous adipose tissue lipoprotein lipase (LPL) activity. It was upregulated by ~40-50 % after a standardised lipid-enriched meal and this was very similar in type 2 diabetes patients and control subjects, suggesting that the postprandial hypertriglyceridemia found in type 2 diabetes is not explained by an altered nutritional regulation of LPL in subcutaneous fat. In conclusion, the present work provides evidence for novel interactions between glucocorticoids and insulin in the regulation of glucose metabolism that may potentially contribute to the development of insulin resistance. High levels of glucose and insulin produce perturbations in the insulin signalling pathway that may be of relevance for human type 2 diabetes. Cellular insulin resistance may be secondary to the diabetic state in vivo, e.g. via glucotoxicity. This is supported by our finding that insulin resistance in adipocytes from type 2 diabetes patients can be reversed after incubation at a physiological glucose level. Key words: adipocyte, insulin resistance, type 2 diabetes, insulin signalling, glucose uptake, insulin, glucose, dexamethasone, insulin receptor substrate, protein kinase B, GLUT4, lipoprotein lipase.
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