Changes in lung cancer incidence and mortality in Estonia were studied for 20 years (1968-87). A steady upward trend was observed for men and women. The 1983-87/1968-72 age-standardized incidence rate ratio was 1.22 (95% confidence interval (CI) 1.15-1.29) in men and 1.34 (95% CI 1.16-1.54) in women. The corresponding mortality rate ratio was 1.26 (95% CI 1.18-1.34) in men and 1.35 (95% CI 1.16-1.57) in women. The age-specific incidence and mortality rates increased clearly towards the younger birth cohorts. For men and women, the increase was most evident for the age group 45-64 years. In women there was a more rapid increase in incidence and mortality than in men. It may be a result of a substantial increase of tobacco smoking, particularly among women, after the World War II. The high and still rising occurrence of lung cancer is closely related to the high prevalence of smoking; in addition, high tar yields in domestic cigarettes could have been responsible for an elevated lung cancer risk during the past decades. There is not tobacco control programme in Estonia, and existing legislation and regulations do not defend the non-smoking population.

Aim: The aim of this paper is to provide a deeper understanding of the spread of NTDs but to also determine what is missing in the health interventions that are conducted in the countries affected by NTD.

Method and theory: The method used in this paper is the theory testing approach which is the Social Cognitive Theory. Development in the 1970s by A. Badura, it’s based on the concept of interaction between personal, environmental and social factors.

Results: The results showed that both the previous research and today’s health interventions lack the understanding of the roll social and personal factors play in the spread of NTD. They mainly target the environmental factors and medical. Therefore, the NTDs are still endemic despite the effort during many years.

Sweden has for many decades witnessed a decrease of the spread of tuberculosis (TB), but between the years of 2003-2012 a new pattern has emerged with refugees carrying TB entering the country and contributing to a situation where the infection has slowly begun to spread again. The communication between the refugees and the health professionals has been inefficient, which inevitably results in fewer refugees undergoing health examinations. This in turn can lead to an increase of infections and diseases.

The purpose of this study is to examine the current health communication between Swedish health professionals and immigrants, asylum seekers and refugees, and to give an overview of what type of health care currently exist for refugees with a high risk of TB. This is done to understand what is missing in the communication process, what has been done in order to improve the situation, and how it can be further improved in order to prevent TB. In order to fulfill the purpose of this study, a qualitative method has been used combining text analysis of interviews and secondary sources.

This study has shown based on the interviews and secondary sources that the Swedish prevention work regarding TB is developing positively in general, but the communication between newly arrived refugees, health professionals and authorities in Sweden is lacking due to the fact that most of what is written and said in this communication process is in Swedish. This makes it difficult for the refugees to understand what is communicated and is stated as one of the main reasons why many refugees do not undergo health examinations, combined with the lack of awareness. Therefore a better functioning health communication between refugees, authorities and health professionals is required to support refugees seeking health care, as well as co-operating with health professionals to prevent the spread of not only TB but other infections and diseases in Sweden.

Waterborne diseases are illnesses caused by microscopic organisms, like viruses, bacteria and  parasites, that transmitted via the fecal-oral route through ingestion of contaminated water or food or by direct person to person contact. The transmission cycle can be broken through safe water supplies, maintaining standards of sanitation and proper handwashing practices. Two waterborne diseases are considered in this study: hepatitis A and amebic dysentery. The study aimed to understand the important factors for preventing waterborne diseases in order to improve public health. A descriptive cross-sectional study was conducted to assess the effect of different drinking water sources, sewage systems and different active practices of soap use for hand washing on incidence of waterborne diseases in different regions in Saudi Arabia. Data was obtained from Ministry of Health and Household Environment Survey provided by General Authority for Statistics. Statistical analysis performed by using general linear model and type II Analysis of Variance. In comparison of different drinking water sources, this study showed borderline rise in incidence of waterborne diseases with the use of private well water. Whereas different sewage systems had no clear effect on the incidence of waterborne diseases. The study also revealed that not using soap for hand washing would increase the risk for hepatitis A infection. Moreover, the study showed significant decline in waterborne diseases incidence when access to filtered water combined with regular soap use in the same linear model.

OBJECTIVE: To describe the magnitude of socioeconomic inequalities in tuberculosis (TB) mortality by level of education in male, female, urban and rural populations in several European countries. DESIGN: Data were obtained from the Eurothine Project, covering 16 populations between 1990 and 2003. Age- and sex-standardised mortality rates, the relative index of inequality and the slope index of inequality were used to assess educational inequalities. RESULTS: The number of TB deaths reported was 8530, with a death rate of 3 per 100000 per year, of which 73% were males. Educational inequalities in TB mortality were present in all European populations. Inequalities in TB mortality were greater than in total mortality. Relative and absolute inequalities were large in Eastern European and Baltic countries but relatively small in Southern European countries and in Norway, Finland and Sweden. Inequalities in mortality were observed among both men and women, and in both rural and urban populations. CONCLUSIONS: Socio-economic inequalities in TB mortality exist in all European countries. Firm political commitment is required to reduce inequalities in the social determinants of TB incidence. Targeted public health measures are called for to improve access to treatment of vulnerable groups and thereby reduce TB mortality.

This paper uses secondary data analysis and a literature review to explore a “Swedish Dilemma”: Can Sweden continue to provide a high level of comprehensive health services for all regardless of ability to pay — a policy emphasizing “solidarity” — or must it decide to impose increasing constraints on health services spending and service delivery — a policy emphasizing “cost containment?” It examines recent policies and longer term trends including: changes in health personnel and facilities; integration of health and social services for older persons; introduction of competition among providers; cost sharing for patients; dismantling of dental insurance; decentralization of government responsibility; priority settings for treatment; and encouragement of the private sector. It is apparent that the Swedes have had considerable success in attaining cost containment — not primarily through “market mechanisms” but through government budget controls and service reduction. Further, it appears that equal access to care, or solidarity, may be adversely affected by some of the system changes.

Deliberate fire-setting, such as the crime of arson, can have devastating, even lethal, consequences. This study compared factors at the time of arson by female and male offenders in Sweden between 2000–2010. The women (n = 100), and men (n = 100) included in this study were randomly chosen from among all individuals who had been convicted for arson during this period and who underwent forensic psychiatric investigations. Information regarding psychiatric and somatic characteristics, their psychosocial situation, and whether they were in contact with health or social services before the arsons were examined. The results showed that both women and men have complex psychiatric and somatic characteristics, as well as psychosocial situations. Women showed more self-destructive behaviour, lower Global Assessment of Functioning scores, and had been in contact with psychiatric health services to a greater extent than men. More women than men had children. These findings suggest that specific actions may be needed for preventing and treating women compared with men at risk for committing arson. 

This study examines global incentives to reduce maternal mortality, namely the fifth Millenium Developmnet Goal to reduce maternal mortality with 75% by 2015. More specifically it examines maternal mortality and obstetric care in situations of emergency. When exposed to extreme situations the risks of negative pregnancy- and delivey outcomes are increased. Data was collected from seconday sources and from interviews with health staff with experiences from humanitarian work in the field. The findings were analyzed using a theoretical framework explaining maternal mortality be referring to both direct and indirect causes. The two theoretical models used in the study are similar and reminds of each other when explaining maternal mortality. One is based on the assumption that an obstetric complication has occurred and differnt delays in recieving care is the main cause maternal mortality, whilst the other theory is more in depth and elaborates the underlying causes. The first theory is used a base tto analyze the data after which the other theory is applied in order to introdue a deeper dimension to the analysis. The findings suggest that direct causes accounts for 80 per cent of all maternal deaths, homorrhage being the largest, including in disasters. Further causes are infections, unsafe abortions, eclampsia and obstructed labor. Also, underlying socail factors such as gender inequality indirectly has a negative impact on maternal mortality. Moreover, findings suggest that obstetric care is prioritized in disaster relief response.

Qualitative interviews are generally conducted in person. As the coronavirus pandemic (COVID-19) prevents in-person interviews, methodological studies which investigate the use of the telephone for persons with different illness experiences are needed. The aim was to explore experiences of the use of telephone during semi-structured research interviews, from the perspective of participants and researchers. Data were collected from mobile phone interviews with 32 individuals who had common mental disorders or multimorbidity which were analyzed thematically, as well as field notes reflecting researchers’ experiences. The findings reveal several advantages of conducting interviews using mobile phones: flexibility, balanced anonymity and power relations, as well as a positive effect on self-disclosure and emotional display (leading to less emotional work and social responsibility). Challenges included the loss of human encounter, intense listening, and worries about technology, as well as sounds or disturbances in the environment. However, the positive aspects of not seeing each other were regarded as more important. In addition, we present some strategies before, during, and after conducting telephone interviews. Telephone interviews can be a valuable first option for data collection, allowing more individuals to be given a fair opportunity to share their experiences.

Coordinators may play a key role during the return-to-work (RTW) process for people on sickness absence. There are still few studies on the newly implemented rehabilitation coordinators (RECO) within Swedish healthcare, and none focus on their competence. The aim of this study was to explore how persons with multimorbidity and psychosocial difficulties describe the professional competence of the RECO they encountered during their RTW process. The study takes a relational and practical approach in defining professional competence, including both what professionals do and what they possess. Interviews with 12 people with multimorbidity and psychosocial difficulties who had encountered a RECO during their RTW process were analysed using thematic analysis. Six different themes were found: communicative and coordinating skills; advisory and guidance skills; engagement and advocacy skills; being persistent and flexible; being empathic and therapeutic; being professional and trustworthy. Most of these are found in research on RTW coordinators, but being persistent, and having advisory, guidance, advocacy and therapeutic skills have not been recognised as important competences previously. This study adds patients’ views on important professional competence that support the RTW process, which should be regarded in further developments of RECOs’ functions and their competence descriptions.

OBJECTIVES: To assess to what extent educational differences in total life expectancy (TLE) and disability-free life expectancy (DFLE) could be reduced by improving fruit and vegetable consumption in ten European countries.

METHODS: Data from national census or registries with mortality follow-up, EU-SILC, and ESS were used in two scenarios to calculate the impact: the upward levelling scenario (exposure in low educated equals exposure in high educated) and the elimination scenario (no exposure in both groups). Results are estimated for men and women between ages 35 and 79 years.

RESULTS: Varying by country, upward levelling reduced inequalities in DFLE by 0.1-1.1 years (1-10%) in males, and by 0.0-1.3 years (0-18%) in females. Eliminating exposure reduced inequalities in DFLE between 0.6 and 1.7 years for males (6-15%), and between 0.1 years and 1.8 years for females (3-20%).

CONCLUSIONS: Upward levelling of fruit and vegetable consumption would have a small, positive effect on both TLE and DFLE, and could potentially reduce inequalities in TLE and DFLE.

OBJECTIVES: A considerable increase in social inequalities in mortality was observed in Eastern Europe during the post-communist transition. This study evaluated the contribution of avoidable causes of death to the difference in life expectancy between Estonians and non-Estonians in Estonia.

STUDY DESIGN: Descriptive study.

METHODS: Temporary life expectancy (TLE) was calculated for Estonian and non-Estonian men and women aged 0-74 years in 2005-2007. The ethnic TLE gap was decomposed by age and cause of death (classified as preventable or treatable).

RESULTS: The TLE of non-Estonian men was 3.53 years less than that of Estonian men, and the TLE of non-Estonian women was 1.36 years less than that of Estonian women. Preventable causes of death contributed 2.19 years to the gap for men and 0.78 years to the gap for women, while treatable causes contributed 0.67 and 0.33 years, respectively. Cardiorespiratory conditions were the major treatable causes of death, with ischaemic heart disease alone contributing 0.29 and 0.08 years to the gap for men and women, respectively. Conditions related to alcohol and substance use represented the largest proportion of preventable causes of death.

CONCLUSIONS: Inequalities in health behaviours underlie the ethnic TLE gap in Estonia, rather than inequalities in access to health care or the quality of health care. Public health interventions should prioritize primary prevention aimed at alcohol and substance use, and should be implemented in conjunction with wider social policy measures.

AIMS: To analyse the independent effects of age, period and cohort on estimated daily alcohol consumption in Estonia.

METHODS: This study used data from nationally representative repeated cross-sectional surveys from 1996 to 2018 and included 11,717 men and 16,513 women aged 16-64 years in total. The dependent variables were consumption of total alcohol and consumption by types of beverages (beer, wine and strong liquor) presented as average daily consumption in grams of absolute alcohol. Mixed-effects negative binomial models stratified by sex were used for age-period-cohort analysis.

RESULTS: Alcohol consumption was highest at ages 20-29 years for both men and women and declined in older ages. Significant period effects were found indicating that total alcohol consumption and consumption of different types of beverages had increased significantly since the 1990s for both men and women. Cohort trends differed for men and women. Men born in the 1990-2000s had significantly lower daily consumption compared to earlier cohorts, whereas the opposite was found for women.

CONCLUSION: While age-related patterns of alcohol consumption are aligned with life course stages, alcohol use has increased over the study period. Although the total daily consumption among men is nearly four times higher than among women, the cohort trends suggest convergence of alcohol consumption patterns for men and women.

Hepatitis C virus (HCV) affects up to 45,000 people in Sweden today. Although it is a very treatable disease, the prevalence of HCV is extremely high within the population of people who inject drugs (PWID). This study examines the direct effect of needle exchange programs (NEPs) on HCV rates in Sweden. Previous research has shown that NEPs reduce the transmission of other blood-borne diseases among PWID. Using an interrupted time series (ITS) analysis, this study investigates if there are statistically significant differences between HCV rates in Swedish counties before and after the implementation of NEPs. The study also investigates via linear regression to see if there is a relationship between sterile injecting equipment (needles and syringes) dispensed and HCV rates in the counties where NEPs exist. While there has been a steady decrease in HCV rates across the country as a whole, the ITS analyses show no statistically significant differences in HCV rates due to the opening of NEPs. Because of the relatively recent introduction of NEPs in Sweden, more data points post-intervention may be needed before we can truly see the effect they have on regional HCV rates. There is also no relationship between the number of needles and syringes dispensed and county HCV rates. However, Sweden falls far short of the 300 syringes/needles per user per year recommendation of the World Health Organization at this time. Standardized data collection and further research can help answer these questions more clearly. 

The hypotheses of this study are that reduction and rational usage of antibiotics reduces development of antibiotic resistance. In Sweden, the trends do not follow this pattern. Despite a decrease in prescriptions of antibiotics, there is an increase in the number of patients infected with Methicillin-resistant Staphylococcus Aureus (MRSA), Extended Spectrum Beta-Lactamases (ESBL) and ESBL selecting for carbapenem-resistance (ESBLCARBA). This study aims to study factors affecting antibiotic resistance management. An additional aim is to use a multidisciplinary approach for a subject that has mostly been studied with quantitative methods. First, linear regressions investigated any possible significant changes of prescription rates in outpatient care, hospital usage of antibiotic groups and antibiotic resistance. After this, nine interviews were conducted with physicians in outpatient care, hospital care and with representatives from the Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (Strama), a network working for Swedish prevention against antibiotics resistance. There was a significant decrease in the number of prescriptions of antibiotics in outpatient care among all Swedish counties and a small, but significant increase of antibiotics used in hospitals. The number of patients infected with multidrug resistant bacteria also show a significant increase. The interviews revealed that health care workers in all counties follow the same guidelines and try to be as specific as possible in choosing antibiotics to hit specific bacteria. The respondents suggested migration and extended travelling as explanations to the growing number of cases of multidrug resistant bacteria. Further, two major factors emerged as important for an efficient antibiotic resistance management; Education/knowledge and Discussion. The results indicate a need for further research on rational usage of antibiotics and the use of broad-spectrum antibiotics in hospital care, rather than the reduction through prescriptions. The results indicate that rational usage has a bigger impact than reduction. Using a multidisciplinary approach gave a broader perspective on the issue and future studies should see the possibilities of mixing quantitative and qualitative studies.

Background: Receiving support from a return-to-work (RTW) coordinator (RTWC) may be beneficial for people on long-term sick leave. The aim of this study was to investigate whether the number of contacts with an RTWC and their involvement in designing rehabilitation plans for the patients were associated with perceiving support for RTW, emotional response to the RTWC, and healthcare utilization. Methods: In this cross-sectional study, 274 patients who had recently been in contact with an RTWC in Swedish primary or psychiatric care answered questions regarding their interaction with an RTWC, perceived support for RTW, and emotional response to the RTWC. Results: Having more contact with an RTWC was associated with perceiving more support in the RTW process (adjusted OR 4.14, 95% CI 1.49–11.47). RTWC involvement in designing a rehabilitation plan for the patient was associated with perceiving more support in the RTW process from an RTWC and having a more positive emotional response to the RTWC. Conclusions: From the patient’s perspective, this study indicates that the involvement of an RTWC and receiving a rehabilitation plan that an RTWC has helped to design might be perceived as important in the RTW process.

Purpose: Return-to-work coordinators (RTWCs) give people on sick leave individualized support and coordinate between different stakeholders, including physicians.  The aim of this study was to explore physicians’ experience of RTWCs and investigate factors that influence how much physicians collaborate with RTWCs, or refer patients to them, in primary, orthopaedic, and psychiatric care clinics.

Materials and methods: Of the 1229 physicians responding to a questionnaire, 629 physicians who had access to a RTWC in their clinic answered to questions about collaborating with RTWCs.

Results: Among physicians who had access to a RTWC, 29.0% collaborated with a RTWC at least once a week. Physicians with a more favourable experience of RtWcs reported more frequent collaboration (adjusted OR 2.92, 95% CI 2.06–4.15). Physicians also collaborated more often with RTWCs if they reported to often deal with problematic sick-leave cases, patients with multiple diagnoses affecting work ability, and conflicts with patients over sickness certification.

Conclusions: Physicians who had more problematic sick-leave cases to handle and a favourable experience of RTWCs, also reported collaborating more often with RTWCs. The results indicate that RTWCs’ facilitation of contacts with RtW stakeholders and improvements in the sickness certification process may be of importance for physicians.

Introduction In order to foster innovation of medical devices within the healthcare sector, a collaboration project, PUSH, has been initiated including the hospitals managed by the Stockholm County Council. The collaboration aims to capture ideas from employees and turn them into so called “high-practice” products as well as facilitate the possibilities for medical device companies to try out their products in the settings of healthcare. Collaborations for innovation, comparable to the PUSH project, can be found in both Swedish and foreign regions, but some of them fail to survive due to obstacles affecting the progress of each collaboration. Avoiding the same destiny will be a challenge to the PUSH project.

Purpose The purpose is to search for factors affecting organizational collaboration concerning innovation systems for medical device development. The study is focusing on ”high-practice” products within the PUSH project.

Theoretical approach In order to emphasize factors affecting innovation, theories regarding innovation systems, clusters and networks has been studied hence they  all concern organizational collaboration.

Method The study’s qualitative approach is based on a semi deductive method. The analysis derives from a deductive outlook consistent with chosen theories, whereas collected data is used inductively to stress and enlarge part of the theoretical framework. Semi structured interviews, earlier research and evaluations constitutes most of the collected data.

Results and analysis Experience from collaborations for innovation shows that some affecting factors can’t be influenced by collaborators, as political decisions and medical device directives. Collaborators can however affect circumstances such as connections and networking, which is significant to manage the innovation process; from idea to commercialization. An explicit focus on commercialization is important to the collaboration project’s surviving opportunities. A central cause why innovation projects don’t last is lack of funding, both for commercializing certain products as well as for retaining and developing existing innovation structures.

Conclusion Collaborating projects should utilize existing structures and complement their networks to involve extensive competency. Decision makers need to decide whether innovation ventures shall be part of the County Council’s assignment. To fulfil the visions of the collaboration project, a policy common to all participants in the forthcoming innovation project needs to be stated, regarding ownership relations, risk sharing, funding and sharing of profits.

The purpose is to study the demand for a testbed for telemedicine and to analyze the medical device-developing companies’ requirements on the testbed’s facilities when collaborating with the healthcare sector in their product development. The study’s aim is to result in a commercialization plan for Karolinska Testbed for telemedicine and eHealth, at the department of Biomedical Engineering at Karolinska University Hospital. During the study, 19 interviews and 6 telephone-interviews has been held with people from the medical device industry, hospitals, potential funders and collaboration structures which foster medical device development. A web-survey has been sent to 279 companies within the fields of medical technologies, IT and telecom, to quantify the results from the interviews.

The study describes how the clinical research on medical technologies has changed over the last decades and what the situation is like today. Present and forthcoming challenges to the Swedish health care system is presented, like demographic changes, increasing healthcare-costs, expensive treatments and the scarcity of medical device innovations being commercialized. Obstacles affecting the medical device development are studied, including the regulatory differences between IT and medical devices. An analysis of the research on product and service development is also looked at from the perspectives on how the medical device companies develop their products, which is derived from both interviews and the web-survey.

The result shows that medical device companies rely upon the ability to collaborate with the hospitals in different phases of their product development process and that there is an extensive need for a testbed structure amongst companies. The companies that collaborate with hospitals do it primarily because it makes their products more adaptive to functioning in the settings of healthcare, time to market and development costs can be decreased and it facilitates the process when validating the functionality of their products. Several companies have their ways of collaborating with hospital wards whilst others explicitly lack indispensable collaboration structures. The study has identified some companies which have shown interest in collaborating with Testbed Karolinska for telemedicine and eHealth and other ones whom wish to receive more information on what the testbed can offer them. In the commercialization plan it is suggested that Karolinska Testbed for telemedicine and eHealth shall focus on their niche and elaborate the competency which the companies doesn’t have. It is also suggested that the Testbed continues the work with developing the internal organization within Karolinska to enable efficient, flexible and qualitative collaboration between companies and the clinics at Karolinska University Hospital.

Strong political neoliberal currents in Sweden are directing attention toward communities’ responsibility to address local issues, particularly in disadvantaged areas. In parallel, community sports clubs in Sweden have gained strong traction as being sites where social issues can be addressed. In Swedish disadvantaged areas, where infrastructure is of poor quality, these clubs can be an important addition to statutory interventions, but they need to be further explored in terms of strategic pathways and conditions. Community sports have only recently been conceptualized with Chaskin’s capacity-building concept. In this paper, I seek to further stimulate this line of inquiry. By using material from two interrelated projects with informants in the sports movement, I show how sports clubs use multiple strategies according to three of Chaskin’s proposed strategies: leadership development, organizational development, and inter-organizational collaboration. By outlining an empirically dense illustration, this paper contributes to the research on sports clubs and their role in the community and provides suggestions on how strategical assessments must include how associations develop strategies online.

Experiences of, and access and barriers to, physical activity (PA) differ between individuals. This becomes perpetuated in a migration context. Although there is super-diversity between migrant groups, health research rarely accounts for this cultural diversity. More concerningly, the matter of context is rarely scrutinized or juxtaposed with the specifics of certain ethnic groups. This integrative review assessed the evidence on post-socialist migrants’ PA levels, constraints, and enablers for PA in the Nordic region. The results show that post-socialist female migrants have an especially high risk of being physically inactive. The qualitative work elucidates socio-cultural factors that impose specific constraints on females when attempting to engage in PA. Furthermore, in scrutinizing the context, Nordic nature (Friluftsliv) is a viable way for migrants to access PA with additional health benefits (e.g., mental). However, the Nordic environment also poses specific PA challenges, such as harsh winters. This can be understood by considering post-socialist migrants’ prior use of, and attitude to, nature. The review highlights the importance of understanding specifics about both migrant groups and contexts through a critical-realist lens in the pursuit of providing PA opportunities. Future PA programs need to understand the contextual, sociohistorical, and cultural settings in which they and migrants are embedded.

Research Question: The war in Ukraine has forced approximately eight million people into neighboring European countries. As part of sports clubs’ societal commitment, many have received Ukrainian refugees. However, compared to previous so-called ‘refugee waves’, forced migration from Ukraine is different in terms of demographics, culture, and (sports) traditions. This paper aimed to assess these ‘new’ nuances and their implications for the European sports movement. Research Methods: Data were gathered through 17 semi-structured interviews with Swedish sports club representatives, analyzed with a critical realist-inspired thematic analysis, and interpreted with Bronfenbrenner’s process-person-context-time framework. Results and Findings: The representatives expressed that Ukrainian refugees are more in-tune with organized sports compared to other refugee populations; however, there are also culturally discrepant ideas about sports. Specifically, there seems to be an influx of skilled (youth) refugees, who approach sports in ways incompatible with Swedish conventions about youth sports. While the sporting capital often enables easier inclusion, it also presents challenges in extreme cases. Implications: The findings show that the European sports movement must be attentive to new challenges and opportunities associated with the current humanitarian crisis. Sports representatives need to balance culturally sensitive approaches with ethical considerations regarding youth sports. 

This paper introduces a model that explains psychosocial development by embedding the developmental concept of rough-and-tumble play (RTP) into the contextual settings of martial arts (MA). Current sport-for-change literature relies on theories that address contextual factors surrounding sport but agrees that sport in itself does not facilitate developmental outcomes. In contemporary times where western societies invest substantial resources in sport programs for their psychosocial contribution, this becomes problematic. If the contextual factors surrounding sport are exclusively what produce developmental outcomes, what is the rationale for investing resources in sport specifically? We challenge this idea and argue that although contextual factors are important to any social phenomena, the developmental outcomes from sport can also be traced to the corporeal domain in sport. To date, we have lacked the theoretical lenses to articulate this. The developmental concept of RTP emphasizes how "play fighting" between consenting parties stimulates psychosocial growth through its demand for self-regulation and control when "play fighting" with peers. In short, RTP demands that individuals maintain a self-regulated mode of fighting and is contingent on a give-and-take relationship to maintain enjoyment. RTP can thus foster empathy and prosocial behavior and has strong social bonding implications. However, such play can also escalate. A fitting setting to be considered as moderated RTP is MA because of its resemblance to RTP, and its inherent philosophical features, which emphasizes self-regulation, empathy, and prosocial behavior. This paper outlines what constitutes high-quality RTP in a MA context and how this relates to developmental outcomes. By doing so, we present a practitioner's framework in which practitioners, social workers, and physical educators can explain how MA, and not merely contextual factors, contributes toward developmental outcomes. In a time where sport is becoming increasingly politicized and used as a social intervention, it too becomes imperative to account for why sport, and in this case, MA, is suitable to such ends.

The purpose of this study is to examine how the effects of commercialisation impact the management of sports organizations. Additionally, the study aims to investigate how sports organizations handle commercialisation to ensure a sustainable balance between the market logic and safe sports for children. Neo -institutional theory, and its various components, have been used as a theoretical lens to answer these research questions. The study was conducted using a deductive, qualitative method, and the questions for the semi-structured interviews were designed and analysed with the help of neo-institutional theory.

The results and analysis show that commercialisation primarily affects the management of sports organizations through increased professionalisation. To manage commercialisation and maintain a sustainable balance between market logic and safe sports for children, sports organizations work on educating employees, coaches, and parents. They establish guidelines and ensure compliance, focusing on a proactive approach to prevent infringement. Within the organizations, there is an ongoing dialogue to integrate these guidelines into the organization. The results also highlight the importance of understanding the individual needs of athletes so that sports activities can be conducted on their terms. A long-term perspective on sports participation is also emphasised as important for sustainability.

BACKGROUND: At the end of the 19th century, infant mortality was high in urban and rural areas in Sweden. In Stockholm, the mortality rate was particularly high among foster children. This study addresses the importance for health of targeted public policies and their local implementation in the reduction of excess mortality among foster children in Stockholm at the turn of the 19th century. In response to public concern, a law was passed in 1902 on inspections of foster homes. Stockholm city employed a handful of inspectors who visited foster homes and advised parents on child care and feeding. METHODS: Analysis of historical records from the City of Stockholm was combined with epidemiological analysis of mortality rates and hazard ratios on individual-level data for 112 746 children aged <1 year residing in one part of Stockholm between 1878 and 1925. Hazard ratios of mortality were calculated using Cox' regression analysis. RESULTS: Mortality rates of foster infants exceeded 300/1000 before 1903. Ten years later the mortality rates among foster children had declined and were similar to other children born in and out of wedlock. Historical accounts and epidemiological analysis of individual-level data over a longer time period showed similar results. CONCLUSIONS: Targeted policy measures to foster children may have potentiated the positive health effects of other universal policies, such as improved living conditions, clean water and sanitation for the whole population in the city, contributing to an equalization of mortality rates between different groups.

Study objective: To investigate whether the income distribution in a Russian region has a "contextual" effect on individuals' self rated health, and whether the regional income distributions are related to regional health differences. Methods: The Russia longitudinal monitoring survey (RLMS) is a survey (n = 7696) that is representative of the Russian population. With multilevel regressions both individual as well as contextual effects on self rated health were estimated. Main results: The effect of income inequality is not negative on men's self rated health as long as the level of inequality is not very great. When inequality levels are high, however, there is a tendency for men's health to be negatively affected. Regional health differences among men are in part explained by regional income differences. On the other hand, women do not seem to be affected in the same way, and individual characteristics like age and educational level seem to be more important. Conclusions: It seems that a rise in income inequality has no negative effect on men's self rated health as long as the level of inequality is not very great. On the other hand, when inequality levels are higher a rise tends to affect men's health negatively. A curvilinear relation between self rated health and income distribution is an interesting hypothesis. It could help to explain the confusing results that arise when you look at countries with a high degree of income inequality (USA) and those with lower income inequality (for example, Japan and New Zealand).

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide. MATERIALS AND METHODS: We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients. RESULTS: Patients infected with COVID-19 have high amounts of IL-1 beta, IFN-gamma, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed. CONCLUSIONS: COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.

Legislation on benefit sharing dates back to 1992 and the commandment of the UNConvention on Biological Diversity, hence implementation still has few cases to fall back on(CBD, 1992). The case study of the project ProBenefit presented by the thesis highlights howlack of deliberation can undermine a democratic process. The objective of the thesis is thatProBenefit’s attempt to implement the standards of the CBD on access and benefit sharingwill highlight not only problems met by this specific project, but difficulties that generallymeet democratic processes in contexts of high inequality. To define if the project ProBenefitsucceeded in carrying out a deliberative process the project will be analyzed by the criteria:access to information, representation, legitimacy and involvement.The population in the project area of ProBenefit had a long history of social marginalization,which made it hard for foreign projects to gain legitimacy. The lack of independentorganizations and the late establishment of the project, which resulted in time shortage, madeit impossible to prevent the distrust of the local population. The failure of the projectcoordinators to ensure active participation of all stakeholders resulted in a late and lowinvolvement of the local participants. The absence of independent organization also madedemocratic legitimacy of the process questionable. Even if ProBenefit had a vision ofdemocratic deliberation the project was unable to break down the prevailing unequal powerdistribution which resulted in an unsustainable process and failure. The conclusion of thethesis is that the attainment of deliberation foremost depends on how a project deals with theexisting distribution of power and how it succeeds in involving all stakeholders.

Abortion stigma, while observable as a global phenomenon, is constructed locally through various pathways and institutions, and at the intersection of transnational and local discourses. Stigmatisation of abortion has been challenged in varied ways by pro-choice adherents. This article investigates strategies for identifying and opposing stigmatisation of abortion in Ireland and Poland, focusing on campaigns aimed in one context, at repealing a near total prohibition of abortion, and in another, on resisting further restrictions concerning reproductive rights. We examine how mobilisation on sexual and reproductive health (SRH) in both contexts worked to address stigma and discrimination in SRH, drawing on the concept of framing and showing similarities between these two national contexts. Our analysis explains how the logic of inclusion and exclusion works in efforts at destigmatising abortion.

Background: On 1 January 2020, the UNCRC was incorporated into the Swedish national law. The Convention argues that all children have the right to health, life, survival and development. The Articles of the UNCRC require higher authorities, health facilities and parents to act in the best interest of children, and to do everything to secure children’s rights. Interpreting the Convention, it is possible to conclude that all children have the right to safe and effective vaccines. Even though vaccines are accessible and free of charge to all children in Sweden, vaccination coverage for multiple vaccine-preventable diseases in Sweden has dropped. As one of the reasons for this drop in vaccination coverage is proposed vaccination hesitancy. To fulfil children’s rights as proposed in the UNCRC, vaccination hesitancy needs to be understood and addressed. 

Aim: The objective of the study is to understand causes of vaccination hesitancy among parents living in Stockholm, Sweden and to examine how healthcare professionals in Stockholm County are working to eliminate vaccination hesitancy, in goal to promote children’s rights to health, life, survival and development after the UNCRC became a Swedish law on 1 January 2020. Additionally, to analyze if strategies applied by Stockholm County are truly addressing identified causes of vaccination hesitancy among parents living in Stockholm, Sweden and in that way increasing vaccination rates this year.

Method: This study used a qualitative research strategy. Vaccination hesitancy in Sweden was studied using 20 semi-structured interviews with parents living in Stockholm, while effect of the UNCRC incorporation into Swedish law on vaccination hesitancy was studied using a semi-structured interview with one health professional working in Stockholm County. The gathered data was summarized, categorized and analyzed according to the proposed themes of two theories. The theoretical framework consisted of the Health Belief Model and Social-Ecological Model.

Conclusion: It was possible to conclude that the choice of immunization among parents is shaped by; 1) sources and type of the received information on vaccines, vaccination and vaccine-preventable diseases included in the general Swedish child vaccination program, 2) their views on vaccine quality, safety, effectiveness and necessity for satisfying children’s rights to health, life, survival and development, 3) the level of knowledge of epidemiological concepts, mechanisms, infectious diseases and vaccines included in the vaccination program, and 4) the level of trust in the Swedish Government and healthcare, and belief if they are acting in the best interest of children. After the UNCRC incorporation into Swedish law, there have not been observed any changes in the strategic work of Stockholm County against vaccination hesitancy. For the past ten years, they are applying methods at the individual- and interpersonal level, which are not quite reaching vaccine hesitant parents living in Stockholm. Other methods at the community- and public policy level are needed. Due to unclear implications of the UNCRC entrance as a national law and COVID-19 pandemic, it is not possible to estimate if there are any changes in the vaccination rates this year.

The aim of this study was to investigate how district nurses work with their emotions and how they experience their discretion and stress in the workplace. To answer the study's purpose and questions, a qualitative method was used in the form of six semi-structured interviews with district nurses. The study is based on theories of emotional work and street-levelbureaucracy.

The study results show that the district nurses organize their emotions in a number of different ways and through different strategies, such as through deep and superficial emotional action. The most common strategies that are used by district nurses to manage their emotions are both mental and work-related management systems. Furthermore, the results show that the districtnurses experience a large discretion when performing a medical assessment and when prioritizing patient visits. Furthermore, the results show that the district nurses' discretion isnot limited by regulations, but it is the lack of time that limits their room for discretion andwhich leads to stress experiences. This problem is addressed by all district nurses through theuse of different management systems.

OBJECTIVE: To assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe.

METHODS: In this prospective registry-based study, we determined changes in cardiovascular mortality between the 1990s and the early 2010s in 12 European populations by gender, educational level and occupational class. In order to quantify changes in the magnitude of differences in mortality, we calculated both ratio measures of relative inequalities and difference measures of absolute inequalities.

RESULTS: Cardiovascular mortality has declined rapidly among lower and higher socioeconomic groups. Relative declines (%) were faster among higher socioeconomic groups; absolute declines (deaths per 100 000 person-years) were almost uniformly larger among lower socioeconomic groups. Therefore, although relative inequalities increased over time, absolute inequalities often declined substantially on all measures used. Similar trends were seen for ischaemic heart disease and cerebrovascular disease mortality separately. Best performer was England and Wales, which combined large declines in cardiovascular mortality with large reductions in absolute inequalities and stability in relative inequalities in both genders. In the early 2010s, inequalities in cardiovascular mortality were smallest in Southern Europe, of intermediate magnitude in Northern and Western Europe and largest in Central-Eastern European and Baltic countries.

CONCLUSIONS: Lower socioeconomic groups have experienced remarkable declines in cardiovascular mortality rates over the last 25 years, and trends in inequalities can be qualified as favourable overall. Nevertheless, further reducing inequalities remains an important challenge for European health systems and policies.

Cochlear implant technology was initially designed to promote reception of speech sounds; however, music enjoyment remains a challenge. Music is an influential ingredient in our well-being, playing an important role in our cognitive, physical and social development. For many cochlear implant recipients it is not feasible to communicate how sounds are perceived, and consequently the benefits of music listening may be reduced. Non-speech sounds may also be important to persons with multiple functional deficits that relay on information additional to verbatim for participating in communication. Deaf-born children with multiple functional deficits constitute a special vulnerable group as lack of reaction to sound often is discouraging to caregivers. Individually adapted tools and methods for sound awareness may promote exploration and appreciation of the information mediated by the implant. Two current works involving habilitation through sound production and music will be discussed. First, the results from a pilot study aiming at finding musical toys that can be adapted to help children explore their hearing with engaging sounds and expressive interfaces will be presented. The findings indicate that children with multiple functional deficits can be more inclined to use the auditory channel for communication and play than the caregivers would anticipate. Second, the results of a recent questionnaire study, which compared the music exposure and appreciation of preschool cochlear implant recipients with their normally hearing peers will be presented. The data from this study indicate that preschool children with cochlear implants spend roughly the same amount of time interacting with musical instruments at home and watching television programmes and DVDs which include music. However, the data indicate that these children receive less exposure to recorded music without visual stimuli and show less sophisticated responses to music. The provision and supported use of habilitation materials which encourage interaction with music might therefore be beneficial.

Background: The stressful and complex nature of police work and its adverse effects on mental health are well-documented in police research. The mental health of police students however, has not been given the same attention. To the best of our knowledge, studies on the mental health of Swedish police recruits have not been undertaken since 2010.

Objectives: The present study aims to examine whether there are differences in the mental health between two cohorts (2009 and 2020) of Swedish police recruits, as well as to compare the mental health of both cohorts with the general population data collected in 2002.

Methods: Data was collected using the SCL-90-R survey. Data was analyzed using multivariate analysis of variance (MANOVA) and independent sample T-tests. Bi-variate analyses including t-test and chi-square were used to examine differences in sociodemographic variables between the two cohorts.

Results: A total of 376 police recruits participated in the study. Results indicated no significant differences between the cohorts with regards to the three global indices of the SCL-90-R: Global Severity Index (GSI), Positive Symptom Total (PST), and Positive Symptom Distress Index (PSDI). Recruits with a college degree had lower scores on GSI and PSDI, similar to respondents that where in a relationship vs. singles. A total of 15 (four female) recruits had GSI scores above the Swedish patient mean. Compared with the general population, males and females from the 2009, as well as females from the 2020 cohorts had lower or insignificantly different mean scores on all global indices, with males from the 2020 cohort having a significantly lower PST score.

Conclusions: While the vast majority of recruits had results that where indicative of a low prevalence and intensity with regards to mental health disorders, some recruits did score above the Swedish patient mean. While mental preparedness is part of the curriculum for Swedish police recruits, interventions targeting the stigmas of poor mental health could be of value. The fact that educational attainment appears to have a positive impact on the mental health of police recruits, could be taken in to consideration when recruiting future police officers.

We interviewed 20 adolescents who were coercively placed in residential or psychiatric care. The aim was to explore their views on the way staff relate and perform their duties, favorable characteristics in staff, consequences of different treatment from staff and their safety experiences. Thematic analysis identified the following themes: Situational triggers of frustration; Care-based; rule-based; or passive-avoidant interaction styles toward adolescents and their responses; Adolescents' reflections about staff's interaction styles; and the Consequences on the unit atmosphere depending on different interaction styles toward the adolescents. Adolescents preferred staff who showed them respect and a clear wish to make life easier.

In Europe, educational attainment and diabetes are inversely related, in terms of both morbidity and mortality rates. This underlines the importance of targeting interventions towards low SEP groups. Access and use of healthcare services by people with diabetes also need to be improved.

Countries of the Baltic Sea region differ strongly with regard to the magnitude and pattern of the educational inequalities in cancer mortality.

This study investigates empirically how natural snow depth affects the number of downhill skiers. Data include the number of skier visits for the 32 largest ski resorts in Sweden from the 1998/1999 to the 2018/2019 seasons. Results of spatial dynamic estimations show that an increase in natural snow depth in the ski area has a significant negative impact on the number of skier visits in the short term, although the magnitude is small. This implies that a snow deficit leads to increased demand for downhill skiing both directly and indirectly (in the neighbouring areas). The variable snow depth in the neighbouring ski areas is not significantly different from zero, indicating that no spatial substitution takes place. There is, however, a strong positive relationship between skier visits to neighbouring areas, revealing that ski resorts are complements rather than substitutes. The long-term influence of snow depth is not significant, implying that the ski business is independent of variations in snow depth. Instead, the number of skier visits is mainly determined by past visits, revealing a high degree of persistence.

The specific health benefits achieved from different formsand patterns of leisure-time physical activity are not established.We analyzed the mortality in a cohort of Swedishgolf players. We used the Swedish Golf Federation’s membershipregistry and the nationwide Mortality Registry. Wecalculated standardized mortality ratios (SMR) with stratificationfor age, sex, and socioeconomic status. The cohortincluded 300 818 golfers, and the total number of deaths was1053. The overall SMR was 0.60 [95% confidence intervals(CIs): 0.57–0.64]. The mortality reduction was observed inmen and women, in all age groups, and in all socioeconomiccategories. Golfers with the lowest handicap (the mostskilled players) had the lowest mortality; SMR50.53(95% CI: 0.41–0.67) compared with 0.68 (95% CI: 0.61–0.75) for those with the highest handicap. While we cannotconclude with certainty that all the 40% decreased mortalityrates are explained by the physical activity associatedwith playing golf, we conclude that most likely this is part ofthe explanation. To put the observed mortality reduction incontext, it may be noted that a 40% reduction of mortalityrates corresponds to an increase in life expectancy of about5 years.