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På senare år har skolfrånvaro blivit en allt större problematik som uppmärksammats genom olika rapporter. Vår studies syfte är att bidra med ökade kunskaper utifrån åtta specialpedagogers syn på orsaker och insatser när det gäller oroväckande frånvaro samt utveckling för att främja närvaro. Våra frågeställningar lyder: Hur beskriver specialpedagogerna orsakerna till oroväckande frånvaro? Hur beskriver specialpedagoger insatser kring elever i oroväckande frånvaro på sina respektive gymnasieskolor? Vilka insatser är enligt specialpedagogerna önskvärda för att utveckla verksamheten kring att främja närvaro? I vår intervjustudie framkommer att orsaker till oroväckande frånvaro främst ses ur ett kompensatoriskt perspektiv, vilket gör att eleven blir bärare av problematiken. Vi utläser två huvudsakliga kategorier som kompensatoriska förklaringsmodeller, nämligen bristförklaringar och psykologiska förklaringar. Studien pekar på vikten av att fånga upp oroväckande frånvaro tidigt. Tidigare insatser, kontaktpersoner och samverkan är exempel på hur specialpedagoger vill utveckla verksamheten för att främja närvaro. Det är ur ett dilemmaperspektiv vi relaterar problematiken som är komplex. Det finns inte någon enkel generell lösning utan insatser är unika och krävs på både på individ-, grupp- och organisationsnivå. Skolans verksamhet behöver arbeta främjande genom att skapa en lärmiljö som bygger på framgångsfaktorer och innefattar det som behövs för att alla ska må bra och utvecklas mot målen.

Aims Epidemiological evidence indicates a protective effect of light to moderate alcohol consumption compared to non-drinking and heavy drinking. Although several mechanisms have been suggested, the effect of alcohol on atherosclerotic changes in vessel walls is unclear. Therefore, we explored the relationship between alcohol consumption and common carotid intima media thickness, a marker of early atherosclerosis in the general population. Methods Individual participant data from eight cohorts, involving 37,494 individuals from the USE-IMT collaboration were used. Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) with alcohol consumption. Results The mean age was 57.9 years (SD 8.6) and the mean CIMT was 0.75 mm (SD 0.177). About, 40.5% reported no alcohol consumed, and among those who drank, mean consumption was 13.3 g per day (SD 16.4). Those consuming no alcohol or a very small amount (10 g per day, after adjusting for a range of confounding factors. Conclusion In this large CIMT consortium, we did not find evidence to support a protective effect of alcohol on CIMT.

Background For an individual participant data (IPD) meta-analysis, multiple datasets must be transformed in a consistent format, e.g. using uniform variable names. When large numbers of datasets have to be processed, this can be a time-consuming and error-prone task. Automated or semi-automated identification of variables can help to reduce the workload and improve the data quality. For semi-automation high sensitivity in the recognition of matching variables is particularly important, because it allows creating software which for a target variable presents a choice of source variables, from which a user can choose the matching one, with only low risk of having missed a correct source variable. Methods For each variable in a set of target variables, a number of simple rules were manually created. With logic regression, an optimal Boolean combination of these rules was searched for every target variable, using a random subset of a large database of epidemiological and clinical cohort data (construction subset). In a second subset of this database (validation subset), this optimal combination rules were validated. Results In the construction sample, 41 target variables were allocated on average with a positive predictive value (PPV) of 34%, and a negative predictive value (NPV) of 95%. In the validation sample, PPV was 33%, whereas NPV remained at 94%. In the construction sample, PPV was 50% or less in 63% of all variables, in the validation sample in 71% of all variables. Conclusions We demonstrated that the application of logic regression in a complex data management task in large epidemiological IPD meta-analyses is feasible. However, the performance of the algorithm is poor, which may require backup strategies.

Aims Epidemiological evidence indicates a protective effect of light to moderate alcohol consumption compared to non-drinking and heavy drinking. Although several mechanisms have been suggested, the effect of alcohol on atherosclerotic changes in vessel walls is unclear. Therefore, we explored the relationship between alcohol consumption and common carotid intima media thickness, a marker of early atherosclerosis in the general population. Methods Individual participant data from eight cohorts, involving 37,494 individuals from the USE-IMT collaboration were used. Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) with alcohol consumption. Results The mean age was 57.9 years (SD 8.6) and the mean CIMT was 0.75 mm (SD 0.177). About, 40.5% reported no alcohol consumed, and among those who drank, mean consumption was 13.3 g per day (SD 16.4). Those consuming no alcohol or a very small amount (10 g per day, after adjusting for a range of confounding factors. Conclusion In this large CIMT consortium, we did not find evidence to support a protective effect of alcohol on CIMT., published version, peerReviewed

Clinical characteristics of participants not included in the analysis due to missing blood samples. Table S2. Multivariate linear regression models of the effect of different treatment regimes on the change in fasting levels of hs-GH over 12 months in BCAPS. Adjusted for LDL-C at baseline and at 12 months. (DOCX 16 kb)

Estimated regression coefficients (95 % confidence intervals (CI)) for the association between cyber harassment, parental/friend support, and subjective health complaints (SHC) among 9th grade girls in Sweden, additionally adjusted for traditional bullying victimization. (DOC 17 kb)

Estimated regression coefficients (95 % confidence intervals (CI)) for the association between cyber harassment, parental/friend support, and subjective health complaints (SHC) among 9th grade boys in Sweden, additionally adjusted for traditional bullying victimization. (DOC 17 kb)

Syftet med arbetet är att undersöka hur byggnadsmaterial behandlas inom BREEAM, LEED, Miljöbyggnad och Svanen samt inom byggvarudatabaserna Basta, Byggvarubedömningen och SundaHus. Med hjälp av systemens bedömningskriterier har relevant information bearbetats och sammanfattats i en diskussion samt ett grafiskt resultat. Resultatet har visat att BREEAM-SE ställer höga krav med både standardiserade livscykelanalyser, kemiskt innehåll, dokumentation, avfallshantering, emissioner och tillverkning. LEED ställer krav på återvinning, återanvändning och emissioner men nämner inte utfasningsämnen eller fullständig materialdokumentation. Miljöbyggnad ställer krav på materialdokumentation men el- och installationssystem behöver inte dokumenteras. Det finns även krav på utfasningsämnen men grundkraven är oftast inte svåra att klara av. Svanen ställer höga krav på byggnadsmaterialets innehåll men behandlar inte produkterna ur ett livscykelperspektiv. När det kommer till materialdatabaserna bedömer Basta enbart det kemiska innehållet och bygger på tillverkares egendeklaration. Byggvarubedömningen ställer krav på kemiskt innehåll och bedömer flest antal aspekter ur ett livscykelperspektiv. Hälften av livscykelkriterierna behöver bli godkända för att produkten ska rekommenderas. SundaHus ställer liknande krav på byggnadsmaterialets påverkan under hela dess livscykel men har något mer realistiska krav på bedömningen. De aspekterna som är svåra att bedöma är därför inte med i bedömningskriterierna. Viktiga skillnader mellan Byggvarubedömningen och SundaHus är att Byggvarubedömningen inte tar hänsyn till utfasningsämnen i tillverkningsskedet.

The aim of this study was to depict care personnel’s perception of social treatment in care relations. Another aim was to bring forth what the personnel acknowledge as important factors to reach a goal of good encounters with the elderly. Through interviews with five care assistants working at the same nursing home, three different themes were formulated in order to answer the study questions. The themes were Concerning treatment, Organized care, and Personnel force.The personnel described the social treatment as something else than just being friendly and polite when approaching the elderly. They meant that the importance was lying in the energy and the feeling you convey everyday when coming in to the ward in the beginning of the shift. Organizational issues, however, were perceived as hinders for the personnel to always be able to accomplish a desirable encounter in care relations. The most important factor that improved the conditions for a positive social treatment in care relations was the team of colleagues. Within the team they had the opportunity to reflect over work, issues, the social treatments and other problems, and also learn from each other. The most important issue that the interviewed persons emphasized is that it is not about being friendly and polite when approaching care takers. It is about being percipient and able to create a positive energy around yourself and others.Nyckelord: Bemötande, omsorgspersonal, social omsorg, äldreboende, äldreomsorg

Skolan innefattar inte bara lärande utan handlar även om elevers hälsa och välmående. För att eleverna ska kunna tillgodogöra sig undervisningen i skolan krävs en god psykisk hälsa. Enligt de rapporter och den litteratur vi tagit del av har elevers psykiska ohälsa ökat de senaste åren. Stämmer nu detta, att allt fler barn och ungdomar i skolan mår psykiskt dåligt, är det av en enorm vikt att skolan tar sitt ansvar att uppmärksamma och försöka förebygga psykisk ohälsa hos eleverna. Detta är ett ämne som ständigt är aktuellt eftersom det alltid kommer att finnas elever som mår dåligt, dvs. det kommer alltid att finnas behov för ett psykiskt hälsofrämjande arbete. Syftet med uppsatsen är att belysa vilka innebörder ett psykiskt hälsofrämjande arbete i skolan har för eleverna. För att kunna uppnå vårt syfte inledde vi vårt arbete med en omfattande litteraturgenomgång, detta för att skaffa oss kunskap inom ämnet. Det finns en rad olika hälsofrämjande faktorer skolan kan arbeta med för att främja elevernas psykiska hälsa. De aspekterna av god psykisk hälsa vi fokuserar på i denna uppsats är en känsla av välmående/välbefinnande, ett gott självförtroende, att känna sig trygg och trivas med sig själv och tillvaron. För att få svar på våra frågeställningar kom vi fram till att en kvantitativ studie är det mest fördelaktiga för vår studie då vi kan se resultatet i form av siffror och diagram. Vi tror även att eleverna är mer öppna i en anonym enkät än under en intervju. Vi valde att jämföra gymnasieelever från två olika skolor, varav den ena är studieförberedande (skola 1) och den andra är yrkesinriktad (skola 2), för att se om elevernas uppfattningar skiljer sig åt vad gäller psykiskt hälsofrämjande arbete i skolan. Data sammanställdes sedan och presenteras som resultat och bilagor till uppsatsen. Resultatet visade att de faktorer som enligt oss ingår i främjandet av den psykiska hälsan är mer framträdande i skola 2 vilket tyder på att skola 2 kommit längre med sitt psykiskt hälsofrämjande arbete. Vår undersökning visar överlag inte samma problematik som vi tagit upp i bakgrunden. Vår studie ger ett mer positivt intryck av elevers psykiska hälsa. Slutsatsen vi kan dra av vår studie är att skolan som social miljö är främjande för den psykiska hälsan ur vissa aspekter. Även om skola 2 är mer psykiskt hälsofrämjande utesluter det inte att båda skolorna bör arbeta mer med psykiskt hälsofrämjande arbete. Vi anser att det alltid finns psykiskt hälsofrämjande faktorer att utveckla och arbeta mer med eftersom det optimala målet, enligt oss, är att skolan bör främja varje faktor till 100 %. Detta inser vi är näst intill omöjligt men man ska alltid sträva efter att uppnå ett så gott resultat som möjligt.

AIMS: Carotid intima media thickness (CIMT) predicts cardiovascular (CVD) events, but the predictive value of CIMT change is debated. We assessed the relation between CIMT change and events in individuals at high cardiovascular risk. METHODS AND RESULTS: From 31 cohorts with two CIMT scans (total n = 89070) on average 3.6 years apart and clinical follow-up, subcohorts were drawn: (A) individuals with at least 3 cardiovascular risk factors without previous CVD events, (B) individuals with carotid plaques without previous CVD events, and (C) individuals with previous CVD events. Cox regression models were fit to estimate the hazard ratio (HR) of the combined endpoint (myocardial infarction, stroke or vascular death) per standard deviation (SD) of CIMT change, adjusted for CVD risk factors. These HRs were pooled across studies. In groups A, B and C we observed 3483, 2845 and 1165 endpoint events, respectively. Average common CIMT was 0.79mm (SD 0.16mm), and annual common CIMT change was 0.01mm (SD 0.07mm), both in group A. The pooled HR per SD of annual common CIMT change (0.02 to 0.43mm) was 0.99 (95% confidence interval: 0.95-1.02) in group A, 0.98 (0.93-1.04) in group B, and 0.95 (0.89-1.04) in group C. The HR per SD of common CIMT (average of the first and the second CIMT scan, 0.09 to 0.75mm) was 1.15 (1.07-1.23) in group A, 1.13 (1.05-1.22) in group B, and 1.12 (1.05-1.20) in group C. CONCLUSIONS: We confirm that common CIMT is associated with future CVD events in individuals at high risk. CIMT change does not relate to future event risk in high-risk individuals.

AIMS: Carotid intima media thickness (CIMT) predicts cardiovascular (CVD) events, but the predictive value of CIMT change is debated. We assessed the relation between CIMT change and events in individuals at high cardiovascular risk. METHODS AND RESULTS: From 31 cohorts with two CIMT scans (total n = 89070) on average 3.6 years apart and clinical follow-up, subcohorts were drawn: (A) individuals with at least 3 cardiovascular risk factors without previous CVD events, (B) individuals with carotid plaques without previous CVD events, and (C) individuals with previous CVD events. Cox regression models were fit to estimate the hazard ratio (HR) of the combined endpoint (myocardial infarction, stroke or vascular death) per standard deviation (SD) of CIMT change, adjusted for CVD risk factors. These HRs were pooled across studies. In groups A, B and C we observed 3483, 2845 and 1165 endpoint events, respectively. Average common CIMT was 0.79mm (SD 0.16mm), and annual common CIMT change was 0.01mm (SD 0.07mm), both in group A. The pooled HR per SD of annual common CIMT change (0.02 to 0.43mm) was 0.99 (95% confidence interval: 0.95-1.02) in group A, 0.98 (0.93-1.04) in group B, and 0.95 (0.89-1.04) in group C. The HR per SD of common CIMT (average of the first and the second CIMT scan, 0.09 to 0.75mm) was 1.15 (1.07-1.23) in group A, 1.13 (1.05-1.22) in group B, and 1.12 (1.05-1.20) in group C. CONCLUSIONS: We confirm that common CIMT is associated with future CVD events in individuals at high risk. CIMT change does not relate to future event risk in high-risk individuals. The PROG-IMT project, which includes this publication, has been funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, www.dfg.de) under the grants DFG Lo 1569/2-1 and DFG Lo 1569/2-3, received by MWL. The DFG had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Simon Thompson is supported by the British heart Foundation (CH/12/2/29428). Some of the contributing studies were funded by different parties, as listed in the acknowledgement section. Here, too, the funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Sí

Background Patients living under better socioeconomic circumstances often receive more active treatments after an acute myocardial infarction (AMI) compared to less affluent patients. However, most previous studies were performed in countries with less comprehensive coverage for medical services. In this Swedish nation-wide longitudinal study we wanted to evaluate long-term survival after AMI in relation to socioeconomic position (SEP) and use of revascularization. Methods From the Swedish Myocardial Infarction Register we identified all 45 to 84-year-old patients (16,041 women and 30,366 men) alive 28 days after their first AMI during the period 1993 to 1996. We obtained detailed information on the use of revascularization, cumulative household income from the 1975 and 1990 censuses and 5-year survival after the AMI. Results Patients with the highest cumulative income (adding the values of the quartile categories of income in 1975 and 1990) underwent a revascularization procedure within one month after their first AMI two to three times as often as patients with the lowest cumulative income and had half the risk of death within five years. The socioeconomic differences in the use of revascularization procedures could not be explained by differences in co-morbidity or type of hospital at first admission. Patients who underwent revascularization showed a similar lowered mortality risk in the different income groups, while there were strong socioeconomic differences in long-term mortality among patients who did not undergo revascularization. Conclusion This nationwide Swedish study showed that patients with high income had a better long-term survival after recovery from their AMI compared to patients with low income. Furthermore, even though the use of revascularization procedures is beneficial, low SEP groups receive it less often than high SEP groups.

BACKGROUND: Various studies have investigated urban/rural differences in cause-specific mortality. A separate body of literature has analysed effects of socioeconomic environment on mortality. Almost no studies have attempted to disentangle effects of population density and socioeconomic environment on mortality, beyond the effects of individual characteristics. METHODS: Considering all individuals living in the region of Scania, Sweden, from 1970-93, we performed 10 year mortality follow-ups on (i) individuals aged 55, (ii) individuals aged 65, and (iii) individuals aged 75 years at baseline. Cox multilevel models adjusted for individual factors allowed us to investigate the independent effects of population density and median income in the parish of residence on mortality from ischaemic heart disease (IHD), lung cancer, and chronic obstructive pulmonary disease (COPD) among individuals who had lived in the same parish for at least 10 years prior to mortality follow-up. RESULTS: In females, as in males, after adjustment for individual and contextual socioeconomic status, we found a dose-response association between population density and mortality from lung cancer and COPD in all age groups investigated, and from IHD especially in the youngest age group. Overall, the population density effect was the strongest on lung cancer mortality. Median income had an additional impact only in 2 out of 16 subgroups of age x gender x cause of death. CONCLUSIONS: In our region-wide study conducted at the parish level, contextual disparities in mortality were dominated by the population density effect. However, it may be unwise to conclude that truly contextual effects exist on mortality, before identification of plausible mediating processes through which urbanicity may influence mortality risk.

BackgroundTo more efficiently reduce social inequalities in mortality, it is important to establish which causes of death contribute the most to socioeconomic mortality differentials. Few studies have investigated which diseases contribute to existing socioeconomic mortality differences in specific age groups and none were in samples of the whole population, where selection bias is minimized. The aim of the present study was to determine which causes of death contribute the most to social inequalities in mortality in each age group in the whole population of Scania, Sweden.MethodsData from LOMAS (Longitudinal Multilevel Analysis in Skåne) were used to estimate 12-year follow-up mortality rates across levels of socioeconomic position (SEP) and workforce participation in 975,938 men and women aged 0 to 80 years, during 1991–2002.ResultsThe results generally showed increasing absolute mortality differences between those holding manual and non-manual occupations with increasing age, while there were inverted u-shaped associations when using relative inequality measures. Cardiovascular diseases (CVD) contributed to 52% of the male socioeconomic difference in overall mortality, cancer to 18%, external causes to 4% and psychiatric disorders to 3%. The corresponding contributions in women were 55%, 21%, 2% and 3%. Additionally, those outside the workforce (i.e., students, housewives, disability pensioners, and the unemployed) showed a strongly increased risk of future mortality in all age groups compared to those inside the workforce. Even though coronary heart disease (CHD) played a major contributing role to the mortality differences seen, stroke and other types of cardiovascular diseases also made substantial contributions. Furthermore, while the most common types of cancers made substantial contributions to the socioeconomic mortality differences, in some age groups more than half of the differences in cancer mortality could be attributed to rarer cancers.ConclusionCHD made a major contribution to the socioeconomic differences in overall mortality. However, there were also important contributions from diseases with less well understood mechanistic links with SEP such as stroke and less-common cancers. Thus, an increased understanding of the mechanisms connecting SEP with more rare causes of disease might be important to be able to more successfully intervene on socioeconomic differences in health.