Aims: The aim of this study was to describe the epidemiology of moderate and severe injury morbidity in a defined population based on ambulance records, and to validate ambulance records as a potential source of surveillance.Methods: A geographical target area was defined; the county of Värmland, Sweden. All ambulance attendances and hospitalisations for unintentional and intentional injury in 2002 were selected, analysed and compared.Results: Ambulance data comprised 3964 injury cases (14.5/1000). Most injuries for which ambulance attention was sought occurred in road traffic areas (27 %), followed by residential areas (20 %), school and institutional areas (14 %) and sports areas (8 %). An ecological comparison between ambulance based data and hospitalisations showed that ambulance services captured approximately the same amount of injury cases (3235 ambulance reports compared to 3456 hospital discharges) with a similar profile.Conclusions: This study provides epidemiological support for ambulance services as a potential source of regular surveillance data on moderate and severe injuries. However, at a population level, our results indicate that ambulance data tend to overestimate some injury categories, and underestimate others, compared to hospital data. The significance of these differences for preventive work, as well as other practical aspects of the feasibility for regular injury surveillance will be analysed and discussed on the basis of general criteria for evaluation of surveillance systems in a forthcoming paper.

Background: Honour-related violence and oppression is a violation of human rights and a public health problem. Oppression can be manifested by not being allowed to choose future partners and can increase the risk of abuse and mental health problems. Aims: The aim of this study was to investigate associations between restrictions regarding choice of future partner (RCP), child maltreatment and mental health problems among adolescents in Sweden. Methods: The study was based on cross-sectional data, including a nationally representative sample of 4741 pupils from grade nine in primary school and second year in high school. Pearson's chi-square tests and binary logistical regression analyses adjusting for socio-demographic factors were conducted. Results: RCP was significantly associated to child maltreatment, including poly-victimisation, and mental health problems. In the adjusted analysis, an increased risk for all types of maltreatment, poly-victimisation (adjusted odds ratio (aOR) 10.2, confidence interval (CI) 5.6-18.4), self-harm (aOR 1.9, CI 1.1-3.2) and suicide attempt (aOR 2.4, CI 1.3-4.7) were shown in adolescents exposed to RCP compared to non-exposed. Conclusions: There is an increased risk of child maltreatment including poly-victimisation and mental health problems among adolescents exposed to RCP compared to non-exposed. The study emphasizes the matter as a public health problem requiring immediate preventive measures to ensure the rights of children and adolescents.

Aim: The aim was to analyse the association between economic stress during youth and adulthood, and poor mental health through life course models of (1) accumulation of risk and (2) sensitive period. Methods: The study was based on the Northern Sweden Cohort, a 26-year prospective cohort (N = 1010 in 2007; 94% of those participating in 1981 still alive) ranging from adolescence to middle age. Economic stress was measured at age 16, 21, 30 and 42 years. Two life course models of accumulation of risk and sensitive period were analysed using ordinal regression with internalized symptoms of mental health as outcome. Results: Exposure of economic stress at several life course periods was associated with higher odds of internalized mental health symptoms for both women and men, which supports the accumulated risk model. No support for a sensitive period was found for the whole sample. For men, however, adolescence appears to be a sensitive period during which the exposure to economic stress has negative mental health consequences later in life independently of economic stress at other ages. Conclusion: This study confirms that the duration of economic stress between adolescence and middle age is important for mental health. In addition, the results give some indication of a sensitive period of exposure to economic stress during adolescence for men, although more research is needed to confirm possible gender differences.

Aim: The aim of this study was to develop and to validate the self-administered Falun health instrument. An additional aim was to test its applicability in measuring people's lifestyles linked to health. Methods: In 2002, an instrument was constructed containing questions regarding the hazardous use of alcohol, tobacco, unhealthy diets and insufficient physical activity. A pilot study using the instrument was assessed between 2002 and 2006. In Sweden, it was further expanded and tested during the years 2004-2014 among a total of 1295 people. Results: Face validity was evaluated among colleagues and experts for clarity and completeness resulting in minor adjustments of some questions. With the test-retest method, the self-administered Falun health questionnaire showed a positive and high reproducibility and high compliance. Cronbach's alpha showed a high level of consistency (average 0.86). Factor analysis demonstrated the choice of questions correlated highly to the measured lifestyle. Conclusions: This study showed that the self-administered Falun health questionnaire is a valid and reliable instrument, useful for detecting individuals at risk of developing diseases that are related to individual choice of lifestyle.

Aim: The aim of this study was to compare and describe gender differences and the associations between symptoms of depression and family conflict and economics, lifestyle habits, school satisfaction and the use of health-care services among adolescents. Methods: Data were retrieved from Ungdata which is a cross-sectional study. Adolescents (n=8052) from secondary school grades 8, 9 and 10 (age 13–16 years) participated in the study from 41 municipal schools in four counties. Results: Girls reported a higher prevalence of symptoms of depression than boys. Gender differences were seen on all items related to symptoms of depression, family conflict and economics, lifestyle habits, school satisfaction and health-care services. Multiple regressions showed that family conflicts and economics contributed to 19.2% of the variance in symptoms of depression in girls and 12.4% in boys. School satisfaction made a strong contribution: 21.5% in girls and 15.4% in boys. The total model explained 49% of the total variance in symptoms of depression in girls and 32.5% in boys. Conclusions: Gender demonstrated a pattern through a higher proportion of girls reporting symptoms of depression, family conflict and economics, lifestyle habits, school satisfaction and use of health-care services. Even though the adolescents reported symptoms of depression, few used the school health-care services and public health nurses. This indicates that they need a person-centered approach for symptoms of depression. The findings may have important implications for planning for adolescents in school health services.

Aims: Profound changes in family structure took place in many countries, during the second part of the previous century. The purpose of this paper is to analyse the association between the type of family residency and psychosomatic problems in younger and older adolescents, particularly focusing on alternate residency, and to examine the impact of child-parent relations.

Methods: We used data collected in 2009 by Statistics Sweden among 172,298 Swedish students in grade 6 and grade 9 (approximate ages 12 and 15 years old); comprising 80% and 86%, respectively, of the entire population of students in those grades. We collected the data with a questionnaire, completed anonymously in school: We used the Psychosomatic Problems (PSP) scale as the outcome measure.

Results: The type of family residency showed a weaker association with psychosomatic problems than the child-parent relationships did. Living in non-intact families increased the probability of adolescent psychosomatic problems by 0–0.05, compared to intact families. In grade 9, there were no differences in psychosomatic problems between the students in alternate residency and those living with their two parents; and in grade 6, these differences were relatively small. In comparison, a worse relationship with parents increased the probability of psychosomatic problems by 0.11–0.17, depending on the school grade and type of family residency.

Conclusions:The structure of the family, as well as the child-parent relationships needs to be taken into account, to properly estimate the magnitude of the family situation as a determinant of adolescent psychosomatic problems. Our results justify universal intervention at the policy level.

Aims: The aim of this work was to examine psychological distress among Norwegian adolescents in relation to changes over time and the associations with leisure time physical activity and screen-based sedentary behaviour. Methods: This cross-sectional study was based on data retrieved from the Norwegian Youth Health Surveys in 2001 and 2009 in Hedmark County. Adolescents aged 15–16 years old completed a questionnaire regarding physical activity, sedentary behaviour, psychological distress and other health and lifestyle variables. The self-report Hopkins Symptom Checklist-10 was used to assess psychological distress. Multinomial logistic regression was used to analyse the associations between psychological distress, physical activity and sedentary behaviour. Results: Self-reported psychological distress increased significantly from 2001 to 2009 (from 19.4 to 28.2%), with the proportion of girls reporting psychological distress being twice as large as the proportion of boys. The proportion of adolescents who were physically active for ⩾11 hours per week increased significantly over the same period (from 6.0 to 10.4%). Sedentary behaviour ⩾6 hours per school day increased significantly among both sexes between 2001 and 2009. Physical activity (⩾11 hours) and sedentary behaviour (⩾6 hours) were both significantly associated with psychological distress. Conclusions: The association between physical activity, sedentary behaviour and psychological distress was weak; only high amounts of physical activity and high amounts of screen-based sedentary behaviour were associated with psychological distress. Longitudinal studies are needed to provide further insights into these associations and to understand the extent to which these variables might be causally related.

Background: Deliberate self-harm (DSH) in young people is an important public health issue. To prevent DSH, more knowledge is needed about its prevalence and associated contextual factors in community samples of adolescents. Aims: To determine the prevalence of deliberate self-harm in 17-year-old Swedish students and to explore the association of demographic variables, psychological distress, experiences of violence, and school-related factors with DSH. Methods: Data were derived from a cross-sectional study in which 17-year-old students completed questionnaires during school hours (n=1,663; 78.3%). The variables used in this analysis are as follows: deliberate self-harm, demographic variables, psychological distress, experiences of violence, and school-related factors. Data were analysed using chi-squared statistics and logistic regression. Results: The lifetime prevalence of DSH was 17%, and it was more common among girls (23.3%) than boys (10.5%). There were considerable socioeconomic differences in reports of DSH. Psychological distress was strongly associated with DSH in both boys and girls, as were experiences of bullying, sexual harassment, physical violence and sexual assault. Social support, safety and academic factors in school were related to reports of DSH in both girls and boys. There were some gender differences with respect to which factors were associated with DSH. Conclusions: Deliberate self-harm is common and more frequently reported by girls than boys. Psychological distress, experiences of different types of violence, and school-related factors (academic, social and safety-related), should be considered risk factors for DSH in young people. Findings can be applied to health-promotion policy and interventions in various contexts, for example schools.

Aim: Although health effects of social relationships are well-researched, long-term health consequences of adolescent family as well as peer relationships are poorly understood. The aim of the study was to explore the prospective importance of parental and peer social relationships in adolescence on internalising and functional somatic symptoms in adulthood. Methods: Data were drawn from four waves of the Northern Swedish Cohort Study, response rate 94.3%, N=1001. Outcome variables were internalising and functional somatic symptoms at the ages of 21, 30 and 42. Relationship variables at age 16 were poor parental contact and three indicators of poor peer relationships. Associations were assessed in multivariate ordinal logistic regressions with adjustment for confounders and baseline health. Results: Results show that the main relationships-related predictors of adult internalising symptoms were self-rated poor peer relationships in terms of spending time alone during after-school hours and poor parental relationship. Functional somatic symptoms on the other hand were most strongly associated with poor parental contact and not being happy with classmates at age 16. Conclusions: The quality of parental and peer relationships in adolescence predicts adult mental and functional somatic health as much as 26 years later, even when accounting for confounders and adolescent symptomatology. This study extends past research by exploring how both adolescent parental and peer relationships (self-reported as well as teacher reported) predict adult self-reported health.

Objective: To investigate the factors associated with exposure to in-real-life (IRL) bullying, cyberbullying, and both IRL and cyberbullying and to explore the relationship between these types of bullying and mental health among 13-16-year-old Swedish boys and girls. Methods: Data was derived from a cross-sectional web-based study of 13-16-year-old students in northern Sweden (n=1214, response rate 81.9%). Results: The combination of IRL- and cyberbullying was the most common type of bullying. A non-supportive school environment and poor body image were related to exposure to bullying for both genders but the relationship was more distinct in girls. All types of bullying were associated with depressive symptoms in both boys and girls and all forms of bullying increased the likelihood of psychosomatic problems in girls. Conclusions: Cyberbullying can be seen as an extension of IRL bullying. A combination of IRL- and cyberbullying seems to be particularly negative for mental health. Interventions should focus on improved school environment and body image as well as anti-violence programmes. Gender aspects of bullying need to be acknowledged.

Aims: This study examined whether social capital and a sense of coherence are associated with hazardous alcohol use in a large population-based Swedish sample. In particular, the objectives were (a) to examine which of five subdimensions of social capital is associated with hazardous alcohol use, (b) to investigate the moderating role of sense of coherence and (c) to examine possible sex differences. Methods: A postal survey was distributed to a sample of respondents (aged 18-84 years) from five Swedish counties that was stratified by sex, age and city; 40,674 (59.2%) participants responded, of which 45.5% were men and 54.5% were women with a mean +/- SD age of 53.8 +/- 17.9 years. Results: Structural dimensions of social capital were associated with an increased probability of hazardous alcohol use among both men and women, whereas the increased probability associated with cognitive dimensions occurred mostly among women. Sense of coherence was robustly associated with a decreased probability of hazardous alcohol use among both men and women. There were few moderating effects of sense of coherence and sex differences emerged mainly for the cognitive dimension of social capital. Conclusions: Associations between social capital dimensions and hazardous alcohol use were partly sex-specific, whereas the benefits of a sense of coherence accrued to both sexes. Social capital dimensions and sense of coherence were generally unrelated to each other. Only associations between the cognitive dimensions of social capital and hazardous alcohol use differed by sex.

Background:

Antonovsky’s concept of ‘‘sense of coherence’’ (SOC) has been shown to be related to health. The aim of this study was to describe the distribution of SOC scores and their components in an adult Swedish population aged 20–80 years.

Methods:

A random sample of 910 individuals from Jönköping, Sweden, aged 20, 30, 40, 50, 60, 70 and 80 years, of which589 agreed to participate in an oral health examination. The participants answered Antonovsky’s 13-item version of ‘‘the lifeorientation questionnaire scale’’. The response to the items and the distribution of the three components ofcomprehensibility, manageability and meaningfulness were analyzed for different age groups and genders using meanvalues and standard deviations, Student’s t-test and ANOVA.

Results:

A total of 526 individuals, 263 men and 263 women,answered all 13 questions and constituted the final material for the study (response rate 89%). The individual SOC scoreincreased with age. The 20 year olds had a statistically significantly lower SOC score compared with the other age groups and55% of them had a low SOC (≤66 points) compared with 17% of the 80 year olds. Men in the 60 and 70 year age groups hada statistically significantly higher SOC score compared with women of the same age.

Conclusions:

The individualdistribution of SOC varied with age and gender. Twenty year olds had a significantly lower SOC score comparedwith elderly age groups. Elderly men had a statistically significantly higher SOC score compared with women ofthe same age.

Aims: The aim was to examine experiences of bullying among Swedish adolescents and whether victims and perpetrators were also exposed to violence in the home, with particular focus on how abuse severity affected the risk of exposure to bullying. Methods: A nationally representative sample of pupils aged 14-15 responded to a questionnaire exploring exposure to corporal punishment and other types of violence. Results were analysed using Pearson's chi-square and multiple logistic regression, adjusting for factors regarding the child, the parents and the families' socioeconomic status. Results: Among the 3197 respondents, a significant proportion reported at least one incident of either bullying victimisation (girls 36%, boys 26%) or bullying perpetration (girls 24%, boys 36%). Physical and emotional violence in the home, including witnessed intimate partner violence, were significantly associated with both bullying victimisation and bullying perpetration. Odds ratios for exposure to bullying rose with increasing frequency and severity of abuse. Adjusted odds ratios ranged from 1.6 for any event of abuse vs. single episodes of bullying to 20.3 for multiple types of abuse vs. many episodes of bullying. The child's gender and the presence of a chronic health condition were consistently associated with nearly all levels of abuse and bullying. Conclusions: Bullying experiences are common among youth and are clearly associated with abuse. Frequent bullying, whether as victim or perpetrator, warrants particular vigilance, as it appears to be an indicator of severe violence in the home.

Aim: The aim of this study was to describe and investigate family characteristics in relation to support, behaviour of the child, family functioning and sense of coherence from the parents' perspective in families with a child with attention deficit hyperactivity disorder (ADHD). A further aim was to explore predictors of family functioning.

Methods: The study population consisted of 1964 parents of children with ADHD aged 15 years old and younger. In all, 265 parents responded to a questionnaire (response rate 48.2%; 217 mothers and 48 fathers). In addition to questions about the parents, children, family characteristics and support from health services, the questionnaire included the Family Assessment Device (FAD), the Strengths and Difficulties Questionnaire (SDQ), Sense of Coherence (SOC) and Social Cohesion and Support Index (SCS). Data were analysed with descriptive, comparative and standard multiple regression analyses.

Results: Parents with ADHD reported a weaker SOC and poorer FAD in the family than parents without ADHD. Parents with children medicated for ADHD were significantly more satisfied with social support (SCS), rated their children's behaviour as less problematic and reported better family functioning. Parents' age, SOC, SCS, SDQ and support from the community health services explained 46.2% of the variation in FAD.

Conclusions: A strong SOC, social support and support from the community health services were strongly associated with a positive effect on family functioning. Parents with ADHD reported a weaker SOC and poorer family functioning than parents without ADHD. This knowledge may be useful and should be taken into account when planning support for such families.

Aims: This study investigated the association between domestic work and self-rated health among women and men in the general population. Methods: The study is based on women (N = 12,910) and men (N = 9784) aged 25-64 years, who responded to a survey questionnaire in 2008 (response rate 56%). Logistic regression models were used to assess the association adjusting for age, educational level, employment status, family status and longstanding illness. Population attributable risks (PAR) were calculated to assess the contribution of domestic work to the prevalence of suboptimal self-rated health. Results: More women (29%) than men (12%) spent more than 20 hours per week in domestic work. Women also experienced domestic work more often as burdensome. Disability pensioners and single mothers reported highest levels of burdensome domestic work. There was a strong independent association between burdensome domestic work and suboptimal self-rated health both in women and men. The PAR for burdensome domestic work was 21% in women and 12% in men and comparable to other major risk factors. Conclusions: The results suggest that domestic work should not be omitted when considering factors that affect self-rated health in the general population.

Aim: To examine differences in the prevalence of self-reported diagnosed asthma by socioeconomic status and the contribution of lifestyle factors to these differences. Methods: The study was based on 28,531 persons aged 18 years or older who answered a survey questionnaire sent to a random population sample in mid-Sweden in 2017. The overall response rate was 44%. Socioeconomic status was measured with educational level and economic difficulties, and lifestyle factors with physical activity, smoking, snuff use, risk-drinking of alcohol and obesity. The associations between socioeconomic status and asthma were analysed using multivariate logistic regression. Results: The overall asthma prevalence was 9% among women and 7% in men and decreased with increasing age. Educational level was not independently associated with asthma, but a statistically significant odds ratio (with 95% confidence intervals) for the prevalence of asthma was observed for economic difficulties 1.5 (1.3-1.7). Also, physical inactivity 1.2 (1.1-1.3) and obesity 1.6 (1.4-1.8) were associated with increased asthma prevalence. Smoking and risk-drinking were not statistically significantly associated with asthma whereas snuff users had a higher prevalence of asthma among women. Adjusting for lifestyle factors did not affect the association between socioeconomic status and asthma. Conclusions: In this population-based study, self-reported diagnosed asthma was independently associated with economic difficulties but not with educational level. Lifestyle factors did not explain the association between economic difficulties and asthma prevalence. This applies to both men and women as well as younger and older age groups.

Background: One in ten children have a parent diagnosed with a mental illness by specialised psychiatric services. Severe parental mental illness is a well-established risk factor for children's mental health problems, making the identification and support of these children a public health concern. This study investigated the mental health and family context of children of parents diagnosed with depression, anxiety, or bipolar disorder in this clinical setting. Methods: Parental reports on 87 children aged 8-17 years were analysed. The children's mental health was compared with that of a Swedish population-based sample. Multiple linear regression was used to investigate associations between child mental health and child gender, child age, parent symptoms and social status, family functioning, and perceived parental control. Furthermore, a cumulative risk index explored the effect of multiple risk factors on child mental health. Results: The children reportedly had significantly more mental health problems than did the population-based sample and about one-third had scores above the clinical cut-off. A significant multiple linear regression explained 49% of the variance in child mental health, with lower perceived parental control and younger child age being associated with more child mental health problems. With more reported risk factors, children reportedly had more mental health problems. Conclusions: The results underline the importance of identifying a patient's children and assessing multiple relevant risk factors in the child's life. Furthermore, the results indicate that the needs of younger children and of patients in their parenting role are important to address.

Aims: The aim was to investigate changes in child and adolescent sleep habits in Sweden over time. This had not been done previously. Methods: Cross-sectional questionnaire data over three decades of investigations of the Health Behaviours of School Children study (1985/1986, 2005/2006 and 2013/2014) were used. The sample included 18,682 children and adolescents, aged 11, 13 and 15. Empirically based age-specific sleep duration recommendations were used to operationalise sleep duration. Results: The results showed that, over time, fewer go to bed early and more go to bed late. Regarding sleep duration, there have been decreases in the proportion of children and adolescents that sleep as much as is recommended for their age. Sleep onset difficulties have increased for all ages and increase the odds of sleeping less than recommended as well as having late bedtimes. Boys were more likely than girls to have later bedtimes and to sleep less than recommended. A vocational educational track, not planning to study further or being unsure of which track to choose increased the odds for 15 year olds to have late bedtimes and to sleep less than recommended compared with a college preparatory track. Conclusions: The results indicate that over time, fewer children and adolescents attain sufficient sleep duration. This may have implications for study results, mental health and cognitive abilities.

Aims: the aim of the present study was to examine changes over time in the relationship between self-reported school demands and psychosomatic problems, also considering the impact of student influence and teacher support. Methods: Data from a cross-sectional study (young in Värmland) including eight data collections (1988–2011) among Swedish students aged 15–16 were used (n = 20,115). Analyses with multinomial logistic regression and descriptive statistics were applied. Results: Between 1988 and 2011, the proportions of students with a higher degree of psychosomatic problems increased, as did the proportion of students experiencing school demands that were too high. Finer-level analyses based on stratification of student groups did not show any associations at the aggregated level between increases of school demands and psychosomatic problems. Similarly, individual level analyses showed that the strength of the association between school demands and psychosomatic problems was not affected by year of investigation. Conclusions:Changes in school demands over time could not explain the increasing trend in psychosomatic problems among adolescents. Since the relationship between school demands and psychosomatic problems is strong across time, there is, however, a continued need for school-based interventions. More studies are required to gain further understanding of adolescent mental health from a trend perspective.

Aims: To explore patients' experiences of very low calorie diet (VLCD) and subsequent corset treatment of obesity in a primary care setting, and to explore their perceptions of factors influencing weight control. Methods: In western Sweden, five focus group sessions were carried out. The main themes for the discussions were the informants' perceptions of the treatment they had received and their experiences of living with obesity. The analysis was based on the Grounded Theory methodology. Results: The outcomes reflect obese individuals' struggle to handle the demands of their life situation and to recognize their own resources. The core category generated was labelled "Achieving a balance in life and adjusting one's identity". Three categories related to the process of weight reduction were identified: living with obesity, reducing weight and developing self-management. The group treatment with VLCD was positively perceived by the participants, but the corset treatment was considered to be of less value. Conclusions: Maintenance after weight reduction was demanding and the findings indicate a need for extended support. For some individuals the corset treatment could be a psychological support. Follow-up after weight reduction programmes should focus on long-term self-help strategies.

Aims: The goal of this research project was to explore circumstances surrounding each drowning death occurring to children and adolescents ages 0–17 in Sweden during the years 1998–2007. Methods: Records from the National Board of Forensic Medicine (NBFM) and other sources were analysed. We collected information on children’spersonal characteristics (sex, age, ethnic background, weight, height, physical condition, and pre-existing health conditions) and the circumstances of deaths (time and place of occurrence, type of drowning, resuscitation efforts and medical care given, for example). We also collected information on prevention factors: the physical environment, adult supervision, whether or not the child could swim, and if the child was using a personal flotation device at the time of death. Results: Our analysis showed that 109 children had drowned in Sweden during the study period – of this group, 96 had died from unintentional causes. Children from immigrant backgrounds, particularly with families coming from the Middle East and Iran, were inordinately represented in the group of victims who had died from unintentional drowning deaths. Other risk factors included: coming from a single parent-headed family, alcohol use by older victims and a lack of ability to swim. Conclusions: Prevention efforts to prevent drowning in the future should focus on preventing alcohol use by young bathers; better fencing around swimming sites; improved coverage of swimming lessons to all children in Sweden, especially children from immigrant families; more education on drowning risks for single parents; and better awareness by adults on the need for constant supervision of children and adolescents in and near water.

Aim: Our objective was to develop and implement an intervention program in collaboration with workplace personnel, to evaluate the process as a vehicle to prevent and combat bullying. Methods: The project emanates from a community-based participatory approach. We obtained data from individual and focus group interviews. We used grounded theory methodology, and made a comparative analysis before and after the intervention. Results: Focus group interviews at the three first meetings indicated that those best positioned to prevent and combat bullying were the immediate supervisors, in collaboration with co-workers and upper management. The goal of zero tolerance toward bullying can be achieved if all concerned work together, using a humanistic value system, an open workplace atmosphere, group collaboration and conflict resolution. We developed an intervention, including lecturers and reflection groups, which ultimately resulted in an action plan. Focus group interviews at the fourth meeting, after the implementation, showed that employees were then more aware of bullying problems; the atmosphere at the workplace improved; the collaboration between and within the group was stronger; and the supervisor worked continuously to prevent and combat bullying, using the humanistic values suggested. We propose additional systematic work to implement our action plan and a conflict resolution system. Conclusions: The anti-bullying program implementation in the workplace achieved some success, but the intervention process is ongoing.

Background: Qualitative methods such as phenomenology and grounded theory have been valuable tools in studying public health problems. Aim: A description and comparison of these methods. Results: Phenomenology emphasises an inside perspective in form of consciousness and subjectively lived experiences, whereas grounded theory emanates from the idea that interactions between people create new insights and knowledge. Fundamental aspects of phenomenology include life world, consciousness, phenomenological reduction and essence. Significant elements in grounded theory are coding, categories and core categories, which develop a theory. Conclusions: There are differences in the philosophical approach, the name of the concept and the systematic tools between the methods. Thus, the phenomenological method is appropriate when studying emotional and existential research problems, and grounded theory is a method more suited to investigate processes. © 2015 the Nordic Societies of Public Health.

In 2008, Sweden introduced a policy change to limit the number of days for sickness benefits (SB). This study aimed to elucidate the characteristics of those who reached the maximum entitlement period for receiving sickness benefits (MEPSB) and their future main source of income. Methods: All 5,309,759 individuals, aged 20–63 and residents of Sweden in 2009 were followed from July 2008 to July 2010 regarding SB-days and date of MEPSB and then categorised into three groups: I) no SB-days, II) ongoing SB-days, and III) MEPSB. Mean numbers of SB-days 2.5 years before and 2 years after the policy change and main source of income in 2011 were assessed. Associations between sociodemographic factors, occupation and paid work as main source of income were estimated by odds ratio (OR). Results: A total of 0.7% reached MEPSB in 2010. The mean numbers of SB-days before and after the policy change were higher in the MEPSB group than in the other two groups. In the MEPSB group, 14% had their main source of income from paid work in 2011; this was more common among women born in Sweden (OR = 1.29), people living with a partner and children (women OR = 1.29; men OR = 1.48), and those with occupations representing high educational levels. Conclusions: One out of seven individuals with MEPSB in 2010 had their main source of income from paid work in 2011, although they had a long-term SB before and after the policy change. Further research is warranted to address the long-term effects of this policy change.