| 1. |
- Diderichsen, Saima, 1981-
(författare)
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It's just a job : a new generation of physicians dealing with career and work ideals
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Today, women constitute about half of medical students. However, women are still underrepresented in prestigious specialties such as surgery. Some suggest that this could be explained by women being more oriented towards work-life balance.Aim: The overall aim of this dissertation was to explore aspects of gender in work-life priorities, career plans, clinical experiences and negotiations of professional ideals among medical students and newly graduated doctors, all in a Swedish setting.Method: We based the analysis on data from two different sources: an extensive questionnaire exploring gender and career plans among medical students (paper I-III) and interviews with newly graduated doctors (study IV).In paper I, four classes of first- and final-year medical (N=507, response rate 85%) answered an open-ended question about their future life, 60% were women. We conducted a mixed methods design where we analyzed the answers qualitatively to create categories that could be analyzed quantitatively in the second stage.In paper II, five classes of final-year medical students were included (N = 372, response rate 89%), and 58% were women. We studied their specialty preference and how they rated the impact that the motivational factors had for their choice. In order to evaluate the independent impact of each motivational factor for specialty preference, we used logistic regression. In paper III, final-year medical students answered two open-ended questions: “Can you recall an event that made you interested of working with a certain specialty?” and “Can you recall an event that made you uninterested of working with a certain specialty?”. The response rate was 62% (N = 250), and 58% were women. The analysis was similar to paper I, but here we focused on the qualitative results.In paper IV, thematic interviews were conducted in 2014 and 2015. We made a purposeful sampling of 15 junior doctors, including nine women and six men from eight different hospitals. Data collection and analysis was inspired by constructivist grounded theory methodology.Results: When looking at the work-life priorities of medical students and junior doctors it is clear that both men and women want more to life than work in their ideal future. The junior doctors renounced fully devoted and loyal ideal and presented a self-narrative where family and leisure was important to cope and stay empathic throughout their professional lives.The specialty preferences and the highly rated motives for choosing them were relatively gender neutral. However, the gender neutrality came to an end when the final-year medical students described clinical experiences that affected their specialty preference. Women were more often deterred by workplace cultures, whereas men were more often deterred by knowledge area, suggesting that it is a male privilege to choose a specialty according to interest.Among the newly graduated doctors, another male privilege seemed to be that men were able to pass more swiftly as real doctors, whereas the women experienced more dissonance between their self-understanding and being perceived as more junior and self-doubting.Conclusions: The career plans and work-life priorities of doctors-to-be were relatively gender neutral. Both female and male doctors, intended to balance work not only with a family but also with leisure. This challenges the health care system to establish more adaptive and flexible work conditions.Gender segregation in specialty choice is not the result of gender-dichotomized specialty preferences starting in medical school. This calls for a re-evaluation of the understanding where gender is seen as a mere background characteristic, priming women and men for different specialties.
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| 2. |
- Lundqvist, Anette, 1963-
(författare)
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Nutritional aspects of behaviour and biology during pregnancy and postpartum
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundA well-balanced nutritious diet is important for the pregnant woman and the growing fetus, as well as for their future health. Poor nutrition results from both over-consumption of energy-rich foods which can lead to a higher weight gain than is healthy and under-nutrition of essential nutrients. Food intake is regulated in complex biological systems by many factors, where steroid hormone is one factor involved.The overall aim of this thesis is to describe dietary intake, vitamin D levels, dietary information and dietary changes, and to study the relation between allopregnanolone and weight gain during pregnancy and postpartum.Methods Study I was a qualitative study with focus group interviews with 23 pregnant women. The text was analysed with content analysis. Study II was a quantitative cross-sectional study conducted in early pregnancy (n=209) with a reference group (n=206). Self-reported dietary data from a questionnaire was analysed using descriptive comparative statistics and a cluster analysis model (Partial Least Squares modelling). Study III had a quantitative longitudinal design. Vitamin D concentrations were analysed in 184 women, collected on five occasions during pregnancy and postpartum. Descriptive comparative statistics and a linear mixed model were used. Study IV was a quantitative longitudinal study with 60 women. Concentrations of allopregnanolone were analysed in gestational week 12 and 35. Descriptive and comparative statistics as well as Spearman’s correlation (rho) were used to describe the relationship between weight gain and allopregnanolone concentrations. Results The focus group interviews showed that women wanted to know more about different foods to reduce any risk for their child but the information about foods was partly up to themselves to find out. They expressedfeelingsof insecurityand guiltif they accidentallyate something“forbidden”. The recommendationswere followedas best as possiblealong withcommon sense todeal with dietchanges. The main themes were “Finding out by oneself”, “Getting professional advice when health problems occur”, “Being uncertain” and “Being responsible with a pinch of salt”. Some differences in the dietary patterns were found among the pregnant women compared to references, with less, vegetables (47 g/day), potatoes/rice/pasta (31 g/day), meat/fish (24 g/day) and intake of alcohol and tobacco/snuff but a higher intake of supplements. Bothpregnant women and referenceshad intakes offolatethrough diet45% (pregnant) and 22% (references) lower than current recommendations(500vs400g/day). Vitamin Dintake was34% lower than the recommendationsof 10mg/day. At least a third of the participants had insufficient plasma levels below 50 nmol/L of vitamin D. Season was a strong factor influencing the longitudinal pattern. Gestational week, season, total energy intake, dietary intake of vitamin D, and multivitamin supplementation over the previous 14 days were factors related to vitamin D levels. A correlation betweenallopregnanoloneconcentrations ingestationalweek 35and weight gainin weeks12–35was seen (p = 0.016). Therewas alsoa correlation betweenthe increase inallopregnanolone(weeks12–35) andweight gain(see above) (p = 0.028). ConclusionsDietary recommendations were described as contradictory and confusing and the dietary advice felt inadequate. The women faced their diet changes and sought information on their own but would have wished for more extensive advice from the midwife. The intake of vitamins essential for pregnancy was lower than recommended, which is also confirmed by low plasma levels of vitamin D in at least one third of the pregnant women. Vitamin D levels peaked in late pregnancy. Aside from gestational week and season which were related to plasma levels, intake from foods and supplements also affected the levels. Reasons for weight gain are complex and depend on many factors. Allopregnanolone is a factor that was seen to relate to the weight gain of the studied pregnant women.
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| 3. |
- Lundqvist, Anette, et al.
(författare)
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Reported dietary intake in early pregnant compared to non-pregnant women : a cross-sectional study
- 2014
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 14:373
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Tidskriftsartikel (refereegranskat)abstract
- Background: A woman's nutritional status before conception and during pregnancy is important for maternal health and the health of the foetus. The aim of the study was to compare diet intake in early pregnant women with non-pregnant women. Methods: Between September 2006 and March 2009, 226 women in early pregnancy were consecutively recruited at five antenatal clinics in Northern Sweden. Referent women (n = 211) were randomly selected from a current health screening project running in the same region (the Vasterbotten Intervention Program; VIP). We collected diet data with a self-reported validated food frequency questionnaire with 66 food items/food aggregates, and information on portion size, alcohol consumption, and supplement intake. Data were analysed using descriptive, comparative statistics and multivariate partial least square modelling. Results: Intake of folate and vitamin D from foods was generally low for both groups. Intake of folate and vitamin D supplements was generally high in the pregnant group and led to significantly higher total estimated intake of vitamin D and folate in the pregnant group. Iron intake from foods tended to be lower in pregnant women although iron supplement intake evened out the difference with respect to iron intake from foods only. Energy intake was slightly lower in pregnant women but not significant, a reflection of that they reported consuming significantly less of potatoes/rice/pasta, meat/fish, and vegetables (grams/day) than the women in the referent group. Conclusions: In the present study, women in early pregnancy reported less intake of vegetables, potatoes, meat, and alcohol than non-pregnant women. As they also had a low intake (below the Nordic Nutritional Recommendations) of folate, vitamin D, and iron from foods, some of these women and their unborn children are possibly at risk for adverse effects on the pregnancy and birth outcome.
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| 4. |
- Hariz, Gun-Marie, et al.
(författare)
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Perceptions of living with a device-based treatment : an account of patients treated with deep brain stimulation for Parkinson’s disease
- 2014
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Ingår i: Neuromodulation. - : Elsevier BV. - 1094-7159 .- 1525-1403. ; 17:3, s. 272-278
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Deep brain stimulation (DBS) is an established treatment for Parkinson's disease. Little is known about patients' own perceptions of living with the implanted hardware. We aimed to explore patients' own perceptions of living with an implanted device. Materials and Methods Semistructured interviews with open-ended questions were conducted with 42 patients (11 women) who had been on DBS for a mean of three years. The questions focused on patients' experiences of living with and managing the DBS device. The interviews were transcribed verbatim and analyzed according to the difference and similarity technique in grounded theory. Results From the patients' narratives concerning living with and managing the DBS device, the following four categories emerged: 1) The device—not a big issue: although the hardware was felt inside the body and also visible from outside, the device as such was not a big issue. 2) Necessary carefulness: Patients expressed the need to be careful when performing certain daily activities in order not to dislocate or harm the device. 3) Continuous need for professional support: Most patients relied solely on professionals for fine-tuning the stimulation rather than using their handheld controller, even if this entailed numerous visits to a remote hospital. 4) Balancing symptom relief and side-effects: Patients expressed difficulties in finding the optimal match between decrease of symptoms and stimulation-induced side-effects. Conclusions The in-depth interviews of patients on chronic DBS about their perceptions of living with an implanted device provided useful insights that would be difficult to capture by quantitative evaluations.
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| 5. |
- Hamberg, Katarina, 1952-
(författare)
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Genusperspektiv i allmänmedicinskt arbete
- 2015. - 2
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Ingår i: Allmänmedicin. - Lund : Studentlitteratur AB. - 9789144084466 ; , s. 1028-1035
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Kristoffersson, Emelie, et al.
(författare)
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"It was as if I wasn't there" : experiences of everyday racism in a Swedish medical school
- 2021
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 270
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore and analyze how cultural/ethnic minority students at a Swedish medical school perceive and make sense of educational experiences they viewed as related to their minority position. We interviewed 18 medical students (10 women, and 8 men), who self-identified as coming from minority backgrounds. Data were collected and analyzed simultaneously, inspired by constructivist grounded theory methodology. The concepts 'everyday racism' and 'racial microaggressions' served as a theoretical framework for understanding how inequities were experienced and understood. Participants described regularly encountering subtle adverse treatment from supervisors, peers, staff, and patients. Lack of support from bystanders was a common dimension of their stories. These experiences marked interviewees' status as 'Other' and made them feel less worthy as medical students. Interviewees struggled to make sense of being downgraded, excluded, and discerned as different, but seldom used terms like being a victim of discrimination or racism. Instead, they found other explanations by individualizing, renaming, and relativizing their experiences. Our results indicate that racialized minority medical students encounter repeated practices that, either intentionally or inadvertently, convey disregard and sometimes contempt based on ideas about racial and/or cultural 'Otherness'. However, most hesitated to name the behaviors and comments experienced as "discriminatory" or "racist", likely because of prevailing ideas about Sweden and, in particular, medical school as exempt from racism, and beliefs that racial discrimination can only be intentional. To counteract this educational climate of exclusion medical school leadership should provide supervisors, students, and staff with theoretical concepts for understanding discrimination and racism, encourage them to engage in critical self-reflection on their roles in racist power relations, and offer training for bystanders to become allies to victims of racism.
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| 7. |
- Kristoffersson, Emelie, 1986-
(författare)
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Är det bara jag? Om sexism och rasism i läkarutbildningens vardag : erfarenheter, förklaringar och strategier bland läkarstudenter
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Medical education is characterized by unequal conditions for women/men and white/racialized students. Even subtle interactional processes of inclusion and exclusion convey messages about who rightfully belongs in medical school. Insights into these processes, though, are scarce – especially in the Swedish context. In this thesis, the concepts ’everyday sexism/racism’ and ’gendered/racial microaggressions’ serve as a theoretical framework for understanding these processes.Aim: The main objective of this thesis is to explore and analyze how medical students experience, understand, and handle the norms, perceptions, and expectations about gender and culture/ethnicity that are expressed and (re)created in the specific contexts of medical education and clinical practice. In the analysis, a particular focus is placed on power inequalities. The role that the image of Sweden, which is characterized by equality, and the notion of medical education as characterized by objectivity and neutrality play in the participants' understanding and actions is discussed.Method: The four articles that make up this thesis are based upon three empirical studies conducted among medical students at Umeå University. In the first study, focus groups were performed with 24 students (15 women, 9 men) to explore their experiences of situations during clinical training where they perceived that gender mattered. The material was explored using qualitative content analysis. In the second study, 250 students’ written answers to two short essay questions were analyzed to explore the impact of medical school experiences on specialty preferences. Utilizing a sequential mixed methods design, their responses were analyzed qualitatively to create categories that thereafter were compared quantitatively between men and women. In the third study, generating two articles, individual interviews were conducted with 18 students (10 women, 8 men) who self-identified as coming from cultural or ethnic minority backgrounds, exploring their experiences of interactions related to their minority position. Inspired by constructivist grounded theory, data collection and analysis were iterative.Findings and reflections: In individual interviews and focus groups, many participants initially described the medical school climate as equal and inclusive. Still, in their narratives about concrete experiences they gave another picture. In interactions with supervisors, staff, and patients almost everyone had regularly encountered stereotypes, discriminatory treatment, and demeaning jargon. Simultaneously, a subtle favoring of male and white majority students was noted. Thus, values, norms, and hierarchies concerning gender and culture/ethnicity were crucial dimensions in their narratives.These experiences made female students feel like they were rendered invisible and not taken seriously, and marked racialized minority students’ status as ’Others’ – making both female- and minority students feel less worthy as medical students. However, most were unsure whether they could call their experiences “sexist”, ”racist”, or ”discriminatory”. Instead, they found other explanations for people's actions such as curiosity, fear, or ignorance. Participants strove to manage the threat of constraining stereotypes and exclusion while maintaining an image of themselves as professional physicians-to-be. They opposed being seen – and seeing themselves as – problematic and passive victims. The clinical power hierarchy, fear of repercussions, and lack of support from bystanders affected what modes of action seemed accessible. Consequently, participants tended to stay silent, creating emotional distance, and adapting to avoid stereotypes rather than resisting, confronting, and reporting unfair treatment. The school climate also had consequences for specialty preferences. Both women and men expressed that working tasks and potential for work-life balance were motifs for their specialty preference. These aspects, however, were often secondary to feeling included or excluded during clinical practice. More women than men had been discouraged by workplaces with perceived hostile or sexist climates. In contrast, more men had been deterred by specialty knowledge areas and what they thought were boring work tasks. Conclusions: Medical students experience everyday sexism- and racism or microaggressions, i.e., practices that, intentionally or inadvertently, convey disregard or contempt. However, the contemporary discourse, which confines sexism and racism into conscious acts perpetrated by immoral or ignorant people, and the pretense that these phenomena no longer pose a problem in Sweden or in medical school, obscure their structural and systemic nature. In fact, this limited view of sexism and racism leaves inequities normalized and disempowers those targeted by discrimination. Constraining stereotypes and exclusion are not caused by the actions of their recipients, that is, female or racialized/minority students. Consequently, their behavioral changes like avoidance and adaptation will not eliminate discrimination but, instead, tend to re-establish the white male medical student as the norm. As long as students who do not fit the norm, rather than the norm itself are regarded as the problem, the sexist and racist practices described in this study will remain part of the hidden curriculum and part of the process of becoming and being a physician. Simultaneously, formal commitments to equality are at risk of being only symbolic while inequities persist. To counteract these inequities, the medical community needs to acknowledge female and racialized medical students’ knowledge about sexist and racist practices within our institutions. Further, medical school leadership should provide students, supervisors, and teachers with an account of structural and everyday sexism and racism, encourage them to engage in critical self-reflection on their roles in sexist and racist power relations, and with strategies and training on how to intervene as bystanders and allies.
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| 8. |
- Waller, Göran, 1954-
(författare)
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Self-rated health : from epidemiology to patient encounter
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In epidemiology self-rated health is often measured as people’s subjective answer to a question “How is your health in general?” or “How is your general health compared to persons of your own age?”. The answers have a strong association with significant medical outcomes such as death, diabetes, coronary heart disease, functional ability and depression, medical diagnoses and how these are perceived. The overarching aim of this thesis was to investigate if and how a use of the epidemiologists’ tool of self-rated health might aid GPs in practising medicine with a holistic perspective, contextually sensitive and taking into account the patients’ medical and personal histories.Methods: In Paper I, I used semantics to elucidate the meaning of self-rated health. Data came from the Northern Sweden Monica Project 1990–1999. In Paper II, with data from the MONICA Project in 1999–2009, I used ordinal regression to investigate associations between self-rated health, medical factors, psychosocial factors and emotions. In Paper III, I used data from the Västerbotten Intervention Programme 1990–2004 in Cox regression analyses to investigate the relationship between self-rated health and standard risk factors for the outcome myocardial infarction. Paper IV is a qualitative study from seven primary care health centres. Actual consultations were audio-recorded and analysed with systematic text condensation, measuring apportionment of speaking time and by taking into account GPs’ assessments of using a question about comparative self-rated health in a consultation.Results: In Paper I, I found “health” in questionnaires being understood not through definitions of health but through associations of the word “health” with “sense relations”, that are important connotations of the word “health”. Age-comparative self-rated health was semantically clearer as it pointed towards comparison with a reference group. In Paper II, emotions of anxiety or depression and discontent with personal economy were associated with lower self-rated health and were common in the population. Paper III established self-rated health as an independent risk factor for myocardial infarction when adjusted for standard risk factors. In the qualitative Paper IV, self-rated health affected consultations, increased patients’ speaking time in relation to doctors’ when discussing self-rated health and elicited reactions, sometimes with strong language. Reflections ensued that could give vivid descriptions of function, life circumstances and resources or obstacles in handling symptoms and illnesses.Conclusion: Comparative self-rated health constitutes a feasible tool in general practice, particularly in taking account of patients’ medical and personal histories. It is holistic, sensitive to psychosocial factors. It is useful to solicit information on risk and the patient’s feelings related to an illness/disease, and to encourage the patient’s active reflection on functional abilities, life situation, health and health strategies. However, self-ratings are not to be seen as a standard procedure in all consultations.
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| 9. |
- Waller, Göran, 1954-, et al.
(författare)
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What does age-comparative self-rated health measure? : A cross-sectional study from the Northern Sweden MONICA Project
- 2016
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Ingår i: Scandinavian Journal of Public Health. - London : Sage Publications. - 1403-4948 .- 1651-1905. ; 44:3, s. 233-239
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Forskningsöversikt (refereegranskat)abstract
- Aims: Self-rated health comprehensively accounts for many health domains. Using self-ratings and a knowledge of associations with health domains might help personnel in the health care sector to understand reports of ill health. The aim of this paper was to investigate associations between age-comparative self-rated health and disease, risk factors, emotions and psychosocial factors in a general population. Methods: We based our study on population-based cross-sectional surveys performed in 1999, 2004 and 2009 in northern Sweden. Participants were 25-74 years of age and 5314 of the 7500 people invited completed the survey. Comparative self-rated health was measured on a three-grade ordinal scale by the question How would you assess your general health condition compared to persons of your own age?' with the alternatives better', worse' or similar'. The independent variables were sex, age, blood pressure, cholesterol, body mass index, self-reported myocardial infarction, stroke, diabetes, physical activity, smoking, risk of unemployment, satisfaction with economic situation, anxiety and depressive emotions, education and Karasek scale of working conditions. Odds ratios using ordinal regression were calculated. Results: Age, sex, stroke, myocardial infarction, diabetes, body mass index, physical activity, economic satisfaction, anxiety and depressive emotions were associated with comparative self-rated health. The risk of unemployment, a tense work situation and educational level were also associated with comparative self-rated health, although they were considerably weaker when adjusted for the the other variables. Anxiety, depressive emotions, low economic satisfaction and a tense work situation were common in the population. Conclusions:Emotions and economic satisfaction were associated with comparative self-rated health as well as some medical variables. Utilization of the knowledge of these associations in health care should be further investigated.
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| 10. |
- Wennberg, Anna Lena, 1952-
(författare)
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Pregnant women and midwives are not in tune with each other about dietary counseling : studies in Swedish antenatal care
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background During pregnancy, a healthy diet is beneficial for the expecting mother and her fetus. Midwives in antenatal care have an ideal position for promoting a healthy diet and thereby help women to not only lower the risks of pregnancy complications and adverse birth outcomes, but improve maternal health. The overall aim of this thesis was to describe diet and dietary changes during pregnancy from the women’s and the midwives’ perspectives with a focus on dietary counseling. The thesis comprises four studies. The specific aims in the respective studies were to: I) Describe pregnant women’s attitudes to and experiences of dietary information and advice, as well as dietary management during pregnancy. II) Explore midwives’ strategies in challenging dietary counseling situations. III) Describe how midwives’ perceive their role and their significance in dietary counseling of pregnant women. IV) Describe women’s food habits during pregnancy and up to six months postpartum.Methods Studies I-III were qualitative. Study I included focus group interviews with 23 pregnant women. Study II included telephone interviews with 17 experienced midwives working in Swedish antenatal health care. Study III included the same 17 interviews from study II and supplemented them with four face-to-face-interviews. Qualitative content analysis was performed in all three studies. Study IV was a longitudinal study including a quantitative analysis of a questionnaire, which was given to women at five occasions during and after pregnancy. It concerned their food habits and it was answered by 163 women. The quantitative data was analyzed using comparative and descriptive statistics.Results The overall findings of the thesis were summarized as the main theme “Pregnant women and midwives are not in tune with each other about dietary counseling”. The main theme included the two themes ‘Pregnant women are concerned about risks for their child but fail to change to healthier dietary habits over time’, and ‘Midwives view themselves as authorities, though questioned ones’. In subthemes it was highlighted that pregnant women are well informed and interested in risk reduction for their child’s best and that they try to do their best to improve their diet during pregnancy. However, their diet did not reach levels of healthy eating recommendations and became even unhealthier after pregnancy. It was also highlighted that midwives experienced insufficient knowledge in dietary issues and related risks and that they had difficulties to give dietary support to pregnant women. Midwives were found to mainly focus on giving information and they lacked sufficient competence for challenging counseling.Conclusion Pregnant women, on the one hand, experience a lack of support from the midwives when dealing with dietary changes. The midwives, on the other hand, feel exposed and express a need for both further education in dietary issues and training in counseling. Women’s food habits during, but in particular after pregnancy need improvement, and dietary counseling could be more focused on healthy eating in a long-term perspective.
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