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- Dapi N., Léonie, 1971-
(författare)
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Socioeconomic and sex differences in adolescents’ dietary intake, anthropometry and physical activity in Cameroon, Africa
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: People in Cameroon are experiencing a dietary transition characterized by changing from traditional food habits to increased intake of highly processed sweet and fatty food. The rapid change in food pattern combined with an increased sedentary lifestyle has resulted in a rather high prevalence of obesity, hypertension, cardiovascular diseases and type 2 diabetes. Nutritional intake is important during adolescence for growth spurt, health, cognitive development and performance in school. Objective: The aim of this thesis was to assess dietary intake, anthropometry and physical activity of adolescents according to sex and socioeconomic status (SES) and to investigate food perceptions of adolescents living in urban and rural areas of Cameroon. Methods: Girls and boys, 12-16 years of age, were randomly selected from schools in urban and rural areas. Food frequency questionnaire, 24-hour dietary and physical activity recalls, anthropometric measurements, qualitative interviews and a background questionnaire were used for data collection. Results: The proportion of overweight was three times higher in girls (14%) compared to boys (4%). Stunting and underweight were more common among boys (15% and 6%) than girls (5% and 1%). The prevalence of stunting was two times higher among the urban adolescents with low SES (12%) compared to those with high SES (5%). The rural adolescents had the highest proportion of stunting but more muscle that the urban adolescents. The rural adolescents ate in order to live and to maintain health. Urban adolescents with low SES ate in order to maintain health, while those with high SES ate for pleasure. More than 30% of the adolescents skipped breakfast in the urban area. Urban adolescents with high SES and girls reported a more frequent consumption of in-between meals and most food groups compared to the rural adolescents, boys and those with low SES. Over 55% of the adolescents had a protein intake below 10% of the energy (E%). Twenty-six percent of the adolescents had fat intake below 25 E%, and 25% had fat intake above 35 E%. A large proportion of the adolescents had an intake of micronutrients below the estimated average recommendation. Boys and the adolescents with low SES reported a higher energy expenditure and physical activity level than girls and the adolescents with high SES, respectively. Both under- and over-reporting of energy intake were common among the adolescents. Conclusions: The present study showed that nutrient inadequacy, stunting, underweight, as well as overweight and obesity were common among the adolescents in Cameroon. Therefore an intervention program targeting both under- and overnutrition among school adolescents is needed. Sex and socioeconomic differences also need to be considered.
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| 2. |
- Enarsson, Per, 1962-
(författare)
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Mellan frihet och trygghet : personalgemensamt förhållningssätt i psykiatrisk omvårdnad
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The common staff approach in psychiatric care has not been studied explicitly before. Earlier studies in related areas of social processes in psychiatric care highlight the importance of the interaction between the patient and the carer to understanding communication patterns and attitudes. Other studies on social order and power in psychiatric care shows carers and patients as taking part in a hierarchical system in which patients are subordinate to carers. Aim: The overall aim of this thesis is to study the phenomenon of the common staff approach in psychiatric care, how it emerges, and how it is used and experienced by both carers and patients. Method: In the first study, grounded theory was applied to data from observations and interviews carried out with carers and clients in two psychiatric care group dwellings. In the second and third studies, a phenomenological hermeneutic method was used to analyse narrative interviews conducted with nine careers working on psychiatric wards and nine patients with experience of psychiatric in-care, respectively. In the fourth study, qualitative content analysis was used to analyse data obtained by a vignette method from interviews with 13 carers with experience of working in psychiatric in-care. Results: A common staff approach can be understood as a social process in municipality-level group dwellings and psychiatric in-care, imposed by carers on clients or patients with the aim of restoring a predetermined order desired by the carers. When the order is disturbed the carers try to restore it by adopting a common and consistent approach towards the single patient perceived as the threat to order. Barriers to the success of a common staff approach, from the point of view of the carers, include the likelihood that colleagues will interpret situations differently, the chance that patients might succeed in dividing carers into “good” and “bad” camps, and the knowledge that the patient suffers under a common staff approach. The patients’ experiences partly confirm those of the carers – the dominant picture is that the patient feels persecuted and suffers under a common staff approach. However in some situations, patients can perceived the common approach as supportive and aimed to promote their recovery. Carers’ ethical reasoning about the common staff approach is usually applied on an individual basis; it can change depending upon the patient, the situation, and the proposed approach, as well as upon how the approach might affect other patients, staff members, or the carers themselves. Conclusions: The overall results from the four studies show that the common staff approach may meet carers’ needs, which under the approach take precedence over those of patients, but that the approach is more an exercise in asserting power and maintaining control than it is a therapeutic technique; that it is a difficult choice for the single carer to choose between the interests of the patient and the approval of colleagues; that the patient often suffers when a common staff approach is used; and that carers are seldom aware of the suffering experienced by the patient being managed by such an approach. A common staff approach has no part in a care-strategy; it is not an intentional care-plan; instead it appears to be a way for carers who feel vulnerable and under pressure to maintain order by controlling particular patients.
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| 3. |
- Erlingsson, Christen
(författare)
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Elder abuse through a prism of perceptions : perspectives of potential witnesses
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to deepen understanding of elder abuse (EA) by exploring and comparing perceptions held by experts, older persons, representatives of potential support organizations, and family members. Experts’ perspectives (I) were examined through risk indicators and screening questions (a) located in EA literature and (b) selected by an international Delphi panel. Risk indicators most commonly found in the literature or selected by the panel were compiled into consensus lists. There were differences between risk indicators and questions in the two lists. In papers II and III participants were interviewed in focus groups about their perceptions of EA. Older persons (II) considered EA to be due to changing society and family systems where children are not brought up to respect older persons. EA was mainly conceptualized as ageism, criminal actions, mistreatment in residential care, and societal abuse. The abuser was perceived as a stranger or a healthcare worker. Fear was discussed as a major consequence of EA; especially fear among women. Abused persons were described as carrying the responsibility to seek help. Witnesses were described as hesitant to get involved. Improvements in society such as educating children and healthcare workers were considered ways to cope with EA. Besides family and friends there were few spontaneous suggestions for where to seek help and support in society. These suggestions included healthcare, police, church, and volunteer organizations. Representatives of these suggested organizations were interviewed in focus groups about their perceptions of EA (III). Perceptions of both causes and conceptions of EA were very similar to perceptions of older persons (II). Four themes emerged in the data; good intentions in abusive situations, older generation’s responsibility for EA, failing to report abuse, and prevention of abuse. Participants (III) also expressed ageist attitudes themselves and findings included victim blaming and tolerance for EA. Participants perceived that anyone could be provoked to abuse, and that abusers can be considered victims in abusive situations. Confidentiality was discussed as a barrier to reporting and the need for educating children to show respect for older persons was identified. Interviews with an adult family member (IV) explored her experiences of witnessing abuse situations between her uncle and his wife. In her desire to protect and remain loyal to her family she felt powerless and tolerated abuse. She longed for support she could trust but was locked into passivity by her feelings of shame. Synthesis of findings (I – IV) revealed issues of isolation, autonomy, vulnerability, victim blaming, perceiving the abuser as a victim of circumstances, ageism, tolerating EA, shame, and power as essential elements in EA. Based on the findings, alternative descriptions of EA are offered as a challenge to existing EA definitions. Findings suggest that a key to unlocking EA is compassion, understood as the ability to see a situation as if we were in it ourselves, experiencing the potential for disrespect, shame and unworthiness inherent in abusive acts.
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| 4. |
- Sandvide, Åsa
(författare)
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Våld i särskilda boenden för äldre : språk och sociala interaktioner
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present thesis aims to study the relationship between the violence that occurs in institutional care for older people and the language employed when this violence and the involved parties are talked and narrated. The thesis has been guided by social constructionism, and violence, victims and perpetrators have been considered as social phenomena constructed in discursive processes. Narrative interviews were conducted with 57 care providers who had been involved in social interactions in which violence occurred. The thesis comprises four studies. Study I is a qualitative description of the interactions. In study II, narrative analysis and positioning theory were used to explore the involved parties’ positions. Discourse analysis was employed to investigate discursively created identities (Study III), discursive constructions and how problems related to violence are framed (Study IV). When the care providers described the interactions, they talked about mutual misunderstandings, mutual invasions of personal space and an acceptance of violence in their work. It seemed more reasonable to consider the involved parties as both victims and perpetrators as opposed to one party being exposed and the other perpetrating the violence (I). When the positions of victim and perpetrator were questioned in one care provider’s narrative, they appeared to alter from perpetrator to victim to protector throughout the account by use of available discourses. The way of narrating, taking up or resisting the positions offered by the available discourses made it possible to create a preferred identity (II). These discursively created identities can be viewed as a way of defining an undesirable situation, thereby legitimizing the actions taken. The various identities led to consequences and effects such as loss of autonomy, the use of force, humiliation and exclusion. The construction of identities was connected to various beliefs about older persons (III). Beliefs define what actions are possible and legitimate in a certain context as well as forming the basis for the articulation of problems, thus studying such expressions made it possible to explore beliefs. The articulated problems were viewed as a way to create boundaries, indicating certain possible and relevant solutions. When the care providers talked about the interactions, they presented them as being due to a difficult and unavoidable problem related to the illness, caring for the body, competence and profession as well as social order (IV). The discursive struggle, competence, power, powerlessness, resistance, identity constructions, justification and quality of care are reflected upon and discussed. The analysis of the care providers’ narratives has made it possible to disclose how discourses concur and compete in order to give meaning to concrete social interactions involving violence. It has also been possible to show how to describe, understand and resist as well as to legitimize and justify the actions performed in relation to such interactions. The narratives opened up possibilities to study practices that are talked about as natural. The things that the care providers narrated about have been regarded as manifestations of discourses. Discourses produce certain versions of the interactions, victims and perpetrators, but it must be borne in mind that these are just a few among many possible versions, which are constantly changing.
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