| 1. |
- Elwér, Sofia, 1979-
(författare)
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Gender equality and health experiences : workplace patterns in Northern Sweden
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to gender inequalities in health experiences. The workplace is an important part of the social circumstances under which health opportunities and constraints are shaped. The workplace has also been identified as an important arena for gender constructions. Still, there is a lack of research about the relations between workplace gender equality and health experiences. The aim of this thesis was to explore gender equality and health experiences in a workplace setting.Qualitative and quantitative methods were used. In the qualitative studies all caregiving staff at two establishments providing care for elderly was invited to participate in focus groups (Papers I & II). A moderator led 14 focusgroup discussions. Qualitative content analysis was used to analyse the transcribed discussions. For the quantitative studies questionnaire data from the Northern Swedish Cohort (n=836) were analysed and supplemented with register data about the participants’ workplaces. The register data were used to stratify the workplaces according to gender composition (paper IV) and to create gender equality indicators of the number of women and men at the workplace, education, salary and parental leave (Paper III). Cluster analysis was used to identify patterns of gender equality at the workplaces. Logistic regression analysis, adjusting for individual socio-demographics and previous psychological distress, were used to analyse psychological distress in relation to both clusters and gender compositions.This thesis identifies various workplace patterns of gender equality and how they are related to health experiences. The results from the focus group study showed that workplace stressors had a structural character, often originating from societal processes outside the own organization, whereas health resources had a relational character and were constructed within the organization (paper I). Gender equality was seen as a structural issue not connected to the individual health experiences and gender inequalities were justified through focusing on personalities and interests in work division (paper II). The cluster analysis resulted in six distinctive clusters with different workplace patterns of gender equality (paper III). The most gender-equal cluster was characterized by gender equality in salary and parental leave and was associated with the lowest prevalence of psychological distress, with no significant differences between women and men. The clusters were associated with psychological distress among women only. The highest odds for psychological distress among women were found in a traditional unequal cluster. Analyses of the gender composition at the workplace showed that the highest prevalence of psychological distress was found at workplaces with a mixed gender composition (paper IV). The psychosocial work environment was rather similar independent of the workplace gender composition.The factors most strongly associated with psychological distress were high demands and low control at workplaces with more men, being looked down upon at workplaces with a mixed gender composition, and social support at workplaces with more women.Gender perspectives highlight the importance of gender relations in research on work-related health. Gender inequalities at workplaces can be part of the explanation to women’s worse self-rated health. A multidimensional view of gender equality is necessary to understand health consequences of specific workplace situations. Workplaces are important arenas for health promotion activities and gender equality aspects needs to be taken into account to reach both women and men. Adequate health promotion needs to shift focus from individual health strategies to structural solutions that can challenge the root of the problem.
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| 2. |
- Elwer, Sofia, et al.
(författare)
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Gender (in)equality among employees in elder care : implications for health
- 2012
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Gendered practices of working life create gender inequalities through horizontal and vertical gender segregation in work, which may lead to inequalities in health between women and men. Gender equality could therefore be a key element of health equity in working life. Our aim was to analyze what gender (in) equality means for the employees at a woman-dominated workplace and discuss possible implications for health experiences.Methods: All caregiving staff at two workplaces in elder care within a municipality in the north of Sweden were invited to participate in the study. Forty-five employees participated, 38 women and 7 men. Seven focus group discussions were performed and led by a moderator. Qualitative content analysis was used to analyze the focus groups.Results: We identified two themes. "Advocating gender equality in principle" showed how gender (in) equality was seen as a structural issue not connected to the individual health experiences. "Justifying inequality with individualism" showed how the caregivers focused on personalities and interests as a justification of gender inequalities in work division. The justification of gender inequality resulted in a gendered work division which may be related to health inequalities between women and men. Gender inequalities in work division were primarily understood in terms of personality and interests and not in terms of gender.Conclusion: The health experience of the participants was affected by gender (in) equality in terms of a gendered work division. However, the participants did not see the gendered work division as a gender equality issue. Gender perspectives are needed to improve the health of the employees at the workplaces through shifting from individual to structural solutions. A healthy-setting approach considering gender relations is needed to achieve gender equality and fairness in health status between women and men.
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| 3. |
- Elwér, Sofia, et al.
(författare)
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Health against the odds : experiences of employees in elder care from a gender perspective
- 2010
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 20:9, s. 1202-1212
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Tidskriftsartikel (refereegranskat)abstract
- Women-dominated elder care in Sweden is a low-paid, low-status job with a high prevalence of sick leave. Our aim was to analyze health experiences of employees in elder care from a gender perspective. All caregiving staff at two establishments providing care to the elderly were invited to participate in the study. A moderator led seven focus group discussions. Qualitative content analysis was used to analyze the transcribed focus groups. We identified two central themes in relation to the employees' health. "Working against the odds" describes gendered workplace stressors of a structural character, to a large extent triggered by societal processes outside the organization. "Making work matter" refers to gendered health resources with a relational character, constructed within the organization. Health-promoting programs directed toward women-dominated workplaces need to include a gender perspective, and focus on creating structural, supportive environments to avoid the negative health effects of the stressors.
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| 4. |
- Elwér, Sofia, et al.
(författare)
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Life course models of economic stress and poor mental health in mid-adulthood : Results from the prospective Northern Swedish Cohort
- 2015
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 43:8, s. 833-840
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 5. |
- Elwér, Sofia, 1979-, et al.
(författare)
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Patterns of gender equality at workplaces and psychological distress
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Research in the field of occupational health often uses a risk factor approach which has been criticized by feminist researchers for not considering the combination of many different variables that are at play simultaneously. To overcome this shortcoming this study aims to identify patterns of gender equality at workplaces and to investigate how these patterns are associated with psychological distress. Questionnaire data from the Northern Swedish Cohort (n=715) have been analysed and supplemented with register data about the participants’ workplaces. The register data were used to create gender equality indicators of women/men ratios of number of employees, educational level, salary and parental leave. Cluster analysis was used to identify patterns of gender equality at the workplaces. Differences in psychological distress between the clusters were analysed by chi-square test and logistic regression analyses, adjusting for individual socio-demographics and previous psychological distress. The cluster analysis resulted in six distinctive clusters with different patterns of gender equality at the workplaces that were associated to psychological distress for women but not for men. For women the highest odds of psychological distress was found on traditionally gender unequal workplaces. The lowest overall occurrence of psychological distress as well as same occurrence for women and men was found on the most gender equal workplaces. The results from this study support the convergence hypothesis as gender equality at the workplace does not only relate to better mental health for women, but also more similar occurrence of mental ill-health between women and men. This study highlights the importance of utilizing a multidimensional view of gender equality to understand its association to health outcomes. Health policies need to consider gender equality at the workplace level as a social determinant of health that is of importance for reducing differences in health outcomes for women and men.
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| 6. |
- Elwér, Sofia, 1979-, et al.
(författare)
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Workplace gender composition and psychological distress : the importance of the psychosocial work environment
- 2014
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Ingår i: BMC Public Health. - London : BioMed Central. - 1471-2458. ; 14, s. 241-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Health consequences of the gender segregated labour market have previously been demonstrated in the light of gender composition of occupations and workplaces, with somewhat mixed results. Associations between the gender composition and health status have been suggested to be shaped by the psychosocial work environment. The present study aims to analyse how workplace gender composition is related to psychological distress and to explore the importance of the psychosocial work environment for psychological distress at workplaces with different gender compositions.Methods: The study population consisted of participants from the Northern Swedish Cohort with a registered workplace in 2007 when the participants were 42 years old (N = 795). Questionnaire data were supplemented with register data on the gender composition of the participants' workplaces divided into three groups: workplaces with more women, mixed workplaces, and workplaces with more men. Associations between psychological distress and gender composition were analysed with multivariate logistic regression analysis adjusting for socioeconomic position, previous psychological distress, psychosocial work environment factors and gender. Logistic regression analyses (including interaction terms for gender composition and each work environment factor) were also used to assess differential associations between psychosocial work factor and psychological distress according to gender composition.Results: Working at workplaces with a mixed gender composition was related to a higher likelihood of psychological distress compared to workplaces with more men, after adjustments for socioeconomic position, psychological distress at age 21, psychosocial work environment factors and gender. Psychosocial work environment factors did not explain the association between gender composition and psychological distress.Conclusions: The association between gender composition and psychological distress cannot be explained by differences in the perception of the psychosocial work environment and thus the work environment hypothesis is not supported. Workplaces with a mixed gender composition needs further research attention to explain the negative development of psychological distress during working life for both women and men at these workplaces.
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| 7. |
- Hammarström, Anne, et al.
(författare)
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Central gender theoretical concepts in health research : the state of the art
- 2014
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ Publishing Group Ltd. - 0143-005X .- 1470-2738. ; 68:2, s. 185-190
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Tidskriftsartikel (refereegranskat)abstract
- Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (ie, a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.
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| 8. |
- Hammarström, Sofia, 1984-, et al.
(författare)
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Ask me, listen to me, treat me well and I shall tell: a qualitative study of Swedish youths’ experiences of systematic assessment of sexual health and risk-taking (SEXIT)
- 2022
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Ingår i: Sexual and Reproductive Health Matters. - : Informa UK Limited. - 2641-0397. ; 30:1
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Tidskriftsartikel (refereegranskat)abstract
- Sexual ill health among young people, in terms of sexually transmitted infections (STIs), unintended pregnancy, transactional sex and sexual violence, is a global public health concern. To that end, the SEXual health Identification Tool (SEXIT) was developed. The purpose of this study was to explore the visitors’ experiences of a youth clinic visit when SEXIT was used. A purposively selected sample of 20 participants (16–24 years of age) was recruited from three Swedish youth clinics using SEXIT. Participants were interviewed individually in March and April 2016, and data were analysed using inductive qualitative content analysis. The analysis resulted in four main categories describing the participants’ experiences of using SEXIT: “Issues of concern” includes descriptions of the items in SEXIT as important; “Enabling disclosure” describes how SEXIT serves as an invitation to talk and facilitates disclosure of negative experiences; “Road to change” captures experiences of the conversation with the healthcare professional; and “Managing power imbalance” describes experiences regarding the response and attitudes of the healthcare professional as well as the participants’ fears of being judged. The categories are connected by the overarching theme “Ask me, listen to me, treat me well and I shall tell”. This study contributes knowledge on young people’s experiences of a tool-supported dialogue on sexual health and risk-taking initiated by the healthcare professional. Structured questions in a written format, as a basis for dialogue, are appreciated and experienced as a functioning way of addressing sexual ill health and risk-taking at Swedish youth clinics.
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| 9. |
- Hammarström, Sofia, 1984-, et al.
(författare)
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Identification and risk assessment of Swedish youth at risk of chlamydia.
- 2015
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 43:4, s. 399-407
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to identify youth at high risk of chlamydia including variables related to sexual health and negative experiences of sexuality.
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| 10. |
- Hammarström, Sofia, 1984-
(författare)
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Identification of young people at risk of sexual ill health : implementing a new tool in youth clinics
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Young people are at increased risk of sexual ill health in terms of sexually transmitted infections, unintended pregnancy, and sexual violence. There is limited knowledge of evidence-based preventive practices for identification of young people at risk of sexual ill health when in contact with health care. Aims: The overall aim of this thesis was to generate new knowledge concerning how Swedish youth clinics can work systematically to identify young people at risk of sexual ill health or who have negative sexual experiences. Specific objectives were to develop a risk-assessment model for the identification of youth at risk of contracting chlamydia; to develop and pilot-implement an evidence-informed tool for identifying young people at risk of sexual ill health in terms of sexually transmitted infections, unintended pregnancies, and sexual violence at Swedish youth clinics; and to explore youth clinic visitors’ and staff’s experiences of using that tool. Methods: The thesis takes a mixed methods approach and includes four studies. First, data from a national sample of sexually active young people, aged 15–24 years (n=6544), were used to develop a risk-assessment model for chlamydia infection. Second, a risk-assessment tool (SEXual health Identification Tool; SEXIT) was developed and pilot-implemented at three youth clinics for 1 month. The tool includes three components: (1) staff training; (2) a questionnaire for youth clinic visitors; and (3) a written guide for staff to support the subsequent dialogue and risk assessment based on the questionnaire. Questionnaire data from visitors (n=268) and staff (n=18) were analysed. Third, youth clinic visitors’ experiences were explored in 20 interviews with visitors (15–24 years) from the participating youth clinics. Fourth, staff’s experiences of working with SEXIT were investigated in four focus group discussions (n=16). Quantitative and qualitative methods were used for data analyses. Results: The risk-assessment model demonstrated that the distribution of chlamydia is skewed; 38% of cases were estimated to occur among a tenth of the population. Women most at risk of chlamydia were best identified using the variables age, number of sexual partners in the past year, and experience of sex for reimbursement. The corresponding variables for men were age, number of sexual partners, and alcohol use. SEXIT was validated and pilot-implemented at three youth clinics (response rate 86%). Before implementation, all staff perceived a need for more systematic screening for sexual risk-taking and sexual ill health at youth clinics. Youth clinic visitors demonstrated between 0 and 7 parallel risk factors. Staff experienced that using SEXIT systematically increased the consistency and quality of the clinics’ work, and youth clinic visitors reported that the questions were important and not uncomfortable or difficult. The visitors explained that questions in a written format followed by a dialogue initiated by the youth clinic staff enabled disclosure of negative experiences. Conclusions: The risk-assessment model demonstrates that the number of partners during the past year is the most important risk factor for chlamydia regardless of gender. SEXIT is an acceptable, appropriate, and feasible tool from the perspective of youth clinic staff, youth clinic visitors, and from an implementation point of view. Using the tool systematically may help raise important questions on sexual risk-taking and sexual ill health with youth clinic visitors and identify visitors with multiple risk factors. Being asked the sensitive yet important questions in SEXIT, followed by a respectful and non-judgemental conversation led by the youth clinic staff, has the potential to open up a more in depth and broader dialogue about the visitors’ sexual health. The systematic procedure helps youths feel that they are taken seriously and instils a feeling of trust that enables disclosure of sensitive experiences. From the staff perspective, SEXIT facilitates identification of young people exposed to or at risk of sexual ill health by simplifying and ensuring consistency and quality in their work.
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| 11. |
- Hammarström, Sofia, et al.
(författare)
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Identifying young people exposed to or at risk of sexual ill health: pilot implementation of an evidence-informed toolkit (SEXIT) at Swedish youth clinics
- 2019
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Ingår i: European Journal of Contraception and Reproductive Health Care. - : Informa UK Limited. - 1362-5187 .- 1473-0782. ; 24:1, s. 45-53
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We aimed to develop and pilot-implement an evidence-informed toolkit (SEXual health Identification Tool; SEXIT) for identifying young people exposed to or at risk of sexual ill health, at Swedish youth clinics, and to investigate SEXIT’s potential to identify young people in need of special care and monitoring. Methods: The SEXIT toolkit was developed, validated and pilot-implemented at three Swedish youth clinics. Pre-implementation staff readiness was assessed and youth clinic visitors’ responses to SEXIT were analysed. Results: All staff perceived a need for screening for sexual risk-taking and exposure. The response rate from 268 youth clinic visitors (aged 15–24 years) was 86%. Half of the visitors had one or no variable associated with sexual ill health, a third had two or three, and 15% reported between four and seven variables. The most common variables were alcohol use, three or more sexual partners in the past year and previous chlamydia. Visitors rated SEXIT as important and not uncomfortable or difficult to answer. Conclusions: The SEXIT toolkit was found to be feasible and highly acceptable in a clinical setting. The use of SEXIT may facilitate important questions on sexual risk-taking and sexual ill health to be raised with youth clinic visitors. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 12. |
- Hammarström, Sofia, et al.
(författare)
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Sexual health interventions for young people in state care: a systematic review
- 2018
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 46:8, s. 817-834
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe evaluated sexual health interventions for young people in state care and provide an assessment of the quality of and evidence for these interventions. Methods: A systematic review of sexual health interventions for young people in state care was conducted. Randomised controlled trials and quasi-experimental designs were eligible, 2051 records were screened, 412 full-text studies retrieved, and 12 publications with low-to-moderate risk of bias included. Results: Due to substantial heterogeneity in study populations, settings, intervention approaches, outcomes and measures, standard summary measures for intervention outcomes was not used. Instead, data were synthesised across studies and presented narratively. Conclusion: Without making recommendations, the result suggests that group-based educational interventions in general increase knowledge, attitudes and behaviour compared with standard care. However, these findings need to be further investigated, with a special emphasis on cultural context and the involvement of young people.
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| 13. |
- Hammarström, Sofia, 1984-, et al.
(författare)
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Staff´s experinces of the SEXual health Identification Tool (SEXIT)
- 2022
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Ingår i: ESC Abstract Book 2022. - : European Society of Contraception and Reproductive Health. ; , s. 88-89
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundIn 2016 SEXIT, an evidence-informed the toolkit, was developed and pilot-implemented at three Swedish youth clinics. Swedish youth clinics are highly accessible and focused primarily on concerns related to sexual and reproductive health and mental health among young persons aged 13-25 years. The SEXual health Identification Tool (SEXIT) was developed to facilitate identification of young people exposed to, or at risk of, sexual ill health in terms of sexually transmitted infections, unintended pregnancy, transactional sex, or sexual violence. The tool includes three components; (1) staff training, (2) a questionnaire for visitors, and (3) a written guide for staff to support the dialogue and risk assessment. Previous results demonstrated promising results; a high response rate from visitors (86%), few missing answers, and youth clinic visitors reporting factors associated with sexual ill health. Interviews demonstrated that youth clinic visitors appreciated structured questions in a written format as a basis for dialogue and found SEXIT appropriate for addressing sensitive topics. ObjectivesTo explore the youth clinic staff’s experiences of using SEXIT systematically with all visitors, with a focus on usefulness, implementation determinants, and feasibility of implementing SEXIT at Swedish youth clinics.MethodFour focus group discussions with youth clinic staff who participated in the pilot implementation. The clinics had used SEXIT systematically with all visitors for one month. Data were analysed using qualitative analysis designed for focus groups.ResultsMost participants experienced that the SEXIT routines were well functioning and that using SEXIT gave a comprehensive picture of the visitor and resulted in more concrete answers, which facilitated the risk assessment. Youth clinic staff experienced that SEXIT advanced their knowledge and the midwifes experienced that they identified more youth at risk with SEXIT, while the psychosocial staff were less convinced on how SEXIT best should be applied. Existing challenges related to the routines at the clinics and heavy workload during drop-in hours. Further, the staff were concerned about the continued care of vulnerable, and hard-to-reach youth clinic visitors that sometimes do not attend the scheduled revisits.Conclusions Staff experience SEXIT as useful for identifying young people exposed to or at risk of sexual ill health. Systematic use ensures consistency and quality in assessing the visitors, which may facilitate implementation. The use of SEXIT is challenged by heavy workload, conflicting routines, and the experience that some visitors identified through SEXIT decline further care. Implementation of SEXIT in Swedish youth clinics is considered feasible.
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| 14. |
- Hammarström, Sofia, 1984-, et al.
(författare)
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Staff's experiences of a pilot implementation of the SEXual health Identification Tool for assessing sexual ill health among visitors to Swedish youth clinics: A focus group study
- 2021
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Ingår i: Sexual and Reproductive Healthcare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 29
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Tidskriftsartikel (refereegranskat)abstract
- Background: Young people are disproportionally burdened by sexual ill health. The SEXual health Identification Tool (SEXIT) was developed for use at youth clinics, to facilitate identification of visitors exposed to or at risk of sexual ill health. The aim of this study was to explore experiences of using SEXIT among youth clinic staff who participated in a pilot implementation, with a focus on usefulness, implementation determinants, and feasibility of implementing SEXIT at Swedish youth clinics. Methods: Four focus group discussions were conducted with youth clinic staff from three clinics. The clinics had used SEXIT systematically in consultations with all visitors for one month. Data were analysed using qualitative analysis designed for focus groups. Results: Most participants experienced that the SEXIT routines were well functioning and that using SEXIT gave a comprehensive picture of the visitor and resulted in more concrete answers, which facilitated the risk assessment. The medical staff experienced that they identified more youth at risk with SEXIT, while the psychosocial staff were less convinced. Existing challenges related to the routines at the clinics and heavy workload during drop-in hours. Conclusions: Staff experience SEXIT as useful for identifying young people exposed to or at risk of sexual ill health. Systematic use ensures consistency and quality in assessing the visitors, which may facilitate implementation. The use of SEXIT is challenged by heavy workload, conflicting routines, and the experience that some visitors identified through SEXIT decline further care. Implementation of SEXIT in Swedish youth clinics is considered feasible. © 2021
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| 15. |
- Hammarström, Sofia, et al.
(författare)
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Violence and sexual risk taking reported by young people at Swedish youth clinics
- 2022
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Ingår i: Upsala Journal of Medical Sciences. - : Upsala Medical Society. - 0300-9734 .- 2000-1967. ; 127:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early identification of sexual risk taking and exposure to violence is fundamental when seeking to strengthen young people's health. The purpose of this study was to study factors associated with sexual risk taking and ill health, as well as to study gender differences, and the associations amongst exposure to multiple forms of violence, sexual risk taking and ill health. Methods:This was a cross-sectional study based on data from 3,205 young people answering a questionnaire belonging to the Sexual health Identification Tool (SEXIT 2.0), during consultations at 12 youth clinics in Sweden. The analyses are based on descriptive statistics and nominal multiple regression analysis. Results: Male, transgender and non-binary youths reported significantly more events of sexual risk taking and ill health compared to women. Those who reported sexual initiation before the age of 15 (OR 2.87, CI 1.81-4.56), three or more sexual partners in the past 12 months (OR 2.68, CI 1.70-4.22) and to have ever experienced an unintended pregnancy (OR 2.29, CI 1.32-3.97) were more than twice as likely to report exposure to physical, emotional and sexual violence.Transgender, non-binary youths and women were more exposed to multiple violence (OR 3.68, 13.50) compared to men. Conclusions:Transgender and non-binary youths are exposed to significantly more violence compared to women and men. Experiences of sexual risk taking and ill health demonstrated strong associations with exposure to multiple violence.
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| 16. |
- Kilander, Helena, et al.
(författare)
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Identifying sexual risk-taking and ill health in the meeting with young people-experiences of using an assessment tool
- 2022
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Ingår i: Scandinavian Journal of Caring Sciences. - Chichester, United Kingdom : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 36:4, s. 1189-1196
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Identifying young people exposed to sexual risk-taking or violence is fundamental, when seeking to strengthen their health. However, young people seldom share sexual health concerns or experiences of violence with healthcare professionals (HCPs). Studies evaluating how use of a risk assessment tool influences the dialogue about sexual health and violence are sparse.AIMS: The aim of this study was to explore HCPs' experiences of using the SEXual health Identification Tool (SEXIT) in encounters with young people at Swedish youth clinics.METHOD: Three focus group interviews were conducted with 21 HCPs from nine youth clinics, where SEXIT had been introduced. Data were analysed using thematic content analysis.RESULTS: Three themes were identified. The theme, Facilitates dialogue about sexuality and vulnerability, describes how the questionnaire pertaining to SEXIT helped to normalise and help both HCPs and young people to take part in the dialogue about sensitive issues. Need for a trustful encounter presents HCPs' ethical concerns regarding how the questionnaire affects the integrity of young people and trust-making. Sensitive topics entail challenges describes HCPs' challenges when dealing with sensitive issues. Additionally, it describes needs for knowledge and collaboration when targeting vulnerable young people.CONCLUSIONS: The HCPs stated that using SEXIT developed their ability to address sensitive issues and helped both them and young people to take part in the dialogue about sexuality and exposure to violence. SEXIT involves experiences of ethical concerns regarding integrity and trust-making. It also entails challenges in having dialogues about sensitive issues, how to deal with risk assessment outcomes and in improvements regarding inter-professional collaborations.
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| 17. |
- Mezheyeuski, Artur, et al.
(författare)
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An immune score reflecting pro- and anti-tumoural balance of tumour microenvironment has major prognostic impact and predicts immunotherapy response in solid cancers
- 2023
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Ingår i: EBioMedicine. - : Elsevier. - 2352-3964. ; 88
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cancer immunity is based on the interaction of a multitude of cells in the spatial context of the tumour tissue. Clinically relevant immune signatures are therefore anticipated to fundamentally improve the accuracy in predicting disease progression.Methods: Through a multiplex in situ analysis we evaluated 15 immune cell classes in 1481 tumour samples. Single-cell and bulk RNAseq data sets were used for functional analysis and validation of prognostic and predictive associations.Findings: By combining the prognostic information of anti-tumoural CD8+ lymphocytes and tumour supportive CD68+CD163+ macrophages in colorectal cancer we generated a signature of immune activation (SIA). The prognostic impact of SIA was independent of conventional parameters and comparable with the state-of-art immune score. The SIA was also associated with patient survival in oesophageal adenocarcinoma, bladder cancer, lung adenocarcinoma and melanoma, but not in endometrial, ovarian and squamous cell lung carcinoma. We identified CD68+CD163+ macrophages as the major producers of complement C1q, which could serve as a surrogate marker of this macrophage subset. Consequently, the RNA-based version of SIA (ratio of CD8A to C1QA) was predictive for survival in independent RNAseq data sets from these six cancer types. Finally, the CD8A/C1QA mRNA ratio was also predictive for the response to checkpoint inhibitor therapy.Interpretation: Our findings extend current concepts to procure prognostic information from the tumour immune microenvironment and provide an immune activation signature with high clinical potential in common human cancer types.
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| 18. |
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| 19. |
- von Oelreich, Kristina, et al.
(författare)
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Waste prevention in criteria in public procurement : Tools for achieving the national environmental quality objectives
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The Environmental Protection Agency has carried out regular questionnairebased surveys in order to monitor the extent to which environmental requirements are imposed in connection with public procurement in Sweden. Questionnairebased surveys have been carried out in 2004, 2007, 2009 and 2013. The target group for the surveys has been procurement officers within municipal authorities, county councils, government agencies, state-owned companies and embassies belonging to the Ministry of Foreign Affairs.The Environmental Protection Agency carried out another questionnairebased survey during 2015 which focused on the extent to which and the way in which purchasing government agencies impose requirements concerning waste prevention measures in procurement.The conclusions that are drawn from the results of the survey and a subsequent workshop are that the extent to which requirements are imposed concerning waste prevention measures varies between different procurement areas, and that the work to impose this type of requirement needs to be improved.Among other things, the survey shows that many of the organizations that responded to the questionnaire have governing documents such as procurement policies which impose requirements to ensure that procurements are environmentally compatible. Despite these government documents, the survey shows that no significant requirements concerning waste prevention measures are imposed in procurements and that there is a lack of knowledge of how these requirements are imposed. One conclusion is that the management at various levels within the organization need to become better at monitoring and requiring the imposition of waste prevention measures in connection with procurement and the way in which they should be handled during the agreement period.The survey also shows that the majority of the organizations have both a centralized and decentralized procurement organization, which may also be of significance as regards the way in which the requirements are imposed in connection with procurement. There is a tendency for many people to believe that it costs more and takes longer to carry out procurements if requirements concerning waste prevention measures are imposed. In spite of this, the majority of the organizations will impose such requirements and there is demand for more and simpler tools, i.e. concrete assistance in individual cases for formulating requirements for different types of procurement.In order to achieve this, better training of procurement officers/buyers is needed, and those who provide the courses must have the right background and competence. Better internal collaboration is also needed within the organization between staff with a knowledge of environmental matters and buyers. In order to contribute to a reduction in the environmental impact, organizations should impose requirements concerning waste prevention measures in the first instance on the basis of a number of prioritized areas,such as energy, the construction sector, transport, food products, chemicals, IT and textiles.Environmentally compatible procurement where requirements are imposed concerning waste prevention measures is an important instrument for contributing to achievement of the generational goal and the national environmental quality objectives. In order to environmentally compatible procurements with requirements concerning waste prevention measures to achieve a breakthrough as desired, the issue needs to be monitored and brought up at political level and government agencies with central responsibility for procurement issues need to prepare guidance and offer courses within the area.The most important results from the present survey are as follows:Procurement methodA majority (59 percent) of the organizations carry out their own procurements and have their own framework agreements.The way in which procurements are organizedA large majority (61 percent) of the organizations have decentralized procurements in the organization.The quality/environment models by which the organization is governedJust over two out of every five (45 percent) replied that the organization is governed by a process-oriented working method.Environmental reviewOne in four (27 percent) have carried out an environmental review which covers the work relating to environmentally compatible procurement.Procurement policyOne third (32 percent) replied that their organization has a procurement policy or central guidelines which include environmental considerations in connection with procurement.Requirements concerning waste prevention measuresTwo in five (42) of the organizations impose environmental requirements concerning waste prevention measures within construction and demolition.Types of requirements concerning waste prevention measuresJust over half (56 percent) usually impose general requirements. Almost as many (54) usually require an environmental management system to be in place.Requirement for a reduction in volumes of wasteJust over two in five organizations (43 percent) have imposed a requirement for waste volumes to be reduced as regards construction and demolition contracts.Requirement for reduction in volumes of hazardous waste Almost half (49 percent) have imposed a requirement to reduce the volumes of hazardous waste generated as regards construction and demolition contracts.How requirements are imposedMost organizations (83 percent) which impose requirements in connection with procurement impose them as obligatory requirements/shall requirements.Decisive in connection with contract awardsA few of the organizations (three percent) replied that the use of waste prevention criteria was decisive in connection with the awarding of contracts during 2014.Criteria linked to Sweden’s 16 environmental quality objectivesDuring 2014, one third of the organizations (33 percent) used one or more criteria linked to Sweden’s environmental quality objectives.More guidance on how criteria can be linked to the 16 environmental quality objectivesA large majority (69 percent) believe that their organization needs more guidance on how criteria that have been imposed can be linked to the 16 environmental quality objectives.Use of tools and guidelinesA majority (54 percent) of the organizations use the criteria prepared by the Environmental Management Council.Use of total cost/life-cycle cost calculationsTwo in five organizations (43 percent) usually use total cost/life-cycle cost calculations where relevant.Waste prevention measures in a life-cycle perspectiveMost organizations (89 percent) believe that waste prevention measures must be viewed in a life-cycle perspective.Innovation procurementsAlmost two out of every five (38 percent) think that innovation procurements are preferable to ordinary procurements in order to stimulate new concepts for waste prevention measures.Follow-up of requirements concerning waste prevention measuresOne in five (21 percent) extensively follow up the requirements concerning waste prevention measures that are imposed in connection with procurement during the agreement period.Measurements to determine whether the criteria have reduced the environmental impact Very few organizations (two percent) have been able to any significant degree to measure whether the use of waste prevention criteria have reduced the environmental impact in the procurements that the organizations have carried out.The need for waste prevention measuresThree in ten organizations (30 percent) think that there is a strong need for waste prevention measures.The biggest obstacles to the imposition of waste prevention requirementsA very large majority (76 percent) replied that the biggest obstacle to imposing requirements concerning waste prevention measures is a lack of awareness concerning how to impose requirements.How can more requirements concerning waste prevention measures be imposed?A quarter of the organizations (24 percent) replied that they would impose environmental requirements concerning waste prevention measures if they received help to formulate the requirements.
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