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- Omer-Salim, Amal, 1964-
(författare)
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Mothers’ Agency in Managing Breastfeeding and Other Work in Dar es Salaam, Tanzania and New Delhi, India
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Combining breastfeeding and other forms of work is desirable from both public health and labour productivity perspectives. This is often challenging, especially in low- or middle-income fast-growing urban settings. The aim of this thesis was to gain a deeper understanding of mothers’ perspectives on combining breastfeeding and other work in the urban contexts of Dar es Salaam, Tanzania, and New Delhi, India. Individual semi-structured interviews were conducted with community mothers (n=8) and health worker mothers (n=12) in Dar es Salaam, and mothers working in the health (n=10) and education sectors (n=10) in New Delhi. The methods of analysis were: qualitative content analysis, grounded theory approach, and directed and general inductive content analyses. Mothers’ agency manifested in several ways. Striving to integrate or segment the competing domains of home and work was a goal of these mothers to reduce conflicts in managing breastfeeding and other work. Spatial and time constraints led mothers to engage in an array of carefully planned actions and troubleshooting tactics that included ways of ensuring proximity between them and their baby and efficient time managing. The timing of these strategic actions spanned from pregnancy, over maternity leave, to the return to employment. Managing breastfeeding and work triggered emotions such as stress, frustration and guilt, but also satisfaction and joy. Mothers negotiated with family, employers, colleagues and informal networks to gain support for their strategies, displaying both individual, collective and proxy agency. Changing family structures and roles highlight the potentially greater supportive role of the partner/husband. Work/Family Border Theory and Bandura’s agency constructs provided frameworks for a deeper understanding of mothers’ perspectives, but using existing family relationship constructs would better diffentiate between various modes of agency. Workplaces and maternity protection conditions were generally inadequate. Interventions are required: to strengthen the breastfeeding mother’s own agential capacity using an individual approach; to provide information to families and communities; to improve regulatory, structural and attitudinal conditions at workplaces, and to strengthen health and social services to adequately support mothers in managing breastfeeding and other work.
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| 2. |
- Daerga, Laila, 1965-
(författare)
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Att leva i två världar : hälsoaspekter bland renskötande samer
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: There is a gap of knowledge of the health situation among the reindeer herding Sami in Sweden. The Swedish government has also got criticism for not taking responsibility for the Sami health. The aim of this thesis was to get more knowledge to understand the health situation of the reindeer herding Sami in Sweden. Furthermore, gender specific risk factors in the working environment among reindeer herders and their perception of healthcare and social services were investigated.Method: Cross–sectional questionnaires covering different aspects of health such as musculoskeletal disorders, trust for different healthcare providers and work related psychosocial factors was distributed to reindeer herding Sami and non-Sami populations. Interviews with nine reindeer herding Sami about trust in healthcare and social services were carried out and analyzed with thematic analysis. Sixteen discussion meetings with 80 reindeer herders focusing on psychosocial perspectives of working conditions in Sami communities were performed.Result: The prevalence of musculoskeletal symptoms from elbow, hand/wrist and lower back from male reindeer herders were higher compared to blue-collar worker. Psychosocial risk factors for health were identified such as high workload on a few herders, difficulties to get relief and support as well as to get appreciation in work and lack of participation in decisionmaking among women were common in the organization of reindeer husbandry. The trust in healthcare and social services was lower among reindeer herding Sami compared to non-Sami majority population. A hypothesis is that healthcare professionals do not know that the "Reindeer cloud" (metaphor to iCloud) affects all parts in the reindeer herders life. The distrust are influenced by historically traumas, reindeer herding Sami experiences from healthcare professionals and healthcare organization and culturally generated norms.Conclusio: The thesis hypothesized that health disorders, attitude towards healthcare and psychosocial environment are important aspects when trying to understand the health situation among the reindeer herding Sami. There is a need to introduce long-term public health work for all Sami people, to establish ethical guidelines for Sami health research and develop healthcare services that provides access to healthcare for the reindeer herding Sami, on equal terms.
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| 3. |
- Lundvall, Lise-Lott, 1959-
(författare)
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Radiography in Practice : Work and Learning in Medical Imaging
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Those following the profession of radiographer mainly work in the healthcare sector, with image production in medical imaging or with radiotherapy treatments. Radiographers are responsible for patient care and handling technology in this profession al field. Radiographers’ practice is interesting to study in relation to technical developments and changing conditions for performing professional work.The general aim of this thesis was to empirically explore the main features of radiographers’ work, how advances in tech n ology affect radiographers’ practice, interconnections with other practices and students learn in g in practice on the way to becoming professionals.Methods: Data was collected using interviews and observations (Papers I, II & IV). For Paper III, individual interviews were conducted. Data was analysed using a phenomenological interpretative method (Paper I) and practice theory perspective (Papers II–IV).Findings: Radiographers’ professional work with image production was seen as a process comprising three phases: planning the examination, producing the images, and evaluating the images. During this process, radiographers make judgements to ensure patient safety and adapt the technology in use to the individual patient. When conventional imaging techniques are converted into examinations performed by Computer Tomography, the planning phase of radiographers’ work process becomes more important. Technology improvements also mean that the technical aspects of radiographers’ work with image production are easier to foresee in scheduling examinations. The caring aspects however are difficult to plan for because of little information about the patient before the examination. The professional practices involved in medical imaging interconnect to ensure patient safety through materiality and common tasks and/ or projects. The content and quality of two artefacts, the referral and the image, in these interconnections are important in collaborative work to ensure patient safety within medical imaging. Radiography students learn professional knowing in practice i.e. practice-as-work, practice-as language and practice-as-morality, during their clinical placements through alternating between two modes of participation: either observing and listening or acting by themselves. The students developed knowing in practice if the other practitioners allowed them to alternate between these two modes of participation.Implications: The description of radiographers’ general tasks an d responsibilities in a work process can be used for both educational and professionalization purposes. The identified interconnections between involved professions are useful for quality improvement to secure patient safety. The findings about development of knowing in practice can be used in the planning and evaluation of clinical placements for students.
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| 4. |
- Darvish, Bijan, 1969-
(författare)
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Post-Dural Puncture Headache in Obstetrics : Audiological, Clinical and Epidemiological studies
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Post-dural puncture headache (PDPH) is the most common complication of obstetric epidural analgesia. The characteristic positional headache, often associated with visual, vestibular or cochlear symptoms, is severe and disabling for the parturient. The diagnosis is clinical without the possibility of confirmatory objective tests. Although epidural blood patch (EBP) is considered the gold standard for treatment of PDPH, many aspects of this treatment modality remain to be explored. This thesis was performed in order to improve our current knowledge of the diagnosis and the short and long-term consequences of PDPH. We found that the incidence of accidental dural puncture in labour epidural analgesia was 1% in the Nordic countries and 90% of these patients were managed with an EBP (study I). Auditory impairment related to PDPH was prospectively investigated in 21 parturients with PDPH treated with EBP (study II). A significantly greater number of parturients suffering from PDPH had hearing loss (> 20 dB) in the low frequency range compared to controls which improved spontaneously but independent of treatment with EBP. At 4 hours, 95% of subjects had a successful EBP but headache recurred in 24% at 24 hours. In study III, we investigated residual hearing deficit several years after PDPH treated with EBP. We found statistically significant long-term impairment of hearing but this was of minor clinical relevance. In study IV, 60 women with previous PDPH and treated with EBP responded to a validated questionnaire to determine the long-term effects of EBP on headache and backache. We found that subjects who had been treated with EBP had a significantly greater incidence and severity of headache compared to controls. The incidence of mild backache was also significantly higher but of limited clinical importance. In conclusion, PDPH after labour epidural analgesia is an important clinical problem. Parturients suffering from PDPH may have audiometric deterioration in the early postpartum period that recovers spontaneously over time and some long-term effects of PDPH on hearing may be evident but these are of minor clinical relevance. Clinically important headache, but not backache, may be present several years after PDPH.
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