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1.
  • Andersson, Lena, 1965, et al. (författare)
  • Help-seeking behaviour, barriers to care and experiences of care among persons with depression in Eastern Cape, South Africa
  • 2013
  • Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 151:2, s. 439-448
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Little is known about the help-seeking behaviour and barriers to care among people with depression in poor resource settings in Sub-Saharan Africa. Methods This is a cross-sectional population-based study including 977 persons aged 18-40 living in the Eastern Cape Province in South Africa. The prevalence of depression was investigated with the help of a questionnaire (the Mini International Neuropsychiatric Interview). Several socio-economic variables, statements on help-seeking and perceptions of earlier mental health care were included. Data collection was performed from March to July 2012. Results The prevalence of depression was 31.4%. People aged 18-29 and those with no or low incomes were less likely to seek help. Promotive factors for help-seeking included having social support and tuberculosis comorbidity. Of all people with depression in this sample, 57% did not seek health care at all even though they felt they needed it. Of the variety of barriers identified, those of most significance were related to stigma, lack of knowledge of their own illness and its treatability as well as financial constraints. Limitation Recall bias may be present and the people identified with depression were asked if they ever felt so emotionally troubled that they felt they should seek help; however, we do not know if they had depression at the time they referred to. Conclusions Depression is highly prevalent among young adults in the Eastern Cape Province, South Africa; however, many do not seek help. Health planners should increase mental health literacy in the communities and improve the competence of the health staff.
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  • Ahlberg, Beth Maina, et al. (författare)
  • 'It's only a tradition' : making sense of eradication interventions and the persistence of female 'circumcision' within a Swedish context
  • 2004
  • Ingår i: Critical Social Policy. - London : Sage Publications. - 0261-0183 .- 1461-703X. ; 24:1, s. 50-78
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper questions why female circumcision (FC) persists despite eradication interventions and the migration of people to non-practising countries and discusses the reasoning of Somali immigrants on female circumcision. It is based on interviews with diverse groups and individuals in the Somali community, mostly refugees in Sweden. Paradoxes implying denial and avoidance emerged. Female circumcision was described, as just 'a tradition' that has little to do with Islam. The fear of bringing up an uncircumcised daughter in the liberal sexual morality of Sweden was mentioned as a dilemma. Circumcised women said the health care they received during pregnancy and childbirth was poor while the law failed to take account of the experiences of the Somali people. We conclude that rather than eradication, interventions seem to have silenced and stigmatized the practice due to their failure to take account of its meanings, organization and contexts, including the diasporic dynamics within which immigrants negotiate identities.
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4.
  • Ali, Tazeen S, et al. (författare)
  • Gender roles and their influence on life prospects for women in urban Karachi, Pakistan : a qualitative study
  • 2011
  • Ingår i: Global Health Action. - Häggeby : CoAction Publishing. - 1654-9716 .- 1654-9880. ; 4, s. 7448-
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women’s and men’s life prospects. Objective: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men’s and women’s life circumstances. Design: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied. Findings: Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve women’s subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. Conclusions: This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women’s empowerment.
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5.
  • Ali, T. S., et al. (författare)
  • Intimate Partner Violence and Mental Health Effects: A Population-Based Study among Married Women in Karachi, Pakistan
  • 2013
  • Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 20:1, s. 131-139
  • Tidskriftsartikel (refereegranskat)abstract
    • Intimate partner violence (IPV) is recognized all over the world for its association with mental health This cross-sectional study involved 759 women between the ages of 25 and 60 years, selected using a In the total population of women, mental symptoms were prevalent. Women subjected to any form of The findings in this study highlight that the violence women have to face contributes to the
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  • Ali, Tazeen S, et al. (författare)
  • Violence permeating daily life : a qualitative study investigating perspectives on violence among women in Karachi, Pakistan
  • 2012
  • Ingår i: International Journal of Women's Health. - : Dove Medical Press Ltd.. - 1179-1411. ; 4, s. 577-585
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: This study explored how married women perceive situations which create family conflicts and lead to different forms of violence in urban Pakistan. In addition, it examines perceptions of consequences of violence, their adverse health effects, and how women resist violence within marital life.METHODS: Five focus group discussions were conducted with 28 women in Karachi. Purposive sampling, aiming for variety in age, employment status, education, and socioeconomic status, was employed. The focus group discussions were conducted in Urdu and translated into English. Manifest and latent content analysis were applied.RESULTS: One major theme emerged during the analysis, ie, family violence through the eyes of females. This theme was subdivided into three main categories. The first category, ie, situations provoking violence and their manifestations, elaborates on circumstances that provoke violence and situations that sustain violence. The second category, ie, actions and reactions to exposure to violence, describes consequences of ongoing violence within the family, including those that result in suicidal thoughts and actions. The final category, ie, resisting violence, describes how violence is avoided through women's awareness and actions.CONCLUSION: The current study highlights how female victims of abuse are trapped in a society where violence from a partner and family members is viewed as acceptable, where divorce is unavailable to the majority, and where societal support of women is limited. There is an urgent need to raise the subject of violence against women and tackle this human rights problem at all levels of society by targeting the individual, family, community, and societal levels concurrently.
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7.
  • Ali, T. S., et al. (författare)
  • Violence permeating daily life: a qualitative study investigating perspectives on violence among women in Karachi, Pakistan
  • 2012
  • Ingår i: International journal of women's health. - : Informa UK Limited. - 1179-1411 .- 1179-1411. ; 4, s. 577-85
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: This study explored how married women perceive situations which create family conflicts and lead to different forms of violence in urban Pakistan. In addition, it examines perceptions of consequences of violence, their adverse health effects, and how women resist violence within marital life. METHODS: Five focus group discussions were conducted with 28 women in Karachi. Purposive sampling, aiming for variety in age, employment status, education, and socioeconomic status, was employed. The focus group discussions were conducted in Urdu and translated into English. Manifest and latent content analysis were applied. RESULTS: One major theme emerged during the analysis, ie, family violence through the eyes of females. This theme was subdivided into three main categories. The first category, ie, situations provoking violence and their manifestations, elaborates on circumstances that provoke violence and situations that sustain violence. The second category, ie, actions and reactions to exposure to violence, describes consequences of ongoing violence within the family, including those that result in suicidal thoughts and actions. The final category, ie, resisting violence, describes how violence is avoided through women's awareness and actions. CONCLUSION: The current study highlights how female victims of abuse are trapped in a society where violence from a partner and family members is viewed as acceptable, where divorce is unavailable to the majority, and where societal support of women is limited. There is an urgent need to raise the subject of violence against women and tackle this human rights problem at all levels of society by targeting the individual, family, community, and societal levels concurrently.
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  • Andersson, Lena, 1965-, et al. (författare)
  • Associations between general self efficacy, barriers to care and self-reported mental illness—a population-based study
  • 2010
  • Ingår i: European Journal of Public Health. - Oxford : Oxford University Press. - 1101-1262 .- 1464-360X. ; 20:Suppl. 1, s. 69-69
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundMental illness is an increasing health problem globally. However, many individuals do not seek health care although evidence-based care is available. Research has shown that self efficacy is associated with various health outcomes and it is of importance to investigate if it also is associated mental illness. Early detection promotes recovery and decreases suicide risk.AimThe aim of this study is to investigate whether low levels of self efficacy is associated with a higher degree of mental illness and whether level of self-efficacy influence health seeking behaviour.MethodsThis is a cross-sectional study based on data from the Health Assets study, with data collected in 2008 in West Sweden. The study population is a randomly selected population sample of 4027 individuals, aged 18–65 years. Data collection was done by a postal questionnaire and the response rate was 50.4%. Bi-and multivariate analyses were employed to investigate associations and results were stratified on sex, age, civil status, education and social support.ResultsA total number of 1361 (36%) out of 3811 individuals answered ‘Yes’ on the question ‘Have you ever felt so mentally ill that you had (felt a need) to seek care’. A total of 33% of the women answering yes were found in the lowest quartile of the general self efficacy scale, 20% in the highest quartile. Corresponding figures for men were 30 and 23% respectively. The most common reason stated for not seeking health care was a belief that the mental health problem would disappear by itself. Others reasons mentioned were beliefs that health care would not help, they did not know were to go or they felt ashamed for showing others they suffered from mental illness.ConclusionMental illness is a serious health problem and access to care needs to be improved. Health promotion should also include individual traits/characteristics such as self efficacy and health-seeking behaviour.
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  • Andersson, Lena, 1965, et al. (författare)
  • General Self-efficacy and Its Relationship to Self-reported Mental Illness and Barriers to Care: A General Population Study
  • 2014
  • Ingår i: Community mental health journal. - : Springer Science and Business Media LLC. - 0010-3853 .- 1573-2789. ; 50:6, s. 721-728
  • Tidskriftsartikel (refereegranskat)abstract
    • Given the prevalence of mental illness worldwide, it is important to better understand the dynamics of mental health help-seeking behavior to improve access to care. The aim of this study was to investigate if general self-efficacy (GSE) was associated with self-reported mental illness and help-seeking behavior and barriers to care in a randomized population. This study utilized a mailed questionnaire completed by 3,981 persons aged 19-64 years who resided in Western Sweden. GSE was measured and logistic regression models calculated, controlling for various sociodemographic variables. Results showed that 25 % of men and 43 % of women reported a lifetime prevalence of mental illness that they felt could have benefitted from treatment. Of those, 37 % of the men and 27 % of the women reported barriers to care. Men and women with low GSE were more likely to suffer from mental illness compared with persons high in GSE, but GSE did not enhance help-seeking behavior or perceived barriers to care. The most prevalent barriers to care for both sexes were beliefs that the illness will pass by itself, doubt whether treatment works, lack of knowledge of where to go and feelings of shame. Overall, GSE scores did not differ among those who experienced various barriers to care with the exception of two barriers only among women.
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  • Beausang, Angela, et al. (författare)
  • "Möjligheten att rädda några av dessa kvinnors liv har inte vägts in"
  • 2014
  • Ingår i: Dagens Medicin. - : Dagens Medicin.
  • Tidskriftsartikel (populärvet., debatt m.m.)abstract
    • Namnet på Socialstyrelsens vägledning lyder: Hur upptäcka våldsutsatthet? Ja, det kan man verkligen fråga sig efter att ha läst detta föga vägledande dokument, skriver ett stort antal kritiska debattörer.
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14.
  • Berntsson, Leeni, 1938, et al. (författare)
  • Gender differences in work-home interplay and symptom perception among Swedish white-collar employees.
  • 2006
  • Ingår i: Journal of epidemiology and community health. - : BMJ. - 0143-005X. ; 60:12, s. 1070-6
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To analyse gender differences in paid and unpaid workload and symptoms in matched groups of Swedish white-collar workers with children. DESIGN AND SETTING: Paid and unpaid workload and perceived stress from paid work, conflict between demands and control over household work were measured by a total workload (TWL) questionnaire. Some symptoms were rated with regard to frequency and severity as a measure of health. Cross-sectional analyses were performed. PARTICIPANTS: Matched groups of male (n = 440) and female (n = 529) well-educated white-collar workers in full-time employment, aged 32-58 years and living with children in the home. RESULTS: Women in higher positions in Sweden are healthier than the average population of women, but report more symptoms than men in the same position as well as more stress from paid work, more conflict between demands and a greater TWL. However, women also reported more control over household duties and TWL was not associated with more symptoms. The men were mainly focused on their paid work role and perhaps even more so than men in the general population as they were fairly resistant to feelings of conflicting demands. CONCLUSION: Even among matched groups of full-time employed, well-educated men and women, traditional gender differences in division of responsibilities and time allocation were found. Even though the women were healthy at this stage, they might risk future ill health, owing to high workload, stress and feelings of conflicting demands.
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15.
  • Carlsson, Linnea, et al. (författare)
  • Socio-demographic and psychosocial characteristics of male and female perpetrators in intimate partner homicide : A case-control study from Region Västra Götaland, Sweden
  • 2021
  • Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 16:8
  • Tidskriftsartikel (refereegranskat)abstract
    • Risk factor studies on male-perpetrated intimate partner homicide (IPH) are often compared with studies on intimate partner violence (IPV) or non-partner homicide perpetrators. This not only excludes female perpetrators, but also fails to take socio-demographic and psychosocial differences between perpetrators and the general population into consideration. The aim of this study was to examine male- and female-perpetrated IPH cases, and to compare socio-demographic factors in IPH perpetrators and in matched controls from the general population. Data were retrieved from preliminary inquiries, court records and national registers for 48 men and 10 women, who were perpetrators of IPH committed in 2000–2016 and residing in Region Västra Götaland, Sweden. The control group consisted of 480 men and 100 women matched for age, sex and residence parish. Logistic regression, yielding odds ratios (OR) with 95% confidence intervals (CI), was performed for male perpetrators and male controls to investigate associations for selected socio-demographic and psychosocial characteristics. This was not performed for females due to the small sample size. Female perpetrators were convicted of murder to a lesser extent than male perpetrators. No woman was sentenced to life imprisonment while five men were. Jealousy and separation were the most common motivational factors for male perpetration while the predominant factor for female perpetrators was subjection to IPV. Statistically significant differences were found between male perpetrators and male controls in unemployment rate (n = 47.9%/20.6%; OR 4.4; 95% CI 2.2–8.6), receiving benefits (n = 20.8%/4.8%; OR 5.2; 95% CI 2.3–11.7) and annual disposable income (n = 43.8%/23.3% low income; OR 5.2; 95% CI 1.9–14.2) one year prior to the crime. Female IPH perpetrators were less educated than female controls (≤ 9-year education 30%/12%) and were more often unemployed (70%/23%) one year before the crime. Male and female IPH perpetrators were socio-economically disadvantaged, compared with controls from the general population.
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  • Ehn, S., et al. (författare)
  • Global health education in Swedish medical schools
  • 2015
  • Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 43:7, s. 687-693
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: Global health education is increasingly acknowledged as an opportunity for medical schools to prepare future practitioners for the broad health challenges of our time. The purpose of this study was to describe the evolution of global health education in Swedish medical schools and to assess students' perceived needs for such education. Methods:Data on global health education were collected from all medical faculties in Sweden for the years 2000-2013. In addition, 76% (439/577) of all Swedish medical students in their final semester answered a structured questionnaire. Results: Global health education is offered at four of Sweden's seven medical schools, and most medical students have had no global health education. Medical students in their final semester consider themselves to lack knowledge and skills in areas such as the global burden of disease (51%), social determinants of health (52%), culture and health (60%), climate and health (62%), health promotion and disease prevention (66%), strategies for equal access to health care (69%) and global health care systems (72%). A significant association was found between self-assessed competence and the amount of global health education received (p<0.001). A majority of Swedish medical students (83%) wished to have more global health education added to the curriculum. Conclusions: Most Swedish medical students have had no global health education as part of their medical school curriculum. Expanded education in global health is sought after by medical students and could strengthen the professional development of future medical doctors in a wide range of topics important for practitioners in the global world of the twenty-first century.
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18.
  • Enander, Viveka, 1967, et al. (författare)
  • Before the killing: Intimate partner homicides in a process perspective, part I
  • 2021
  • Ingår i: Journal of Gender-Based Violence. - : Policy Press. - 2398-6808 .- 2398-6816. ; 5:1, s. 59-74
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper puts intimate partner homicide (IPH) into a process perspective, and describes the situational precursors that constitute the build-up, i.e. the first stage of the IPH process that precedes the deed. Fifty court files, from cases involving 40 male and 10 female perpetrators, underwent thematic analysis. Our findings indicate that the build-up phase of an IPH is complex and encompasses several different features, of which some are clearly gendered. The results point to an escalation during the build-up: of possessiveness and violent behaviour in male-to-female cases, of alcohol/drug abuse, of mental health problems and/or of fears for the future, often connected to separation. Concurrent with previous research we found that women often kill in the context of their own victimisation. However, also other situations and motives protruded as pertinent. The practical implications of these findings are that practitioners should be particularly attentive to escalation of known risk factors, especially male possessiveness, and be aware that (the victim wanting) a separation may initiate escalation with lethal consequences.
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19.
  • Enander, Viveka, 1967, et al. (författare)
  • Bereaved by Intimate Partner Homicide: Consequences and Experiences of Support
  • 2024
  • Ingår i: Sage Open. - 2158-2440. ; 14:2
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this qualitative study is to present the experiences of family members bereaved by intimate partner homicide (IPH). The focus is on immediate and long-term consequences of the killing, and on the participants' experiences of subsequently offered information and support. This includes interactions with healthcare, social services, the criminal justice system, and the media. Twenty-two interviews with parents, siblings, and adult children of IPH victims underwent thematical analysis. The bereaved mainly described the social support following the IPH as lacking or inadequate, and recounted that they had been left alone with handling practical and emotionally difficult tasks, such as cleaning up after the killing. More specifically, they felt that institutional responses had been lacking with regard to information, understanding, coordination between professionals, continuity, professionalism, and redress. These results indicate that a coordinated response to people bereaved by IPH is necessary and, if lacking, must be developed. Using thematic analysis, this interview study explores the experiences of family members who have been bereaved by intimate partner homicide. The focus is on the social support they were offered, which they found lacking or inadequate. In hindsight, they would have wanted some professional to reach out to the family and offer emotional and practical support, as well as information.
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  • Enander, Viveka, 1967, et al. (författare)
  • Intimate partner homicide in West Sweden 2000-2014
  • 2015
  • Ingår i: Fighting Femicide Conference: Queen Mary University of London.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • This is a study at planning stage. The study aims to map and describe all intimate partner homicides perpetrated in West Sweden during the last 15 years (approx. 50 cases). The study has a special focus on the role of health care workers; had they or had they not identified intimate partner violence prior to the homicide? Could identification and prevention be enhanced and how? The project will proceed in two stages. In the first stage archive data – i.e. national registers of different kinds, police investigations, court material, social services and health care records – will be analyzed. In the second stage some cases will be selected for further and deeper understanding, via interviews with professionals as well as with family to the victim, and possibly also with the perpetrators.
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  • Enander, Viveka, 1967, et al. (författare)
  • Intimate partner homicide in West Sweden 2000-2016
  • 2018
  • Ingår i: Brottsoffermyndighetens viktimologiska forskarkonferens: Stockholm.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Intimate partner homicide in West Sweden 2000-2016 This study aims to map and describe all intimate partner homicides perpetrated in West Sweden during the chosen time period. The major aim of the project is to identify risk factors for intimate partner homicide (IPH), which could possibly contribute to prevention work. The intention is to search for possible gaps in the coordination of collaboration and reporting between agencies and authorities, such as health care, criminal justice and social services. Further, the experiences of family and friends who have been bereaved will be explored, as well as the perceptions of the perpetrators and their family and friends. The study has a special focus on the role of health care workers; had they or had they not identified intimate partner violence prior to the homicide? Could identification and prevention be enhanced and how? The project includes several sub-studies and proceeds in two stages. In the first stage registry and criminal justice data (mainly court files) are investigated. In the second stage 10 heterogeneous cases of IPH are chosen for an in-depth analysis, including case material such as police investigations, court material, social services and health care records as well as interviews. At the conference we will present some preliminary findings from the study’s first stage.
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  • Enander, Viveka, 1967, et al. (författare)
  • Intimate partner homicides in a process perspective
  • 2019
  • Ingår i: 3rd European Conference on Domestic Violence. Oslo 2-4 september 2019.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Intimate partner homicides in a process perspective Introduction In their pivotal work on men who murder women, Dobash & Dobash (2014) write about the project that changes: from trying to keep the woman in the relationship and/or under his control to deciding to kill her, as punishment, when he realizes that this can (no longer) be attained. This was a point of departure for this study, in which we aimed to describe what this process entails. Methods The study presented is part of the STOP study, which aims to map and describe all intimate partner homicides perpetrated in West Sweden 2000-2016. In this qualitative study, 50 court files with 40 male and 10 female perpetrators were analyzed using thematic analysis. The research questions guiding our research were: When does the project change? What does the buil-up for the killing entail? and finally What does the aftermath of the deadly violence look like? Our rationale for focusing on IPH a process perspective was that many risk factors for IPH have been described in previous research, but it may be difficult put these into context. In many cases, several risk factors can be found; but which are most pertinent of the time of the crime? Further we sought to analyze in what way women’s changing of the project, i.e. deciding to kill their partners, are different from or similar to men´s. Results We discerned a process in which the borders between charging up to kill, and actually making this decision, were blurry. Yet some distinctive features of this process were visible. Further we found that possessiveness was a more prominent theme when the perpetrators were male. Conclusion A process perspective is valuable in understanding IPHs.
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24.
  • Enander, Viveka, 1967, et al. (författare)
  • The killing and thereafter : intimate partner homicides in a process perspective, part II
  • 2022
  • Ingår i: Journal of Gender-Based Violence. - Bristol : Policy Press. - 2398-6808 .- 2398-6816. ; 6:3, s. 501-517
  • Tidskriftsartikel (refereegranskat)abstract
    • This article puts intimate partner homicide (IPH) into a process perspective, and describes the latter two stages of the IPH process, that is, ‘changing the project’ and ‘the aftermath’. The focus of analysis is on the moment when the perpetrator chooses to kill the victim, and what s/he does and says in the wake of the killing. Fifty court files, from cases involving 40 male and 10 female perpetrators, underwent thematic analysis. Regarding the final trigger pertaining to changing the project, some situational factors that trigger male-perpetrated IPH seem to differ from the corresponding factors in female-perpetrated IPH. Feelings of rejection and jealousy seemed to be more common as triggers to kill for men than for women, while some cases of female-perpetrated IPH were linked to self-defence in response to IPV. Moreover, as noted previously, no female perpetrators displayed possessiveness.
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25.
  • Eriksson, Ulla-Britt, 1949- (författare)
  • "Man är ju inte mer än människa" : Långtidssjukskrivning ur ett emotionellt, relationellt och strukturellt perspektiv
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The background to this thesis is the dramatic increase of the long-term sickness absence that took place in Sweden from the late 1990s. There was also a shift in the diagnostic pattern with rising mental diagnoses. The overall purpose was to describe and try to understand the process leading to long-term sickness absence from the perspective of the sickness absentees, in order to get a better knowledge base for preventive and rehabilitative actions. The thesis comprises four studies (I-IV). Research methods have been both qualitative and quantitative. In study I data from individual interviews with 32 persons on long-term sick leave due to burnout was analyzed using a grounded theory approach. In study II the study population comprised of 2064 employed sick-listed persons, a sub sample derived from the 2002 national Swedish survey on health, working conditions, life situation and sick-listing. It was analyzed if persons with burnout had higher probability of having experienced the steps in the burnout staircase compared to other diagnostic groups in accordance with the previously suggested hypothesis of "the burnout staircase". Study III comprised of 2521 employed persons, a sub sample derived from the same national survey as in study II. It was analyzed if psychosocial work environment and conflicts and losses in private life independently or in combination were more strongly associated to sickness absence with mental diagnoses as compared to a healthy population. In study IV individual interviews with 25 professional rehabilitation actors and 14 unemployed sick-listed persons were conducted. Data were analyzed according to grounded theory method. The process that led to sicknes absence can be described as an emotional deprivation process, illustrated as a flight of stairs (the burnout staircase) describing a sequence of steps toward sickness absence (I). In accordance with the tested hypothesis persons with burnout to a noticeable higher extent reported expereince of being in the different steps in the burnout staircase compared to sickness absentees with other diagnoses. The model seemed to be valid also for persons with other mental diagnoses (II). Reorganization and conflicts at work as well as adding adverse private life events were associated with increased risk for sickness absence with mental diagnosis (III). Three significant factors behind the weak co-operation between local social insurance and employment agencies were identified: indistinct regulation of co-operation, shifting political goals over time and conflicting goals between agencies (IV). In this thesis it has been suggested that the course of events preceding sickness absence might be understood as a process of emotional deprivation, where the individual is gradually emptied of the life-giving emotional energy revealed in joy, commitment, and empathy. This life-giving force finds its nourishment in safe and secure social relations with others and in a social structure that promotes this type of social relations. The profound changes in the Swedish labour market during the 1990s influenced not just the psychosocial work climate but also the rehabilitation efforts for unemployed sick-listed persons. When the political goal of reducing the unemployment level came to the forefront the indistinct regulation and the conflicting goals in addition were factors that impaired co-ordinated rehabilitation. In this process also the physicians were involved. A labour market problem was turned into a medical problem.
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27.
  • Farid-ul-Hasnain, Syed, et al. (författare)
  • What do young adults know about the HIV/AIDS epidemic? Findings from a population based study in Karachi, Pakistan.
  • 2009
  • Ingår i: BMC infectious diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 9
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: HIVAIDS is spreading globally, hitting the younger generations. In Pakistan, the prevalence of HIV in high-risk subpopulations is five per cent or higher. This poses a serious threat of a generalised epidemic especially among the younger population. In the wake of HIVAIDS epidemic this is worrying as a well informed younger generation is crucial in restricting the spread of this epidemic. This study investigated Pakistani young adults' (male and female) knowledge and awareness of the HIV/AIDS disease. METHODS: A population-based, cross-sectional study of 1,650 male and female adults aged 17-21 years living in Karachi was conducted using a structured questionnaire. A multi-stage cluster sampling design was used to collect data representative of the general population in an urban area. Bivariate and multivariate analyses were performed separately for males and females. RESULTS: Of 1,650 subjects, 24 per cent (n = 390) reported that they had not heard of HIV/AIDS. Among the males, those with a poor knowledge were younger (AOR = 2.20; 95 per cent CI, 1.38, 3.49), with less than six years of schooling (AOR = 2.46; 1.29 4.68) and no computer at home (AOR = 1.88; 1.06 3.34). Among the females, the risk factors for poor knowledge were young age (AOR = 1.74; 1.22, 2.50), low socio-economic status (AOR = 1.54; 1.06, 2.22), lack of enrolment at school/college (AOR = 1.61; 1.09, 2.39) and being unmarried (AOR = 1.85; 1.05, 3.26). CONCLUSION: Alarming gaps in knowledge relating to HIV/AIDS were detected. The study emphasises the need to educate young adults and equip them with the appropriate information and skills to enable them to protect themselves from HIV/AIDS. However, taboos surrounding public discussions of sexuality remain a key constraint to preventive activities.
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28.
  • Friberg, Ingrid Osika, et al. (författare)
  • Patients' perceptions and factors affecting dialysis modality decisions
  • 2018
  • Ingår i: Peritoneal Dialysis International. - : SAGE Publications. - 0896-8608. ; 38:5, s. 334-342
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Home-based dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has been shown to be associated with tower costs and higher health-related quality of life than in-center HD. However, factors influencing the choice of dialysis modality, including gender, are still not well understood. Methods: A questionnaire was sent out to all dialysis patients in the western region of Sweden in order to investigate factors affecting choice of dialysis modality. Logistic regression was used to analyze the data. Results: Patients were more likelyto have home dialysis if they received predialysis information from 3 or more sources and, to a greater extent, perceived the information as comprehensive and of high quality. In addition, patients had a lower likelihood of receiving home dialysis with increasing age and if they lived closer to a dialysis center. Men had in comparison with women a greater likelihood of receiving home dialysis if they lived with a spouse. In-center dialysis patients more often believed that the social interaction and support provided through in-center HD treatment influenced the choice of dialysis modality. Conclusion: This study highlights the need for increased awareness of various factors that influence the choice of dialysis modality and the importance of giving repeated, comprehensive, high-quality information to dialysis and predialysis patients and their relatives. Information and support must be adapted to the needs of individual patients and their relatives if the intention is to improve patients' well-being and the proportion of patients using home dialysis.
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29.
  • Friberg, Ingrid Osika, et al. (författare)
  • Sex differences in health care consumption in Sweden: A register-based cross-sectional study
  • 2016
  • Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 44:3, s. 264-273
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Generally, health care consumption, especially primary care, is greater among women than men. The extent to which this sex difference is explained by reproduction and sex-specific morbidity is unclear. Methods: We examined age- and sex-specific health care service utilization and costs in the western region of Sweden. Data were retrieved from a regional health care database of information on total health care consumption in the population. Use of health care resources was divided into the following diagnosis categories: health care associated with reproduction; health care received for sex-specific morbidity; and health care provided for all other conditions. Results: Total per capita cost for health care was 20% higher for women than for men. When adjusted for reproduction and sex-specific morbidity, the cost-difference decreased to 8%. The remaining cost-difference could be explained by women's substantially higher costs for mental and behavioral disorders and diseases of the musculoskeletal system. Women were more likely to receive more accessible, less expensive primary care, while men were more likely to receive specialist inpatient care. Conclusions: The substantially greater use of reproduction-associated care among women, which largely occurs within primary care, might make it easier to also seek health care for other reasons. Efforts to eliminate barriers that prevent men from investing in their health and seeking primary care could reduce future morbidity and costs for specialist care. More studies and appropriate actions are needed to determine why women are overrepresented in mental, behavioral and musculoskeletal disorders.
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30.
  • Graner, Sophie, 1971-, et al. (författare)
  • Adverse perinatal and neonatal outcomes and their determinants in rural Vietnam 1999-2005
  • 2010
  • Ingår i: Paediatric and Perinatal Epidemiology. - : Wiley. - 0269-5022 .- 1365-3016. ; 24:6, s. 535-545
  • Tidskriftsartikel (refereegranskat)abstract
    • Population-based estimations of perinatal and neonatal outcomes are sparse in Vietnam. There are no previously published data on small for gestational age (SGA) infants. A rural population in northern Vietnam was investigated from 1999 to 2005 (n = 5521). Based on the birthweight distributions within the population under study, reference curves for intrauterine growth for Vietnamese infants were constructed and the prevalence and distribution of SGA was calculated for each sex. Neonatal mortality was estimated as 11.6 per 1000 live births and the perinatal mortality as 25.0 per 1000 births during the study period. The mean birthweight was 3112 g and the prevalence of low birthweight was 5.0%. The overall prevalence of SGA was 6.4%. SGA increased with gestational age and was 2.2%, 4.5% and 27.1% for preterm, term and post-term infants, respectively. Risk factors for SGA were post-term birth: adjusted odds ratio (AOR) 7.75 [95% CI 6.02, 9.98], mothers in farming occupations AOR 1.72 [95% CI 1.21, 2.45] and female infant AOR 1.61 [95% CI 1.27, 2.03]. There was a pronounced decrease in neonatal mortality after 33 weeks of gestation. Suggested interventions are improved prenatal identification of SGA infants by ultrasound investigation for fetal growth among infants who do not follow their expected clinical growth curve at the antenatal clinic. Other suggestions include allocating a higher proportion of preterm deliveries to health facilities with surgical capacity and neonatal care.
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31.
  • Graner, Sophie, 1971-, et al. (författare)
  • Maternal health care professionals' perspectives on the provision and use of antenatal and delivery care : a qualitative descriptive study in rural Vietnam
  • 2010
  • Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 10:1, s. 608-
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. METHOD: The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. CONCLUSION: Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.
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32.
  • Graner, Sophie, 1971-, et al. (författare)
  • 'Normal foetal movements make me happy' : a qualitative study on pregnant women's perception on signs and symtoms during pregnancy and maternal helath care in rural Vietnam
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Women's understanding of pregnancy and antenatal care is influneced by their cultural context. In low income settings women may have limited influence over their reproductive health including when to seek health care. Awareness of signs of pregnancy complications is essential to seek timely care. The use of antenatal care services in Vietnam has been studied with quantatative methods but there are few qualitative studies on the perception of pregnancy and maternal health care among Vietnamse women. Method: The study was conducted in a rural district in northern Vietnam. Four focus group discussions with pregnant women were performed. The data was analysed using manifest and latent content analysis. Result: The latent theme 'Securing pregnancy during normal course and at deviation' consisting of the main categories 'Ensuring a healthy pregnancy' and 'Seperating the normal from the abnormal' emerged. Conclusion: This qualitative study of pregnant women in rural Vietnam indicates how women create a stategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insight in pregnancy-related conditions were sought from various sources and influenced both by Vietnamese traditions and modern medical knowledge. Public knowledge about deviating symtoms during pregnancy and high confidence in maternal health care are most likely contributing factors to the relative good maternal health status in Vietnam.
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33.
  • Graner, Sophie, et al. (författare)
  • Pregnant women's perception on signs and symptoms during pregnancy and maternal health care in a rural low-resource setting
  • 2013
  • Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 92:9, s. 1094-1100
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Women's understanding of pregnancy and antenatal care is influenced by their cultural context. In low-income settings women may have limited influence over their reproductive health, including when to seek health care. Awareness of signs of pregnancy complications is essential for timely care. The use of antenatal care services in Vietnam has been studied with quantitative methods but there are few qualitative studies on the perceptions of pregnancy and maternal health care among Vietnamese women. Design. Four focus group discussions with pregnant women were performed. Setting. The study was conducted in a rural district in northern Vietnam. Population. Pregnant women in the last trimester. Method. Manifest and latent content analysis. Result. The latent theme that emerged was a need for "securing pregnancy during its normal course and at deviation", consisting of the main categories "ensuring a healthy pregnancy" and "separating the normal from the abnormal". Conclusion. This qualitative study of pregnant women in rural Vietnam indicates how women create a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insight into pregnancy-related conditions was sought from various sources and influenced both by local traditions and modern medical knowledge. Public knowledge about different symptoms during pregnancy and a high confidence in maternal health care are the most likely contributing factors to the relatively good maternal health status in Vietnam.
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34.
  • Graner, Sophie, 1971- (författare)
  • Reproductive outcomes in rural Vietnam. Perspectives and experiences by pregnant women and health care professionals on pregnancy promotion and maternal health care.
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background Reproductive health and health events associated with pregnancy including induced abortions are among the most important factors for the health of fertile women. Adverse outcomes have an impact on women’s reproductive health and their overall health as well as the health of their offspring. Pregnancy and child bearing take place within a cultural context. Risk factors for adverse pregnancy outcomes depend on factors both associated with the individual woman as well as contextual factors. Aims This thesis investigates reproductive health indicators and their determinants for women in a rural district in Vietnam with special focus on adverse pregnancy outcomes and their determinants. In addition, this thesis explores the perspectives and experiences among pregnant women and health care professionals on maternal health care in Vietnam and risks during pregnancy and delivery. Methods The studies used quantitative and qualitative methods.  In the quantitative studies a total of 4,396 women reporting 5,838 pregnancies, and 5,521 infants were included. Parametric and non parametric tests and univariate and multivariate logistic regression analysis was performed.   For the estimation of small for gestational age a population-specific reference curve was constructed based on the mean birth weight at term in the study population. In the qualitative studies data were collected from eight focus group discussions, four with pregnant women and four with health care professionals. Manifest and latent content analysis was applied.  Main findings Women belonging to an ethnic minority or women giving birth at home were at increased risk of stillbirth.  The risk of induced abortion increased with maternal age. Neonatal mortality was estimated to 11.6 per 1000 live births and perinatal mortality to 25.0 per 1000 births. The prevalence of small for gestational age was estimated to 6.4%. Risk factors for small for gestational age included women in farming occupations and post-term birth. There was a marked decrease in perinatal mortality after 33 weeks of gestation. Contextual conditions influenced both pregnant women’s use of maternal health care and the performance of the health care professionals. The use of maternal health care was influenced by economical conditions as well as cultural norms that impeded women’s autonomy. Structural constraints included inadequate financing of the health system, including lack of staff, insufficient professional re-training, and inadequate equipment. Pregnant women in rural Vietnam created a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insights in pregnancy-related conditions were sought from various sources and were influenced both by Vietnamese traditions and modern medical knowledge. Conclusions Knowledge about pregnancy complications and their related signs and symptoms, and a high confidence in the maternal health care probably contribute to the relatively good maternal health status and pregnancy outcomes in Vietnam. To improve perinatal and neonatal outcomes there is a need to ensure access for all pregnant women to delivery units with surgical capacity in case of an obstetrical emergency. Also, a higher proportion of premature infants need to be born at units with access to neonatal care. This may be achieved by an improved system for referral including capacity of medical care during transportation. Other desirable improvements include antenatal identification of small for gestational age foetuses. In our study the induced abortion rate increased with maternal age and was highest among married women, indicating that induced abortions may be used as a method for family planning. The cultural norms in Vietnam limit women’s autonomy and reduce their possibility to make independent decisions about their reproductive health. Our studies emphasize the importance of adequate access for all women to maternal health care adjusted for their individual needs. A better understanding is needed of context-specific factors that influence couples’ choice of family planning methods, place of birth, and maternal health care. The communication between pregnant women and health care professionals needs further investigation. This knowledge is essential in order to develop reproductive health services that are accessible, acceptable and affordable to all.  
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35.
  • Graner, Sophie, 1971-, et al. (författare)
  • The panorama and outcomes of pregnancies within a well-defined population in rural Vietnam 1999-2004.
  • 2009
  • Ingår i: International journal of behavioral medicine. - : Springer Science and Business Media LLC. - 1532-7558 .- 1070-5503. ; 16:3, s. 269-77
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Pregnancy outcomes in the general population are important public health indicators. PURPOSE: The overall aim of this study was to investigate the outcomes of reported pregnancies within a well-defined population, to identify risk groups for adverse pregnancy outcomes, and to suggest preventive measures. METHOD: A prospective population-based cohort study of pregnant women in Bavi district, Vietnam between 1 January 1999 and 30 June 2004. RESULTS: Pregnancy outcome was reported for 5,259 cases; 4,152 (79%) resulted in a live birth, 67 (1.3%) in a stillbirth, 733 (14%) in an induced abortion, and 282 (5.4%) in a spontaneous abortion. There was an increased risk of home delivery for women from ethnic minorities (OR = 1.85; 95%CI = 1.06-3.24) or with less than 6 years of schooling (OR = 7.36; 95%CI = 3.54-15.30). The risk of stillbirth was increased for ethnic minorities (OR = 6.34; 95%CI = 1.33-30.29) and women delivering at home (OR = 6.81; 95%CI = 2.40-19.30). The risk of induced abortion increased with maternal age. CONCLUSION: Our findings emphasize the public health significance of access to adequate family planning, counselling, and maternal health care for all women. Policies should specifically target women from high-risk groups.
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36.
  • Hasnain, Syed Farid-ul, et al. (författare)
  • Young adults' perceptions on life prospects and gender roles as important factors to influence health behaviour: a qualitative study from Karachi, Pakistan.
  • 2012
  • Ingår i: Global journal of health science. - : Canadian Center of Science and Education. - 1916-9736 .- 1916-9744. ; 4:3, s. 87-97
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this qualitative study was to explore perceptions and expectations of young males and females, in Karachi, Pakistan, regarding their life prospects and gender roles, with resulting implications for health behaviour. The main theme emerging was "Young adults' prospects in life are hampered by psychosocial and gender equality constraints". Gender inequality and the low status of women in society were described as major obstacles to the overall development. Persistent withholding of information to the younger generation on sexual and reproductive health issues was perceived to increase exposure to health risks, particularly sexually transmitted infections (STIs). The present study reveals new discourses on equality among young adults, pointing towards an increasing, sound interaction between the sexes and aspirations for more gender equal relationships. Such views and awareness among the younger generation constitutes a strong force towards change of traditional norms, including reproductive health behaviour, and calls for policy change.
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37.
  • Hayati, Elli Nur, 1966- (författare)
  • Domestic violence against women in rural Indonesia : searching for multilevel prevention
  • 2013
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Domestic violence has been recognized globally as one of the most important Public Health concerns with severe negative health consequences for the exposed women. Through UN bodies several international milestones have successfully pushed attention towards worldwide improvements in the life situations of women. Since the ratification of the Convention on Elimination of All Forms of Discrimination against Women (CEDAW) in 1984, significant positive changes towards equality between men and women in Indonesia have been initiated, one being the enactment of the Domestic Violence Act in 2004. However, there is still a need to improve the knowledge about what preventive measures that are feasible and work in different settings. This thesis aims to contribute to a better understanding of appropriate prevention strategies against domestic violence in rural Indonesia by exploring: i) risk factors for domestic violence; ii) women’s ways of coping with exposure to violence; iii) men’s views on masculinity and violence within marriage; and iv) challenges faced by local service agency in managing services for women survivors of domestic violence.Methods: Data from a cross sectional population based study was used to analyze risk factors for physical and sexual abuse among a cohort of pregnant women in Purworejo district. Further, a qualitative phenomenological interview study was conducted to reveal the dynamics of coping among women survivors of domestic violence in the same district. A Grounded Theory study based on focus group discussions with men formed the basis for a situational analysis of the linkage between masculinity and the use of violence within marriage. Finally, a qualitative case study was performed to explore the management practices of a local service agency in the district, to understand the challenges faced in their efforts to address domestic violence.Results: Sexual violence was associated with husbands’ demographic characteristics (age and low educated) and women’s economic independence. Exposure to physical violence among women was strongly associated with husbands’ personal characteristics. The attitudes and norms expressed by women confirmed unequal gender relationships. Experiencing violence led women to using an elastic band coping strategy, moving between actively opposing the violence and surrendering or tolerating the situation. The national gender equality policies were shown to have played a crucial role in transforming gender power relations among men and women (the gender order) in the Indonesian society. Three different positions of masculinity were identified, the traditionalist, the egalitarian, and the progressive, with different beliefs about men’s role within marriage and with various levels of accepting the use of violence. Long term structural preventive efforts and individual interventions targeted to the conflicting couples were preferred over reporting the abuser to the authorities. The major challenges faced by the local service agency were the low priority given by the authorities, mirrored also in low involvement in the daily service by the assigned volunteers. The local agency also stammered in translating the current law and policies into a society that held on to traditional and religious norms regulating the relationships between men and women.Conclusion: Overall, this thesis illustrates that sociocultural traditions and religious teaching still viscously influence people’s attitudes and beliefs about the use of violence within relationships. Domestic violence has not been accepted as a criminal act but is still to a large extent seen as a private family affair. Culturally sensitive programs aimed to bridging the gap between the current laws and policies and the socio-cultural traditions need to be further developed to protect women from domestic violence and increase gender equity in the Indonesian setting.
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38.
  • Hensing, Gunnel, 1956-, et al. (författare)
  • The impact of health problems in sickness absence might be underestimated in Sweden
  • 2010
  • Ingår i: European Journal of Public Health. - Oxford : Oxford University Press. - 1101-1262 .- 1464-360X. ; 20:Suppl. 1, s. 228-228
  • Tidskriftsartikel (refereegranskat)abstract
    • Changes in the welfare systems including the sickness insurance scheme are ongoing in several countries, and better knowledge on the extent of health problems in sickness absence seems needed. The overall aim of this cross sectional study was to assess and compare self-rated health, common symptoms and mental well-being in two samples of incident sick-leave cases with the general population. The study was performed in Sweden, 2008, and three samples of individuals aged 19–64 years were selected. The final study populations consisted of 3310 consecutive new employer reported sick-leave cases, 498 consecutive new self-reported sick-leave cases and 4027 individuals from a random general population sample. A mailed questionnaire was distributed. Validated questions and instruments on health and demographic data was analysed in bivariate and multivariate analyses. Poor self-rated health, high levels of symptoms and low mental well-being was reported by a significantly higher proportion in the two sick-leave samples compared with the general population. In logistic regressions with the generalpopulation as reference we adjusted for age, income, occupational class and current sick-leave. The fully adjusted OR for poor self-rated health, high levels of symptoms and low mental well-being respectively were 1.54 (95% confidence intervals 1.24–1.91), 1.95 (1.54–2.48) and 1.41 (1.11–1.79) among the employer reported male sick-leave cases and 1.94 (1.34–2.82), 1.76 (1.14–2.70) and 2.11 (1.40–3.17) among self reported male sick-leave cases. Corresponding figures for women were 1.80 (1.56–2.08), 1.42 (1.22–1.66) and 1.21 (1.03–1.43) and 2.10 (1.60–2.75), 1.97 (1.1–2.57) and 1.78 (1.35–2.36). Differences in health problems between the groups remained significant in the fully adjusted model. We conclude that sick-listed individuals have a higher burden of illness also after control for current sick leave than the general population. Consequence analyses of more rigorous legislation and increased demands need to take this into account.
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39.
  • Hitimana, Regis, et al. (författare)
  • Cost of antenatal care for the health sector and for households in Rwanda
  • 2018
  • Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Rwanda has made tremendous progress in reduction of maternal mortality in the last twenty years. Antenatal care is believed to have played a role in that progress. In late 2016, the World Health Organization published new antenatal care guidelines recommending an increase from four visits during pregnancy to eight contacts with skilled personnel, among other changes. There is ongoing debate regarding the cost implications and potential outcomes countries can expect, if they make that shift. For Rwanda, a necessary starting point is to understand the cost of current antenatal care practice, which, according to our knowledge, has not been documented so far.Methods: Cost information was collected from Kigali City and Northern province of Rwanda through two cross-sectional surveys: a household-based survey among women who had delivered a year before the interview (N = 922) and a health facility survey in three public, two faith-based, and one private health facility. A micro costing approach was used to collect health facility data. Household costs included time and transport. Results are reported in 2015 USD.Results: The societal cost (household + health facility) of antenatal care for the four visits according to current Rwandan guidelines was estimated at $160 in the private health facility and $44 in public and faith-based health facilities. The first visit had the highest cost ($75 in private and $21 in public and faith-based health facilities) compared to the three other visits. Drugs and consumables were the main input category accounting for 54% of the total cost in the private health facility and for 73% in the public and faith-based health facilities.Conclusions: The unit cost of providing antenatal care services is considerably lower in public than in private health facilities. The household cost represents a small proportion of the total, ranging between 3% and 7%; however, it is meaningful for low-income families. There is a need to do profound equity analysis regarding the accessibility and use of antenatal care services, and to consider ways to reduce households’ time cost as a possible barrier to the use of antenatal care.
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40.
  • Hitimana, Regis, et al. (författare)
  • Health-related quality of life determinants among Rwandan women after delivery: does antenatal care utilization matter? A cross-sectional study
  • 2018
  • Ingår i: Journal of Health Population and Nutrition. - : Springer Science and Business Media LLC. - 1606-0997 .- 2072-1315. ; 37
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Despite the widespread use of antenatal care (ANC), its effectiveness in low-resource settings remains unclear. In this study, self-reported health-related quality of life (HRQoL) was used as an alternative to other maternal health measures previously used to measure the effectiveness of antenatal care. The main objective of this study was to determine whether adequate antenatal care utilization is positively associated with women's HRQoL. Furthermore, the associations between the HRQoL during the first year (113 months) after delivery and socio-economic and demographic factors were explored in Rwanda. Methods: In 2014, we performed a cross-sectional population-based survey involving 922 women who gave birth 1-13 months prior to the data collection. The study population was randomly selected from two provinces in Rwanda, and a structured questionnaire was used. HRQoL was measured using the EQ-5D-3L and a visual analogue scale (VAS). The average HRQoL scores were computed by demographic and socio-economic characteristics. The effect of adequate antenatal care utilization on HRQoL was tested by performing two multivariable linear regression models with the EQ-5D and EQ-VAS scores as the outcomes and ANC utilization and socio-economic and demographic variables as the predictors. Results: Adequate ANC utilization affected women's HRQoL when the outcome was measured using the EQ-VAS. Social support and living in a wealthy household were associated with a better HRQoL using both the EQ-VAS and EQ-5D. Cohabitating, and single/unmarried women exhibited significantly lower HRQoL scores than did married women in the EQ-VAS model, and women living in urban areas exhibited lower HRQoL scores than women living in rural areas in the ED-5D model. The effect of education on HRQoL was statistically significant using the EQ-VAS but was inconsistent across the educational categories. The women's age and the age of their last child were not associated with their HRQoL. Conclusions: ANC attendance of at least four visits should be further promoted and used in low-income settings. Strategies to improve families' socio-economic conditions and promote social networks among women, particularly women at the reproductive age, are needed.
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41.
  • Hitimana, Regis, et al. (författare)
  • Incremental cost and health gains of the 2016 WHO antenatal care recommendations for Rwanda: results from expert elicitation
  • 2019
  • Ingår i: Health Research Policy and Systems. - : Springer Science and Business Media LLC. - 1478-4505. ; 17
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: High-quality evidence of effectiveness and cost-effectiveness is rarely available and relevant for health policy decisions in low-resource settings. In such situations, innovative approaches are needed to generate locally relevant evidence. This study aims to inform decision-making on antenatal care (ANC) recommendations in Rwanda by estimating the incremental cost-effectiveness of the recent (2016) WHO antenatal care recommendations compared to current practice in Rwanda. Methods: Two health outcome scenarios (optimistic, pessimistic) in terms of expected maternal and perinatal mortality reduction were constructed using expert elicitation with gynaecologists/obstetricians currently practicing in Rwanda. Three costing scenarios were constructed from the societal perspective over a 1-year period. The two main inputs to the cost analyses were a Monte Carlo simulation of the distribution of ANC attendance for a hypothetical cohort of 373,679 women and unit cost estimation of the new recommendations using data from a recent primary costing study of current ANC practice in Rwanda. Results were reported in 2015 USD and compared with the 2015 Rwandan per-capita gross domestic product (US$ 697). Results: Incremental health gains were estimated as 162,509 life-years saved (LYS) in the optimistic scenario and 65,366 LYS in the pessimistic scenario. Incremental cost ranged between $5.8 and $11 million (an increase of 42% and 79%, respectively, compared to current practice) across the costing scenarios. In the optimistic outcome scenario, incremental cost per LYS ranged between $36 (for low ANC attendance) and $67 (high ANC attendance), while in the pessimistic outcome scenario, it ranged between $90 (low ANC attendance) and $168 (high ANC attendance) per LYS. Incremental cost effectiveness was below the GDP-based thresholds in all six scenarios. Discussion: Implementing the new WHO ANC recommendations in Rwanda would likely be very cost-effective; however, the additional resource requirements are substantial. This study demonstrates how expert elicitation combined with other data can provide an affordable source of locally relevant evidence for health policy decisions in low-resource settings.
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42.
  • Jakobsson, Annika, 1949, et al. (författare)
  • Possibilities and Hindrances for Prevention of Intimate Partner Violence: Perceptions Among Professionals and Decision Makers in a Swedish Medium-Sized Town.
  • 2013
  • Ingår i: International journal of behavioral medicine. - : Springer Science and Business Media LLC. - 1532-7558 .- 1070-5503. ; 20:3, s. 337-343
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Intimate partner violence (IPV) is a major public health problem, but few evidence-based prevention programs have yet been implemented. PURPOSE: This study explored the perceptions and beliefs of local-level decision makers, social and health-care professionals, and representatives from the police force regarding the possibilities and hindrances for prevention of IPV. METHOD: An explorative qualitative approach was used, and participants were strategically selected for focus group discussions. The participants, 19 men and 23 women, were professionals or decision makers within health-care services, social welfare, municipal administration, the police force, local industry, and local politicians in a Swedish town of 54,000 inhabitants. The focus group discussions were audio recorded, transcribed verbatim, and thematically analyzed. A manifest content analysis was performed on the text. RESULTS: Preschools, schools, sports associations, workplaces, and the mass media were suggested as possible arenas for prevention measures. The proposed activities included norm building and improved social support structures. Hindrances were conceptualized as societal beliefs and attitudes, shame, silence, gender inequality, the counteracting influence of the media, and lack of resources. The participants demonstrated closeness and distance to IPV, expressed as acceptance or referral of responsibility to others regarding where and by whom prevention measures should be executed. CONCLUSION: This study gave new insights in the prevailing perceptions of professionals and decision makers of a medium-sized Swedish town, which can be a useful knowledge in future preventive work and contribute to bridge the gap between research and practice.
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43.
  • Johansson, E., et al. (författare)
  • Chlorination and biodegradation of lignin
  • 2000
  • Ingår i: Soil Biology and Biochemistry. - 0038-0717 .- 1879-3428. ; 32:7, s. 1029-1032
  • Tidskriftsartikel (refereegranskat)abstract
    • Recent research has shown that large amounts of high-molecular weight organic chlorine of unknown origin are present in the terrestrial environment. There are indications that an underlying process may be microorganisms which produce reactive chlorine that chemically degrades organic matter and facilitates degradation of recalcitrant organic matter on one hand, and on the other hand causes a formation of organic chlorine. Our aim was to test one part of this hypothesis by investigating whether reactive chlorine facilitates microbial degradation of lignin. Different concentrations of chlorine dioxide were added to the autoclaved lignin suspension. Mycelium of the white-rot fungus P. chrysosporium was used to inoculate flasks with the lignin solutions. The evolution of CO2 was followed during 8 d of continuous measurement. At the end of the experiment the solutions were analyzed for organic chlorine. The amount of CO2 evolved was variable, but the results were repeatedable, addition of chlorine dioxide to the lignin solutions caused an increase in the mineralization by P. chrysosporium that increased with increasing additions of chlorine dioxide. This suggests that exposure of lignin to reactive chlorine enhance its biodegradability. The most likely cause of the observed effect is that the addition of chlorine dioxide initiated a fragmentation and oxidation of the lignin, thus rendering a more easily degraded substrate. However, the results may also be interpreted as if an additional cause to the observed effect is that the chlorination in itself somehow enhanced degradation. The amount of organically-bound chlorine decreased during the incubation, and the decrease was more pronounced with the chlorination of lignin, whereas no change at all was observable in the control batches. This makes it tempting to suggest that P. chrysosporium rather than having an enzyme system just capable of handling the chlorinated compounds, actually has a system that preferentially degrades such compounds. (C) 2000 Elsevier Science Ltd.
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44.
  •  
45.
  • Jonzon, Robert, et al. (författare)
  • Violence against women in intimate relationships: Explanations and suggestions for interventions as perceived by healthcare workers, local leaders, and trusted community members in a northern district of Vietnam
  • 2007
  • Ingår i: SCANDINAVIAN JOURNAL OF PUBLIC HEALTH. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 35:6, s. 640-647
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: This study explored professionals' and trusted community inhabitants' explanations of the violence between intimate partners and their suggestions for preventive activities. It was performed in a rural district in northern Vietnam. Methods: A total of 20 men and 20 women were strategically selected for focus-group discussions and the analyses followed the procedure for qualitative thematic content analysis. Results: It was pointed out that violence against women was not discussed openly in the community and women subjected to violence kept silent and avoided seeking help in order not to reveal what was happening in the family. The informants perceived the violence as an interplay between individual and family-related factors and sociocultural norms and practices where Confucian ideology exerted a strong influence. When it came to prevention, there was a strong belief in educating the people and in enforcing policy and law. Conclusions: As described by the informants, traditional attitudes to gender roles and women's power disadvantage are found to be behind most of the explanations for intimate partner violence. Collaboration between sectors at local level, between the health sector and other bodies, and with community leaders as spokesmen would help to improve openness and reduce society's tolerance of violence against women. The mass media also have an important role to play.
  •  
46.
  •  
47.
  • Krantz, Gunilla, et al. (författare)
  • The role of controlling behaviour in intimate partner violence and its health effects: a population based study from rural Vietnam.
  • 2009
  • Ingår i: BMC public health. - : Springer Science and Business Media LLC. - 1471-2458. ; 9
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Studies in North America and other high-income regions support the distinction between extreme "intimate terrorism" and occasional "situational couple violence", defined conceptually in terms of the presence or absence of controlling behaviour in the violent member of the couple. Relatively little research has been conducted on the different forms intimate partner violence may take in low-income countries. The aim of this study was to investigate whether these expressions of intimate partner violence in one low-income country, Vietnam, adhere to patterns observed in western industrialised countries as well as to investigate the resulting health effects. METHODS: This cross-sectional study collected structured interview data from 883 married women aged 17-60, using the Women's Health and Life Experiences questionnaire developed by WHO. Intimate partner violence was assessed by past-year experience of physical or sexual violence and control tactics were assessed using six items combined into a scale. Three different health parameters constituted the dependent variables. Bi- and multivariate analyses, including effect modification analyses, were performed. RESULTS: Of the participants, 81 (9.2%) had been exposed to physical or sexual violence during the past 12 months; of these, 26 (32.1%) had been subjected to one or more controlling behaviours by their partners. The risk of ill health associated with combined exposure was elevated eight to 15 times, compared to a two-fourfold risk increase after exposure to only one of the behaviours, i.e. violent acts or control tactics. CONCLUSION: Physical or sexual violence combined with control tactics acted synergistically to worsen health in rural Vietnamese women. The occurrence of such violence calls for altered policies, increased research and implementation of preventive and curative strategies. The unacceptability of intimate partner violence as a part of normal Vietnamese family life must be recognised in the general debate.
  •  
48.
  •  
49.
  • Krantz, Gunilla, et al. (författare)
  • Total workload, work stress and perceived symptoms in Swedish male and female white-collar employees.
  • 2005
  • Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 15:2, s. 209-214
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of this study was to analyse how paid work, unpaid household tasks, child care, work-child care interactions and perceived work stress are associated with reported symptoms in male and female white-collar employees. Methods: A questionnaire was mailed to 1300 men and 1300 women belonging to the white-collar sector, with at least 35 hours of regular employment a week and a participant age of between 32 and 58 years. It contained items relating to total workload (hours spent on paid work, unpaid household tasks and childcare), subjective indices for work stress and symptoms. The response rate was 65% (743 women; 595 men). Gender difference in symptom prevalence was tested by analyses of variance. Odds ratios were used to estimate the bivariate associations between work-related variables and symptom prevalence. A multivariate analysis estimated the effect of paid and unpaid work interaction, work-childcare interplay and possible synergy. Results: The frequency and severity of symptoms was higher in women than in men (P < 0.0001). Employed women's health was determined by the interaction between conditions at work and household duties (OR 2.09; 1.06-4.14), whereas men responded more selectively to long working hours, i.e. >50h/week (OR 1.61; 1.02-2.54). However, childcare (<21 h/week) appeared to have a buffer effect on the risk of a high level of symptoms in men working long hours. Conclusion: Working life and private circumstances and the interplay between them need to be taken into account to curb stress-related ill health in both men and women.
  •  
50.
  • Krantz, Gunilla, et al. (författare)
  • Violence against women.
  • 2005
  • Ingår i: Journal of epidemiology and community health. - : BMJ. - 0143-005X. ; 59:10, s. 818-21
  • Tidskriftsartikel (refereegranskat)abstract
    • Violence against women is now well recognised as a public health problem and human rights violation of worldwide significance. It is an important risk factor for women's ill health, with far reaching consequences for both their physical and mental health. This glossary aims to describe various forms of interpersonal violence that are directed towards women and girls. Terms and basic concepts used in research and policy on this public health problem will be explained.
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