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1.	Gustafsson, Cecilia, 1977- (författare) "For a better life..." : a study on migration and health in Nicaragua 2014 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract This thesis explores and analyses the manifold relations between migration and health, what I call the migration-health nexus, in the contemporary Nicaraguan context. The study is based on fieldwork in León and Cuatro Santos and a mixed-methods approach combining qualitative in-depth interviews and quantitative survey data. In the thesis health is “traced” within the migration process; i.e. in places of origin, during travel, at the destination and after return, including the situation and consequences for both migrants and family members to migrants (“left-behinds”). The study shows that migration-health relations in Nicaragua are connected to broader economic, social and political factors and to the country’s historical experiences of colonization, neo-colonization and structural adjustments. Contemporary Nicaraguan migrations are primarily related to the strategies of making a living and the struggle for a better life (i.e. a practice of mobile livelihoods). In the study setting health concerns were both indirectly embedded in people’s mobile livelihoods, as well as directly influencing decisions to move or to stay, and migration involved both advantages and disadvantages for health. Through migration, women could see an end to physical violence and sexual abuse. Internal migrants could improve their access to health care and medicine. Vulnerabilities related to the unpredictable nature conditions could be avoided through moving. And, through the money made from migrant work people’s everyday lives and health could be improved, in terms of better nutrition, housing, and access to education, health care and medicine. However, remittances do not necessarily lead to development, as they are used to compensate for the lacking public sector in Nicaragua. Under these circumstances, I argue that the Nicaraguan population is not guaranteed their social rights of citizenship. I also argue that the negative aspects surrounding migration must be taken into account when discussing the development potentials of migration and remittances. Both internal and international migrants in this study experienced stress while moving to a new place. International migrants had difficulties accessing health care in the destination, particularly those lacking documentation. The separation within families due to migration often caused emotional pain. Family members left behind did not rate their physical health as good as often as non-migrant families. The vulnerability, stress experiences and sufferings of migrants and left-behinds varied, however. I therefore conclude that social differences (in terms of e.g. gender, class, skin colour, and legal immigration status) are key for the enactment of the migration-health nexus, and that an interplay of individual, social and structural factors influence the outcome.
2.	Dahlblom, Kjerstin, 1950- (författare) Home alone : sibling caretakers in León, Nicaragua 2008 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Sibling caretaking, although common across time and cultures, has not been well researched from the carer’s point of view. In Nicaragua, ranked as one of the poorest countries in the Americas, sibling caretaking is common. The country’s historical background and its state of chronic poverty, widespread unemployment, loose family structures, and migration and mobility makes of the old practise of shared management child care a necessity. Households headed by sing¬le mothers constitute a particular Nica¬raguan charact¬eristic. Many children are expected to help in their own families and care for their siblings and other children living in their households. In its broadest sense sibling caretaking is a public health concern, and we conducted this study to widen the understanding of the phenomenon as it is represented in a setting undergoing a rapid social transition. The main objectives were to identify, describe and analyse the life situation of sibling caretakers in poor areas in León, Nicaragua, with focus on how they perceived it themselves. A combined qualitative and quantitative methodological design was used, mainly applying an ethnographic approach. A further ambition was to explore involvement of children in a participatory research process in accordance with the ‘Convention on the Rights of the Child’. The overall emotion expressed among the caretakers was pride, even if their situation often was characterized by stress and coping problems. They perceived their work as important for their families and they appreciated to fend for their siblings. Household work and nurturing of siblings were shaping the future lives of the caretakers and constituted part of their socialization. Even if many of these children achieve essential life skills as caretakers, they are at risk of falling behind as they grow older. Their long-term personal development is likely to be hampered by the obligations they have as caretakers. The carers' awareness of missing out on education was the most problematic issue for them. From a societal point of view, caretaking has negative consequences. The individual child is marginalised with limited access to basic education, contributing to overall low educational levels in Nicaragua. While the structuring conditions leading to sibling caretaking may be difficult to change, awareness of how these can affect children might make way for improvements in terms of access to school education and support from the society. The knowledge gained from this study should be further utilised to plan for interventions that take children’s perspectives into consideration.
3.	Salazar Torres, Virgilio Mariano, 1976- (författare) Intimate partner violence in Nicaragua : studies on ending abuse, child growth, and contraception 2011 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: Intimate partner violence (IPV) is a pervasive, worldwide public health problem and one of the most common violations of human rights. The aim of this thesis were twofold: (i) to study the process and factors related to ending of IPV of Nicaraguan women and (ii) to examine to what extent IPV exposure is associated with the child linear growth and women’s contraceptive use after pregnancy.Methods: Data were collected from a panel study which followed 398 women who were inquired about their IPV exposure during pregnancy and at follow-up a median of 43 months after delivery. Three hundred seventy five of their children were available for anthropometric assessment. Thirteen in-depth interviews were conducted with women exposed to physical/sexual IPV during pregnancy but not at follow-up. For analysis both quantitative and qualitative methodologies were used.Results: Women experienced four patterns of abuse: never abused, ending abuse, continued abuse, and new abuse. Of the women who experienced any IPV before or during pregnancy, 59% (95% CI 52-65%) reported no abuse at follow-up (135/229). Women exposed to a continued abuse pattern and those exposed to any IPV, emotional or physical IPV at follow-up had higher odds of reversible contraceptive use. Further, exposure to any IPV and controlling behavior by a partner during pregnancy impaired the index child linear growth. Girls whose mothers had low social resources during pregnancy were the most affected. Women felt that being inquired about IPV while pregnant contributed to process of ending the abuse.Ending IPV was experienced as a process with three phases: “I came to a turning point,” “I changed,” and the “Relationship ended or changed.” Successful strategies to ending abuse mainly involved utilizing informal networks. Ending IPV did not always mean ending the relationship. IPV awareness, severity of the abuse, and economic independence were individual factors associated with ending of abuse. At the relationship level, diminishing or no exposure to controlling behavior by their partner was a key element. At the community level, a supportive and less tolerant to IPV environment as well as exposure to IPV inquiry during pregnancy facilitated the process of ending abuse.Conclusion: The study found that IPV exposure is associated with the children’s linear growth and women’s reversible contraceptive use. In addition, it is clear that gender norms regarding IPV are not static and that they play an important role in facilitating the process ending the abuse by increasing abused women’s access to emotional and material support. Our results emphasize the relevance of improving public services response to IPV.
4.	Schmeer, Kammi K., et al. (författare) Maternal resources and household food security : evidence from Nicaragua 2015 Ingår i: Public Health Nutrition. - 1368-9800 .- 1475-2727. ; 18:16, s. 2915-2924 Tidskriftsartikel (refereegranskat)abstract Objective: Women (especially mothers) are theorized as critical to reducing household food insecurity through their work and caregiver roles. The present study tests these assumptions, assessing how maternal economic and social resources are associated with food insecurity in households with young children. Design: Data from a population-based sample of households was collected in Leon, Nicaragua (n 443). Data include a newly validated measure of household food insecurity (ELCSA), maternal resource measures, and household economic status and demographics. Regression analysis tests the statistical associations (P<0.05) of maternal resources with household, adult-specific and child-specific food insecurity. Setting: Municipality of Leon, Nicaragua. Subjects: Households with children aged 3-11 years in rural and urban Leon. Results: Only 25 % of households with young children were food secure, with 50 % mildly food insecure and 25 % moderately/severely food insecure. When mothers contributed substantially to household income, the odds of moderate/severe household food insecurity were 34 % lower than when their spouse/partner was the main provider. The odds of food insecurity were 60 % lower when mothers managed household money, 48 % lower when mothers had a secondary (v. primary) education, 65 % higher among single mothers and 16 % lower with each indicator of social support. Results were similar for adult-and child-specific food insecurity. Conclusions: This research provides new evidence that maternal economic and social resources are important for reducing household food insecurity and adult- and child-specific food insecurity. Women's social status, social support and access to economic resources need to be enhanced as a part of policies aimed to reduce food insecurity in high-poverty settings.
5.	Alm, Erika, 1975, et al. (författare) Parenting the nation : state violence and reproduction in Nicaragua and Sweden 2023 Ingår i: Struggles for reproductive justice in the era of anti-genderism and religious fundamentalism. - London : Palgrave Macmillan. - 9783031312595 - 9783031312625 - 9783031312601 ; , s. 213-240 Bokkapitel (refereegranskat)abstract Reproduction is a core question for the state, a site of struggle between the reproduction of the nation and the reproduction of liveable lives, especially for those citizens whose rights are rarely recognized in the first place. What role does the exceptionalisation of reproductive rights play in the reproduction of the nation-state? Nicaragua and Sweden are countries where debates about reproductive justice highlight tensions in the projection of a state that cares for its citizens. Nicaragua, the second-poorest country in the Western hemisphere with one of the most repressive and punitive legislations on abortion in the world. Sweden with its reputation as a pioneering nation in matters of gender equality and reproductive justice. This chapter draws on a particular formulation of the centrality of the state in theories and practices of reproductive justice: the notion of the state as a parent with a particular responsibility to protect and foster, but also discipline and subjugate, its citizens. Political leaders, Fathers and Mothers of the Nation, form the discourse within which the state regulates its imagined children’s, the citizens, reproductive rights. As such the governance of reproduction is a vital aspect of the political fantasy about the nation-state and its futuriority.
6.	Zelaya Blandon, Elmer (författare) Adolescent pregnancies in Nicaragua. The importance of education 1999 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Early adolescent pregnancy implies increased social and medical risks. There is lack of understanding of the mechanisms behind early sexual debut and pregnancy. This contributes to the difficulties to meet the educational and health care needs of adolescents. In Nicaragua, few reproductive health interventions target adolescents and even fewer studies focus on sexual and reproductive health in this age group. Therefore, the aim of this thesis is to analyze the background of adolescent pregnancy in Nicaragua, for future interventions.Focus group discussions and in-depth interviews were carried out with young and adult women and men from different social backgrounds in the city of León. Results were used in the planning of a cross-sectional household study carried out in 1993, covering a population of 43,765 in 50 randomly selected clusters in rural and urban León. Reproductive histories were obtained from all women aged 15 to 49 years (n= 10,867), corresponding to 176281 person years of reproductive life. Random sub-samples of men (n=388) and women (n=413) were interviewed in privacy about their age at sexual debut, contraceptive use and reproductive history. The background to early adolescent pregnancy was further analyzed in a matched case-referent study of girls who got their first pregnancy before 17 years of age (146 cases, 242 randomly selected age-matched referents).Economic deprivation and disturbed family relations with an unsatisfied craving for parental affection influence adolescent sexual behavior. Girls' romanticism, belief in virginity until marriage and the contrasting male machismo culture contribute to a lack of empowerment of adolescents.At 15 years of age, 25% of boys and girls had had their sexual debut, and at 18 years this was the case for 85% of boys and 53% of girls. Among girls, the latency period from sexual debut to the end of first pregnancy was only 22 months, indicating very limited access to contraceptive counseling and services. At 17 years of age, one fourth had become pregnant. Contraceptive use was 54% among sexually active adolescents, aged 15-19 years, pills being the most common method. Among adults, female sterilization was the most common method, followed by Intra Uterine Device (IUD) and pilL Condom use was low as well as the use of traditional methods. Low educational attainment was a strong determinant for lack of contraception.Age at sexual debut and age at first pregnancy had been increasing, and fertility rate had declined in Nicaragua from the 1970s to the 1990s. The increase in women’s education was found to be the strongest explanatory factor behind this transition in fertility. Girls who had successfully completed at least 5 years of schooling had lower risk for early pregnancy. This protective effect of education was found for groups with high as well as low socioeconomic status.The background of adolescent pregnancy consists of a complex interaction of socioeconomic, familial and cultural factors. Lack of political will to challenge current values, religious influence in sexual and educational issues, romanticism and lack of empowerment, especially among adolescent women, are also influencing elements. Contraceptive use is still low among sexually active teenagers in Nicaragua, and pregnancy follows soon after first intercourse. There is a strong need for family life education at schools and health services geared to adolescents. Non-use of contraception is associated with poverty and lack of education. The association between education and fertility decline, and the protective effect of education in preventing early pregnancies, even among poor families, indicates that education is a powerful tool in breaking the vicious cycles of poverty and early pregnancy.
7.	Caldera, Trinidad, et al. (författare) Parasuicide in a low income country : results from a three year hospital surveillance in Nicaragua. 2004 Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 32:5, s. 349-355 Tidskriftsartikel (refereegranskat)abstract Aims: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. Method: All hospital-admitted parasuicide cases in the area of León, Nicaragua, were assessed over a three-year period using standardized instruments. Results: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15 - 19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May - June and September - October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. Conclusions: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.
8.	Herrera Rodríguez, Andrés, 1966- (författare) Heaven can wait : studies on suicidal behaviour among young people in Nicaragua 2006 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract In developed countries, suicidal behaviour is recognised as a significant public health problem among young people, but there are few studies from developing countries on this subject. The present thesis aims at estimating the extent of the problem and at exploring factors related to suicidal behaviour among young people in a developing country, Nicaragua, using a combined quantitative and qualitative approach. Three studies were conducted between 1999 and 2006. In the first study, all hospital admitted suicide attempt cases in the area of León were assessed over a three year period. Secondly, a qualitative study using individual in-depth interviews was conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. Thirdly, a study using the Attitudes Towards Suicides (ATTS) questionnaire was conducted in a community based sample of 278 young people aged 15-24 years to assess own suicidal behaviours, attitudes towards suicide as well as exposure to suicidal behaviour among significant others. The hospital surveillance showed that suicide attempt rates were highest among females in the age group 15-19 years with a female rate three times that of males (302.9 versus 98.9 per 100,000 inhabits per year). Drug intoxication and pesticides were the most commonly used methods for the attempts. A consistent seasonal variation with peaks in May-June and September-October was found in each of the three years, possibly related to exam periods in schools. Findings in the qualitative approach led to a tentative model for pathways to suicidal behaviour based on four main categories: Structuring conditions, triggering events, emotions and action taken. Dysfunctional families, lack of confidential and trustworthy contacts and interpersonal conflicts followed by emotions of shame and anger were some important components in the model. The community studies showed that suicidal expressions (life-weariness, death wishes, suicidal ideation, suicide plans and suicide attempts) were common among young people where more than 44.8% of males and 47.4% of females reported some kind of suicidal expression. Gender differences were small. Exposure to suicidal behaviour among others was associated with higher levels of self-reported suicidal behaviour. The attitude study showed that boys had less pro-preventive attitudes than girls, possibly indicating their higher risk for completed suicide. Exposure to suicidal behaviour and own suicidal behaviour showed an association with specific patterns of attitudes. The findings should be taken into consideration when planning for prevention of suicidal behaviour among young people in a developing country like Nicaragua.
9.	Herrera Rodríguez, Andrés, et al. (författare) Pathways to suicidal behaviour among adolescent girls in Nicaragua 2006 Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 62:4, s. 805-814 Tidskriftsartikel (refereegranskat)abstract Adolescent girls are the most frequent suicide attempters worldwide. However, there is little knowledge about pathways leading to suicidal behaviour among young people, in particular in low-income countries. This study explores the motives and processes related to suicidal behaviour among young girls in Nicaragua. Individual in-depth interviews were conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. The audio-taped interviews lasted 2–4 h and were transcribed, translated into English and coded for content. Grounded theory and content analysis were used to construct a theory of the mechanisms behind their suicidal behaviour. A tentative model exploring pathways to suicidal behaviour is described with four main categories: structuring conditions, triggering events, emotions and actions taken. The model illustrates the dialectic interplay between structure and actions taken. Actions taken were categorized as problem solving or various forms of escape where failure with either of these strategies resulted in a suicide attempt. Dysfunctional families, absent fathers and lack of integration into society were some of the structuring conditions that lead to emotional distress. Abuse, deaths in the family, break-up with boyfriends or suicide among friends acted as triggering events. A striking finding was the obvious narrative competence of the girls. Our findings indicate that suicide prevention programmes for young people must offer support from professionals, independent of their family and social networks. Institutions in the community in contact with young people with suicidal behaviour must develop communicative skills to offer a trusting environment mobilising the resources that young people have.
10.	Ellsberg, Mary Carroll (författare) Candies in hell : research and action on domestic violence against women in Nicaragua 2000 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The overall aim of the research was to explore the magnitude and characteristics of domestic violence against women in Leon, Nicaragua. A cross-sectional survey was carried out among a representative sample of 488 women between the ages of 15-49 years. In-depth interviews were performed with women who had experienced violence. Also, participatory techniques were used in 19 focus groups of men and women from diverse sectors of Nicaraguan society to gain an understanding of how Nicaraguans view social and legal sanctions for domestic violence.Among ever-married women (n=360) lifetime prevalence of physical violence was 52%, and current prevalence (during the last 12 months) was 27%. Seventy percent of the violence was classified as severe. No significant differences were found with regard to women's age, educational attainment, or occupation and the prevalence of partner abuse. Significant positive associations were found between the risk of wife abuse and poverty, number of children, history of violence in husband's family, husband's controlling behavior and lack of social networks. Abused women were six times more likely to present emotional distress than non-abused women. Emotional distress was more related to the severity of the abuse than to how long ago it had taken place. A significant positive association was found between wife abuse and problems among the children, including physical abuse. Nearly half of the abused women reported that their children had witnessed the violence. Both the qualitative as well as the quantitative data indicated that abused women frequently experience feelings of shame, isolation and entrapment, which in turn contribute to their difficulty in recognizing the violence and disengaging from the violent relationship. Women in Nicaragua used a variety of strategies to protect themselves from violence and most abused women eventually did leave abusive relationships. Temporary leaving and help seeking were critical steps in the process of overcoming violence. However, many women indicated that they did not receive support for their situation.The results of the prevalence survey were compared to findings from two other population-based studies carried out subsequently in Nicaragua. This comparison suggested that under-reporting is a significant threat to the validity of prevalence research on violence, and underscored the importance of incorporating specific measures to enhance disclosure into the research plan, such as providing more than one opportunity to disclose violence and using behaviorally specific language.Moreover, measures that have been primarily viewed from the perspective of ethics and safety, such as ensuring privacy and confidentiality and providing special training and support for interviewers, may have a significant impact on data quality, due to their effect on the disclosure of violence.The survey results and the narrative analysis suggest that domestic violence is a serious public health problem in Nicaragua. The focus group research found that opinions regarding domestic violence differed sharply between men and women, but that broad sectors of society felt that psychological violence was as serious as physical violence, and that new laws and programs were needed to punish violent offenders and to prevent future violence.The results of the research were discussed widely in Nicaragua, and contributed to the debate on the reform of the Nicaraguan Criminal Code with regard to sanctions for domestic violence and protection for victims of violence.
11.	Berg, Linda, 1974-, et al. (författare) A conversation about the state in pandemic times : Necropolitics and the legacy of social democracy in Sweden and Nicaragua 2021 Ingår i: Kulturella perspektiv - Svensk etnologisk tidskrift. - : Publicera, Kungliga Biblioteket. - 1102-7908 .- 2004-0288. ; 30:2-3 Tidskriftsartikel (refereegranskat)abstract Established ideas about state responsibility and state violence are placed in a new light in times characterized as states of emergency. The following conversation addresses the role of the state in the safeguarding of public health, taking its departure in media debates and political debates about state responsibility in two countries that have been criticized for not taking strong enough measures to protect the very futuriority of the nation in times of a pandemic Sweden and Nicaragua. Both countries have been castigated for avoiding total lockdown and for having taken a passive approach to what Wendy Brown has called “the political management of the virus” (Brown 2020). At the same time, the rhetoric used to describe their respective strategies has differed vastly in dialogue we explore notions about governance, biopolitics and necropolitics as they are articulated and negotiated in national contexts that claim the label social democracies. One of the points of departure is that while the response to Covid-19 is often described in war metaphors, and hence as a state of emergency, the unjust and unequal distribution of life and death is by no means exceptional.
12.	Valladares Cardoza, Eliette, 1963- (författare) Partner violence during pregnancy, psychosocial factors and child outcomes in Nicaragua 2005 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The objectives of the thesis was to explore partner violence during pregnancy in Nicaragua – its prevalence and characteristics, how women perceive, understand and cope with it, its association with specific child outcomes such as low birth weight (LBW), small for gestational age (SGA) and preterm birth, and possible pathways. A cross-sectional community-based study was conducted with 478 pregnant women and for a sub-sample of 147 salivary cortisol was measured. A case-referent hospital-based study was organized including 303 mothers immediately after delivery. In-depth interviews were conducted with women survivors to increase understanding of partner violence during pregnancy. The prevalence of emotional, physical and sexual partner abuse during pregnancy was 32.4%, 13.4% and 6.7% respectively. Seventeen percent of the victims suffered all three types of violence and in two thirds the abuse was severe and repeated. Half of the abused women had experienced punches and kicks directed to the abdomen; however, only 14% had sought health care and very few had disclosed the abuse or contacted police or authorities. Adolescent mothers, unwanted pregnancy and late registration for antenatal care or no check-ups were more likely among victims. The access to social resources facilitated the women’s ability to cope with the abuse, but the pregnancy itself was a barrier to receiving support from family, friends or society. The ability to confront abuse was determined by a complex interplay of factors such as economic independence, severity of abuse, access to social resources, implications for important others (i.e. children), socioeconomic group and a personal ability to cope with social norms. Low social resources, high levels of emotional distress and attempted suicide were associated with violence during pregnancy. Abuse during pregnancy was also found as an independent risk factor for LBW. Sixteen percent of LBW was attributed to physical abuse by a partner during pregnancy. A significant association between abuse during the index pregnancy and SGA was found. Partner violence during the pregnancy, low social resources and emotional distress were associated with higher levels of salivary cortisol. Pregnant women with high cortisol values were significantly more likely to give birth to SGA babies. A substantial decrease of birthweight, 142 grams, was estimated to be associated with increases in cortisol due to violence exposure. Partner violence during pregnancy is a serious social problem that impacts the rights, health and wellbeing of both the woman and her unborn child. The studies call for prioritization of intervention programmes for prevention and detection of violence, treatment and rehabilitation of the victims and the perpetrators, and change of the structural causes producing violence in society.
13.	Gustafsson, Cecilia, 1977- (författare) ‘“For a better life …“ A study on migration and health in Nicaragua’ 2018 Ingår i: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 11:1 Forskningsöversikt (refereegranskat)abstract Background: Nicaraguans have migrated internally and internationally for centuries due to economic, political and sociocultural factors. Deficiencies in the country’s health care system have produced inequities in people’s access to health care and medicines. Remittances have become an important source of income, partly invested in health.Objectives: The overall aim of the study was to analyse migration–health relations in contemporary Nicaragua within a broader context of socio-economic transformations.Methods: The study uses a mixed-methods approach, combining qualitative interview data and quantitative survey data.Results: The findings show that migration is commonly practised as a strategy for making a living and is related to the struggle for a better life. Health concerns are indirectly embedded in people’s mobile livelihoods, but also directly influence migration motives. Furthermore, migration involves both advantages and disadvantages for health. Physical and sexual violence can come to an end for migrating women, health care and medicine can become more accessible for internal migrants, and vulnerabilities caused by environmental disasters can be avoided by moving. Moreover, remittances can improve people’s everyday life and health. Yet migration can also be a stressful and health-damaging event. International migrants, particularly the undocumented, can have problems accessing health care, and also experience much danger at border crossings. Transnational families can suffer emotionally as well as physically due to separation. Findings from the survey show that family members of migrants do not rate their physical health as good as often as non-migrating families.Conclusions: The Nicaraguan population is not guaranteed its social rights of citizenship. This results in mobile livelihoods and the need for translocal social support (e.g. remittances). Migration can have both positive and negative effects on health for migrants and their family members; geographical distance and social differences are key to the outcome.
14.	Obando Medina, Claudia, 1980- (författare) When no-one notices...Studies on suicidal expressions among young people in Nicaragua : 2011 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background Suicidal behaviour among young people is one of the major public health problems in low-income countries; it is estimated that every year 70,000 young people take their lives and maybe 40 times as many attempt suicide. Nicaragua has the highest suicide rate among young people of all Latin and Central American countries. This thesis aims at examining: (1) suicidal expressions and their determinants among school adolescents in Nicaragua, (2) cross-cultural aspects on suicidal expressions comparing Nicaragua and Cambodia, (3) pathways to suicide attempts among young men, and (4) primary health care professionals’ perceptions of suicidal behaviour and mental health problems among young people. Method Paper I is a cross-sectional study of 368 school adolescents in Nicaragua using self-report instruments (Youth Self Report and Attitudes Towards Suicide). Paper II compares data from Paper I with corresponding data from a study of 316 adolescents in Cambodia using the same methodology. Paper III is a qualitative study based on interviews with 12 young men who have recently attempted suicide. Paper IV is a qualitative study with 12 primary health care professionals. Results Paper I: Among adolescents, suicide ideation during recent year was reported by 22.6%, suicide plans 10.3%, and suicide attempts 6.5%. Girls were significantly more likely to report suicidal ideation. Multivariate analyses showed that anxious/depressed syndrome (YSR), somatic complaints syndrome (YSR) and exposure to attempted or completed suicide in significant others were significantly associated with their own serious suicidal expressions. Paper II: There was no significant difference in serious suicidal expressions (plans and attempts) between countries, but milder suicidal expressions during past year were more common among Nicaraguan young people. Overall, mental health problems were more commonly reported in Cambodia, where adolescents scored significantly higher on almost all YSR-syndromes as compared to Nicaraguan adolescents, except for withdrawn/depressed syndrome among boys. The pattern of association between mental health problems and suicide plans/attempts differed between countries. In Nicaragua, all eight YSR-syndromes were significantly associated with serious suicidal expressions for both genders compared to only one syndrome among girls and two syndromes among boys in Cambodia. Paper III: A model of the pathways leading to suicide attempts among young men was constructed based on the informants’ experiences. Structural conditions such as poverty or single-headed families, along with normative expectations within a framework of hegemonic masculinity, were all involved to create a sense of failure and an inability to cope. Subsequent increased drinking and drug abuse as well as exposure to attempted and completed suicide among friends and family acted as triggers to their own suicide attempt. Paper IV: Primary health care professionals felt themselves that they lacked knowledge and competence when approached by young people with mental health problems. Misconceptions were common. They felt frustrated which made them either ignore signs of mental health problems or reject help-seeking young people. In practice, a common response from health care professionals was to refer the patient over to someone else, the “hot potato” strategy. Conclusions The prevalence of serious suicidal expressions among young people in Nicaragua is within the range reported from Western high-income countries. Health care professionals need to be aware that somatic complaints as such are related to an increased risk of serious suicidal behaviour among young people, and that those who have been exposed to the attempted or completed suicide of someone close are at increased risk of serious suicidal expressions also when there are no warning signs in terms of mental distress. The cross-cultural comparison lends support to the notion that both cultural specificity and universality characterize serious suicidal expressions, as suggested by several researchers. Whereas prevalence shows less variation between cultures, associated factors might behave differently as shown in the present study, calling for different preventive approaches. The interviews with young men who had attempted suicide tell us that not only difficult socio-economic conditions but also the normative expectations on young men need to be addressed to decrease their risk of suicide. Health care professionals need to be alerted that sometimes serious mental health problems are hidden behind help-seeking for more trivial reasons. There is a necessity of a more integral approach towards mental health problems in PHC, including integral training of staff. The continued involvement of the community, family and other institutions would be essential to develop the care further.
15.	Obando Medina, Claudia, 1980-, et al. (författare) Suicidal expression in adolescents in Nicaragua in relation to youth self-report (YSR) syndromes and exposure to suicide 2011 Ingår i: Clinical Practice and Epidemiology in Mental Health. - : Bentham Open. - 1745-0179. ; 7, s. 89-96 Tidskriftsartikel (refereegranskat)abstract Background: Suicide and suicidal expressions among young people represent a major public health problem worldwide. Most studies are from high-income countries, and it remains unclear whether prevalence and risk factors show a similar pattern in other settings. This study aims to assess the prevalence of suicidal expressions and serious suicidal expressions (ideation, plans and attempts) among adolescents in Nicaragua, in relation to previously reported risk factors, such as exposure to suicide in significant others (parents, siblings, partners or friends) and mental health problems.Methods: 368 adolescents aged 15-18 years were randomly selected from public secondary schools in León, Nicaragua. Data was collected using Attitude Towards Suicide (ATTS) and Youth Self-Report questionnaires (YSR). Bivariate and multivariate analyses were conducted.Results: Suicide ideation prevalence in the past year was 22.6%, suicide plans 10.3%, and suicide attempts 6.5%. Girls were significantly more likely to report suicidal ideation. Multivariate analyses showed that anxious/depressed, somatic complaints and exposure to suicidal behavior in significant others were significantly associated with own serious suicidal expressions.Conclusions: The prevalence of serious suicidal expressions among young people in Nicaragua is within the range reported from Western high-income countries. An attempted or completed suicide in someone close, is associated with own suicidal expressions even in the absence of increased mental distress. Furthermore, somatic complaints should alert healthcare professionals of the possibility of increased suicide risk.
16.	Caldera Aburto, José Trinidad (författare) Mental health in Nicaragua : with special reference to psychological trauma and suicidal behaviour 2004 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract This thesis explores mental health problems relating to war and natural disaster and suicidal behaviour in the Nicaraguan population. The more specific aims of the study were to assess the prevalence and sociodemographic correlates of mental disorder in a community-based study during time of war (Paper I), to assess the mental health impact of Hurricane Mitch in 1998 (Paper II), to assess the incidence of hospitalized parasuicide cases and groups at risk (Paper III), and to examine suicide intent among attempters relating to gender, suicide method and sociodemographic factors and identify predictors for repetition of an attempt (Paper IV).Method: Based on 4453 family food ration books for families living in an urban area of León, Subtiava, 219 families including 746 adults were selected through a systematic sampling procedure. The study was conducted in 1987 during the war. We were able to reach 584 adults for interview according to the Present State Examination for ICD-9 diagnoses and Self-Report Questionnaire (Paper I). In Paper II, 496 adult primary health care attendees were interviewed six months after Hurricane Mitch according to the Harvard Trauma Questionnaire and were diagnosed for post-traumatic stress disorder (PTSD) according to DSM-IV. In Papers III and IV, all cases from León city admitted to HEODRA Hospital for a suicide attempt over a three-year period (n=233) were interviewed regarding sociodemographic factors and method, time and place of the suicide attempt. A subgroup of 204 cases was interviewed using the Suicide Intent Scale (SIS). Out of those 106 cases were followed-up regarding repetition of attempt or completed suicide after a mean period of 1172 days.Results: In the Paper I study, the one-month prevalence of any mental disorder was 28.8% for men and 30.8% for women. Among men, alcoholism was the most common diagnosis, whereas neurosis, crisis reaction and depression were dominant among women. Alcoholism was scored as the second most severe disorder after psychosis in terms of functional level. In the Mitch study six months after the hurricane, traumatic events were common and 39% reported death or serious injury of a close relative as a result of the hurricane. The prevalence of PTSD ranged from 4.5% in the least damaged area to 9.0% in the worst damaged area. At the prolonged follow-up six months later, half of the cases still retained their diagnosis. Trauma-related symptoms were common and death of a relative, destroyed house, female sex, illiteracy and previous mental health problems were associated with a higher level of symptoms. Suicidal ideation was reported among 8.5% and was significantly associated with previous mental health problems and illiteracy. The studies regarding hospitalized parasuicides showed the highest rate among girls aged 15–19 years (302 attempts per 100 000 inhabitants and year). After drug intoxication, pesticide was the second most common method and most often used by men (23%). Half of the women had recent contact with health care services before attempting suicide. There were significant peaks regarding time of attempt in terms of seasonal and diurnal distribution. Overall scores regarding seriousness of the intent (SIS) were equal between the sexes, but the pattern of SIS items showed significant gender differences in terms of relation to background factors and method used. For women, having a child was one factor associated with higher seriousness. Factor analysis of SIS items revealed a four-factor solution, explaining 59% of the variance. Risk for fatal repetition was 3.2% after three years and for non-fatal repetition 4.8%. During follow-up, three men (11%) had completed suicide but no women. We failed to identify any predictors for repetition from background factors or SIS.Conclusion: The studies have identified different groups at risk for mental health problems relating to war and disasters. Parasuicide rates equalled those from European countries. Whereas young girls dominated, attempts among men were more severe in terms of the methods used and completed suicide at follow-up. SIS seemed to give a meaningful pattern among women but not for men. In our study, seriousness of attempt in terms of method or suicide intent did not predict repetition. Overall non-fatal repetition rate was very low as compared to other studies.
17.	Valladares, Eliette, et al. (författare) Violence against pregnant women : prevalence and characteristics. A population-based study in Nicaragua. 2005 Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 112:9, s. 1243-1248 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: This study aims to estimate the prevalence and characteristics of partner abuse during pregnancy as well as to investigate associated social factors in León, Nicaragua. DESIGN: Cross-sectional community-based study. SETTING: All pregnant women from 50 randomly selected geographical clusters out of 208 in the municipality of León, Nicaragua. SAMPLE: A total of 478 pregnant women were included; only one woman refused to participate. METHOD: The domestic violence questionnaire from the WHO-co-ordinated Multi-Country Study on Women's Health and Life Events was used with each participant being interviewed twice during pregnancy. MAIN OUTCOME MEASURES: Prevalence and characteristics of partner violence during pregnancy. RESULTS: The prevalence of emotional, physical and sexual abuse during pregnancy was 32.4%, 13.4% and 6.7%, respectively. Seventeen percent reported experience of all three forms of violence. Two-thirds of the victims reported repeated abuse. Half of the abused women had experienced punches and kicks directed towards the abdomen and 93% had been injured. Most women had not sought health care in relation to the abuse, but those who did were usually hospitalised. Factors such as women's age below 20 years, poor access to social resources and high levels of emotional distress were independently associated with violence during pregnancy. CONCLUSION: Violence against pregnant women in Nicaragua is common and often repeated. Although these women have poor access to social resources and high levels of emotional distress, they are rarely assisted by the health services. Innovative strategies are needed to provide support and counselling.
18.	Dahlblom, Kjerstin, 1950- (författare) Estrella : a gifted narrative 2009 Ingår i: Childhoods Today. - : University of Sheffield. - 1753-0849. ; 3:1 Tidskriftsartikel (refereegranskat)abstract This paper analyses a short written account by a young Nicaraguan girl who narrates an experience she had while taking care of her small niece. She describes a turning point in her life, and narrative analysis was applied to interpret the meaning of her story. The importance and implications of becoming a mother are the key elements in her narrative. Her contribution was part of a larger study on sibling caretaking conducted in León, Nicaragua, in which multiple tools were used for exploration and analysis.
19.	Tercero, F, et al. (författare) The epidemiology of moderate and severe injuries in a Nicaraguan community : a household-based survey 2006 Ingår i: Public Health. - London : Saunders Elsevier. - 0033-3506 .- 1476-5616. ; 120:2, s. 106-114 Tidskriftsartikel (refereegranskat)abstract Although injuries constitute a major public health problem worldwide, the magnitude and nature of this problem is difficult to establish in low-income settings due to the lack of valid and representative data. In Nicaragua, several parallel studies have been carried out attempting to assess levels and patterns of injury using various sources of information. The objective of this study was to describe the magnitude and profile of moderate and severe injuries in a well-defined community in Nicaragua. The study was conducted using a household-based survey design. Randomized cluster sampling provided information from 10,797 households (63,886 inhabitants). The outcomes included fatal and non-fatal injuries registered during a recall period of 6 weeks. Seven percent of all. injuries were classified as moderate or severe. The estimated annual incidence rate of moderate/severe injuries was 27.6 per 1000 [95% confidence intervals (CI): 26.4-29.2], white the mortality and impairment rates were 108.9 (95% CI: 83.5-134.4) and 95.3 (95% CI: 71.4-119.2) per 100,000 inhabitants, respectively. Home and traffic areas were the main environments associated with injury occurrence. The most affected groups were the elderly, children and mates. No differences were found between urban and rural areas. Only 9% of all cases, including minor injuries, sought hospital treatment. The main causes of non-fatal injuries were falls, traffic and cuts, whereas fatalities were largely associated with intentional injuries. For every death due to injury, there was one permanent disability, 25 moderate/severe injuries and 354 minor injuries. This study provides a broad description of injury magnitudes and patterns in a defined Nicaraguan community, and demonstrates the aggregate injury pyramid of the same community. It also identifies the issue of severity and concludes with a recommendation to apply different criteria of severity. Our results support the call for a careful evaluation of injury data sources and severity scores when planning injury prevention programmes.
20.	Obando Medina, Claudia, et al. (författare) I keep my problems to myself : pathways to suicide attempts in Nicaraguan young men 2011 Ingår i: Suicidology Online. - 2078-5488. ; 2, s. 17-28 Tidskriftsartikel (refereegranskat)abstract This qualitative study is an attempt to understand the pathways leading to attempted suicide of young men in León, Nicaragua. Our research is based on in-depth interviews with twelve young men between the ages of 15 and 24 who had recently attempted to take their own life. The analysis is based on a grounded theory approach. The young men who participated in this study had a broadly similar background, insofar as they all came from broken families and had dropped out from school at an early age. They also all faced similar problems, such as unemployment and alcohol abuse. On this basis a model describing the pathways leading to the suicide attempts was constructed based on the informants’ experiences. In all cases the decision to attempt suicide was found to be an expression of frustration with the present conditions of life. Combined with this was the traumatic influence of a troubled childhood within an unloving, unstable family. Attention has been paid to the ambivalent and antagonistic relationships that the informants experienced within their own families from childhood onwards, and the subsequent inability to establish any meaningful relationships in later life. This study aims to increase our understanding of the complexity of suicidal behaviours in order to help develop genderspecific prevention strategies.
21.	Hansson, Erik, et al. (författare) Mapping snakebite epidemiology in Nicaragua : pitfalls and possible solutions 2010 Ingår i: PLoS neglected tropical diseases. - : Public Library of Science (PLoS). - 1935-2735. ; 4:11, s. e896- Tidskriftsartikel (refereegranskat)abstract Using publicly available data, we identified areas likely to be underreporting snakebites and highlighted these areas instead of leaving them "white" on the incidence map. The effects of the case detection bias on the distribution of resources against snakebites could decrease. Although not yet verified empirically, our study provides an example of how snake bite epidemiology may be investigated in similar settings worldwide at a low cost.
22.	Peña, Rodolfo (författare) Infant mortality in transitional Nicaragua 1999 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)
23.	Salazar, Mariano, et al. (författare) Respectable, Disreputable, or Rightful? Young Nicaraguan Women's Discourses on Femininity, Intimate Partner Violence, and Sexual Abuse : A Grounded Theory Situational Analysis 2016 Ingår i: Journal of Aggression, Maltreatment & Trauma. - : Informa UK Limited. - 1092-6771 .- 1545-083X. ; 25:3, s. 315-332 Tidskriftsartikel (refereegranskat)abstract This situational analysis study aims to position the discourses that young Nicaraguan women use in their understanding of femininities, male intimate partner violence (IPV), and men's sexual violence toward women (SA). Eight focus group discussions with a total of 59 women were conducted. Positional maps were used to display the data. The findings show a dominant discourse that portrays femininity as enacting attributes habitually bestowed to men such as independence and agency, while still upholding key patriarchal conceptions (respectability) limiting women's agency. Tolerance of IPV and SA by nonpartners varies depending on women's perceived respectability and agency. Most important, we identified a pro-women's rights resistance discourse that constructs femininity and advocates nonviolence from a human rights perspective.
24.	Torres, Virgilio Mariano Salazar, et al. (författare) 'Expanding your mind' : the process of constructing gender-equitable masculinities in young Nicaraguan men participating in reproductive health or gender training programs 2012 Ingår i: Global Health Action. - : CoAction Publishing. - 1654-9716 .- 1654-9880. ; 5:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Traditional forms of masculinity strongly influence men's and women's wellbeing.OBJECTIVE: This study has two aims: (i) to explore notions of various forms of masculinities in young Nicaraguan men participating in programs addressing sexual health, reproductive health, and/or gender equality and (ii) to find out how these young men perceive their involvement in actions aimed at reducing violence against women (VAW).DESIGN: A qualitative grounded theory study. Data were collected through six focus groups and two in-depth interviews with altogether 62 young men.RESULTS: Our analysis showed that the informants experienced a process of change, labeled 'Expanding your mind', in which we identified four interrelated subcategories: The apprentice, The responsible/respectful man, The proactive peer educator, and 'The feminist man'. The process showed how an increased awareness of gender inequities facilitated the emergence of values (respect and responsibility) and behavior (thoughtful action) that contributed to increase the informant's critical thinking and agency at individual, social, and political levels. The process was influenced by individual and external factors.CONCLUSIONS: Multiple progressive masculinities can emerge from programs challenging patriarchy in this Latin American setting. The masculinities identified in this study show a range of attitudes and behaviors; however, all lean toward more equitable gender relations. The results suggest that learning about sexual and reproductive health does not directly imply developing more gender-equitable attitudes and behaviors or a greater willingness to prevent VAW. It is paramount that interventions to challenge machismo in this setting continue and are expanded to reach more young men.
25.	Obando Medina, Claudia, et al. (författare) Suicidal expressions among young people in Nicaragua and Cambodia : a cross-cultural study 2012 Ingår i: BMC Psychiatry. - London : BioMed Central. - 1471-244X. ; 12, s. 28- Tidskriftsartikel (refereegranskat)abstract Background Whereas prevalence of suicidal expressions among young people is fairly similar in different countries, less is known about associated risk factors. This study compares young people in Nicaragua and Cambodia to examine if the pattern of association between mental health problems and suicidal expressions differs.Methods 368 and 316 secondary school students, from each country respectively, participated. Self-reported suicidal expressions, exposure to suicidal behavior in significant others and mental health problems among the students were measured using Attitude Towards Suicide (ATTS) and the Youth Self-Report (YSR) questionnaires.Results Prevalence of serious suicidal expressions (plans and attempts) during recent year, did not differ between countries. Cambodian young people scored significantly higher on all eight YSR-syndromes, except for withdrawn/depressed. In Nicaragua, all YSR-syndromes were significantly associated with serious suicidal expressions in both genders compared to Cambodia where only one syndrome showed an association in each gender; Withdrawn/depressed among girls and Somatic complaints among boys. Associations between being exposed to suicide among significant others and serious suicidal expressions also differed between Cambodia and Nicaragua.Conclusions While the magnitude of serious suicidal expressions is similar between these structurally similar but culturally different countries, determinants behave differently. Qualitative studies are warranted to further explore cultural specific determinants for suicidal expressions among young people.
26.	Dahlblom, Kjerstin, et al. (författare) Home alone : children as caretakers in León, Nicaragua 2009 Ingår i: Children and society. - : Wiley. - 0951-0605 .- 1099-0860. ; 23:1, s. 43-56 Tidskriftsartikel (refereegranskat)abstract This article seeks to explore and understand the life situations of sibling caretakers in poor areas in León, Nicaragua. The every day lives for caretakers were studied through observations and interviews with children, informants and parents. The children themselves were satisfied and proud to be trusted as caretakers and felt useful in contributing to their families' livelihood. However, in a life course perspective the caretaking role implies a narrowing of life options. Early on they seem to acquire essential life skills but as they grow older many are at risk of falling behind due to their marginalised situation and lack of basic education.
27.	Salazar, Mariano, 1976-, et al. (författare) Intimate partner violence and early child growth : a community-based cohort study in Nicaragua 2012 Ingår i: BMC Pediatrics. - : BioMed Central. - 1471-2431. ; 12 Tidskriftsartikel (refereegranskat)abstract Background: This study analyses whether a mother's exposure to different forms of Intimate Partner Violence (IPV) during pregnancy was associated with the index child linear growth, and whether these associations were modified by the gender of the child.Methods: A pregnancy cohort of 478 women in Leon, Nicaragua, resulted in 461 live births. From this group, 81% (375/461) children were available for anthropometric follow-up at 40 to 46 months. Analysis of covariance (ANCOVA) was used to assess the association between IPV and height-for-age Z-scores, adjusting for confounding factors.Results: Sixty-three percent (236/375) of the mothers had been exposed to some form of IPV during pregnancy (emotional, physical, sexual or controlling behavior). After adjustment for confounding factors, maternal exposure to any IPV during pregnancy was associated with 0.24 lower mean height-for-age Z-scores (p = 0.02). A separate analysis of each IPV type showed that emotional, physical or sexual IPV during pregnancy were not significantly associated with lower mean height-for-age Z-scores, whereas ever exposure to controlling behavior by the father of the child was related to 0.29 lower mean height-for-age Z-scores (p < 0.01) When stratified by gender, these associations remained significant only for young girls.Conclusions: This study has contributed to the growing amount of evidence pointing to the pervasive effect of different forms of IPV on child health. Our study highlights the relevance of maternal autonomy for linear child growth, especially for young girls in the Nicaraguan context.
28.	Ljuslinder, Karin (författare) Monitoring disabled women's human rights in Nicaragua 2007 Ingår i: 10 years anniversary : NNDR - Nordic Network on Disability Research. ; , s. 1- Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract This project studied violations of human rights of disabled women in Nicaragua, in order to apply the Convention on the Rights of persons with disabilities.
29.	Caldera, Trinidad, et al. (författare) Suicide intent among parasuicide patients in Nicaragua. : A surveillance and follow-up study. 2007 Ingår i: Archives of Suicide Research. - 1381-1118 .- 1543-6136. ; 11:4, s. 351-360 Tidskriftsartikel (refereegranskat)
30.	Herrera, Andrés, et al. (författare) Suicidal expressions among young people in Nicaragua : a community-based study 2006 Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 41:9, s. 692-697 Tidskriftsartikel (refereegranskat)
31.	Salazar, Mariano, et al. (författare) Violence against women and unintended pregnancies in Nicaragua : a population-based multilevel study 2014 Ingår i: BMC Women's Health. - : Springer Science and Business Media LLC. - 1472-6874. ; 14, s. 26- Tidskriftsartikel (refereegranskat)abstract Background: Despite an increased use of contraceptive methods by women, unintended pregnancies represent one of the most evident violations of women's sexual and reproductive rights around the world. This study aims to measure the association between individual and community exposure to different forms of violence against women (physical/sexual violence by the partner, sexual abuse by any person, or controlling behavior by the partner) and unintended pregnancies.Methods: Data from the 2006/2007 Nicaraguan Demographic and Health Survey were used. For the current study, 5347 women who reported a live birth in the five years prior to the survey and who were married or cohabitating at the time of the data collection were selected. Women's exposure to controlling behaviors by their partners was measured using six questions from the WHO Multi-Country Study on Women's Health and Domestic Violence against Women. Area-level variables were constructed by aggregating the individual level exposures to violence into an exposure measurement of the municipality as a whole (n = 142); which is the basic political division in Nicaragua. Multilevel logistic regression was used to analyze the data.Results: In total, 37.1% of the pregnancies were reported as unintended. After adjusting for all variables included in the model, individual exposure to controlling behavior by a partner (AOR = 1.28, 95% CrI = 1.13-1.44), ever exposure to sexual abuse (AOR = 1.31, 95% CrI = 1.03-1.62), and ever exposure to physical/sexual intimate partner violence (AOR = 1.44, 95% CrI = 1.24-1.66) were significantly associated with unintended pregnancies. Women who lived in municipalities in the highest tertile of controlling behavior by a partner had 1.25 times higher odds of reporting an unintended pregnancy than women living in municipalities in the lowest tertile (AOR = 1.25, 95% CrI = 1.03-1.48).Conclusions: Nicaraguan women often experience unintended pregnancies, and the occurrence of unintended pregnancies is significantly associated with exposure to different forms of violence against women at both the individual and the municipality level. National policies aiming to facilitate women's ability to exercise their reproductive rights must include actions aimed at reducing women's exposures to violence against women.
32.	Herrera, Andrés, et al. (författare) Attitudes towards suicide among young people in Nicaragua : a community-based study Annan publikation (övrigt vetenskapligt/konstnärligt)
33.	Salazar, Mariano, 1976-, et al. (författare) Questions about intimate partner violence should be part of contraceptive counselling : findings from a community-based longitudinal study in Nicaragua 2012 Ingår i: Journal of family planning and reproductive health care. - : BMJ Publishing Group Ltd. - 1471-1893 .- 2045-2098. ; 38:4, s. 221-228 Tidskriftsartikel (refereegranskat)abstract Background and methodology: The study aim was to examine whether exposure to intimate partner violence (IPV) was associated with reversible contraceptive use in ever-pregnant partnered women. The authors conducted a longitudinal panel study in León municipality, Nicaragua. At baseline (2002–2003), 478 pregnant women were interviewed and 398 were available for questioning about contraceptive use 40–47 months after childbirth. IPV was assessed at baseline and follow-up, with women classified as never abused, ending abuse, continued abuse or new abuse. Reversible contraceptive use was defined as women using any form of contraception apart from sterilisation. Adjusted odds ratios (AORs) were used to assess the association between reversible contraceptive use, IPV patterns and IPV exposures at follow-up.Results: Eighty percent of the women were not pregnant and with a partner at follow-up. Half were using reversible contraceptives and 28% were sterilised. Women exposed to a continued abuse pattern (AOR 2.50, 95% CI 11.04–5.99), and those exposed to emotional (AOR 2.80, 95% CI 1.32–5.95), physical (AOR 3.60, 95% CI 1.15–11.10) or any IPV at follow-up (AOR 2.59, 95% CI 1.24–5.40) had higher odds of reversible contraceptive use than those not exposed, even after adjusting for demographic factors. No significant differences in the type of reversible contraceptive used were found between women exposed or not to IPV.Discussion and conclusions: IPV exposure was associated with more reversible contraceptive use. Abuse inquiring at health facilities providing contraceptives should be implemented to identify women exposed to IPV and provide adequate support.
34.	Penayo, Ulises, et al. (författare) Mental disorders among primary health care patients in Nicaragua. 1990 Ingår i: Acta Psychiatrica Scandinavica. - 0001-690X .- 1600-0447. ; 82:1, s. 82-5 Tidskriftsartikel (refereegranskat)abstract The objective of this study was to validate the Self Report Questionnaire (SRQ-20) as a screening instrument to identify probable psychiatric cases in the general population in Nicaragua and to study the prevalence and identification of mental disorders in primary health care. In the general population 576 people were screened using SRQ-20. A subsample was further interviewed using the Present State Examination (PSE). In primary health care centers 781 patients were screened according to SRQ-20 and staff indicated whether a mental disorder was identified or not. In the general population study, 9/10 turned out an adequate cut-off for SRQ-20, identifying 23% as probable cases. Using the same cut-off, 47% of the primary health care patients were identified as probable cases. Among male probable cases only 7% were identified as cases by health care staff, and among female probable cases health care staff identified 13% as cases. When the results are compared with previous studies, it becomes evident that the general level of psycho-emotional complaints and accordingly the cut-off for caseness differ in different parts of the world. SRQ must be calibrated for each cultural setting. Among primary health care patients, mental disorders were overrepresented and frequently overlooked by the physicians. Educational programs with training in psychiatry should be implemented for primary health care staff.
35.	Salazar, Mariano, 1976-, et al. (författare) Ending intimate partner violence after pregnancy : findings from a community-based longitudinal study in Nicaragua 2009 Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 9, s. 350- Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Although reducing intimate partner violence (IPV) is a pervasive public health problem, few longitudinal studies in developing countries have assessed ways to end such abuse. To this end, this paper aims to analyze individual, family, community and societal factors that facilitate reducing IPV.METHODS: A longitudinal population-based study was conducted in León, Nicaragua at a demographic surveillance site. Women (n = 478) who were pregnant between 2002 and 2003 were interviewed, and 398 were found at follow-up, 2007. Partner abuse was measured using the WHO Multi-country study on women's health and domestic violence questionnaire. Women's socio demographic variables, perceived emotional distress, partner control, social resources, women's norms and attitudes towards IPV and help-seeking behaviours were also assessed. Ending of abuse was defined as having experienced any abuse in a lifetime or during pregnancy but not at follow-up. Crude and adjusted odds ratios were applied.RESULTS: Of the women exposed to lifetime or pregnancy IPV, 59% reported that their abuse ended. This finding took place in a context of a substantial shift in women's normative attitudes towards not tolerating abuse. At the family level, no or diminishing partner control [ORadj 6.7 (95%CI 3.5-13)] was associated with ending of abuse. At the societal level, high or improved social resources [ORadj 2.0 (95%CI 1.1.-3.7)] were also associated with the end of abuse.CONCLUSION: A considerable proportion of women reported end of violence. This might be related to a favourable change in women's norms and attitudes toward gender roles and violence and a more positive attitude towards interventions from people outside their family to end abuse. Maintaining and improving social resources and decreasing partner control and isolation are key interventions to ending abuse. Abuse inquiring may also play an important role in this process and must include health care provider's training and a referral system to be more effective. Interventions at the community level are crucial to reducing partner violence.
36.	Penayo, U, et al. (författare) Prevalence of mental disorders among adults in Subtiava, León, Nicaragua 1992 Ingår i: Boletin de la Oficina Sanitaria Panamericana. - 0030-0632. ; 113:2, s. 137-148 Tidskriftsartikel (refereegranskat)abstract The objective of this study was to estimate the prevalence of mental disorders in the Subtiava district of León, Nicaragua. Two-stage cluster sampling was used to select 219 families (n = 584 persons). The study was carried out in two phases. In the first, probable mental disorder cases were screened using the Self-Reporting Questionnaire. In the second, the diagnoses were confirmed through the Present State Examination questionnaire. The validity and reliability of the questionnaires had been confirmed in a pilot study. The present study was conducted in October and November 1987, when Nicaragua was still immersed in armed conflict. Construction of a family map made it possible to analyze, through the multiple imputation method, the characteristics of persons who were absent at the time of the interviews or who did not respond. The estimated prevalence percentages and their respective 95% confidence intervals were as follows: neurosis, 7.5% (5.2%-9.8%); depression, 6.2% (2.6%-8.1%); reactive crisis, 3.3% (2.6-6.5%); alcoholism, 5.8% (3.9%-8.9%); organic brain syndrome, 3.9% (1.7%-5.2%); psychosis, 0.5% (0.2%-1.6%); and other disorders, 0.7% (0.2%-1.6%). The estimated overall prevalence of mental disorders in the study population was 27.9%. Disorders were more prevalent among men (30.8%) than women (26.3%). It is concluded that these high estimated prevalences are associated with stress caused by the war.
37.	Ljuslinder, Karin, et al. (författare) Disability and poverty : The impact of poverty on disabled women's living conditions in Nicaragua 2008 Ingår i: UNESCO Small Grants Programme on Poverty Eradication Building national capacities for research and policy analysis. - : UNESCO, Paris. Bokkapitel (refereegranskat)abstract The aim of this project is to focus on violations of Human Rights concerning women with disabilities in a developing country.
38.	Caldera, Trinidad, et al. (författare) Psychological impact of the hurricane Mitch in Nicaragua in a one-year perspective 2001 Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 36:3, s. 108-114 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Whereas natural disasters more commonly occur in low-income countries, almost all studies on psychological consequences have been conducted in the Western world. In countries where resources are poor it is of importance to know which groups should be targeted for early intervention after a disaster. The study aims at assessing the prevalence of post-traumatic stress disorder PTSD and of post-traumatic symptoms among people afflicted by hurricane Mitch in Nicaragua and at identifying risk factors for PTSD symptoms 6 months following a disaster. METHOD: At four primary health care centres, 496 consecutive adult patients were interviewed 6 months after hurricane Mitch regarding PTSD symptoms (Harvard Trauma Questionnaire, HTQ), disaster experiences and post-disaster help-seeking. RESULTS: All individuals resident in the area during Mitch were judged to have experienced a trauma fulfilling A criteria for PTSD. Regarding more specific traumas, 39% reported a close relative to be dead or seriously injured and 72% had their house partly or completely destroyed. Prevalence of PTSD ranged from 9.0% in the worst afflicted area to 4.5% in a less damaged area. From a dimensional perspective, PTSD symptoms according to HTQ 6 months after the disaster were significantly associated with the death of a relative (beta-coefficient 0.257, P = 0.000), a house destroyed (beta-coefficient 0.148, P = 0.001), female sex (beta-coefficient 0.139, P = 0.001), previous mental health problems (beta-coefficient 0.109, P = 0.009) and illiteracy (beta-coefficient 0.110, P = 0.009). Those with previous mental health problems (OR = 4.84; 95% CI = 3.04-7.66) were more likely than others to seek from help, any source whereas the opposite was true for illiterate people (OR = 0.38; 95% CI = 0.21-0.69). Of all respondents, 8.5% reported that they had thought of taking their lives, and illiterates (OR 2.84; 95% CI = 1.12-4.37) and those with previous mental health problems (OR 2.84; 95% CI = 1.12-4.57) were at particular risk for suicidal problems. One year after Mitch, half of those identified as PTSD cases at 6 months still fulfilled the criteria for a PTSD diagnosis. CONCLUSION: PTSD represents a serious mental health problem after a disaster. Those with illiteracy, females and those with previous mental health problems should be targets for early post-disaster intervention.
39.	Obando Medina, Claudia, et al. (författare) A qualitative study on primary health care professionals' perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua 2014 Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 15, s. 129- Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Mental health problems among young peoples are a growing public health issue around the world. In low- income countries health systems are characterized by lack of facilities, human resources and primary health care is rarely an integrated part of overall health care services. This study aims at exploring how primary health care professionals in Nicaragua perceive young people's mental health problems, suicidal problems and help-seeking behaviour.METHODS: Twelve in-depth interviews were conducted with nurses and doctors working in primary health care services in León, Nicaragua. A qualitative research design was applied. Data was analysed using thematic analysis approach.RESULTS: This study revealed that doctors and nurses were reluctant to deal with young people presenting with suicidal problems at the primary health care. This was more likely to stem from feelings of incompetence rather than from negative attitudes. Other barriers in providing appropriate care to young people with mental health problems were identified such as lack of time, lack of privacy, lack of human resources, lack of trained professionals and difficulties in communicating with young people. The primary health care (PHC) professionals suggested different solutions to improve care for young people with suicidal problems.CONCLUSION: PHC doctors and nurses in Nicaragua felt that providing skilled mental health services to young people was a priority for them but they also identified a number of barriers to be able to do so. They discussed ways to improve young people's willingness to share sensitive issues with them and suggested ways to make PHC more appreciated by young people.
40.	Valaldares, Eliette, et al. (författare) Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua 2002 Ingår i: Obstetrics and Gynecology. - 0029-7844 .- 1873-233X. ; 100:4, s. 700-705 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To assess whether being physically abused during pregnancy increases the risk of a low birth weight (LBW) infant. METHODS: We conducted a hospital-based case-control study in León, Nicaragua. Cases consisted of 101 newborns with a birth weight under 2500 g, and for each case two controls with a birth weight over 2500 g were selected randomly from infants born the same day. Anthropometry of newborns was done immediately after birth, and background information and data on experiences of violence and potential confounders were obtained through private interviews with mothers. Crude and adjusted odds ratios (ORs) and population-attributable proportion were calculated for exposure to partner abuse in relation to LBW. Multivariate logistic regression analysis was used to control for potential confounding. RESULTS: Seventy-five percent of LBW newborns (cases) were small for gestational age and 40% were preterm. Twenty-two percent of the mothers of LBW infants had experienced physical abuse during pregnancy by their intimate partners compared with 5% of controls. Low birth weight was associated with physical partner abuse even after adjustment for age, parity, smoking, and socioeconomic status (OR 3.9; 95% confidence interval 1.7, 9.3). Given a causal interpretation of the association, about 16% of the LBW in the infant population could be attributed to physical abuse by a partner in pregnancy. CONCLUSION: Physical abuse by a partner during pregnancy is an independent risk factor for LBW.
41.	Sundbom, Elisabet, et al. (författare) Personality and defenses : a cross-cultural study of psychiatric patients and healthy individuals in Nicaragua and Sweden. 1998 Ingår i: Psychological Reports. - 0033-2941 .- 1558-691X. ; 83:3 Pt 2, s. 1331-47 Tidskriftsartikel (refereegranskat)abstract This study examined cross-cultural variability in personality and defenses among Nicaraguan and Swedish healthy individuals, patients with borderline personality disorder and schizophrenic disorders by means of the projective perceptual Defense Mechanism Test. The over-all aim was to test the hypothesis proposed by Anthony Marsella of 'severity related cross-cultural variability' suggesting that differences in symptom profile or personality patterns between cultures are most pronounced among healthy individuals and less so among individuals with severe mental disorders as they are perceived as more universal and less culturally determined. The over-all results showed that cross-cultural differences were in accordance with the proposed hypothesis. In addition, there were significant intracultural differences between the different diagnostic groups in both countries. The conclusion is that the Defense Mechanism Test and Partial Least Squares analysis seem to be powerful methods for personality assessment and potentially for cross-cultural research, and culture-specific norms in the Defense Mechanism Test must be employed.
42.	Berg, Linda, 1974- (författare) "25 dollar rebel": Identity politics, Legislation and Class in stories from Lesbian Activists in Nicaragua 2010 Ingår i: Dissident Citizenship: Queer Postcolonial Belonging. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract One interviewee says she has always been a marimacha, another view herself as a lesbian identified with gay men and a third talk about the importance of being a woman and not a cochóna. At manifestations they all have t-shirts with a person screaming “Soy Rebelde, Soy lesbiana, Soy mujer, Soy Ciudadana!!!” and “Exijo mis Derechos!”. The common political symbols and rhetoric are a huge part of the campaigns for sexual diversity, towards being able to exist as a sexual minority and a Nicaraguan citizen. To get finance for the work towards “sexual freedom”, identity politics is absolutely necessary. Fighting for acknowledge GLBT rights (in the ‘west’), are legitimate reasons for funding through international non-governmental organizations. Through this perspective identity politics, rather than queer theory, seem to be part of a colonial heritage. Hence categories such as lesbian, gay and trans- are presented as liberating space in the work for “a sexuality free from prejudice” and I find it interesting to ask how, why and when the identity-labels are being used.One important goal for the lesbian activists in Nicaragua is still visibility – to be recognized and accepted as lesbian women. In 1992 a law against same-sex, Article 204, was initiated and upheld by the Nicaraguan Supreme Court in 1994. The main target of article 204 was not women; but the initiative was part of an increased security for (heterosexual) women. Fortunately the article was abolished 2008, when a new Penal Code was drafted. Hence as in so many places and for such a long time the sexuality of women has been ignored in the legislation. On top of this, lesbian women generally have a hard time getting an independent life in Nicaragua. Women in the popular classes are often expected to take care of a common household and are economically dependent on male relatives. In the following paper I will discuss strategies to survive as a lesbian and lesbianism as part of survival as a queer citizen in Nicaragua.
43.	Valladares, Eliette, et al. (författare) Neuroendocrine response to violence durin pregnancy - impact on duration of pregnancy and fetal growth 2009 Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 88:7, s. 818-823 Tidskriftsartikel (refereegranskat)abstract Objective. To study the neuroendocrine release of cortisol in response to perceived stress among pregnant women exposed to partner violence and how this affects the duration of pregnancy and the intrauterine growth of the infant. Design. Cross-sectional community-based study. Setting. Health and Demographic Surveillance System of Leon, Nicaragua. Population. One-hundred and forty-seven pregnant women. Methods. Standardized scales to measure intimate partner violence, social resources, perceived stress, and socio-economic conditions were applied. Two salivary samples for cortisol were collected in the morning and afternoon on the same day. Linear regression and path analysis were used. Main outcome measures. Cortisol levels, gestational age, and weight at delivery. Results. Partner violence during the pregnancy, low social resources, and perceived maternal stress were associated with high level of salivary cortisol. Pregnant women with high cortisol levels were significantly more likely to give birth to small-for-gestational age babies, but not to deliver preterm. A substantial decrease of birthweight, 121-186 g, was associated with an increase in cortisol in association with violence exposure. Conclusion. Partner violence during pregnancy is a stressor that provokes high levels of cortisol, which is associated with reduction of birthweight.
44.	Karin, Ljuslinder (författare) The Interface of Poverty, Disability and Gender – Towards Strengthening Advocacy Capacity of Disabled Women and Women’s Disability Organizations in Nicaragua 2008 Ingår i: Small Grants Programme: “Human Rights Based Approach to Poverty Eradication. - : UNESCO, Paris. Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract Final reports of the UNESCO Small Grants Programme: “Human Rights Based Approach to Poverty Eradication
45.	Caldera, Trinidad, et al. (författare) Is treatment in groups a useful alternative for psychiatry in low-income countries? An evaluation of a psychiatric outpatient unit in Nicaragua. 1995 Ingår i: Acta Psychiatrica Scandinavica. - 0001-690X .- 1600-0447. ; 92:5, s. 386-91 Tidskriftsartikel (refereegranskat)abstract Centro de Atención Psicosocial in León, Nicaragua is a psychiatric outpatient unit that has developed a group-oriented model of working, in which 80% of all visits are in groups: first-admission groups, insight-oriented group psychotherapy, psycho-educative, family groups and relatives groups. The aim of the present study was to analyze patient characteristics and make a preliminary study of improvement, compliance and patient satisfaction in a 1-year perspective. One hundred consecutive visits were assessed, 44 of them first admissions. They were assessed according to all axes of DSM-III-R plus the Structural Clinical Interview for DSM-III Disorders. A 1-year follow up was conducted on 39 of 41 selected patients within the major diagnostic groups. One of 4 patients had a psychotic disorder where schizophrenia dominated. Among nonpsychotics major depression, anxiety and adjustment disorders were most frequent. Personality disorders were common (80%) among nonpsychotic patients, paranoid, obsessive-compulsive, passive-aggressive and masochistic personality disorders dominating. The illiteracy rate was 10%, but 50% had high school or university background. Severity of mental disorders and functional level did not differ between educational levels. There was a strong male dominance in all diagnostic, socioeconomic and educational level strata and few old patients. Improvement in functional level was clinically and statistically significant in all groups, and more than two thirds were very satisfied with the group treatment offered.
46.	Obando Medina, Claudia, et al. (författare) "...It's a shock when someone doesn't want to live". Nurses and doctors' perceptions of young people's help-seeking in primary health care in Nicaragua. Annan publikation (övrigt vetenskapligt/konstnärligt)
47.	Bhoomikumar, Jegannathan, et al. (författare) Gender difference in suicidal expressions and it's determinants among young people in Cambodia, a post-conflict country 2011 Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 11:1, s. 47- Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Suicide among young people is a global public health problem, but adequate information on determinants of suicidal expression is lacking in middle and low income countries. Young people in transitional economies are vulnerable to psychosocial stressors and suicidal expressions. This study explores the suicidal expressions and their determinants among high school students in Cambodia, with specific focus on gender differences.METHODS: A sample of 320 young people, consisting of 153 boys and 167 girls between 15-18 years of age, was randomly selected from two high schools in Cambodia. Their self-reported suicidal expressions, mental health problems, life-skills dimensions, and exposure to suicidal behavior in others were measured using the Youth Self-Report (YSR), Life-Skills Development Scale (LSDS)-Adolescent Form, and Attitude Towards Suicide (ATTS) questionnaires.RESULTS: Suicidal plans were reported more often by teenage boys than teenage girls (M=17.3%, F=5.6%, p=0.001), whereas girls reported more attempts (M=0.6%, F=7.8%, p=0.012). Young men scored significantly higher on rule-breaking behavior than young women (p=0.001), whereas young women scored higher on anxious/depression (p=0.000), withdrawn/depression (p=0.002), somatic complaints (p=0.034), social problems (p=0.006), and internalizing syndrome (p=0.000). Young men exposed to suicide had significantly higher scores for internalizing syndrome compared to those unexposed (p=0.001), while young women exposed to suicide scored significantly higher on both internalizing (p=0.001) and externalizing syndromes (p=0.012). Any type of exposure to suicidal expressions increased the risk for own suicidal expressions in both genders (OR=2.04, 95% CI=1.06-3.91); among young women, however, those exposed to suicide among friends and partners were at greater risk for the serious suicidal expressions (OR=2.79, 95% CI=1.00-7.74). Life skills dimension scores inversely correlated with externalizing syndrome in young men (p=0.026) and internalizing syndrome in young women (p=0.001).CONCLUSIONS: The significant gender differences in suicidal expressions and their determinants in Cambodian teenagers highlight the importance of culturally appropriate and gender-specific suicide prevention programs. School-based life skills promotion may indirectly influence the determinants for suicidal expressions, particularly among young women with internalizing syndrome in Cambodia.
48.	Jegannathan, Bhoomikumar, 1953- (författare) ‘Striving to negotiate… dying to escape’ : suicidal expressions among young people in Cambodia 2014 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background Suicide among young people is a global public health problem, but information on determinants and understanding of suicidal expressions are lacking in low and middle income countries (LMIC). Though school-based interventions are common in many parts of the world, evidence for efficacy is less reported, particularly from post-conflict countries.Aim To explore suicidal expressions and their determinants with psychosocial and gender perspective in Cambodia and Nicaragua and to evaluate a school based intervention to promote mental health and prevent suicidal behavior among young people in Cambodia.Method School students between the age of 15-19 from Cambodia and Nicaragua responded to Attitude Towards Suicide (ATTS) and Youth Self-Report (YSR) questionnaires. In addition, Life Skill Dimension Scale Adolescent Form (LSDS-AF) was used in schools in Cambodia, one experimental and the other control, to measure the impact of intervention. Six focus group discussions (FGDs), both gender-specific and mixed groups, were held to understand young people’s perception of gender, culture, religion and media and their impact on suicide among them.Results Paper I. Revealed few gender differences in suicidal expressions, except girls reporting more attempts than boys. Girls exposed to suicide among friends and partners were likely to report own suicidal expressions and girls with internalizing syndrome were at risk for suicidal expressions. Paper II. Cambodian teenagers reported more mental health problems but fewer suicidal expressions as compared to Nicaragua. The determinants varied between countries. Paper III. Participants of FGDs mentioned “Plue Plun” male and “Kath Klei” female to describe gender difference in suicidal behavior among young people in Cambodia who found it a challenge to negotiate between traditional and modern values.Paper IV. Suicide ambiguity in Buddhism, stigmatizing culture and double edged media were seen as suicide-provoking by the young people in Cambodia, who recommended peer-focused, school based program.Paper V. School based Life Skills Intervention overall benefited girls. Boys with high risk behavior had shown improvement on many Life Skills dimensions, as well as in their mental health profile.Conclusion The gender and cultural differences in suicidal expressions and their determinants among teenagers emphasize the importance of culturally sensitive and gender-specific suicide prevention programs. The influence of religion and media ought to be considered while planning intervention programs. School-based program may be a window of opportunity to promote mental health and prevent suicide among young people in Cambodia.
49.	Sheffield, Perry E., et al. (författare) Current and Future Heat Stress in Nicaraguan Work Places under a Changing Climate 2013 Ingår i: Industrial Health. - : National Institute of Occupational Safety & Health, Japan. - 0019-8366 .- 1880-8026. ; 51:1, s. 123-127 Tidskriftsartikel (refereegranskat)abstract While climate change continues to increase ambient temperatures, the resulting heat stress exposure to workers in non-climate controlled settings is not well characterized, particularly in low and middle income countries. This preliminary report describes current heat stress in Nicaraguan work places and estimates occupational heat stress in 2050. From over 400 measurements of heat exposure using wet bulb globe temperature, more than 10% of all measurements exceeded the safety threshold for the combination of light work and rest at the ratio of 25:75. By 2050, that percentage of "over-heated" days is projected to increase to over 15%. These findings support the idea that common working conditions in Nicaragua already represent a threat to the health and safety of the workers and that climate change driven trends could mean either a necessary curbing of economic productivity or an increased threat to worker health and safety.
50.	Wesseling, Catharina, et al. (författare) The Epidemic of Chronic Kidney Disease of Unknown Etiology in Mesoamerica: A Call for Interdisciplinary Research and Action. 2013 Ingår i: American Journal of Public Health. - 1541-0048 .- 0090-0036. ; 103:11, s. 1927-1930 Tidskriftsartikel (refereegranskat)abstract During the last 20 years, several regions in Central America and Mexico have seen a dramatic increase of a rapidly progressive chronic kidney disease, unexplained by diabetes and hypertension.(1-3) This regional epidemic of chronic kidney disease of unknown origin (CKDu) is also being referred to as the Mesoamerican nephropathy or MeN.(4) It has been estimated that this largely unknown epidemic has caused the premature death of at least 20 000 men.(3) In MeN-affected areas in Nicaragua(3) and Costa Rica (C. W., unpublished data), chronic kidney disease mortality is up to five-fold the national rates. In El Salvador, kidney disease was the second most common cause of death among males in 2009.(5) MeN primarily, but not only, affects young and middle-aged male laborers in the agricultural sector, in particular sugarcane workers.(1-3) (Am J Public Health. Published online ahead of print September 12, 2013: e1-e4. doi:10.2105/AJPH.2013.301594).

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