| 1. |
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| 2. |
- Abbo, Catherine, et al.
(author)
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Psychological distress and associated factors among the attendees of traditional healing practices in Jinja and Iganga districts, Eastern Uganda : a cross-sectional study.
- 2008
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In: International Journal of Mental Health Systems. - : Springer Science and Business Media LLC. - 1752-4458. ; 2:1, s. 16-
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Journal article (peer-reviewed)abstract
- Psychological distress and associated factors among the attendees of traditional healing practices in Jinja and Iganga districts, Eastern Uganda: a cross-sectional study.Abbo C, Ekblad S, Waako P, Okello E, Muhwezi W, Musisi S.Karolinska Institutet, Department of Clinical Neuroscience, Section of Psychiatry, Stockholm, Sweden. cathya180@gmail.com.ABSTRACT: BACKGROUND: Mental health problems are a major public health concern worldwide. Evidence shows that African communities, including Uganda, use both modern and traditional healing systems. There is limited literature about the magnitude of psychological distress and associated factors among attendees of traditional healing practices. This study aimed to determine the prevalence and associated factors of psychological distress among attendees of traditional healing practices in two districts in Uganda. METHODS: Face-to-face interviews with the Lusoga version of the Self Reporting Questionnaire (SRQ-20) were carried out with 400 patients over the age of 18 years attending traditional healing in Iganga and Jinja districts in Eastern Uganda. Patients were recruited consecutively in all the traditional healers' shrines that could be visited in the area. Persons with 6 or more positive responses to the SRQ were identified as having psychological distress. Prevalence was estimated and odds ratios of having psychological distress were obtained with multiple logistic regression analysis. RESULTS: 387 questionnaire responses were analyzed. The prevalence of psychological distress in connection with attendance at the traditional healers' shrines was 65.1%. Having a co-wife and having more than four children were significantly associated with psyclogical distress. Among the socioeconomic indicators, lack of food and having debts were significantly associated with psychological distress. The distressed group was more likely to need explanations for ill health. Those who visited both the healer and a health unit were less likely to be distressed. CONCLUSION: This study provides evidence that a substantial proportion of attendees of traditional healing practices suffer from psychological distress. Associated factors include poverty, number of children, polygamy, reason for visiting the healer and use of both traditional healing and biomedical health units. These findings may be useful for policy makers and biomedical health workers for the engagement with traditional healers.
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| 3. |
- Bäärnhielm, Sofie, et al.
(author)
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Introducing a psychological agenda for understanding somatic symptoms--an area of conflict for clinicians in relation to patients in a multicultural community.
- 2008
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In: Cult Med Psychiatry. - : Springer Science and Business Media LLC. - 0165-005X .- 1573-076X. ; 32:3, s. 386-405
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Journal article (peer-reviewed)abstract
- ntroducing a psychological agenda for understanding somatic symptoms--an area of conflict for clinicians in relation to patients in a multicultural community.Bäärnhielm S, Ekblad S.Transcultural Center, Stockholm County Council, St Göran's Hospital, Floor 13, 112 81 Stockholm, Sweden. sofie.baarnhielm@sll.seCulturally capable care requires that clinicians possess insights into patients' reasoning about illness. It is universally common for emotional distress to be expressed in terms of somatic symptoms. Converting meanings of illness from a somatic to a psychological agenda for understanding distress may be complicated for patients. Objectives of this study were to explore (a) professionals' experiences of encountering patients who use a bodily idiom for emotional distress in a multicultural milieu and their ascriptions of meaning and (b) how professionals impart their agenda of illness meaning to patients. Data were collected by seven focus-group interviews with professionals working in a multicultural suburban area of Stockholm, Sweden, and analyzed in two steps. The first step was content analysis. The second step was an inductive analysis with a revised grounded theory approach. Results showed that the caregivers stressed the importance of constructing a working alliance with the patient. With few exceptions, this did not include a patient-centered approach by the staff for exploring patients' perspectives and understandings of illness. Current knowledge about the importance of gaining insights into patients' perspectives was not implemented. Results of this study point to the importance of implementing new knowledge and according priority to research on the outcomes of that implementation.
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| 4. |
- Dejman, Masoumeh, et al.
(author)
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Explanatory model of help-seeking and coping mechanisms among depressed women in three ethnic groups of Fars, Kurdish, and Turkish in Iran.
- 2008
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In: Arch Iran Med. - 1029-2977. ; 11:4, s. 397-406
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Journal article (peer-reviewed)abstract
- Explanatory model of help-seeking and coping mechanisms among depressed women in three ethnic groups of Fars, Kurdish, and Turkish in Iran.Dejman M, Ekblad S, Forouzan AS, Baradaran-Eftekhari M, Malekafzali H.Department of Psychiatry, Welfare and Rehabilitation University, Tehran, Iran. dejmanms@hbi.ir.BACKGROUND: As one of the most prevalent diseases globally and as an important cause of disability, depressive disorders are responsible for as many as one in every five visits to primary care doctors. Cultural variations in clinical presentation, sometimes make it difficult to recognize the disorder resulting in patients not being diagnosed and not receiving appropriate treatment. To address this issue, we conducted a qualitative pilot study on three ethnic groups including Fars, Kurdish, and Turkish in Iran to test the use of qualitative methods in exploring the explanatory models of help-seeking and coping with depression (without psychotic feature) among Iranian women. METHODS: A qualitative study design was used based on an explanatory model of illness framework. Individual interviews were conducted with key informant (n=6), and depressed female patients (n=6). A hypothetical case vignette was also used in focus group discussions and individual interviews with lay people (three focus groups including 25 participants and six individual interviews; n=31). RESULTS: There were a few differences regarding help-seeking and coping mechanisms among the three ethnic groups studied. The most striking differences were in the area of treatment. Non-psychotic depressive disorder in all ethnicities was related to an external stressor, and symptoms of illness were viewed as a response to an event in the social world. Coping mechanisms involved two strategies: (1) solving problems by seeking social support from family and neighbors, religious practice, and engaging in pleasurable activities, and (2) seeking medical support from psychologists and family counselors. The Fars group was far more likely to recommend professional treatment and visiting psychiatrists whereas the other two ethnic groups (i.e., Turks and Kurds) preferred to consult family counselors, psychologists or other alternative care providers, and traditional healers. CONCLUSION: The study has educational and clinical implications. Cultural reframing of the patient's and family's perceptions about mental illness and depression may require community education. Family counseling, family therapy, and also religious practices can be used to empower the patient.
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| 5. |
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| 7. |
- Ekblad, Solvig, et al.
(author)
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An exploration of the connection between two meaning perspectives : an evidence-based approach to health information delivery to vulnerable groups of Arabic- and Somali-speaking asylum seekers in a Swedish context
- 2012
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In: Global Health Promotion. - : SAGE Publications. - 1757-9759 .- 1757-9767. ; 19:3, s. 21-31
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Journal article (peer-reviewed)abstract
- The right to health care is significant for asylum seekers, particularly as many of them have experienced traumatic life events in their home country, during flight or in their host country. Postmigration living conditions have more impact than pre-migration conditions on ill health among asylum seekers, which underscores the importance of health care-related refugee reception policies. The purpose of this article is to explore the perceived meaning of comprehensive health information provided by a nurse to Arabic- and Somali-speaking adult asylum seekers, in a Swedish context, during its introduction at the Migration Board. In our study, the endpoint was whether asylum seekers found such health information relevant, understandable and respectful. Following an oral presentation, participants filled in a questionnaire consisting of three close-ended questions. A total of 39 groups of presentation attendees included 626 asylum seekers (415 Arabic-and 211 Somali-speaking). Data were analysed with descriptive statistics. Comments underwent content analysis. We also present some socio-demographic data on these asylum seekers. Independently of gender and language, the participants expressed their gratitude for and the meaningfulness of receiving professional, fact-based information, as well as being treated with concern and respect. They indicated a great need for this and felt relieved by being listened to. They liked the pedagogic group method, the opportunity for dialogue and to practice exercising their rights. These promising results indicate that exercising the asylum-seekers' right to receive such health information would improve future reception policies not only in Sweden, but throughout the EU. A renewed focus on communication and pedagogic skills, instead of just cultural training, should be considered for health care professionals assisting asylum seekers. (Global Health Promotion, 2012; 19(3): 21-31)
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| 8. |
- Ekblad, Solvig, et al.
(author)
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Cultural challenges in end-of-life care: reflections from focus groups' interviews with hospice staff in Stockholm
- 2000
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 31:3, s. 623-630
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Journal article (peer-reviewed)abstract
- During the past few decades, Swedish society has changed from a society with a few ethnic groups to one with over a hundred groups of different ethnic backgrounds, languages and religions. As society is becoming increasingly multicultural, cultural issues are also becoming an important feature in health care, particularly in end-of-life care where the questions of existential nature are of great importance. However, cultural issues in health care, especially at hospices, have not been studied sufficiently in Sweden.The purpose of this study was to gather reflections about cultural issues among hospice staff after a 3-day seminar in multicultural end-of-life care, by using a qualitative focus groups method. The 19 participants (majority nurses) were divided into three groups, one per hospice unit. A discussion guide was developed with the following themes: 1) post-training experiences of working with patients with multicultural background; 2) experiences gained by participating in the course of multicultural end-of-life care; 3) post-training reflections about one’s own culture; 4) ideas or thoughts regarding work with patients from other cultures arising from the training; and 5) the need for further training in multicultural end-of-life care. One of the study’s main findings was that to better understand other cultures it is important to raise awareness about the staff’s own culture and to pay attention to culture especially in the context of the individual. The findings from focus groups provide insight regarding the need for planning flexible training in cultural issues to match the needs of the staff at the hospice units studied.
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| 9. |
- Ekblad, Solvig, et al.
(author)
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Educational potential of a virtual patient system for caring for traumatized patients in primary care
- 2013
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In: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 13, s. 110-
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Journal article (peer-reviewed)abstract
- Background: Virtual Patients (VPs) have been used in undergraduate healthcare education for many years. This project is focused on using VPs for training professionals to care for highly vulnerable patient populations. The aim of the study was to evaluate if Refugee Trauma VPs was perceived as an effective and engaging learning tool by primary care professionals (PCPs) in a Primary Health Care Centre (PHC). Methods: A VP system was designed to create realistic and engaging VP cases for Refugee Trauma for training refugee patient interview, use of established trauma and mental health instruments as well as to give feedback to the learners. The patient interview section was based on video clips with a Bosnian actor with a trauma story and mental health problems. The video clips were recorded in Bosnian language to further increase the realism, but also subtitled in English. The system was evaluated by 11 volunteering primary health clinicians at the Lynn Community Health Centre, Lynn, Massachusetts, USA. The participants were invited to provide insights/feedback about the system's usefulness and educational value. A mixed methodological approach was used, generating both quantitative and qualitative data. Results: Self-reported dimensions of clinical care, pre and post questionnaire questions on the PCPs clinical worldview, motivation to use the VP, and IT Proficiency. Construct items used in these questionnaires had previously demonstrated high face and construct validity. The participants ranked the mental status examination more positively after the simulation exercise compared to before the simulation. Follow up interviews supported the results. Conclusions: Even though virtual clinical encounters are quite a new paradigm in PHC, the participants in the present study considered our VP case to be a relevant and promising educational tool. Next phase of our project will be a RCT study including comparison with specially prepared paper-cases and determinative input on improving clinical diagnosis and treatment of the traumatized refugee patient.
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| 11. |
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| 12. |
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| 13. |
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| 14. |
- Ekblad, Solvig
(author)
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Upplevd ohälsa hos vuxna asylsökande
- 2009
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In: Asylsökande i Sverige. - : Department of International Migration and Ethnic Relations (IMER). - 9789171040800 ; , s. 170-192
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Book chapter (other academic/artistic)abstract
- I föreliggande kapitel presenteras en avslutad intervjustudie på 108 asylsökande. Under upplägget togs stor hänsyn till gruppens sårbarhet för upplevd ohälsa, stigma och tillträde endast till akut vård och vård som inte kan anstå. De asylsökande visar jämförbara siffror med andra studier när det gäller erfarenhet av krig, men har högre siffror på svåra traumatiska upplevelser före ankomst såsom tortyr och sexuella övergrepp samt förlust av anhöriga. Att inte känna sig isolerad och inte uppleva tidsspillan under väntan på asyl halverade risken för suicidala tankar. Traumatiska påfrestningar före ankomst kom i bakgrunden för påfrestningarna under asylprocessen. Slutsatserna av studien är att hälsofrämjande strategier bör introduceras och utvecklas från Dag 1 i asylmottagandet på olika nivåer: (1) att tiden för asylprocessen minimeras, (2) att den asylsökande är i ett sammanhang, (3) att mottagningspersonal erbjuds kontinuerlig handledning, (4) att asylsökande får av sjukvårdspersonal hälso- och sjukvårdsinformation och kunskap om risk- och skyddsfaktorer för upplevd ohälsa, (5) att kontinuerligt kvalitetssäkra att varje nyanländ erbjuds en gratis hälsoundersökning och hälsosamtal, att tiden utökas för genomförandet och efter behov, samt följs upp i samband med permanent uppehållstillstånd som grund för mål med introduktion, SFI (svenska för invandrare) praktik och arbete, samt (6) att det finns tillgång för vård efter behov och som är oberoende av juridisk status.
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| 15. |
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| 16. |
- Eriksson-Sjöö, Tina, et al.
(author)
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Hälsoskola för nyanlända flyktingar
- 2010
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In: Migrationens utmaningar inom hälsa, omsorg och vård. - : Stadskontoret, Malmö stad. - 9789186631017 ; , s. 33-52
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Book chapter (other academic/artistic)
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| 17. |
- Eriksson-Sjöö, Tina, et al.
(author)
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Hög förekomst av sömnproblem och trötthet hos flyktingar på SFI : konsekvenser för inlärning och hälsa
- 2010
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In: Socialmedicinsk Tidskrift. - : Socialmedicinsk tidskrift. - 0037-833X. ; 87:4, s. 302-309
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Journal article (peer-reviewed)abstract
- Sextiosju flyktingar (52 % män och 48 % kvinnor), som påbörjat svenska för invandrare (SFI) besvarade Karolinska sömn- och återhämtningsformulär och som var översatt/tillbakaöversatt till arabiska. Insomnirelaterade sömnbesvär var extremt hög hos deltagarna och liknar svenskt referensmaterial som har symtom på utbrändhet. Utbrändhet är en dold stressfaktor för ohälsa och försvårar SFI-inlärning, inträde på arbetsmarknad och övrig integration i det svenska samhället. Hälsofrämjande flyktingmottagandet behöver utveckla och kvalitetssäkra metoder, t ex kognitivt beteendeinriktad hälso/sömnskola som förebygger och tidigt upptäcker nyanlända flyktingars sömn- och koncentrationssvårigheter. De hinder som finns för nyanlända flyktingar att ta sig in på arbetsmarknaden måste tas på allvar, för att den politik med fokus på ”arbetslinjen” som regeringen för ska ha effekt.
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| 18. |
- Eriksson-Sjöö, Tina, et al.
(author)
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Quality of life and health promotion intervention : a follow up study among newly-arrived Arabic-speaking refugees in Malmö, Sweden
- 2012
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In: International Journal of Migration, Health and Social Care. - : Emerald Group Publishing Limited. - 1747-9894 .- 2042-8650. ; 8:3, s. 112-126
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Journal article (peer-reviewed)abstract
- Purpose – This study aims to illuminate self-perceived health-related quality of life (HRQoL) among newly-arrived Arabic-speaking refugees in Malmo¨ , Sweden participating in a specific group Health Promotion activity. Design/methodology/approach – Data consist of questionnaires, observations and oral evaluations in groups. Questions about HRQoL was measured by EQ-5D self-assessment containing five dimensions and three response options of severity, including a visual analog health rating scale. Participants’ sleep patterns were measured by a sleep and recovery questionnaire with questions about sleep quality and sleep quantity. Findings – The results show that disturbed sleep relates to EQ-5D variables and to health rating scores. Moreover, there are changes over time and participants’ perceptions of their health and quality of life in most EQ-5D variables have significantly increased after the end of activity. In the variables pain and depression an improvement remains even at second follow up and health rating scores are higher at both follow ups relative to what it was originally. Sleep and recovery problems were perceived as less difficult at the course completion and second follow up. Research limitations/implications – Because of practical and ethical reasons there is an absence of a control group in this study. Practical implications – The paper includes implications for education in medicine, health care and social work, for the design of the refugee reception programs and for the inter-professional collaborations. Originality/value – The paper shows that health promotion interventions in group setting in the first stage of resettlement turn out to be useful according to HRQoL and knowledge of the health care system. Keywords Health promotion, Refugees, Arabic-speaking, Health-related quality of life, Sweden, Immigration, Health care
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| 19. |
- Eriksson-Sjöö, Tina, et al.
(author)
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Stress, sömn och livskvalitet : en studie bland flyktingar i SFI-utbildning, lärare och handläggare i Fosie stadsdel, Malmö
- 2009
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Reports (other academic/artistic)abstract
- Sammanfattning Studien består av två delar, en förstudie (innevarande rapport) samt en interventionsstudie som startade efter sommaruppehållet 2009. Förstudien genomfördes med deltagare huvudsakligen från Fosie stadsdel i Malmö under hösten 2008. Syftet med förstudien är att insamla data till den fortsatta studien. Studiens övergripande syfte är att kartlägga stressfaktorer som nyanlända upplever efter ankomsten (postmigrationsstressfaktorer) och hälsorelaterad livskvalitet bland en kohort nyanlända flyktingar som deltar i SFI (Svenska för invandrare) i Malmö, för att söka förstå sambandet mellan stressfaktorer i eftermigrationsskedet och framgång i SFIutbildningen. Studien som beskrivs i denna rapport består av fyra delar: observationer i SFI-klasser hos fyra utbildningsanordnare, deltagarenkät till nyanlända flyktingar, enkät till SFI-lärare, samt en fokusgruppsintervju med handläggare på Fosie AIC (Arbets- & Integrationscenter). Studien visar att många av de nyanlända flyktingarna som studerar SFI har utbrändhetssymtom, vilket torde vara ett handikapp när det gäller deras inlärningsförmåga, men som också försvårar möjligheterna till integration på arbetsmarknad och i samhället i övrigt. Det finns också ett gap mellan deras behov som nyanlända flyktingar och hur verkligheten ser ut. Samstämmighet råder mellan de tre gruppernas uppfattningar (flyktingar, SFI-lärare och handläggare) om flyktingarnas påfrestande sociala tillvaro med konstant stress och upplevd ohälsa. Vad gäller SFIstudierna uppfattade såväl SFI-deltagarna som lärarna sina möjligheter att påverka sin arbetsmiljö som låg. Resultaten av studien har betydelse för framtida introduktionsoch utbildningsplanering då det finns en diskrepans mellan SFIdeltagares upplevda stress och ohälsa och möjligheten att få betyg i svenska för invandrare. Det är viktigt att de hinder som finns för nykomna flyktingar att ta sig in på den svenska arbetsmarknaden tas på allvar, för att den politik med fokus på ”arbetslinjen” som nuvarande regering för skall bli slagkraftig. En strävan bör därmed vara att tidigt identifiera sårbara individer, samt erbjuda anpassat stöd och utbildning, för att möjliggöra att fler uppnår godkänt resultat på SFI-utbildningen.
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| 20. |
- Fürst, Carl Johan, et al.
(author)
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Transcultural palliative care
- 2015
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In: Textbook of Palliative Medicine and Supportive Care. - 9781444135268 - 9781444135251 ; , s. 137-143
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Book chapter (peer-reviewed)
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| 21. |
- Hollander, Anna-Clara, et al.
(author)
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Hospitalisation for depressive disorder following unemployment-differentials by gender and immigrant status : a population-based cohort study in Sweden
- 2013
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In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 67:10, s. 875-881
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Journal article (peer-reviewed)abstract
- Background The association between unemployment and poor mental health in general is explained by both causation and selection. The aim was to study whether experiencing unemployment was a risk factor for hospitalisation for depressive disorder specifically, and whether gender and immigrant status modified the hypothesised risk. Methods A register-based prospective cohort study, 2000-2006, of persons aged 18-64 with a strong connection to the Swedish labour market. Outcome: hospital admission for a depressive episode; F32 in International Classification of Diseases, 10th revision. Exposure: employment status. Explanatory variables: gender and immigrant status. Confounders: age group, education and marital status. Cox regression models were used to estimate HRs with 95% CIs. Results The cohort comprised 3 284 896 adults, 47.5% women. An excess relative risk for hospitalisation was found among those who became unemployed (HR=1.94, 95% CI 1.85 to 2.03). Foreign-born women who experienced unemployment had the highest relative risk (HR=3.47 95% CI 3.02 to 3.98). Conclusions Among persons with a strong connection to the labour market experiencing unemployment, is a risk factor for hospitalisation for depressive disorders. Unemployed foreign-born women had the highest relative risk compared with all Swedish born, all foreign-born men and to employed foreign-born women.
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| 22. |
- Hollander, Anna-Clara, et al.
(author)
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Longitudinal study of mortality among refugees in Sweden
- 2012
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In: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 41:4, s. 1153-1161
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Journal article (peer-reviewed)abstract
- Background Refugee immigrants have poorer health than other immigrant groups but little is known about their mortality. A comparison of mortality among refugees and non- refugee immigrants is liable to exaggerate the former if the latter includes labour migrants, whose mortality risk may be lower than that of the general population. To avoid bias, labour migrants are not included in this study. The aim was to investigate mortality risks among refugees compared with non- labour non- refugee immigrants in Sweden. Methods Population-based cohort design, starting 1 January 1998 and ending with death or censoring 31 December 2006. Persons included in the study were those aged 18-64 years, had received a residence permit in Sweden 1992-98 and were defined by the Swedish Board of Migration as either a refugee or a non-labour non-refugee immigrant. The outcomes were all-cause and cause-specific mortalities and the main exposure was being a refugee. Cox-regression models estimated hazard ratios (HRs) of mortality. Results The study population totalled 86 395 persons, 49.3% women, 24.2 % refugees. Adjusted for age and origin, refugee men had an over-risk of cardiovascular mortality (HR = 1.58, 95% CI = 1.08-2.33). With socio-economic factors added to the model, refugee men still had an over-risk mortality in cardiovascular disease (HR = 1.53, 95% CI = 1.04-2.24) and external causes (HR = 1.59, 95% CI = 1.01-2.50). Conclusion Refugee men in Sweden have a higher mortality risk in cardiovascular and external causes compared with male non-labour non-refugee immigrants. This study suggests that the refugee experience resembles other stressors in terms of the association with cardiovascular mortality.
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| 23. |
- Hollander, Anna-Clara, et al.
(author)
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The validity of screening instruments for posttraumatic stress disorder, depression, and other anxiety symptoms in Tajikistan.
- 2007
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In: J Nerv Ment Dis. - 1539-736X. ; 195:11, s. 955-8
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Journal article (peer-reviewed)abstract
- The validity of screening instruments for posttraumatic stress disorder, depression, and other anxiety symptoms in Tajikistan.Hollander AC, Ekblad S, Mukhamadiev D, Muminova R.Department of Clinical Neuroscience, Psychiatry-HS, Karolinska Institutet, Stockholm, Sweden.Armed conflicts and violations of human rights have a large and long-lasting impact on the mental health of affected individuals. In Tajikistan's civil war, 1992-1997, out of a total population of 6.5 million, about 60,000 were killed and 700,000 became refugees. Little has been done to explore the mental health consequences of this war. The purpose of the present pilot study was to validate 1 screening instrument for PTSD and 1 for depression and anxiety symptoms in a Tajik outpatient population. The sample for the study totaled 75. The appropriate cutoff values were determined empirically. The validity of the instruments was high. In conclusion, the use of validated screening instruments was a feasible way to explore the prevalence of PTSD, depression, and other anxiety symptoms in a Tajikistan context.
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| 24. |
- Johansson Blight, Karin, et al.
(author)
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Medical and licit drug use in an urban/rural study population with refugee background, 7-8 years into resettlement
- 2008
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In: GMS Psycho-Social-Medicine. - 1860-5214. ; 5
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Journal article (peer-reviewed)abstract
- Objective: Research into medical and licit drug use in resettled refugee populations is scarce, despite the fact that mental health status often has been found to be poorer than in general populations. Hence the aim of this study was to estimate the prevalence of self-rated use of medicine and licit drugs among adults who came to Sweden from Bosnia-Herzegovina (1993/94) and who in 2001 were living in either an urban (low employment context) or a rural (high employment context) region (n=4185).Methods: Prevalence was estimated from a cross-sectional questionnaire distributed to a representative sample (n=650) in 2001 (63.5% response rate).Results: The study population estimates of usage of sedatives (26.5%), sleeping tablets (26.2%) and antidepressants (22.3%) did not differ by gender but did so by region, with a higher urban prevalence. The consumption of alcohol (5.1%) and cigarettes (41.0%) did not differ by region but men reported higher alcohol consumption than women.Conclusion: The high consumption of medicine (compared with general populations) raises the question of treatment efficiency and the need for public health attention and evaluation many years after resettlement. Factors to consider for further research with analytic prerequisites concern indications that regional differences may be influenced, not only by urban employment being lower but also by urban/rural differences in prescription rates and/or access to health care; moreover, there might have been a selection to the urban region of older people, with a more vulnerable family situation, and/or poorer mental health. Finally, the overall alcohol (low) and cigarettes (high) consumption in the study population followed prevalence patterns found in Bosnia-Herzegovina rather than in Sweden.
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| 25. |
- Kühner, Sofia, et al.
(author)
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Global surgery for medical students - is it meaningful? : A mixed-method study
- 2021
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:10
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Journal article (peer-reviewed)abstract
- Introduction: There has been an increase in global health courses at medical universities in high-income countries. Their effect on students, however, is poorly understood. In 2016 an elective global surgery course was introduced for medical students at Karolinska Institutet in Sweden. The course includes a theoretical module in Sweden and a two-week clinical rotation in Uganda. The present study aimed to assess the format and determine its effect on students' knowledge of global surgery and approach towards patients of non-Swedish origin.Method: A mixed-methods design was used. Semi-structured case-based interviews were conducted individually with 18 students and analysed using qualitative content analysis. Examination scores and the course evaluation were analysed with Kruskal Wallis one-way analysis of variance, Pearson's Chi-square and a Wilcoxon signed-rank test as appropriate.Results: The course was appreciated and students reported gained insights and interest in global surgery. Students' ability to reason about global surgery issues was improved after the course. Students considered complicating aspects in the meeting with patients of non-Swedish origin. Students with abroad clinical experience felt less compelled to act on preconceptions.Discussion: The global surgery course at Karolinska Institutet is appreciated and students gained valuable knowledge. The case-based interviews acted as a catalyst for reflection and showed that students felt insecure as they lacked knowledge about globally common surgical conditions and struggled with generalized preconceptions of patients of non-Swedish origin. To further support students to integrate theoretical knowledge and professional development, we suggest the introduction of problem-based learning.Conclusion: The ability of the course to inspire students' commitment to global surgery is promising as this engagement is the key to reaching the goal of equitable health globally. Offering such courses is a step towards inspiring and recruiting the future clinicians and researchers needed for expanding the field of global surgery.
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| 26. |
- Lindencrona, Fredrik, et al.
(author)
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Mental health of recently resettled refugees from the Middle East in Sweden : the impact of pre-resettlement trauma, resettlement stress and capacity to handle stress.
- 2008
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In: Soc Psychiatry Psychiatr Epidemiol. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 43:2, s. 121-31
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Journal article (other academic/artistic)abstract
- Mental health of recently resettled refugees from the Middle East in Sweden: the impact of pre-resettlement trauma, resettlement stress and capacity to handle stress.Lindencrona F, Ekblad S, Hauff E.Dept. of Clinical Neuroscience, Psychiatry-HS, Karolinska Institutet, Stockholm University, c/o Stress Research Institute, 10691, Stockholm, Sweden, fredrik.lindencrona@ki.se.The pathways to symptoms of common mental disorder and post-traumatic stress symptoms among refugees during resettlement need to be better specified. We aim to identify models of these different mental health outcomes among refugees during resettlement, taking pre-migration, migration and post-migration stress conditions, a person's capacity to handle such stress and socio-demographic variables into consideration. A new questionnaire developed to better cover resettlement stress, as well as pre-resettlement trauma exposures and different measures of a person's capacity to handle stress, was administered to 124 Middle Eastern refugees that had been granted permanent residency in Sweden only a few months before responding. We found four dimensions of resettlement stress: social and economic strain, alienation, discrimination and status loss and violence and threats in Sweden, that account for 62% of the total variance in resettlement stress. Social and economic strain and alienation are important for explaining symptoms of common mental disorder. In the model of core post-traumatic stress symptoms, pre-resettlement trauma exposure seems to have the strongest impact. A person's capacity to handle stress plays significant, direct and mediating roles in both models. The impact of resettlement stressors in the context of the whole migration process for different mental health outcomes is discussed.PMID: 18060523 [PubMed - in process]
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| 27. |
- Lindencrona, Fredrik, et al.
(author)
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Modes of Interaction and Performance of Human Service Networks : A study of refugee resettlementsupport in Sweden
- 2009
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In: Public Management Review. - 1471-9037 .- 1471-9045. ; 11:2, s. 191-215
-
Journal article (peer-reviewed)abstract
- Performance in health and human service networks requires mutual adjustment between participating organizations with different competencies. In this article the impact of group modes of interaction concerning administration and steering and direct service delivery upon different dimensions of network performance and client outcomes is tested in a sample of eighty-three local networks of refugee resettlement support in Sweden. The results show that networks with group modes of interaction concerning both issues generally perform best, but the effect varies across performance dimensions, is modified by availability of needed competence in the network and does not easily translate to client outcomes.
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| 28. |
- Lynöe, Niels, et al.
(author)
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[Patient participation in clinical training of medical students. Interviews with teachers, patients and students]
- 2008
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In: Lakartidningen. - 0023-7205. ; 105:38, s. 2568-71
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Journal article (other academic/artistic)abstract
- SAMMANFATTATNiels Lynöe, Solvig Ekblad, Göran ElinderE-MAIL niels.lynoe@ki.sePatienter ställer gärna upp i den kliniska undervisningen men vill informeras i förväg och föredrar att bara en student deltar. Om patienten känner sig exploaterad är han/hon mindre benägen att ställa upp nästa gång han/hon tillfrågas.Läkarstudenter letar efter goda förebilder och känner sig obekväma om läraren behandlar patienten respektlöst – de är sig enbart att "så ska jag aldrig själv göra". Läkare bör vara uppmärksamma på att den kliniska undervisningen kan bli kontroproduktiv om man inte visar respekt för patientens självbestämmande. Vid undervisning i undersökningsteknik och diagnostik förmedlas indirekt undervisning i medicinsk etik genom det goda eller dåliga etiska förhållningssätt som läraren visar.
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| 29. |
- Mollica, Richard, et al.
(author)
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Using the Virtual Patient to Improve the Primary Care of Traumatized Refugees
- 2017
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In: Journal of Medical Education and Research. - 0972-1177. ; 16:1, s. 2-16
-
Journal article (peer-reviewed)abstract
- Background: Refugees who have experienced traumatic life experiences have entered into the United States’ primary health care system. Primary care providers (PCPs) have limited training in their diagnoses and treatment. Assessing and caring for the health and mental health of refugees in a culturally effective way in a time limited health care environment is challenging. We conducted a study on the role of the Virtual Patient (VP) as a training instrument for improving the diagnoses and treatment of refugee patients.Methods: This was a descriptive and quantitative study of PCPs at a local neighborhood health care center in Massachusetts. A sample of PCPs initially reviewed an alpha Virtual Patient refugee prototype. An improved β-VP prototype was offered in training. The PCPs performance on pre- and post-diagnosis and treatment planning was assessed after studying the β-VP. 10 PCPs studied the alpha VP prototype; an additional 14 PCPs studied the β-VP prototype (N=24). The Karolinska Institutet Virtual Patient Learning Experience Questionnaire (KI-VP-LEQ) assessed feasibility, and motivation to use the VP. A Trauma-BPPS (Trauma -Bio-Psycho-Social- Spiritual scale) scale measured the PCP’s perception of the patient’s trauma history, and medical, psycho-social and spiritual domains. Pre- and post-VP training using refugee paper clinical cases was performed. Concluding telephone interviews were conducted. Analysis included qualitative methods and significance testing.Results: PCPs were receptive and motivated to use the VP in training. Prior to VP training, respondents scored highly on medical diagnosis and treatment planning (Medical domain); followed by the psychological domain. Respondents scored lower on the social domain and lowest on the trauma and spiritual domains. All five domain scores significantly improved for those PCPs who devoted ≥90 minutes studying the VP. Telephone interviews conducted after training revealed PCPs felt they did not have enough time and/or clinical training to properly diagnose or treat refugee patients in the primary health care setting.Conclusions: The PCPs in this pilot study demonstrated the ability to improve their treatment plan for traumatized refugee patients in the medical and psychological domains after VP training. Devotion of time with the VP training instrument was significantly associated with improvement in all domains.
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| 30. |
- Olsson, Jan-Eric, et al.
(author)
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Psychometric analysis of the Swedish version of the General Medical Council's multi source feedback questionnaires
- 2017
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In: International Journal of Medical Education. - : International Journal of Medical Education. - 2042-6372. ; 8, s. 252-261
-
Journal article (peer-reviewed)abstract
- Objectives: To determine the internal consistency and the underlying components of our translated and adapted Swedish version of the General Medical Council's multisource feedback questionnaires (GMC questionnaires) for physicians and to confirm which aspects of good medical practice the latent variable structure reflected.Methods: From October 2015 to March 2016, residents in family medicine in Sweden were invited to participate in the study and to use the Swedish version to perform self-evaluations and acquire feedback from both their patients and colleagues. The validation focused on internal consistency and construct validity. Main outcome measures were Cronbach’s alpha coefficients, Principal Component Analysis, and Confirmatory Factor Analysis indices.Results: A total of 752 completed questionnaires from patients, colleagues, and residents were analysed. Of these, 213 comprised resident self-evaluations, 336 were feedback from residents’ patients, and 203 were feedback from residents’ colleagues. Cronbach’s alpha coefficients of the scores were 0.88 from patients, 0.93 from colleagues, and 0.84 in the self-evaluations. The Confirmatory Factor Analysis validated two models that fit the data reasonably well and reflected important aspects of good medical practice. The first model had two latent factors for patient-related items concerning empathy and consultation management, and the second model had five latent factors for colleague-related items, including knowledge and skills, attitude and approach, reflection and development, teaching, and trust.Conclusions: The current Swedish version seems to be a reliable and valid tool for formative assessment for resident physicians and their supervisors. This needs to be verified in larger samples.
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| 31. |
- Pantziaras, Ioannis, et al.
(author)
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Innovative Training with Virtual Patients in Transcultural Psychiatry : The Impact on Resident Psychiatrists' Confidence
- 2015
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:3
-
Journal article (peer-reviewed)abstract
- Background Virtual patients are now widely accepted as efficient and safe training tools in medical education, but very little is known about their implementation in psychiatry, especially in transcultural clinical care of traumatized refugee patients. Objective This study aimed at assessing the impact of training with a virtual patient on confidence in providing clinical care for traumatized refugee patients. Methods The authors developed an educational tool based on virtual patient methodology portraying the case of Mrs. K, a traumatized refugee woman with symptoms of PTSD and depression. A group (N=32) of resident psychiatrists tested the system and their confidence in different aspects of providing clinical care for this patient group was evaluated pre- and posttest by using a validated confidence questionnaire. Cronbach's a was calculated for all clusters. Changes between pre- and post-test were compared by using the matched-pair t-test, binomial distribution for exact significance test and a calculation of effect sizes (Cohen's d). Results A statistically significant improvement was exhibited in overall confidence (mean.: 0.34; p < 0.0001; d: 0.89) as well as in four more specific domains of clinical care, with the area of identifying and evaluating trauma-related diagnoses and disability showing the most prominent improvement (mean Delta: 0.47; p < 0.0001; d: 1.00). Conclusions This VP-system can lead to physicians' improvement of confidence in providing transcultural clinical care for traumatized refugee patients. Further research is required to investigate improvement in actual performance and cognitive outcomes with several VPs and in a long-term effect perspective.
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| 32. |
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| 33. |
- Panziaras, Ioannis, et al.
(author)
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A pilot study of user acceptance and educational potentials of virtual patients in transcultural psychiatry
- 2012
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In: International Journal of Medical Education. - : International Journal of Medical Education. - 2042-6372. ; 3, s. 132-140
-
Journal article (peer-reviewed)abstract
- Objectives: The purpose of this pilot study was to evaluate user acceptance, educational potentials and face and con-struct validity of a dedicated Virtual Patient system for refugee trauma cases, designed to enhance clinical, interper-sonal, social and cultural competence.Methods: We developed a Virtual Patient system portraying a female refugee – mediated by a still image and pre-recorded voice – that was evaluated by an invited group of physicians (n=9) working as residents in Psychiatry (n=8) and General Medicine (n=1). The participants were invited to provide insights/feedback about the system’s usefulness and its educational value.Results: Scores across our sample were high regarding the Virtual Patient system’s realistic nature (median value: 5 on a 7-point scale) as well as the Virtual Patient’s ability to mirror the course of a real clinical investigation (median value: 6 on a 7-point scale). The system was said to provide a good environment for safe training of clinical and com-municative skills. The system’s face and construct validity were also demonstrated. Proposed future improvements will include the implementation of detailed feedback from a Virtual Advisor and/or the Virtual Patient him/herself, the use of video-simulated patients and the ability to formulate clinical questions in free text.Conclusions: This dedicated Virtual Patient system was well received by the participants. They appraised it as having a good potential for training in relationship to the clinical encounter and the management of traumatized refugees.
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| 34. |
- Pergert, Pernilla, et al.
(author)
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Bridging obstacles to transcultural caring relationships--tools discovered through interviews with staff in pediatric oncology care.
- 2008
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In: Eur J Oncol Nurs. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 12:1, s. 35-43
-
Journal article (peer-reviewed)abstract
- Bridging obstacles to transcultural caring relationships--tools discovered through interviews with staff in pediatric oncology care.Pergert P, Ekblad S, Enskär K, Björk O.Department of Woman and Child Health, Childhood Cancer Research Unit, Karolinska Institutet, Karolinska University Hospital/Solna Q6:05, SE-171 76 Stockholm, Sweden. pernilla.pergert@ki.seIn this qualitative study we explored how health-care staff continuously resolve "obstacles to transcultural caring relationships" as they care for families with an immigrant background within the context of pediatric oncology care. A constant comparative method was used and data collection included 5 focus group interviews and 5 complementary individual interviews with health-care staff within pediatric oncology care. Bridging emerged as the way that health-care staff deal with obstacles to transcultural caring relationships. Bridging is a process in which various tools may be used and combined, including communicational tools, transcultural tools and organizational tools. Failure to use tools, or to use and combine them insufficiently, can bring the caring relationship to a halt, which leads to inequity in care. In order to ensure the provision of high-quality care despite differences in religion, culture, language and social situation, health-care staff need to bridge obstacles to transcultural caring relationships.
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| 35. |
- Pergert, Pernilla, et al.
(author)
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Obstacles to transcultural caring relationships : experiences of health care staff in pediatric oncology.
- 2007
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In: J Pediatr Oncol Nurs. - : SAGE Publications. - 1043-4542 .- 1532-8457. ; 24:6, s. 314-28
-
Journal article (other academic/artistic)abstract
- Obstacles to transcultural caring relationships: experiences of health care staff in pediatric oncology.Pergert P, Ekblad S, Enskär K, Björk O.Childhood Cancer Care Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital/Solna, Stockholm, Sweden. Stockholm, Sweden. pernilla.pergert@ki.seThis qualitative study explores the caring situation of families with an immigrant background within the context of pediatric oncology care from the perspective of health care staff. Five focus group interviews and 5 complementary individual interviews were conducted after purposive and theoretical sampling, respectively. Grounded theory methodology revealed that obstacles to transcultural caring relationships are a main concern of the health care staff. These obstacles are divided into 4 main categories: linguistic, cultural and religious, social, and organizational. When health care staff fail to recognize obstacles to transcultural caring relationships, the result is inequity in care of families with an immigrant background. Equity in care for all does not mean identical treatment but, rather, care adjusted to the needs of the individual family regardless of background.PMID: 18003591 [PubMed - indexed for MEDLINE]
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| 36. |
- Pergert, Pernilla, et al.
(author)
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Protecting Family Interests : An Interview Study with Foreign-Born Parents Struggling On in Childhood Cancer Care
- 2012
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In: International Journal of Pediatrics. - : Hindawi Publishing Corporation. - 1687-9740 .- 1687-9759.
-
Journal article (peer-reviewed)abstract
- Sweden’s population is gradually changing to become more multiethnic and diverse and that applies also for recipients of health care, including childhood cancer care. A holistic view on the sick child in the context of its family has always been a cornerstone in childhood cancer care in Sweden. The purpose of this study was to gain knowledge about the experiences and main concern of foreign-born parents in the context of paediatric cancer care. Interviews were performed with eleven foreign-born parents and data were analysed using a classic grounded theory approach. Foreign-born parents often feel in a position of powerless dependence, but family interests are protected in their approaches to interaction with healthcare staff, through cooperation, contesting, and reluctant resigning. Healthcare staff need to listen to foreign-born parents and deal with their concerns seriously to prevent powerless-dependence and work for trustful cooperation in the common fight against childhood cancer.
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| 37. |
- Pergert, Pernilla, et al.
(author)
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Protecting professional composure in transcultural pediatric nursing.
- 2008
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In: Qual Health Res. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 18:5, s. 647-57
-
Journal article (peer-reviewed)abstract
- Protecting professional composure in transcultural pediatric nursing.Pergert P, Ekblad S, Enskär K, Björk O.Karolinska Institutet, Stockholm, Sweden.In this qualitative study, we used grounded theory to explore the category of "overwhelming emotional expressions" that emerged in a previous study. Using theoretical sampling, 12 individual interviews were conducted with nurses in Swedish pediatric care. Overwhelming emotional expressions have been found to override nurses' professional preparedness; they continuously resolve this by protecting professional composure. Various strategies are used to protect professional composure, including rationalizing, controlled expression, power display, escape/avoidance, distancing, sharing, and management of space. Some of these strategies are similar to coping strategies. However, they differ in that they are about managing the situation and also include protecting the professional composure of the individual as well as the whole care situation. Nurses need to gain preparedness to meet overwhelming emotional expressions in transcultural care and to be aware of strategies for protecting professional composure so as to use them consciously and positively.
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| 38. |
- Pergert, Pernilla, et al.
(author)
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Resourcing : An approach used by foreign-born parents struggling on in childhood cancer care
- 2016
-
In: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 23, s. 1-7
-
Journal article (peer-reviewed)abstract
- PURPOSE: To gain knowledge about foreign-born parents' experiences of dealing with their child's illness and treatment in the context of pediatric cancer care.METHOD: Data from 11 individual interviews with foreign-born parents were analyzed using qualitative inductive constant comparative analysis.RESULTS: To struggle on in childhood cancer care, foreign-born parents engaged in resourcing using various strategies including: information-monitoring, staying strong, support-seeking and concern-focusing. Parents experienced obstacles to information-monitoring and support-seeking related to their foreign background.CONCLUSIONS: The results provide a framework for understanding how foreign-born parents try to deal with childhood cancer care and can be used by health care staff to support their resourcing. Even though preconditions might differ, the strategies presented might also be used by native-born parents however further studied are needed.
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| 39. |
- Roth, Göran, et al.
(author)
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A longitudinal study of PTSD in a sample of adult mass-evacuated Kosovars, some of whom returned to their home country.
- 2006
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In: European psychiatry : the journal of the Association of European Psychiatrists. - : Cambridge University Press (CUP). - 0924-9338. ; 21:3, s. 152-9
-
Journal article (peer-reviewed)abstract
- PTSD among a sample of mass-evacuated adults from Kosovo was studied using a prospective design with a baseline study and follow-ups at 3 and 6 months in Sweden, and with an additional follow-up after 1.5 years in both Sweden and Kosovo. Trauma events and PTSD-related symptoms were measured by the Harvard Trauma Questionnaire (HTQ). At the additional follow-up after 1.5 years the same measure (HTQ) was used as well as clinical diagnostic interviews with the SCID instrument and measurement of saliva cortisol levels. Thirty-seven percent had PTSD-related symptoms at baseline. Morbidity increased at the three follow-ups. About 80% of the participants had PTSD at the additional follow-up after 1.5 years. The HTQ results were confirmed by clinical diagnoses and the participants diagnosed with PTSD also had low saliva cortisol levels. The results are discussed in terms of trauma, time needed to develop PTSD, post-migration stress and selection mechanisms.
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| 40. |
- Roth, Göran, et al.
(author)
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A study of aggression amongmass-evacuated Kosovo Albanians
- 2009
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In: Torture. - Köpenhamn : IRCT. - 1018-8185. ; 19:2, s. 227-237
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Journal article (peer-reviewed)abstract
- Aggression among a sample of traumatized, massevacuatedadults from Kosovo was studied, usinga prospective design with a baseline study, followupsat three months and six months in Sweden,and an additional follow-up after one and a halfyears in both Sweden and Kosovo. Aggressionwas measured with the Revised Swedish Versionof Aggression questionnaire (AQ-RSV). Traumaticevents and PTSD-related symptoms weremeasured by the Harvard Trauma Questionnaire(HTQ), and depression with HSCL-25. At theadditional follow-up after one and a half years, thesame measures were used, as well as clinical diagnosticinterviews with the SCID. Verbal aggressioncorrelated positively with age and educationallevel. No gender differences were found. Thetrauma level was high – the mean experiencednumber of the 16 trauma events derived from theHTQ was 9.65 (SD 3.55) – and significant correlationswere found between trauma and aggressionat the first follow-up after three months – torture,for instance, correlated with total aggressionscores (p<0.003) – but not in later follow-ups.Aggression increased over time and was linkedwith both mean scores of PTSD and depressivesymptoms, as well as with the diagnoses PTSD(p<0.0001) and depression (p<0.0001), especiallyif both diagnoses were present. Implications arediscussed.
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| 41. |
- Rothlind, Erica, et al.
(author)
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Circling the undefined - A grounded theory study of intercultural consultations in Swedish primary care
- 2018
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:8
-
Journal article (peer-reviewed)abstract
- Well-functioning physician-patient communication is central to primary care consultations. An increasing demand on primary care in many countries to manage a culturally diverse population has highlighted the need for improved communication skills in intercultural consultations. In previous studies, intercultural consultations in primary care have often been described as complex for various reasons, but studies exploring physician-patient interactions contributing to the understanding of why they are complex are lacking. Therefore, the aim of this study was to explore intercultural physician-patient communication in primary care consultations, generating a conceptual model of the interpersonal interactions as described by both the patients and the physicians. Using grounded theory methodology, 15 residents in family medicine and 30 foreign-born patients, the latter with Arabic and Somali as native languages, were interviewed. The analysis generated a conceptual model named circling the undefined, where a silent agreement on issues fundamental to the core of the consultation was inadequately presumed and the communicative behaviors used did not contribute to clarity. This could be a possible contributory cause of the perceived complexity of intercultural consultations. Identifying what takes place on an interpersonal level in intercultural consultations might be a first step towards building a common ground for increased mutual understanding, thereby bringing us one step closer to sharing, rather than circling the undefined.
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| 42. |
- Rothlind, Erica, et al.
(author)
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Primary care consultations on emotional distress - a part of the acculturation process in patients with refugee backgrounds : a grounded theory approach
- 2021
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In: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 22:1
-
Journal article (peer-reviewed)abstract
- Background: Considering the global refugee crisis, there is an increasing demand on primary care physicians to be able to adequately assess and address the health care needs of individual refugees, including both the somatic and psychiatric spectra. Meanwhile, intercultural consultations are often described as challenging, and studies exploring physician–patient communication focusing on emotional distress are lacking. Therefore, the aim was to explore physician–patient communication, with focus on cultural aspects of emotional distress in intercultural primary care consultations, using a grounded theory approach, considering both the physician’s and the patient’s perspective.Methods: The study was set in Region Stockholm, Sweden. In total, 23 individual interviews and 3 focus groups were conducted. Resident physicians in family medicine and patients with refugee backgrounds, originating from Somalia, Syria, Afghanistan and Iraq, were included. Data was analysed using a grounded theory approach.Results: Over time, primary care patients with refugee backgrounds seemed to adopt a culturally congruent model of emotional distress. Gradual acceptance of psychiatric diagnoses as explanatory models for distress and suffering was noted, which is in line with current tendencies in Sweden. This acculturation might be influenced by the physician. Three possible approaches used by residents in intercultural consultations were identified: “biomedical”, “didactic” and “compensatory”. They all indicated that diagnoses are culturally valid models to explain various forms of distress and may thus contribute to shifting patient perceptions of psychiatric diagnoses.Conclusions: Physicians working in Swedish primary care may influence patients’ acculturation process by inadvertently shifting their perceptions of psychiatric diagnoses. Residents expressed concerns, rather than confidence, in dealing with these issues. Focusing part of their training on how to address emotional distress in an intercultural context would likely be beneficial for all parties concerned.
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| 43. |
- Rothlind, Erica, et al.
(author)
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The informal curriculum of family medicine - what does it entail and how is it taught to residents? A systematic review
- 2020
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In: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 21:1
-
Research review (peer-reviewed)abstract
- BackgroundThe informal curriculum is a seemingly well-explored concept in the realm of medical education. However, it is a concept with multiple definitions and the term the hidden curriculum is often used interchangeably. In short, they both refer to the implicit learning taking place outside the formal curriculum, encompassing both a trickling down effect of organizational values and attitudes passed on by a mentor or colleague. While the informal curriculum is a recurrent theme in medical education literature; it is seldom discussed in Family Medicine. As the informal curriculum is likely to be highly influential in the forming of future family practitioners, our aim was to explore the area further, with respect to the following: which elements of the informal curriculum are applicable in a Family Medicine context and what educational interventions for Family Medicine residents, visualizing the various educational elements of it, have been performed?MethodsWe conducted a systematic review comprising iterative literature searches and a narrative synthesis of the results.ResultsTwenty articles, published between 2000 and 2019, were included in the analysis which resulted in three partly interrelated themes comprising the informal curriculum in Family Medicine: gaining cultural competence, achieving medical professionalism and dealing with uncertainty. The themes on cultural competence and uncertainty seemed to be more contextual than professionalism, the latter being discussed in relation to the informal curriculum across other medical disciplines as well. Formalized training for Family Medicine residents in aspects of the informal curriculum appeared to be lacking, and in general, the quality of the few interventional studies found was low.ConclusionsImportant aspects of being a family practitioner, such as cultural competence and dealing with uncertainty, are learned through a context-dependent informal curriculum. In order to ensure a more uniform base for all residents and to reduce the impact of the individual supervisor's preferences, complementary formalized training would be beneficial. However, to date there are too few studies published to conclude how to best teach the informal curriculum.
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| 44. |
- Rothlind, Erica, et al.
(author)
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Virtual patients reflecting the clinical reality of primary care - a useful tool to improve cultural competence
- 2021
-
In: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 21:1
-
Journal article (peer-reviewed)abstract
- Background: Virtual patients are educational tools that may be described as case-based interactive computer simulations of clinical scenarios. In terms of learning outcomes, improved clinical reasoning skills and knowledge acquisition have been shown. For further exploring the role of virtual patients in medical education, a greater focus on context-specific cases, combined with suitable educational activities, has been suggested. A knowledge gap has been identified in cultural competence in primary care. As primary care physicians are often the main medical providers for patients with refugee backgrounds, they would probably benefit from improved training focusing on how to apply cultural competence in everyday work. Using virtual patient cases, as a complement to clinical training, may be one way forward. The aim of this study was therefore to explore a learner perspective on the educational use of a virtual patient system designed to contribute to training in cultural competence in a primary care context.Methods: Three virtual patient cases portraying patients with refugee backgrounds were developed. The cases addressed various issues and symptoms common in primary care consultations, while also incorporating intercultural aspects. The system also provided the informants with individualized feedback. Primary care physicians and medical students were invited to test the cases and participate in an interview about their experience. Data was analyzed using qualitative content analysis.Results: The analysis generated the theme Virtual patients might help improve cultural competence in physicians and medical students by complementing knowledge gained through the informal curriculum. Informants at different educational levels found it suitable as a tool for introducing the topic and for reflecting on one's own consultations. It could also compensate for the predominant informal manner of learning cultural competence, described by the informants.Conclusions: Virtual patients could be useful for gaining cultural competence in a primary care context. Advantages that could benefit learners at both pre- and post-graduate levels are decreased dependence on the informal curriculum and being presented with an illustrative way of how cultural competence may be applied in the consultation.
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| 45. |
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| 46. |
- Sundqvist, Johanna, 1978-
(author)
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Forced repatriation of unaccompanied asylum-seeking refugee children : towards an interagency model
- 2017
-
Doctoral thesis (other academic/artistic)abstract
- Introduction Not all children seeking asylum without parents or other relatives are entitled to residence permits. In the last few years, more than one in four unaccompanied asylum-seeking refugee children have been forced to repatriate, either to their home country or to a transit country. Mostly the children refuse to leave the country voluntarily, and it becomes a forced repatriation. Five actors collaborate in the Swedish child forced repatriation process: social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians. When a child is forced to repatriate, the Swedish workers involved must consider two different demands. The first demand requires dignified repatriation, which is incorporated from the European Union’s (EU’s) Return Directive into Swedish Aliens Act. The second demand requires that the repatriation process be conducted efficiently, which means that a higher number of repatriation cases must be processed. The fact that the same professionals have different and seemingly contradictory requirements places high demands on the involved collaborators. Two professionals have a legal responsibility for the children until the last minute before they leave Sweden: social workers and police officers. That makes them key actors in forced repatriation, as they carry most of the responsibility in the process. Further, they often work with children who are afraid what will happen when they return to their home country and often express their fear through powerful emotions. Being responsible and obliged to carry out the government’s decision, despite forcing children to leave a safe country, may evoke negative emotional and mental stress for the professionals involved in forced repatriation. Aim The overall aim of this study is to explore and analyse forced repatriation workers’ collaboration and perceived mental health, with special focus on social workers and police officers in the Swedish context.Materials and methods The study combines a qualitative and quantitative research design in order to shed light at both a deep and general level on forced repatriation. In qualitative substudy I, a qualitative case study methodology was used in one municipality in a middle-sized city in Sweden. The municipality had a contract regarding the reception of unaccompanied asylum-seeking refugee children iv with the Swedish Migration Board. The municipality in focus has a population of more than 100,000 inhabitants. The city in which the data were collected has developed a refugee reception system where unaccompanied asylumseeking refugee children are resettled and await a final decision regarding their permit applications. This situation made it possible to recruit participants who had worked with unaccompanied refugee children without a permit. Semi-structured interviews were conducted with a total of 20 social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians. A thematic approach was used to analyse the data. In quantitative substudies II, III and IV, a national survey of social workers (n = 380) and police officers (n = 714), with and without experience of forced repatriation, was conducted. The questionnaires included sociodemographic characteristics, the Swedish Demand-Control Questionnaire, Interview Schedule for Social Interaction, Ways of Coping Questionnaire and the 12- item General Mental Health Questionnaire. Factor analysis, correlational analysis, and univariate and multivariable regression models were used to analyse the data.Results The qualitative results in substudy I showed low levels of collaboration among the actors (social workers, staff at care homes, police officers, Swedish Migration Board officers and legal guardians) and the use of different strategies to manage their work tasks. Some of them used a teamwork pattern, showing an understanding of the different roles in forced repatriation, and were willing to compromise for the sake of collaboration. Others tended to isolate themselves from interaction and acted on the basis of personal preference, and some tended to behave sensitively, withdraw and become passive observers rather than active partners in the forced repatriation. The quantitative results in substudy II showed that poorer mental health was associated with working with unaccompanied asylum-seeking refugee children among social workers but not among police officers. Psychological job demand was a significant predictor for mental health among social workers, while psychological job demand, decision latitude and marital status were predictors among police officers. Substudy III showed that both social workers and police officers reported relatively high access to social support. Furthermore, police officers working in forced repatriation with low levels of satisfaction with social interaction and close emotional support increased the odds of psychological disturbances. In substudy IV, social workers used more escape avoidance, distancing and positive-reappraisal coping, whereas police officers used more planful problem solving and self-controlling coping. Additionally, social workers with experience in forced repatriation used more planful problem solving than those without experience.Conclusions In order to create the most dignified forced repatriation, based on human dignity, for unaccompanied asylum-seeking refugee children and with healthy actors, a forced repatriation system needs: overall statutory national guidance, interagency collaboration, actors working within a teamworking pattern, forced repatriation workers with reasonable job demands and decision latitude, with a high level of social support and adaptive coping strategies. The point of departure for an interagency model is that it is impossible to change the circumstances of the asylum process, but it is possible to make the system more functional and better adapted to both the children’s needs and those of the professionals who are set to handle the children. A centre for unaccompanied asylum-seeking refugee children, consisting of all actors involved in the children’s asylum process sitting under the same roof, at the governmental level (Swedish Migration Board, the police authority) and municipality level (social services, board of legal guardians), can meet all requirements.
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| 48. |
- Svensson, Malin, et al.
(author)
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Making meaningful space for oneself: photo-based dialogue with siblings of refugee children with severe withdrawal symptoms
- 2009
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In: Children's Geographies. - London : Routledge. - 1473-3285 .- 1473-3277. ; 7:2, s. 209-228
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Journal article (peer-reviewed)abstract
- The current study explores the use of children's photographs to establish a dialogue about everyday life with healthy siblings of refugee children with severe withdrawal symptoms (SWS). Asylum-seeking refugee children in Sweden with SWS have been officially observed since 2000, yet research has overlooked their healthy siblings. We studied three healthy siblings and found photography to be an applicable communicative tool. When parents focus their attention on the ill child, the healthy children create space for themselves and indicate both resilience and vulnerability. We suggest that, together with a dialogue, children's own photographs are useful for research with refugee children in vulnerable situations.
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| 49. |
- Tran, Carrie, et al.
(author)
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A virtual patient model for students’ interprofessional learning in primary healthcare
- 2020
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:9
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Journal article (peer-reviewed)abstract
- ObjectivesInterprofessional education is important for increasing the quality of patient care, but organising it in primary healthcare is still challenging. The aim of this study was to develop and assess a virtual patient model for primary healthcare and to investigate students' perceptions of learning with this interprofessional virtual patient model.MethodsThe virtual patient case described a patient with several medical conditions who had returned home after surgery. The virtual patient included text files, short videos, and links to illustrate different health professions' roles in home care. Ten interprofessional groups with 39 students assessed the virtual patient from four different study programmes: nursing, physiotherapy, medicine, and occupational therapy. The students answered a questionnaire about how they perceived the usability of the virtual patient and participated in group interviews. Qualitative content analysis was used to analyse the data from the semi-structured group interviews.ResultsThe analysis of the interviews resulted in four main categories: The virtual patient model facilitated the learning process; It was beneficial to have students from different programmes in the group when working with the virtual patient; Working with the virtual patient helped the students to understand the roles and competencies of their own and other professions and All professions are needed in clinical work in order to help the patient. The students perceived that the mixture of text and multimedia made the virtual patient seem authentic and stimulated their group discussions, which they valued most. The students gave generally high points for usability in the questionnaire, but they also gave input for improvement of the program in their comments.ConclusionsThe interprofessional virtual patient model facilitated interactions and discussions between students and may be a useful complement for interprofessional education in clinical contexts and might be a suitable tool in preparing students for future teamwork.
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