Annika Forssén

Compulsive sensitivity - a consequence of caring : a qualitative investigation into women carer's difficulties in limiting their labours

Women are expected to care, both in public and private life, for the sick as well as the healthy. Some women have difficulties in limiting their caring, despite being deeply careworn. In this life-course study, based on in-depth interviews with elderly women in Sweden, the concept “compulsive sensitivity” presents a way toward understanding their difficulties. Compulsive sensitivity denotes the compulsion to see and respond to other peoples needs, whatever ones own situation.

Work, health and ill health : new research makes women's experiences visible

This study presents new knowledge about womens work, health and ill health. The point of departure is a lack of knowledge and understanding in medical research and practice of womens work and experiences of ill health. The study is qualitative and based on the life histories of 20 elderly women. What can be learned from them is often of use also in the encounter with younger female patients. The research constitutes a part of feminist science. The women taught us about invisible and heavy work, paid and unpaid, and often carried out for the benefit of others. The relationship between the married women and their husbands had a strong impact on both the womens work and their health. Being responsible for other peoples well being, and with little sway over their working conditions, the women often had difficulty looking after their own health. The results point to the necessity of asking women thorough questions about their everyday life when they seek primary health care. Great parts of their work and working conditions, crucial to their health, might otherwise be overlooked.

Humour, beauty, and culture as personal health resources: experiences of elderly Swedish women.

Aim: This paper explores how a group of elderly women used humour, beauty, and cultural activities to maintain physical and mental well-being. Methods: The paper reports on one aspect of a qualitative study on womens work and health in a lifetime perspective. Interviews with 20 strategically selected Swedish women, aged 63 to 83 years, were audiotaped and analysed according to a phenomenological approach. Results: During the interview process, the researchers became increasingly aware that the women had clear ideas about what enabled them to feel well and healthy — even when actually quite diseased. Creating and enjoying humour, beauty, and culture formed part of such strategies. Joking with workmates made hard, low-status jobs easier, helped them endure pain, and helped balance marital difficulties. Creating a nice and comfortable home gave pleasure and a little luxury in a life filled with necessities. Making articles for everyday use more beautiful was regarded as worthwhile, because it gave delight to them and their families. Gains from cultural activities were social, aesthetic, and existential — the latter through a feeling of self-recognition and being heard. Conclusions: Humour, beauty, and culture formed a greater part of these womens survival strategies than expected. Making everyday life more aesthetic is an undervalued aspect of womens health-creating work in the family. Through their lifelong experience as carers and homemakers, elderly women possess special knowledge regarding what may promote health, a knowledge that should be tapped. When supplying elderly women with social care, their needs for humour, beauty, and culture should be respected.

Self-rated health and standard risk factors for myocardial infarction: a cohort study

Objective To investigate the relationship between self-rated health, adjusted for standard risk factors, and myocardial infarction. Design Population-based prospective cohort study. Setting Enrolment took place between 1990 and 2004 in Västerbotten County, Sweden Participants Every year, persons in the total population, aged 40, 50 or 60 were invited. Participation rate was 60%. The cohort consisted of 75 386 men and women. After exclusion for stroke or myocardial infarction before, or within 12 months after enrolment or death within 12 months after enrolment, 72 530 persons remained for analysis. Mean follow-up time was 13.2 years. Outcome measures Cox regression analysis was used to estimate HRs for the end point of first non-fatal or fatal myocardial infarction. HR were adjusted for age, sex, systolic blood pressure, total cholesterol, smoking, diabetes, body mass index, education, physical activity and self-rated health in the categories very good; pretty good; somewhat good; pretty poor or poor. Results In the cohort, 2062 persons were diagnosed with fatal or non-fatal myocardial infarction. Poor self-rated health adjusted for sex and age was associated with the outcome with HR 2.03 (95% CI 1.45 to 2.84). All categories of self-rated health worse than very good were statistically significant and showed a dose–response relationship. In a multivariable analysis with standard risk factors (not including physical activity and education) HR was attenuated to 1.61 (95% CI 1.13 to 2.31) for poor self-rated health. All categories of self-rated health remained statistically significant. We found no interaction between self-rated health and standard risk factors except for poor self-rated health and diabetes. Conclusions This study supports the use of self-rated health as a standard risk factor among others for myocardial infarction. It remains to demonstrate whether self-rated health adds predictive value for myocardial infarction in combined algorithms with standard risk factors.

Lifelong Significance of Disempowering Experiences in Prenatal and Maternity Care Interviews With Elderly Swedish Women

In this article I show how the effects of harsh and humiliating treatment, experienced by a number of Swedish women in antenatal care and childbirth in the mid-20th Century, endured for the rest of their lives. This treatment was carried out by medical staff in conformity with a view of expectant mothers as irresponsible and ignorant and with the prevalent idea of “natural birth.” These effects were findings in an interview investigation that, with a colleague, I conducted into paid and unpaid work and health of 20 women, seen in a lifetime perspective. Our biomedical way of understanding risks and complications during pregnancy and birthing was confronted with many participants’ feelings of distress, guilt, and grief linked to their childbearing experience. I interpret the treatments as “violations of dignity” and as abuse. The consequences are similar to those following traumatic birth experiences described in today’s literature.

Pharyngeal Chlamydia trachomatis is not uncommon any more

Abstract Background. The significance of Chlamydia trachomatis (Ct) infection in the pharynx, and possible symptoms, are under discussion. Most studies have involved only homo/bisexual men. We report findings of pharyngeal Ct (PhCt) infections in patients with long-lasting throat discomfort and the prevalence of PhCt in genitally Ct-infected young people in a Swedish primary care setting. Method. Sub-study 1 (SS1) included 48 persons aged 15–35 y, with pharyngeal discomfort for more than 14 days. Sub-study 2 (SS2) included 150 persons, aged 15–35 y, with genital Ct. Questionnaires concerning symptoms, sexual behaviour and sexual identity were completed for both groups. Samples for Ct testing were taken from the pharynx, and in SS1, samples were also collected to ascertain genital Ct. Results. In SS1, 2 of 48 persons (4%) with pharyngeal discomfort had PhCt. In all, 35 of the 48 persons (73%) included in SS1 reported unprotected oral sex during the previous year. In SS2, 11 of 92 women (12%) and 4 of 58 men (7%) tested positive for PhCt. More women (94%) than men (83%) had given unprotected oral sex. Persons with PhCt had more symptoms from the upper respiratory tract (p = 0.04). Conclusions. Some primary care patients with long-lasting throat discomfort have a PhCt infection. PhCt infection is not uncommon in genitally infected sexually active people. More heterosexual women than heterosexual men had given unprotected oral sex and were infected by Ct in the pharynx. Thus, research on PhCt should not focus on homo/bisexual men only. Information about Ct should include the risk of contracting a PhCt infection as well as a gender perspective.

A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study

BackgroundSelf-Rated Health (SRH) correlates with risk of illness and death. But how are different questions of SRH to be interpreted? Does it matter whether one asks: “How would you assess your general state of health?”(General SRH) or “How would you assess your general state of health compared to persons of your own age?”(Comparative SRH)? Does the context in a questionnaire affect the answers? The aim of this paper is to examine the meaning of two questions on self-rated health, the statistical distribution of the answers, and whether the context of the question in a questionnaire affects the answers.MethodsStatistical and semantic methodologies were used to analyse the answers of two different SRH questions in a cross-sectional survey, the MONICA-project of northern Sweden.ResultsThe answers from 3504 persons were analysed. The statistical distributions of answers differed. The most common answer to the General SRH was “good”, while the most common answer to the Comparative SRH was “similar”. The semantic analysis showed that what is assessed in SRH is not health in a medical and lexical sense but fields of association connected to health, for example health behaviour, functional ability, youth, looks, way of life. The meaning and function of the two questions differ – mainly due to the comparing reference in Comparative SRH. The context in the questionnaire may have affected the statistics.ConclusionsHealth is primarily assessed in terms of its sense-relations (associations) and Comparative SRH and General SRH contain different information on SRH. Comparative SRH is semantically more distinct. The context of the questions in a questionnaire may affect the way self-rated health questions are answered. Comparative SRH should not be eliminated from use in questionnaires. Its usefulness in clinical encounters should be investigated.

What does age-comparative self-rated health measure? A cross-sectional study from the Northern Sweden MONICA Project

Aims: Self-rated health comprehensively accounts for many health domains. Using self-ratings and a knowledge of associations with health domains might help personnel in the health care sector to understand reports of ill health. The aim of this paper was to investigate associations between age-comparative self-rated health and disease, risk factors, emotions and psychosocial factors in a general population. Methods: We based our study on population-based cross-sectional surveys performed in 1999, 2004 and 2009 in northern Sweden. Participants were 25–74 years of age and 5314 of the 7500 people invited completed the survey. Comparative self-rated health was measured on a three-grade ordinal scale by the question ‘How would you assess your general health condition compared to persons of your own age?’ with the alternatives ‘better’, ‘worse’ or ‘similar’. The independent variables were sex, age, blood pressure, cholesterol, body mass index, self-reported myocardial infarction, stroke, diabetes, physical activity, smoking, risk of unemployment, satisfaction with economic situation, anxiety and depressive emotions, education and Karasek scale of working conditions. Odds ratios using ordinal regression were calculated. Results: Age, sex, stroke, myocardial infarction, diabetes, body mass index, physical activity, economic satisfaction, anxiety and depressive emotions were associated with comparative self-rated health. The risk of unemployment, a tense work situation and educational level were also associated with comparative self-rated health, although they were considerably weaker when adjusted for the the other variables. Anxiety, depressive emotions, low economic satisfaction and a tense work situation were common in the population. Conclusions: Emotions and economic satisfaction were associated with comparative self-rated health as well as some medical variables. Utilization of the knowledge of these associations in health care should be further investigated.

Health-promoting aspects of a paid job : findings in a qualitative interview study with elderly women in Sweden

This article is one aspect of a larger, qualitative interview study and deals with health-promoting aspects of gainful employment, as experienced by a group of elderly Swedish women. Through these interviews we demonstrate the central importance of outside employment for many of the women, although they belonged to a generation where outside work conflicted with societal norms. We will illustrate a wide variety of ways in which gainful employment can contribute to womens well-being and, ultimately, their health.

GPs asking patients to self-rate their health: a qualitative study

Background In epidemiological research, self-rated health is an independent predictor of mortality, cardiovascular diseases, and other critical outcomes. It is recommended for clinical use, but research is lacking. Aim To investigate what happens in consultations when the question ‘How would you assess your general health compared with others your own age?’ is posed. Design and setting Authentic consultations with GPs at health centres in Sweden. Method Thirty-three planned visits concerning diabetes, pain, or undiagnosed symptoms were voice-recorded. Dialogue regarding self-rated health was transcribed verbatim and analysed using a systematic text condensation method. Speaking time of patients and doctors was measured and the doctors’ assessment of the value of the question was documented in a short questionnaire. Results Two overarching themes are used to describe patients’ responses to the question. First, there was an immediate reaction, often expressing strong emotions, setting the tone of the dialogue and influencing the continued conversation. This was followed by reflection regarding their functional ability, management of illnesses and risks, and/or situation in life. The GPs maintained an attitude of active listening. They sometimes reported a slight increase in consultation time or feeling disturbed by the question, but mostly judged it as valuable, shedding additional light on the patients’ situation and making it easier to discuss difficulties and resources. The patients’ speaking time increased noticeably during this part of the consultation. Conclusion Asking patients to comparatively self-rate their health is an effective tool in general practice.