Lars Dahlgren

“Keeping Up a Front”: Narratives About Intimate Partner Violence, Pregnancy, and Antenatal Care

Nine women who had been subjected to severe intimate partner violence during pregnancy narrated their ambiguous and contradictory feelings and the various balancing strategies they used to overcome their complex and difficult situations. Because allowing anyone to come close posed a threat, the women mostly denied the situation and kept up a front to hide the violence from others. Three women disclosed ongoing violence to the midwives, but only one said such disclosure was helpful. This article highlights the complexity of being pregnant when living with an abusive partner and challenges antenatal care policies from the perspective of pregnant women.

Oral health behaviour and self-esteem in Swedish children

This study focus on the socio-psychological concept of self-esteem and examines its association with oral health behaviour and with some background variables that have been shown to be of importance in previous studies. In 1995, 3370 12-year-olds answered a questionnaire on social and demographic factors. Questions on attitudes and behaviour were also included. After reducing the number of variables and constructing new variables, multivariate analyses were performed. A polytomous regression on self-esteem showed that having very poor self-esteem as opposed to poor, good and very good self-esteem was associated with being a girl, not living with ones biological parents, poor social support, having less interest in politics, poor adaptation in school and poor oral health behaviour. The results also showed that being a boy, choosing statements reflecting less exemplary behaviour, and being less well adapted in school increased the risk of having poor oral health behaviour, as did ethnic group affiliation and having poor self-esteem. Our results showed that self-esteem is a crucial intervening variable between variables measuring social background and outcome variables, especially oral health behaviour.

Swedish Doctoral Students' Experiences on their Journey towards a PhD: Obstacles and opportunities inside and outside the academic building

The overall aim of this article was to provide a picture of how doctoral students experience their working conditions on their journey towards a PhD. It is based mainly on an extensive pilot study and comprised both a qualitative and a quantitative section. The questionnaire was distributed to 278 students of both sexes at Umea § University in Sweden and the interview study comprises six female students. Interest in working at the university after receiving a PhD was about as great for women as it was for men, although, significantly fewer women continued. Different aspects of insecurity (financial insecurity, insecurity concerning ones own capacity, and insecurity concerning unwritten rules), difficulty in combining an academic career and a family, as well as negative experiences, were some of the obstacles mentioned. The opportunities described included intellectual development and a good chance for in-depth study in a special field. Several of the students also felt that their work involved something of importance. Many mentioned freedom, but often as a kind of Janus face (two-faced) freedom. They emphasised the advantages of freedom in doing research, but maintained at the same time that this freedom also meant that there was no clear dividing line between work and leisure time, and the women in particular felt under stress.

Career Choice, Professional Preferences and Gender ? the Case of Swedish Physiotherapy Students

The aim was to identify reasons for the career choice and professional preferences among students enrolled in the Swedish physiotherapy education. The study design was longitudinal and used a questionnaire administered to a cohort of 273 students in the beginning of the university programme in 1997 as well as at the completion of the programme in 1999, yielding a response rate of 93%. Data were analysed with factor analysis and univariate and multivariate logistic regression analysis. To test the relationship between the factors and outcomes that showed significant effect in the logistic regression analysis, a path analysis was performed. The two most preferred healthcare facilities after graduation were sports medicine clinics and fitness centres. Future work in private practice was highly endorsed by a majority of students. Health promotion was highly valued. Care of elderly and hospital work were not preferred. Significant differences between men and women appeared. Men were more likely to have chosen the programme because of their interest in sports and physical activity. Men were also more choice decided about future professional activities, whereas women were more open for several areas of practice. Men preferred to become the owner of a private clinic and to work with alternative approaches to healthcare, such as fitness training in sports medicine clinics.

The social and cultural contexts of HIV/AIDS transmission in the Kagera region, Tanzania

Like poverty the HIV/AIDS epidemic is affecting the sub-continent of Saharan Africa more severely than any other parts of the world with 63% of global AIDS cases occurring in this region. Tanzania is one of the severely affected countries within sub-Saharan Africa. It is evident that AIDS in this continent is transmitted mainly through heterosexual contact. Since a cure is yet to be found a change in sexual behavior seems to be the only reliable method of controlling the further spread of HIV. Sexual behavior is shaped by a variety of social and cultural factors inherent in the society. Therefore understanding the social-cultural context within which AIDS is spreading is important for successful intervention. In order to achieve this the Kagera AIDS Research Project initiated a study aimed at understanding the social cultural processes that shape the dynamics of HIV transmission in the Kagera region of Tanzania. The findings suggest that there are a variety of factors responsible for the rapid transmission of HIV/AIDS in this region which include political factors such as organized violence (war); economic factors particularly poverty; and cultural factors or traditions especially in terms of the way they shape gender inequality romantic attachments and sex meanings and beliefs. The study proposes that intervention strategies must be multi-dimensional and must reflect the local cultural conditions as well as involve the local people. (authors)

Social capital, gender and educational level : impact on self-rated health

Objectives: Social capital has been recognized as one important social determinant for health, but we still have limited knowledge about how it can be used to explain inequality in health. This study investigated the links between individual social capital and self-rated health by gender and educational level, and analyzed if access to social capital might explain the observed disparities in self-rated health between men and women and different educational groups. Study design: A cross-sectional survey in Northern Sweden. Methods: A social capital questionnaire was constructed and mailed to 15 000 randomly selected individuals. Different forms of structural and cognitive social capital were measured. Self-rated health was used as the outcome measure. Crude and adjusted OR and 95% CI were calculated for good self- rated health and access to each form of social capital. Multivariate regression was used to analyze how sociodemographic factors and access to social capital might influence differences in self-rated health by gender and educational level. Results: Access to almost each form of social capital significantly increased the odds for good self-rated health for all groups. A higher education significantly increased the odds for access to each form of social capital, and being a man significantly increased the odds for having access to some forms of social capital. The health advantage for higher educated and men partly decreased when controlling for access to social capital. Conclusions: Access to social capital can partly explain the observed health inequality between men and women and different educational groups. Strengthening social capital might be one way of tackling health inequality. It is important to consider the structural conditions that create unequal opportunities for different groups to access social capital.

Experiences within the process of sick leave.

The aim of this study was to explore what individuals who have been on sick leave experienced as important in the process of returning to work, moving to long-term sick leave, or receiving a disability pension. Grounded Theory was used for interpreting interviews with 15 people who had been on sick leave four years previously. In the results four ideal types were crystallized which are presented in the form of vignettes. The ideal types were discussed focusing on occupational life using the Model of Human Occupation and the theories of Sense of Coherence and Status Passage. The study provided a deeper understanding of peoples experiences during the process of their sick leave. Valuable predictors for re-entry into work or disability retirement were: individual mental resources; clear or unclear diagnosis; how long had been spent in the sick-leave process; and personal belief in an ability to work in the future. The interventions and support given by professionals and the social environment, the balance and sense of coherence in life, and participation in the sick leave process were also important. The idealtypes found could be helpful to professionals working in this field in deepening their understanding of the clients.

Body awareness therapy with sexually abused women. Part 2: Evaluation of body awareness in a group setting

Abstract This study examines the results of a new treatment modality described in part 1 ( JBMT , 1(5), 280–288). Seven women were studied for 20 months. Symptoms (VAS-rating), self-image (SASB) and body image were assessed at the start and 1 year after the therapy. An interview was carried out for an evaluation of the outcome of the therapy as well as to achieve extended knowledge about the consequences of CSA. The tests showed that the symptoms diminished by half. The self-image and body image improved in the majority; patients with most symptom reduction and positive changes in self-love also showed a positive personal relationship with their body. The open interpretation of the interviews generated four categories (the room, the control, the choice, and the gift) which are discussed in a closer analysis of the social dimensions of the CSA phenomena. The authors suggest how the approach with body awareness group therapy can be refined and developed in working with CSA.

A stimulating, practice-based job facing increased stress – Clinical supervisors’ perceptions of professional role, physiotherapy education and the status of the profession

The aim was to study perceptions of professional role, education and the status of the profession among clinical physiotherapy supervisors. Five focus group discussions were conducted with 15 supervisors attached to four universities in Sweden. Qualitative analyses were carried out using constant comparisons. Triangulation of researchers was used to increase trustworthiness. The supervisors experienced themselves as being in the centre of two competing and changing fields – the academic setting and the clinic in healthcare organization. The contact with students and their updated knowledge base were the most positive aspects of being clinical supervisors. To create a good learning environment for the students was considered important, but lack of time in all aspects of the work created stress and dissatisfaction. Students’ hands-on skills and treatment techniques were regarded to be rather poor and there is too much emphasis on theoretical knowledge and research methods in the curriculum. The physiotherapy profession has potentials to develop in innovative fields such as health promotion and disease prevention outside the hospitals, but healthcare with its hierarchical organization is a hindrance for this development. Collaborative efforts to bridge the gap between university and clinical setting are needed.

Socio-geographical patterns of HIV-1 transmission in Kagera region, Tanzania

A population-based study on the prevalence of HIV-1 infection in the Kagera region was performed in 1987. The study was based on a multistage cluster sampling technique covering the age-group 15-54 years. The study showed considerable variation of prevalence of HIV-1 infection in the areas studied. A total of 2475 adults were studied and the overall prevalence of HIV-1 infection in the region was 9.6% with a higher prevalence in the urban area (24.2%) compared to that in the rural areas (4.9%). In the present analysis, information on individuals collected during the prevalence study has been used to characterize smaller geographical areas of several villages (wards) and to form the basis for an aggregated analysis of geographical and social patterns relevant to HIV-1 transmission in the studied areas of the region. Kagera region is a heterogeneous society with respect to, for example, religion, ethnic groups and family patterns. There was a moderately strong positive correlation between HIV-1 prevalence and frequent change of sexual partners on the ward level. In Bukoba town the prevalence varied remarkably among the wards, with the lowest prevalence in the ward having the highest social status. In the rural areas, however, the prevalence in the wards decreased considerably with increasing distance from Bukoba town. This aggregated analysis of socio-geographical patterns of HIV-1 transmission characteristics has provided us with information for prioritizing areas of HIV/AIDS intervention in the Kagera community.