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Masculinity studies are fairly new and young churchgoers are an under-researched group in the current Congolese church context. In response to this knowledge gap, this paper attempts to explore discourses of young churchgoers from deprived areas of Kinshasa regarding masculinity and sexuality in the era of HIV. A series of 16 semi-structured interviews were conducted with unmarried young churchgoers from the Salvation Army, Protestant and Revival churches. The interviews were tape-recorded, transcribed verbatim and analysed using discourse analysis. Five main discourses emerged: ‘we are aware of the church message on sex’, ‘young men need sex’, ‘young women need money’, ‘to use or not to use condoms’ and ‘we trust in the church message’. Although all informants knew and heard church messages against premarital sex, many of them were sexually active. The perception was that young men were engaged in sexual activities with multiple partners as a result of sexual motivations surrounding masculinity and sexual potency, while young women sought multiple partners through transactional and intergenerational sex for economic reasons. These sexual practices of young people conflicted with church messages on sexual abstinence and faithfulness. However, a small number of participants challenged current gender norms and suggested alternative ways of being a man or a woman. To elucidate these alternatives, we suggest that church youths and church leaders might take concrete actions to deconstruct misconceptions about being men. In this way, they can possibly enhance a frank and fruitful dialogue on sex, sexuality and gender to promote positive masculinities and constructive partnerships to prevent HIV.Keywords: masculinity, sexuality, young churchgoers, HIV prevention, gender equality, DR CongoDans le contexte actuel des e´glises Congolaises, les e´tudes relatives a` la masculinite´ sont presque re´centes et les jeunes chre´tiens constituent un groupe d’individus qui ne font pas l’objet des recherches scientifiques approfondies. En re´ponse a` cette insuffisance de connaissances dans le contexte a` VIH, le pre´sent article tente d’explorer les discours relatifs a` la masculinite´ et a` la sexualite´ des jeunes chre´tiens issus des quartiers de´favorise´s de Kinshasa. Une se´rie de 16 interviews semi-structure´es ont e´te´ mene´s aupre`s des jeunes chre´tiens ce´libataires appartenant a` l’Arme´e du Salut, aux e´glises Protestantes et a` celles du Re´veil du Congo. Les interviews ont e´te´ enregistre´es et analyse´es en utilisant la me´thode du discours. Cinq discours ont e´merge´ notamment: « Nous connaissons le message des e´glises au sujet du sexe », « les garc¸ons ont besoin des rapports sexuels », « les filles ont besoin d’argent », « faudrait-il utiliser ou ne pas utiliser les condoms » et « nous croyons dans le message des e´glises ». Alors que tous les participants connaissaient le message des e´glises qui interdisent les rapports sexuels pre´maritaux, beaucoup d’entre eux e´taient de´ja` sexuellement actifs. Les garc¸ons ont e´te´ perc¸us comme des personnes qui ont des rapports sexuels avec plusieurs partenaires concomitants pour prouver leur masculinite´ et leur puissance sexuelle. Les filles chercheraient a` avoir des rapports sexuels mercantiles et interge´ne´rationnels avec des partenaires multiples a` des fins e´conomiques. Ces pratiques sexuelles des jeunes s’opposent aux discours des e´glises qui promeuvent l’abstinence sexuelle et la fide´lite´. Cependant, quelques participants ont remis en cause les normes courantes du genre et ont sugge´re´ des alternatives en ce qui concerne l’identite´ des hommes et des femmes. Pour les e´lucider, nous proposons que les jeunes chre´tiens et les leaders des e´glises puissent mener des actions concre`tes dans le but de de´construire les conceptions errone´es de ce que veut dire eˆtre homme. Ce faisant, ils peuvent probablement maximiser les chances d’un dialogue franc et productif en ce qui concerne le sexe, la sexualite´ et le genre afin de promouvoir la masculinite´ positive et le partenariat constructif, susceptibles de pre´venir l’infection a` VIH.Mots cle´s: masculinite´, sexualite´, jeunes chre´tiens, pre´vention du VIH, e´galite´ du genre, RD Congo

The study explores similarities and differences in motives, experiences and gender equality between parents regarding paid parental leave. Interviews were made with 16 heterosexual couples, drawn from 4 Swedish municipalities: 2 in each of the 2 counties with the widest difference in fathers’ paid parental leave usage. Extensive campaigns encouraging fathers to take paid parental in the northern county during the 1990s may have contributed to this difference. Data was drawn from interviews in 2008; the analysis was inspired by grounded theory. Fathers tend to have an increased child orientation, relating to change in hegemonic masculinity, and gender equality is more pronounced in child care than in household work. Lack of male networks and traditional division of household labor are more common in the low take-up municipalities.

Technical developments in paediatric cardiology over the last few decades have increased expectations on professionals, demanding of them more emotional competence and communicative ability. The aim of this study was to examine the approach of paediatric cardiologists in informing and communicating with the family of the patient.MethodA qualitative interview method was first tested in a pilot study with two paediatric cardiologists. There were nine subsequent semi-structured interviews that were carried out with paediatric cardiologists. A researcher performed all the interviews, which were taped, transcribed, decoded, and analysed.ResultsAmong paediatric cardiologists, how to break bad news to the family is an important concern, evident in findings regarding the significance of trust and confidence, the use of different emotional positions, and a common ambition to achieve skills to handle the situation. There is a need for reflection, education, and sharing of experiences. The cardiologists desire further development of teamwork and of skills in medical students and residents for delivering bad news.ConclusionsDoctors are expected to cope with the complexities of diagnoses and decisions, while simultaneously being sensitive to the feelings of the parents, aware of their own emotions, and able to keep it all under control in the context of breaking the bad news to the parents and keeping them informed. These conflicting demands create a need to expand the professional role of the doctor by including more training in emotional competence and communicative ability, beginning in medical school and continuing through consultancy.

Background: While there exists an extensive amount of research regarding the medical aspects of abortion, there is a great lack of studies investigating staff's views and experiences of working in ...

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.

Social capital is believed to improve the capacity of communities to work together for solving collective health problems. The present study was conducted in a community in northern Sweden where ...

This article seeks to explore and understand the life situations of sibling caretakers in poor areas in Leon, Nicaragua. The every day lives for caretakers were studied through observations and interviews with children, informants and parents. The children themselves were satisfied and proud to be trusted as caretakers and felt useful in contributing to their families' livelihood. However, in a life course perspective the caretaking role implies a narrowing of life options. Early on they seem to acquire essential life skills but as they grow older many are at risk of falling behind due to their marginalised situation and lack of basic education.

To investigate factors influencing rural and urban adolescents' food perceptions during a time of nutritional transition in Cameroon, Africa.Qualitative in-depth interviews.Yaoundé urban and Bandja rural areas.Fifteen adolescents 12 to 15 years old purposely selected from schools in urban and rural areas.Interviews were audiotaped, transcribed, and analyzed using Grounded Theory method.Factors influencing adolescents' food perceptions from the rural area were "to live" "health" and "poverty." Among adolescents from the urban poor area, "health," "beauty," and "not enough money" were factors. Among adolescents from the urban rich area, "pleasure" and "beauty" were factors. Rural girls liked "to be fat," whereas girls from the urban poor wanted "to be a little bit fat," and girls from the urban rich wanted "to be normal."Food behavior is changing from a diet composed of traditional food in rural areas to a more westernized diet in urban areas. The relationship between socioeconomic factors and nutrition needs to be examined with a sufficiently large number of adolescents to investigate these factors in a quantitative survey. Healthful local food should be available at home and from vendors. Nutrition education about food and diet-related diseases is needed in school.

Qualitative research interviews were conducted with professionals working with men inclined to violence. The aim was to explore professional discourses about intimate partner violence with special reference to gender and to the partner's period of pregnancy. Three major findings are presented. Firstly, the professionals had a rather fixed understanding of opposite gender positions as well as a split picture of the violent man as both weak and tough, thus violence may result from poor self-confidence combined with a desire for power and control and the fear of losing it. Secondly, the pregnancy was identified as a stressor that, together with other circumstances, could trigger violence. Thirdly, the topic of pregnancy and other relational topics were typically omitted from the conversations with men inclined to violence. This study discusses inconsistencies that might counteract the professionals' intentions of building an alternative masculinity in men inclined to violence.

Bun-baking mums and subverters: The agency of network participants in a Rural Swedish county

In Western countries about 10 - 15% of those convicted of homicide suffer from a psychotic disorder. Victims are most often from the offender's immediate network, such as family members and frien ...

Individuals with schizophrenia have an increased risk of committing a violent crime, although their contribution to the overall criminality in society is small. In this qualitative study we have interviewed parents of adult sons, diagnosed with schizophrenia and who recently had been referred to forensic psychiatric treatment due to a violent crime, with an aim to explore the parents' experiences and emotional reactions. Four events, or status passages, emerged as crucial and common for all parents. These were the onset of the mental disorder, the diagnosis of schizophrenia, the violent behaviour/criminality and the recent referral to forensic psychiatric treatment. Every passage evoked strong emotional reactions such as guilt, fear, disappointment, anger and relief, which in return led to different actions taken. Unawareness of the character and severity of their sons' mental illness and the type of violent criminality they had committed were common and complicated contacts both between the parents and their sons, and also between family members and official authorities. The findings emphasize that psychiatric health care professionals must take the initiative and responsibility for information, education and support of family members.

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 super ...

In a town in northern Sweden, 3.3% of the 15-year-old adolescents were vegans in 1996. This study describes the process of becoming a vegan among adolescents and interprets the informants' descriptions by constructing categories, which later on were related to relevant theories. Group interviews were conducted with three vegans and in-depth interviews were performed with three other vegan adolescents. The methodology was grounded theory and the adolescents' perceptions were analyzed in the framework of symbolic interactionism. Three types of vegans were identified: the Conformed Vegan, the Organized Vegan, and the Individualistic Vegan. The decision to become a vegan was reported to be influenced by perceived internal reasons such as ethics, health, distaste for meat, and preference for vegetarian food. In addition, friends, family, school, media, and music influenced the decision to become a vegan. The perceived consequences of becoming a vegan were positive as well as negative and differed between the three types of vegans. Veganism as a new type of status passage with specific characteristics was illustrated. No modifications or new properties were discovered that add to the theory of status passage which indicates that the general model is applicable also in a vegan context.

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 one's 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 ...

Faced with the problems of HIV/AIDS, people have to find ways to communicate around them. The aim of this paper is to mirror changes over time in the Kagera people's social cognition regarding HIV/AIDS, using their own language as a tracer of this process. Focus group discussions and personal and group interviews conducted during 1992 to 1995 in urban Bukoba, Kagera, constitute the basis for an analysis of metaphorical expressions in use since 1985. Pronounced uncertainty is later transformed into a deeper understanding of the pandemic and an increased disposition to cope with the situation. Knowledge about the socio-linguistic expressions mapped out in this article can be of help when developing guidelines on how to communicate about interventions.

To describe and analyse physicians' experiences of working with sick-listing and vocational rehabilitation, their perceptions of their co-actors and the interaction they participate in.Thematic interviews with 14 physicians in Västerbotten County, northern Sweden. The physicians were active in primary or occupational health care, or as hospital doctors. The interviews were conducted during the autumn of 1996. The interviews were tape recorded and analysed according to Grounded theory.Feelings of isolation and diminished control, lack of time and increased demands are all seen as obstacles for doing an optimal job with sick-listing and rehabilitation. Other obstacles are insufficient knowledge regarding the labour market and the social insurance legislation. Interaction between primary and in-patient care does not function satisfactorily. The doctors believe in their patients and a majority of the doctors feel that the patients' own understanding of/need for sick-listing guides the doctor in his or her position regarding sick-listing. To facilitate return to work, the doctors encourage part-time sick-listing.The interviews show that the physicians experience a growing discrepancy between ideal and reality. They want to be able to act as "team players", but experience increasing demands due to the increased number of patients who are sicker than before. The doctors experience that decision latitude has diminished and this has been followed by less time for patients.

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 quest ...

Summary Six neurologically impaired people invoked reflex locomotion described by the Czechoslovakian neurologist Vaclav Vojta daily for four months. The purpose of the study was to find: ▪ How the trainees experienced a period of autonomous training based on reflex locomotion as described by Vojta. ▪ If the trainees attained results they ascribed to the training. ▪ If they considered the time and effort spent worth while. After a training period of four months, interviews with the trainees were recorded on tape. The interviews were transcribed word for word, interpreted, coded and categorised according to the grounded theory method. The following categories were established: 1. Fascination with the body. 2. Functional results. 3. Independence. 4. Hard to explain. Conclusions The daily training sessions were considered interesting and rewarding, and the training period was well worth the time and effort spent. The trainees experienced improvements in relaxation, breathing, strength, mobility, balance, walking ability and fine motor function. They found it important to be able to train on their own. They found it hard to explain to others what they were actually doing, and what happened in their bodies during training sessions.

Chronic pelvic pain (CPP) is a frequent and challenging diagnosis within gynaecology. A new kind of psychosomatic physiotherapeutic treatment is delineated and tested with patients where persistent CPP has been the dominating symptom. The treatment modality is described as ?triangle treatment?, where the particular aim is an active participation of a responsible patient. The study describes physiotherapy within the framework of body awareness therapy with five women. During 20 sessions physiotherapy was conducted in close collaboration with a female gynaecologist. Both qualitative (participant observation, field notes, narratives) and quantitative (Body Awareness Scale and sick-leave data) research approaches were used. One purpose of the study was to focus on the working methods of the physiotherapist and throw light on management and interventions in short-term therapy. A focus group of experts was applied for analysing and interpreting the process and treatment outcome. The manner of working with the p...

Background: Public health policy is often concerned with the conflicting values emanating from the individually formulated ethics for curative care and more collectively oriented ethics. In this st ...

Career choices are still strongly gendered in health care professions. In Sweden, physiotherapy is a middle-class women's profession that nowadays also attracts men. Career strategies and professio ...

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.

Child sexual abuse (CSA) and its consequences have become highlighted and the aftermath of the trauma creates severe physical and psychological impairment. The aim of this study was to improve understanding about CSA and to describe and consider a new physiotherapeutic treatment modality led by a physiotherapist and a gynaecologist, where psychological, medical and pedagogical frameworks interweave.

This paper aims to describe the nature of pediatric cardiology teams (PCTs) based in Sweden through the use of a mixed methods approach. Questionnaires examining issues about the organization/ways of working, functions/tasks and attitudes were answered by 30 PCTs. Focus group interviews were conducted with six PCTs, selected purposefully by size and location, and information on experiences and attitudes on interprofessional teamwork was explored in depth. Results from the quantitative indicated that in 17 of the teams, where the nurse acted as the central coordinator, there was a positive attitude to the value of teamwork. In the interviews, different problems and needs of improvements were mentioned regarding structure, leadership, presence of physicians in the team as well as the team's mandate. All of the participants, however, agreed that interprofessional teams were required to manage the complexity of the children's care. In conclusion, this study suggests that PCTs need further support to develop structure, leadership and coordination of resources to function in a more effective manner. National plans or recommendations that mandate the organization and working methods of PCTs would be helpful for the ongoing development of PCTs in Sweden.

Background: Few studies have investigated the experiences of living with pelvic girdle pain (PGP) and its impact on pregnant women's lives. To address this gap in knowledge, this study investigates the experiences of women living with PGP during pregnancy. Methods: A purposive sample, of nine pregnant women with diagnosed PGP, were interviewed about their experiences. Interviews were recorded, transcribed to text and analysed using a Grounded Theory approach. Results: The core category that evolved from the analysis of experiences of living with PGP in pregnancy was "struggling with daily life and enduring pain". Three properties addressing the actions caused by PGP were identified: i) grasping the incomprehensible; ii) balancing support and dependence and iii) managing the losses. These experiences expressed by the informants constitute a basis for the consequences of PGP: iv) enduring pain; v) being a burden; vi) calculating the risks and the experiences of the informants as vii) abdicating as a mother. Finally, the informants' experiences of the consequences regarding the current pregnancy and any potential future pregnancies is presented in viii) paying the price and reconsidering the future. A conceptual model of the actions and consequences experienced by the pregnant informants living with PGP is presented. Conclusions: PGP during pregnancy greatly affects the informant's experiences of her pregnancy, her roles in relationships, and her social context. For informants with young children, PGP negatively affects the role of being a mother, a situation that further strains the experience. As the constant pain disturbs most aspects of the lives of the informants, improvements in the treatment of PGP is of importance as to increase the quality of life. This pregnancy-related condition is prevalent and must be considered a major public health concern during pregnancy.

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.

This study is part of a collaborative study of HIV infection and AIDS which was launched in 1987 in the Kagera region, Tanzania. This region is characterized as one of the areas most affected by the AIDS epidemic. In order to describe and analyse the epidemiology of HIV infection in the area and also to contribute to the intervention process, a long-term population-based project was initiated. The study was launched in January 1989 as an in-depth behavioural study to describe the experiences of the local people of the AIDS epidemic in the region. The specific objectives were to determine the people's attitudes, perceptions, responses and norms relevant to AIDS-related problems. The data were collected through tape recorded interviews, focus group discussions and direct observations of risk behaviour. The interviews were conducted in 10 villages, in urban and rural Bukoba as well as in Muleba districts. In each village five households were selected and visited once a week for about 6 months. The focus group discussions were held mainly with young males, females, married women and married men, elders and religious leaders, government and party leaders, and other key informants. Perceptions, attitudes and patterns of behaviour among the local people are described in the context of the HIV transmission in the area. The descriptions give answers to questions like: How do people perceive and interpret AIDS? How do they react to AIDS? How do they judge causes and risks? What are the attitudes to people with AIDS and those suspected to have AIDS? What are the implications of these values in affected communities?

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.

This article, based on a study of planners in two Swedish municipalities, looks at what planners think is ethical and why. It also examines attitudes of planners towards five substantive issues: the environment, mass transit, low income and minority groups, citizen participation and private development. The design of the study closely follows a similar study of American planners. The results of the two studies are compared. Swedish planners are not inclined favourably towards using political tactics. They are most committed to environment and mass transit and mildly negative about private development. The article also examines possible determinants of ethical views and attitudes. Finally, the article includes a discussion of some implications for planning, including increased pragmatism, flexibility and professional bias.

This article deals with discourses of intimate partner violence and is based on interviews with professionals who meet violent men. The professionals emphasized the importance of men taking unreserved responsibility for their violent behavior. Intimate partner violence was viewed not only as “power and control” but as the result of complex situations and interplays. The discourses presented an ambivalent explanation of violent men as both ordinary and deviant. They were understood as having a strained background, but to be rather ordinary, often functioning well at work and in society. Yet, they have nonstandard views of women, act deviant in their communication and interplay with others, and cannot cope with certain situations in intimate relationships. Based on the interviews, men inclined to partner violence may be generalized as those who: attack immediately, explode unexpectedly, or ultimately become aggressive. The discussion challenges unreflected discourses as means for change when counteracting violence.

Background Public health interventions are directed towards social systems and it is difficult to foresee all consequences. While targeted outcomes may be positively influenced, interventions may at worst be counterproductive. To include self-reported health in an evaluation is one way of addressing possible side-effects. This study is based on a 10 year follow-up of a cardiovascular community intervention programme in northern Sweden. Methods Both quantitative and qualitative approaches were used to address the interaction between changes in self-rated health and risk factor load. Qualitative interviews contributed to an analysis of how the outcome was influenced by health related norms and attitudes. Results Most people maintained a low risk factor load and a positive perception of health. However, more people improved than deteriorated their situation regarding both perceived health and risk factor load. "Ideal types" of attitude sets towards the programme, generated from the interviews, helped to interpret an observed polarisation for men and the lower educated. Conclusion Our observation of a socially and gender differentiated intervention effect suggests a need to test new intervention strategies. Future community interventions may benefit from targeting more directly those who in combination with high risk factor load perceive their health as bad and to make all participants feel seen, confirmed and involved.

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 people's 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.

Background There is a debate on whether preventive home visits to older people have any impact. This study was undertaken to investigate whether preventive home visits by professional health workers to older persons can postpone mortality in a Swedish context. Method A controlled trial in a small community in the north of Sweden. Participants are healthy pensioners aged 75 years and over. 196 pensioners were selected as the intervention group and 346 as the control group. The intervention, two visits per year, lasted two years. Results During the intervention, mortality was 27 per 1000 in the intervention group and 48 per 1000 in the control group. The incidence rate ratio for the control group IR2000–2001 was 1,79 (95%CI = 0,94–3,40). Analysing the data with an "on treatment approach" gave a significant result, 2,31 (95%CI = 1,07–5,02) After the trial the difference between the groups disappeared. Conclusion Preventive home visits in a healthy older population can postpone mortality in a Swedish context if they are carried out by professional health-workers in a structured way. When the home visit programme ended the effect on mortality disappeared. These findings are dependent on contextual factors that make it difficult to form general policy recommendations.

Adolescent girls are the most frequent suicide attempters worldwide. However, there is little knowledge about pathways leading to suicidal behaviour among young people, in particular in low-income countries. This study explores the motives and processes related to suicidal behaviour among young girls in Nicaragua. Individual in-depth interviews were conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. The audio-taped interviews lasted 2-4 h and were transcribed, translated into English and coded for content. Grounded theory and content analysis were used to construct a theory of the mechanisms behind their suicidal behaviour. A tentative model exploring pathways to suicidal behaviour is described with four main categories: structuring conditions, triggering events, emotions and actions taken. The model illustrates the dialectic interplay between structure and actions taken. Actions taken were categorized as problem solving or various forms of escape where failure with either of these strategies resulted in a suicide attempt. Dysfunctional families, absent fathers and lack of integration into society were some of the structuring conditions that lead to emotional distress. Abuse, deaths in the family, break-up with boyfriends or suicide among friends acted as triggering events. A striking finding was the obvious narrative competence of the girls. Our findings indicate that suicide prevention programmes for young people must offer support from professionals, independent of their family and social networks. Institutions in the community in contact with young people with suicidal behaviour must develop communicative skills to offer a trusting environment mobilising the resources that young people have.

Purpose Our analysis of data collected in 1995 showed that 12-year-olds' self-esteem was associated with demographic/socioeconomic background variables and lifestyle variables and with the quality of the variable "oral health behavior." The study reported here was conducted to identify changes at ages 14 (in 1997) and 16 years (in 1999) in the strength of the association between self-esteem and "oral health behavior." Methods In 1995, 3370 12-year-olds answered questions about their demographic/socioeconomic background, personal attitudes/resources, and lifestyle, including "oral health behavior." Two and four years later the same study group (3105 14-year-olds in 1997 and 2836 16-year-olds in 1999) answered similar questionnaires with redefinition of "oral health behavior" as "tooth-brushing." Multivariate and logistic regression analyses were conducted using "self-esteem" and "oral health behavior/tooth-brushing" as the dependent variables. The association was also analyzed between "oral health behavior/tooth-brushing" and components of "self-esteem" (two cognitive: "How do you think your teacher would rate your school work?," "How do you think you are performing in school?," and one emotional: "How content are you with your body/looks?"). Results The association between "self-esteem" and "oral health behavior/tooth-brushing" disappeared during adolescence, but whereas the influence of cognitive components decreased, the influence of the emotional component increased. Overall, the strongest predictor of poor oral health behavior (tooth-brushing less than twice per day) was male gender. Conclusion The motives for good oral health behavior changed from age 12 to age 14 years.

This paper is a follow-up of earlier findings by the Kagera AIDS Research Project (KARP), which documented declining trends in the prevalence and incidence of HIV infection in the Kagera region of Tanzania. The paper examines socio-cultural and sexual behavioral changes as possible determinants of the observed declining trends in Bukoba, the largest urban area of the region. The study used in-depth interviews, focus group discussions, field observations and ethnographic assessments to collect the required data. The findings suggest that since the initial years of the epidemic there have been significant changes in sexual behaviors, norms, values, and customs that are considered high-risk for HIV transmission. The findings show an increase in condom use, abstinence, zero grazing (sticking to one sexual partner) and uptake of voluntary HIV testing while traditional practices such as polygamy, widow inheritance, excessive alcohol consumption, and sexual networking are declining. We suggest that these changes are partly a result of the severity of the epidemic itself in the study area, and interventions that have been carried out in this area since 1987. The major interventions have included health education, the distribution of condoms, AIDS education in schools, voluntary HIV counseling and testing. These are encouraging findings that give hope and we believe that other places within Tanzania and other countries experiencing a severe AIDS crisis have much to learn from this experience. However, changes in norms and behavior are vulnerable; people in Kagera are still at risk and there is a need for continued intervention together with monitoring of the direction of the epidemic.

To examine how self-rated ill-health interacts with biomedical stroke risk factors in predicting stroke and to explore differences between men and women and educational groups.An incident case-referent study where the study subjects had participated in a prior health survey.Nested within the Västerbotten Intervention Program (VIP) and the Northern Sweden MONICA cohorts.The 473 stroke cases had two referents per case, matched for age, sex and residence, from the same study cohorts.Self-rated ill-health independently increased the risk of stroke, specifically for men. The interaction effect between self-rated health and biomedical risk factor load was greater for men than for women. The attributable proportion due to interaction between having a risk factor load of 2+ and self-rated ill-health was 42% for men and 15% for women. Better-educated individuals with self-rated ill-health and two or more of the biomedical risk factors had a higher risk of stroke than the less educated. Calculations of the respective contribution to the stroke cases of self-rated health, hypertension and smoking showed that self-rated ill-health had a role in 20% of the cases and could alone explain more than one-third of the cases among those who rated their health as bad, more so for men than for women.The results underscore the importance of including both a gender and a social perspective in discussing the role of self-rated health as a predictor of disease outcome. Physicians must be more gender sensitive when discussing their patient's own evaluation of health in relation to biomedical risk factors.

Giving birth in a foreign country implies going through a life event with little or no access to your own traditions and social support. The aim of this study was to study the childbirth experiences of Somali women and men in Sweden.Qualitative. Nine women and seven men were interviewed. Data collection was characterised by an openness to new ideas during the interview and the interviews were analysed according to the grounded theory technique.The meeting of Somalis with Swedish antenatal and delivery care was a multicultural event. It revealed social, medical, cultural and gender factors advocating space in the arena of childbirth. The Somalis constituted a homogeneous group with regard to their cultural belonging and motives for exile. The subjects were heterogeneous in that they represented a great variety in social and demographic background as well as in experiences, feelings and modes of expression. One striking finding was the Somali man's dramatic entrance into childbirth, which seemed to have a strong impact on the Somali woman's well-being during delivery. The study showed difficulties in getting used to the Swedish model of parenthood and in finding new role divisions in the couple relationship. Some of the subjects had experienced a strengthening of their marriage and an increased understanding of each other. Others commented that various aspects of traditional womanhood and manhood were lost as a result of the unfamiliar gender structures in Sweden.The Somalis' experiences of childbirth in Sweden can be understood by using the theoretical concept of gender, rather than culture. Our own and other studies show that women and men may have different frames of reference in childbirth, where the women mainly focus on biological circumstances and the men on the social and cultural aspects of birth. The Somali couple were found to be vulnerably positioned, with the professionals having the important role of supporting and empowering Somali parents.

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 one's 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.

In order to deepen the understanding of risk factors associated with HIV infection in the Kagera region of Tanzania and to investigate the potentials of communicating with the people in planning for interventions, two studies were performed in the districts of Bukoba Urban, Bukoba Rural and Muleba in 1989. The HIV prevalence of these areas ranged between 4.5% and 24.2% according to the prevalence study performed earlier in 1987. The studies involved the community in ward meetings on the one hand, and previously studied individuals on the other hand. The studies aimed both at conveying to the people the results of a previously performed study and at collecting new data using a combination of quantitative and qualitative methods in order to better understand the associated risk factors, perceived or real, and what suggestions the community could offer for reducing HIV transmission in the region. From the initial study, awareness about AIDS was found to be universal. Change of sexual partners and infection with syphilis were found to be the major risk factors for HIV-I infection. From the ward meetings people suggested a variety of solutions for interventions which we have categorized as either "hard" or "soft". The "hard" solutions involved suggestions such as isolation, imprisonment, castration and killing of AIDS victims, while the "soft" solutions involved sympathetic handling of the sick and educating the people about the modes of transmission and how best to prevent infection. There was a greater tendency for the low HIV prevalence rural communities to suggest the "hard" solutions than the high HIV prevalence urban ones which tended to suggest the "soft" solutions. However, with the changing dynamics of HIV infection in the region towards higher HIV prevalence in rural areas, it is likely that the "soft" solutions will gain acceptance and become adopted for interventions throughout the region. The information obtained from these studies has provided lessons that can be used for rational counselling as well as for guiding the implementation of IEC activities geared at interventions. It is also suggested that there should be further research into new strategies or their combinations which could be crucial in prevention such as those of community participation, empowerment of women and solidarity in AIDS intervention work.

Background: The productive capacity of retired people is usually not valued. However, some retirees produce much more than we might expect. This diary-based study identifies the activities of older people, and suggests some value mechanisms. One question raised is whether it is possible to scale up this diary study into a larger representative study. Methods: Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data. Results: Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used. Conclusions: An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life. Originally included in thesis in manuscript form with title: "Measuring the value of old people’s production: ideas based on diaries".

A comprehensive community-based programme for prevention of cardiovascular diseases (CVD) and diabetes was established in 1985 in a small municipality in northern Sweden. A cross-sectional survey to the general public was performed and semi-structured open-ended interviews were taken of actors at different levels. Notes from official records were also included in the study. The aim was to describe and discuss some factors that promote or constrain community participation in health programmes. The results generally confirmed that the right of definition concerning the health programme mainly remained with the health professionals. Community participation was mainly defined by the actors based on the medical and health planning approach and, thereby, as a means to transform health policy plans into reality by transmitting health knowledge and increasing consciousness among the citizens of the need for changing lifestyles. However, participation as a means of identifying problems and demonstrating power relationships and as elements in promoting local democracy was hardly represented among the actors at all. Overall, the CVD health programme was characterized by consensus between the actors. Despite this, debates and arguments about interpretations, social interests, personal conflicts and ideological constraints were observed. However, a majority of the public wanted the CVD preventive programme to continue.

Epidemiological studies have demonstrated an excess mortality caused by cancer and cardiovascular diseases among the workers employed at a smeltery in Northern Sweden. The aim of this paper is to elucidate the attitudes of the smelter workers to their working environment and to their health and to examine how these attitudes have changed over time. Moreover, in the analysis, we have sought explanations in the norm systems surrounding the workers and the changes in these. Interviews were carried out with 40 employees and previous employees at the smeltery. The interviewees were strategically chosen to reflect the development process of these norms within the company from its inception in the 1920s and onwards. We have attempted to describe the differences in behavioural patterns and norm expectations which characterize different periods in the history of the smeltery using four ideal type categories; the heroic man, the working-class man, the independent man and the anomic man. The workers' reactions to the norm systems have shifted gradually from conformity to indifference. The degree of individuality during these decades could be shown as a u-shaped curve.

The past few years' debate on the devolution of decision making in Swedish urban communities has increased the importance of examining values among planners and the eventual subjects of the plans. This article presents two case studies which show that the discrepancy in values not only complicates the planning process but also raises the need for further research in developing new techniques in delineating individual values.

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