Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and enhancement of well-being and sexual and reproductive health and rights in receiving countries after migration.

Being a bridge : Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study

Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis. Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women. Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

Medical students’ knowledge, attitudes, and perceptions on contraceptive use and counselling : a cross-sectional survey in Maharashtra, India

Objectives. This study aimed to investigate the knowledge, attitudes and perceptionstowards contraceptive use and counselling among medical students in Maharashtra, India. Setting. Considerable global maternal mortality and morbidity could be avoided through theuse of effective contraception. In India, contraception services are frequently unavailable or there are obstacles to obtaining modern, reversible contraceptives. Participants. A cross-sectional descriptive study using a self-administered questionnaire was conducted among 1996 medical students in their fifth year of study at 27 medical colleges in the state of Maharashtra, India. Descriptive and analytical statistics interpreted the survey instrument and significant results were presented with 95% CI. Results. Respondents expressed a desire to provide contraceptive services. A few studentshad experienced training in abortion care. There were misconceptions about moderncontraceptive methods and the impact of sex education. Attitudes towards contraceptionwere mainly positive, premarital counselling was supported and the influence of traditional values and negative provider attitudes on services was recognised. Gender, area of upbringing and type of medical college did not change the results. Conclusions. Despite mostly positive attitudes towards modern contraceptives, sex education and family planning counselling, medical students in Maharashtra have misconceptions about modern methods of contraception. Preservice and in-service training in contraceptive counselling should be implemented in order to increase women's access to evidence-based maternal healthcare services.

Enviromental health

Edited by two leading public health physicians with chapters written by 48 experts in various aspects of social injustice, this book addresses social injustice and its relationship to public health. Major sections of the book focus on how the health of specific population groups is affected by social injustice, how specific areas of public health and medical care are affected by social injustice, and what needs to be done to reduce social injustice and its impact on health. This book will be of value to a wide range of practitioners and students in health and human services, including medicine, nursing, and social services, as well as in law and other fields.

Understanding health : a determinants approach

This work introduces students to the variety of approaches to old and new public health, by placing them in the broader context of conditions and structures in society. Practical in its approach, this introductory text features a wide range of examples and case studies.

Remaking the body : explorations in the sociology of embodiment

As embodied social agents our lives are preoccupied with the production and reproduction of bodies. Making, unmaking and remaking our embodiment are ongoing activities. Eating, exercise, washing, grooming, dressing, for example, are activities in which the body engages in routine tasks of bodily management. Such activities can be seen as everyday rehabilitation. The study explores the impact of major physical impairment on embodiment, and on the processes involved in re-embodiment after catastrophic injury or disease. The experiences of the people in this study dramatically highlight the continuous, but largely taken for granted processes involved in our embodiment. Four analytical strands are interwoven throughout the study. The first strand relates to the frailty and vulnerability of the human body, characteristics which are epitomised by the bodies of the informants in this study. The second strand engages with key aspects of the context in which re-embodiment takes place, namely a context replete with crisis, danger, fear, uncertainty and risk. The third strand projects into the future in considering the ongoing project of self. The fourth strand addresses the institutional and social impediments which may confine vulnerable bodies and limit the exploration of more expansive bodies. The study is situated within the general theoretical approach of the sociology of the body. While recognizing the powerful impact of social discourse in the production of bodies, the study focuses on the critical role of embodiment in the reconstitution of self. The people in this study have experienced profound bodily change, but although this damage has disrupted, it has not annihilated their embodied selves. The people still possess and occupy their bodies. It is the obduracy of embodiment which directs the processes involved in remaking the body.

Healthy settings : past, present and future

Based on previously published work and data from elite interviews, this thesis identifies four challenges for settings-based health promotion - clarifying theory; building bridges; reconfiguring for the 21st century; and promoting a culture of evaluation, learning and development. It concludes by mapping future directions for health settings research, policy and practice.

Investigating ‘community’ through a history of responses to asbestos-related disease in an Australian industrial region

The government of the State of Victoria has been slow to acknowledge the social costs of asbestos-related diseases (ARD) in the Latrobe Valley. Despite the emphasis on ‘community’ in the discipline of public health and in public health services since the 1970s, ARD was only recognised as a community-wide health problem because of the advocacy of people directly affected by it. An historical view of responses to ARD in a community established as an appendage to the publicly owned power industry and infused with an ethic of public service, shows that contests over the definition of ‘community’ lay at the heart of these responses. It also shows that such disputes did not arise only from the reluctance of authorities to acknowledge the problems resulting from the extensive use of asbestos in power stations. The paper highlights the political nature of the notion of ‘community’ and in doing so raises questions that have implications beyond its narrow regional focus.

'I'm not a druggie, I'm just a diabetic': a qualitative study of stigma from the perspective of adults with type 1 diabetes

While health-related stigma has been the subject of considerable research in other conditions (eg, HIV/AIDS, obesity), it has not received substantial attention in diabetes. Our aim was to explore perceptions and experiences of diabetes-related stigma from the perspective of adults with type 1 diabetes mellitus (T1DM).

Modelos explicativos em saúde coletiva: abordagem biopsicossocial e auto-organização

A complexidade do processo saúde-doença tem ensejado a proposição de uma diversidade de modelos explicativos. Fazemos uma breve revisão dessas propostas, confrontando três perspectivas: o modelo oriundo da Medicina do século XIX, a lógica da História Natural da Doença e o debate epidemiológico no contexto da Medicina Social latino-americana. Tomando-se como referência teórica a ideia de causalidade circular presente na teoria da auto-organização, propomos que os fatores causais privilegiados em cada um dos modelos explicativos acima não seriam conflitantes. Uma noção-chave para se pensar o processo de autoorganização biopsicossocial é o efeito baldwiniano, que descreve uma relação dialética ou coevolutiva entre processos naturais e socioculturais.

O adolescer pós-moderno: novos paradigmas na medicina

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

BioMet®Phon: A system to monitor phonation quality in the clinics

BioMet®Phon is a software application developed for the characterization of voice in voice quality evaluation. Initially it was conceived as plain research code to estimate the glottal source from voice and obtain the biomechanical parameters of the vocal folds from the spectral density of the estimate. This code grew to what is now the Glottex®Engine package (G®E). Further demands from users in laryngology and speech therapy fields instantiated the development of a specific Graphic User Interface (GUI’s) to encapsulate user interaction with the G®E. This gave place to BioMet®Phon, an application which extracts the glottal source from voice and offers a complete parameterization of this signal, including distortion, cepstral, spectral, biomechanical, time domain, contact and tremor parameters. The semantic capabilities of biomechanical parameters are discussed. Study cases from its application to the field of laryngology and speech therapy are given and discussed. Validation results in voice pathology detection are also presented. Applications to laryngology, speech therapy, and monitoring neurological deterioration in the elder are proposed.

La dimensión sociosanitaria del hambre: el testimonio de José María Bengoa Lecanda (1913-2010)

Se analizan algunos de los elementos conceptuales con los que abordó el profesor José María Bengoa Lecanda (1913-2010) la complejidad de factores que están asociados al hambre. Se estudian sus reflexiones sobre la interrelación entre desnutrición, enfermedad y pobreza, así como sus propuestas para romper dicho círculo. Desde los presupuestos de la medicina social, el doctor Bengoa articuló un discurso donde las desigualdades sociales aparecen como uno de los determinantes clave que explican las diferencias socio-sanitarias entre regiones, poblaciones e individuos. El cambio social, con la educación como principal argumento, y la mejora de las condiciones de vida de la población, eran reivindicadas por el doctor Bengoa como las estrategias más adecuadas para abordar la malnutrición en cualquiera de sus manifestaciones.