Contraception in Namibia : usage, methods and the impact of education

Användningen av preventivmedel har blivit en allt viktigare fraga i utvecklingsländerna idag, speciellt i Namibia dar fruktsamheten och HIV-prevalensen är höga. Kondomen är det enda allmänt tillgängliga preventivmedlet som skyddar mot könssjukdomar, medan ocksä injektioner, p-piller och andrà metoder kan användas för att förhindra graviditet. Användningen av preventivmedel har upptäckts korrelera med vissa sociodemografiska faktorer, bland annat utbildningsnivå och förmögenhet. Malet med denna undersökning var att studera användningen av preventivmedel, avsikter att använda preventivmedel samt kunskap om HIV/AIDS och andra könssjukdomar bland kvinnor i Namibia. Detta gjordes frän ett historiskt perspektiv genom att studerà användningsmönster frän 1990 till slutet av 2000-talet. Dessutom undersöktes sociodemografiska faktorers, speciellt utbildningens, inverkan på användningen av preventivmedel, likasä sambandet mellan skolningsnivå och preventivmedelsanvändning pä regionnivå. Undersökningen gjordes utgäende frän statistiska Namibia Demographic and Health Survey -material samlade 1992, 2000 och 2006-2007. Prevalenser och användningen av specifika metoder studerades skilt för olika bakgrundsvariabler 1992, 2000 och 2006-2007, och enligt utbildningsnivå och region är 2006-2007. Utbildning mattes skilt pä individ- och aggregatnivå. Sambandet mellan preventivmedelsanvändning och utbildning undersöktes med hjälp av logistisk regression, i vilken sociodemografiska bakgrundsfaktorer kontrollerades i sex modeller. Resultaten visade att användningen av preventivmedel har fördubblats sedan början av 1990-talet. Skillnader mellan kvinnor med olika utbildningsnivåer existerade redan i början av 1990-talet, likaså mellan olika yrkesgrupper. Undersökningen visade att högre utbildning ökar på reventivmedelsanvändningen, också då sociodemografisk bakgrundfaktorer, även utbildning och användning av preventivmedel på aggregatnivå, kontrollerades. Undersökningen antyder att utbildning på aggregatnivå inte ensam påverkar användningen av preventivmedel hos en individ. De sistnämnda resultaten var dock inte statistiskt signifikanta och kan inte generaliseras över namibiska kvinnor i allmänhet.

Functional outcome and health-related quality of life after traumatic brain injury in the framework of the International Classification of Functioning, Disability and Health (ICF)

Traumatic brain injury (TBI) affects people of all ages and is a cause of long-term disability. In recent years, the epidemiological patterns of TBI have been changing. TBI is a heterogeneous disorder with different forms of presentation and highly individual outcome regarding functioning and health-related quality of life (HRQoL). The meaning of disability differs from person to person based on the individual s personality, value system, past experience, and the purpose he or she sees in life. Understanding of all these viewpoints is needed in comprehensive rehabilitation. This study examines the epidemiology of TBI in Finland as well as functioning and HRQoL after TBI, and compares the subjective and objective assessments of outcome. The frame of reference is the International Classification of Functioning, Disability and Health (ICF). The subjects of Study I represent the population of Finnish TBI patients who experienced their first TBI between 1991 and 2005. The 55 Finnish subjects of Studies II and IV participated in the first wave of the international Quality of life after brain injury (QOLIBRI) validation study. The 795 subjects from six language areas of Study III formed the second wave of the QOLIBRI validation study. The average annual incidence of Finnish hospitalised TBI patients during the years 1991-2005 was 101:100 000 in patients who had TBI as the primary diagnosis and did not have a previous TBI in their medical history. Males (59.2%) were at considerably higher risk of getting a TBI than females. The most common external cause of the injury was falls in all age groups. The number of TBI patients ≥ 70 years of age increased by 59.4% while the number of inhabitants older than 70 years increased by 30.3% in the population of Finland during the same time period. The functioning of a sample of 55 persons with TBI was assessed by extracting information from the patients medical documents using the ICF checklist. The most common problems were found in the ICF components of Body Functions (b) and Activities and Participation (d). HRQoL was assessed with the QOLIBRI which showed the highest level of satisfaction on the Emotions, Physical Problems and Daily Life and Autonomy scales. The highest scores were obtained by the youngest participants and participants living independently without the help of other people, and by people who were working. The relationship between the functional outcome and HRQoL was not straightforward. The procedure of linking the QOLIBRI and the GOSE to the ICF showed that these two outcome measures cover the relevant domains of TBI patients functioning. The QOLIBRI provides the patients subjective view, while the GOSE summarises the objective elements of functioning. Our study indicates that there are certain domains of functioning that are not traditionally sufficiently documented but are important for the HRQoL of persons with TBI. This was the finding especially in the domains of interpersonal relationships, social and leisure activities, self, and the environment. Rehabilitation aims to optimize functioning and to minimize the experience of disability among people with health conditions, and it needs to be based on a comprehensive understanding of human functioning. As an integrative model, the ICF may serve as a frame of reference in achieving such an understanding.

Independent and mediating organizational commitment effects of trust in leadership on employees' job satisfaction and : a study within social and health care sector

The purpose of this study was to examine whether trust in supervisor and trust in senior management enhance employees' job satisfaction and organizational commitment, and whether trust mediates the relationship between perceived justice and these outcomes. Trust in supervisor was expected to mediate the effects of distributive justice and interactional justice, and trust in senior management was expected to mediate the effects of procedural justice. Theoretical background of the study is based on the framework for trust in leadership developed by Dirks and Ferrin (2002). According to the framework, perceived fairness of leaders' actions helps employees to draw inferences about the basis of the relationship and about leaders' characters. This allows trust formation. Reciprocation of care and concern in the relationship and confidence in leaders' characters are likely to enhance employees' job satisfaction and organizational commitment. This study was conducted with cross-sectional data (A/ = 960) of employees from social and health care sector. Hypotheses were studied using correlation analysis and several hierarchical regression analyses. Significances of the mediations were assessed using the Sobel test. Results partially supported the hypotheses. Trust in leadership was positively related to job satisfaction and organizational commitment. Trust in senior management mediated the relationship between procedural justice and the outcomes. Some support was also found for the mediating effect of trust in supervisor in the relationship between distributive justice and organizational commitment. Due to high correlation between trust in supervisor anil interactional justice, it wasn't possible to study the mediating e fleet of trust in supervisor in the relationship between interactional justice and the outcomes. Against expectations, results indicated that trust in senior management had a mediating effect in the relationship between distributive justice and organizational commitment, and in the relationship between interactional justice and organizational commitment. Results also indicated that trust in supervisor had a mediating effect in the relationship between procedural justice and organizational commitment.