Healthcare providers balancing norms and practice : challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study

BACKGROUND: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.

Heat losses and thermal performance of commercial combined solar and pellet heating systems

Various pellet heating systems are marketed in Sweden, some of them in combination with a solar heating system. Several types of pellet heating units are available and can be used for a combined system. This article compares four typical combined solar and pellet heating systems: System 1 and 2 two with a pellet stove, system 3 with a store integrated pellet burner and system 4 with a pellet boiler. The lower efficiency of pellet heaters compared to oil or gas heaters increases the primary energy demand. Consequently heat losses of the various systems have been studied. The systems have been modeled in TRNSYS and simulated with parameters identified from measurements. For almost all systems the flue gas losses are the main heat losses except for system 3 where store heat losses prevail. Relevant are also the heat losses of the burner and the boiler to the ambient. Significant leakage losses are noticed for system 3 and 4. For buildings with an open internal design system 1 is the most efficient solution. Other buildings should preferably apply system 3. The right choice of the system depends also on whether the heater is placed inside or outside of the heated are. A large potential for system optimization exist for all studied systems, which when applied could alter the relative merits of the different system types.

Han, hon, höna? : En kvantitativ studie om attityder till det könsneutrala personliga pronomenet hen

Språk både reflekterar och påverkar vår världssyn. Hur mottas då försök från gräsrotsnivå att introducera ett könsneutralt pronomen i ett språk som speglar den i samhället rådande könsdikotomin? Syftet med denna uppsats är att utifrån Hirdmans och Butlers respektive genusteorier undersöka vilken inställning användare på ett stort svenskt internetforum har till det könsneutrala personliga pronomenet hen. Undersökningen genomfördes med hjälp av en internetbaserad enkät som besvarades av cirka 150 personer. För att analysera svaren till de slutna frågorna tog vi hjälp av statistikprogrammet SPSS och för att bearbeta de öppna frågorna har vi använt oss av en tematisk analys. Resultatet visar på starkt polariserade åsikter runt hen, där ungefär lika många personer är för som emot ordet. Bland dem som är emot användandet av hen uppfattar de flesta att syftet med ordet är att skapa ett könslöst samhälle, medan hen-förespråkarna ser det som ett komplement till hon och han. Vi har även kunnat se att det finns ett visst samband mellan individens attityd till hen och dennes syn på kön och genus, vilket bekräftar vår hypotes om att det finns en sådan korrelation.

Patient participation : what it is and what it is not

In general, patient participation is regarded as being informed and partaking in decision making regarding one’s care and treatment. This interpretation is common in legislation throughout the Western world and corresponding documents guiding health care professionals, as well as in scientific studies. Even though this understanding of the word participation can be traced to a growing emphasis on individuals’ autonomy in society and to certain dictionary defi nitions, there are other ways of understanding participation from a semantic point of view, and no trace of patients’ descriptions of what it is to participate can be found in these definitions. Hence, the aim of this dissertation was to understand patients’ experience of the phenomenon of patient participation. An additional aim was to understand patients’ experience of non-participation and to describe the conditions for patient participation and non-participation, in order to understand the prerequisites for patient participation. The dissertation comprises four papers. The philosophical ideas of Ricoeur provided a basis for the studies: how communication can present ways to understand and explain experiences of phenomena through phenomenological hermeneutics. The first and second studies involved a group of patients living with chronic heart failure. For the fi rst study, 10 patients were interviewed, with a narrative approach, about their experience of participation and non-participation, as defi ned by the participants. For the second study, 11 visits by three patients at a nurse-led outpatient clinic were observed, and consecutive interviews were performed with the patients and the nurses, investigating what they experience as patient participation and non-participation. A triangulation of data was performed to analyse the occurrence of the phenomena in the observed visits. For paper 3 and 4, a questionnaire was developed and distributed among a diverse group of people who had recent experience of being patients. The questionnaire comprised respondent’s description of what patient participation is, using items based on findings in Study 1, along with open-ended questions for additional aspects and general issues regarding situations in which the respondent had experienced patient participation and/or non-participation. The findings show additional aspects to patient participation: patient participation is being provided with information and knowledge in order for one to comprehend one’s body, disease, and treatment and to be able to take self-care actions based on the context and one’s values. Participation was also found to include providing the information and knowledge one has about the experience of illness and symptoms and of one’s situation. Participation occurs when being listened to and being recognised as an individual and a partner in the health care team. Non-participation, on the other hand, occurs when one is regarded as a symptom, a problem to be solved. To avoid non-participation, the information provided needs to be based on the individual’s need and with recognition of the patient’s knowledge and context. In conclusion, patient participation needs to be reconsidered in health care regulations and in clinical settings: patients’ defi nitions of participation, found to be close to the dictionaries’ description of sharing, should be recognised and opportunities provided for sharing knowledge and experience in two-way-communication.

Mother’s experiences and perceptions of a continuous caring model with fathers after caesarean section : a qualitative study

Background: In Chile, mothers and newborns are separated after caesarean sections. The caesarean section rate in Chile is approximately 40%. Once separated, newborns will miss out on the benefits of early contact unless a suitable model of early newborn contact after caesarean section is initiated. Aim: To describe mothers experiences and perceptions of a continuous parental model of newborn care after caesarean section during mother-infant separation. Methods: A questionnaire with 4 open ended questions to gather data on the experiences and perceptions of 95 mothers in the obstetric service of Sótero Del Rio Hospital in Chile between 2009 and 2012. Data were analyzed using qualitative content analysis. Results: One theme family friendly practice after caesarean section and four categories. Mothers described the benefits of this model of caring. The fathers presence was important to mother and baby. Mothers were reassured that the baby was not left alone with staff. It was important for the mothers to see that the father could love the baby as much as the mother. This model of care helped create ties between the father and newborn during the period of mother-infant separation and later with the mother. Conclusions: Family friendly practice after caesarean section was an important health care intervention for the whole family. This model could be stratified in the Chilean context in the case of complicated births and all caesarean sections. Clinical Implications: In the Chilean context, there is the potential to increase the number of parents who get to hold their baby immediately after birth and for as long as they like. When the mother and infant are separated after birth, parents can be informed about the benefits of this caring model. Further research using randomized control trials may support biological advantages.

Teaching Mathematics in English to Swedish Speaking Students : The Use of Second Language Teaching Practices in the Teaching of Mathematics in English to Swedish Speaking Students in Lower Secondary School

Over 20,000 Swedish lower high school students are currently learning mathematics in English but little research has been conducted in this area. This study looks into the question of how much second language learner training teachers teaching mathematics in English to Swedish speaking students have acquired and how many of those teachers are using effective teaching practices for second language learners. The study confirms earlier findings that report few teachers receive training in second language learning but indicates that some of the teaching practices shown to be effective with second language learners are being used in some Swedish schools

La cortesía verbal : Un estudio contrastivo entre los saludos y peticiones en los idiomas sueco y español. Författare: Daisy

The purpose of this study is to examine the differences and similarities regarding verbal politeness in greetings and requests in Swedish and the Chilean variety of Spanish. A survey with 12 questions, both open-ended and closed-ended, has been distributed to 20 native speakers of the two languages. Thus, the questions have been analyzed both quantitatively and qualitatively. The results show that the perception that the Swedes and the Chileans have about verbal politeness is similar, since the speakers of both languages see it as a way to show respect towards others. The study also shows that Swedes and Chileans share a similar view upon politeness, i.e. as a social norm that facilitates social interaction between people.

La cortesía verbal : Un estudio contrastivo entre los saludos y peticiones en los idiomas sueco y español

The purpose of this study is to examine the differences and similarities regarding verbal politeness in greetings and requests in Swedish and the Chilean variety of Spanish. A survey with 12 questions, both open-ended and closed-ended, has been distributed to 20 native speakers of the two languages. Thus, the questions have been analyzed both quantitatively and qualitatively. The results show that the perception that the Swedes and the Chileans have about verbal politeness is similar, since the speakers of both languages see it as a way to show respect towards others. The study also shows that Swedes and Chileans share a similar view upon politeness, i.e. as a social norm that facilitates social interaction between people.