Psychometric properties of the Swedish version of the Fear of Complications Questionnaire

Objectives: To translate and evaluate the psychometric properties of the Swedish version of the Fear of Complications Questionnaire. Design: Cross-sectional study design and scale development. Settings: Totally, 469 adults (response rate 63.5%) with Type 1 diabetes completed the questionnaires. Participants were recruited from two university hospitals in Sweden. Participants: Eligible patients were those who met the following inclusion criteria: diagnosed with Type 1 diabetes, diabetes duration of at least 1 year and aged at least 18 years. Methods: The Fear of Complications Questionnaire was translated using the forward-backward translation method. Factor analyses of the questionnaire were performed in two steps using both exploratory and confirmatory factor analysis. Convergent validity was examined using the Hospital Anxiety and Depression Scale and the Fear of Hypoglycaemia Fear Survey. Internal consistency was estimated using Cronbach’s alpha.Results: Exploratory factor analysis supported a two-factor solution. One factor contained three items having to do with fear of kidney-related complications and one factor included the rest of items concerning fear of other diabetes-related complications, as well as fear of complications in general. Internal consistency was high Cronbach’s alpha 0.96. The findings also gave support for convergent validity, with significant positive correlations between measures (r = 0.51 to 0.54). Conclusion: The clinical relevance of the identified two-factor model with a structure of one dominant subdomain may be considered. We suggest, however a one-factor model covering all the items as a relevant basis to assess fear of complications among people with Type 1 diabetes.

PANA V : Evaluation of a Literacy Project

PANA V Evaluation of a Literacy ProjectSUMMARY AND CONCLUSIONSThis evaluation set out to explore the impact of the literacy work carried out through PANA V. It focussed on clarifying effects such as empowerment and poverty reduction in relation to the civil society. Two specific objectives were to evaluate the methodological approach and the didactic materials and to evaluate the sustainability of the project.Although the focus of the evaluation has been PANA V, the project has been evaluated in its context, as one in a series of five projects located in Rwanda ten years after the war and genocide. The conclusion will consider future plans in this field.The evaluator has striven to create a holistic picture of the effects of the project, although the given time for the evaluation was short. Only three weeks were spent in the field study and only ten days in the actual field. Although there were some organisational and logistic problems, as is common when carrying out a study like this in a poor country, many literacy sites were visited and quite many participators were interviewed. The overall impression from the study is overwhelmingly positive. So many people commit themselves in this task of teaching Rwandans reading, writing and numeracy. Despite harsh conditions learners strive to learn and group leaders devote themselves to the task. Many leaders on different levels try their very best to manage their difficult and demanding task. The main objective was to explore the impact of the project on poverty reduction, particularly on empowerment and strategies for everyday life. Women were to be regarded particularly. From the results it is clear that the project has a strong, positive impact both on poverty reduction and empowerment of marginalised groups. Among those who have benefited from the alphabetisation are mainly women. Unfortunately, when it comes to leaders in PANA, who may also be said to have benefited from the project, only a small minority is women. This is something that is recommended that it be reconsidered inside the organisation. As a majority of the targeted learners are women, and as the economic and social situation of women in Rwanda is generally weak, this is a question that I recommend the Pentesostal church and ADEPR to look particularly into. With many women being single breadwinners of their households, it is important that also women get access to positions that may bring benefits of different kind.It is also clear that the project has positive effects for the civil society. In the present situation in Rwanda, during the process of reconciliation and rapid progress, basic education for the poor majority is a democratic issue. In a country with a plethora of internet-cafés in the capital and a small minority that use cars and mobile-telephones to communicate nation-wide, it is of outmost importance that the majority acquires basic education, of which literacy is a central part. To strengthen the civil society in Rwanda literacy is important. One central issue is then that Rwanda develops toward becoming a country where literacy is used for the benefit of the citizens and it is a democratic issue that all citizens get an opportunity to participate. Crucial for this is that strong efforts are put into primary schools nation-wide. Literacy projects for adults, like PANA, may only complement these efforts, but they constitute important and necessary complements. Other relevant ways to promote literacy are campaigns in Radio and TV and through cultural events such as festivals, music and theatre. News papers, magazines and books are natural parts of such campaigns as well as adult education. As stated under the results not much can be said about the didactics in this evaluation. On the whole the methodology and the materials fill their function well and receive a high reputation. As people learn to read and write under very simple conditions, obviously the approach is appropriate. A few suggestions may be given from the study:•Focus groups leaders’ attention on clearness, that they show very clearly what is to be read. Good structuring is probably of great importance for many learners.•Make clear what is tested in the tests and consider the possibility to use a holistic test that would be more congruent with the methodology. The possibility to use only one grade, pass, would enable a more practical test, such as reading a short, relevant text, writing something relevant and solving practical mathematic problems. Avoid tests that demand school knowledge.•Avoid using methaphors such as “fight against illiteracy” and connections between illiteracy/literacy and darkness/light. It is not true that illiteracy causes bad things and that literacy only brings good. •Be prepared that it may be more difficult in the future to achieve the goals as it may be the case that the early learners where the ones who achieved easily. The goal of “literacy in six month” in PANA will probably hold only for some learners but also those who do not manage in six months need literacy skills.A third objective was to secure sustainability. As for sustainability of the project in itself, and of the literacy process, the main conclusion is that there is a good potential. The commitment and devotedness among many involved in PANA proves good. One weakness is individual leaders in ADEPR who do not see this as an important task for the Pentecostal church in Rwanda. Other weaknesses are the unwillingness to mention explicitly the wish, for example among group leaders, to get some kind of incentive and the fear of loosing believers by cooperation with other organisations. A higher degree of transparency in this issue would probably solve some irritations and tensions.As for the sustainability of the literacy skills much may be done to improve. The acquired skills seem to be comparably relevant. The level achieved, and the level tested, may be defined as basic literacy skills, consisting of basic reading, writing and numeracy skills. However, these skills are very restricted and there is a high risk that the skills will decline, which means that there is a high risk that people will forget how to read and write because of lack of exercising. From these conclusions a few suggestions for future development will be given.

Manoeuvring between anxiety and control : Patients experience of learning to live with diabetes: a lifeworld phenomenological study

Research shows that people with diabetes want their lives to proceed as normally as possible, but some patients experience difficulty in reaching their desired goals with treatment. The learning process is a complex phenomenon interwoven into every facet of life. Patients and healthcare providers often have different perspectives in care which gives different expectations on what the patients need to learn and cope with. The aim of this study, therefore, is to describe the experience of learning to live with diabetes. Interviews were conducted with 12 patients afflicted with type 1 or type 2 diabetes. The interviews were then analysed with reference to the reflective lifeworld research approach. The analysis shows that when the afflicted realize that their bodies undergo changes and that blood sugar levels are not always balanced as earlier in life, they can adjust to their new conditions early. The afflicted must take responsibility for balancing their blood sugar levels and incorporating the illness into their lives. Achieving such goals necessitates knowledge. The search for knowledge and sensitivity to changes are constant requirements for people with diabetes. Learning is driven by the tension caused by the need for and dependence on safe blood sugar control, the fear of losing such control, and the fear of future complications. The most important responsibilities for these patients are aspiring to understand their bodies as lived bodies, ensuring safety and security, and acquiring the knowledge essential to making conscious choices.

Kriminalitetens geografi : vardagsbrottslighetens spatiala fördelning i Borlänge

The aim of this thesis is to describe and analyze the geographical distribution of everyday criminality in the town of Borlänge during the year 2002 and to analyze which measures to be taken in the physical social planning to decrease this everyday criminality there. The term everyday criminality is here to be understood as those categories of crime that appear most frequently in the records of reports to the police every year. Here two kinds of crime have been in focus, thefts from cars and office burglary.In fulfilling this aim two main questions have been answered. The first one is how the everyday criminality was distributed geographically in the town of Borlänge during the year 2002. The second one is which measures to be taken in the physical social planning to decrease this everyday criminality in the town of Borlänge.In order to answer the first question a spatial autocorrelation analysis, Local Moran LISA has been used. This method is based on the measurement Moran´s I and shows the spatial autocorrelation for every single location. To answer the second question three different theories of crime prevention through environmental design have been studied and applied in the analysis. These are Jane Jacobs’ ideas about ”the living city”, Oscar Newman´s ideas about ”defensible space” and Ronald V. Clarke´s theories about crime prevention.The major conclusions that can be drawn from this thesis are that the risk of being exposed to thefts from cars, during the analyzed time period, was highest in Centrum and Hagalund and their surroundings. The lowest risk of being exposed to this type of crime was found in Domnarvet and Islingby, during the year 2002. The highest risk of being a victim of the crime office burglary was found in Hagalund and its surroundings and in the single area of Kvarnsveden. The corresponding lowest risk was found in Lergärdet and its surroundings and in Norra Backa and Kupolen. The measures that should be taken in order to decrease these types of criminality can be divided into overall changes and place-specific changes. When it comes to the crime thefts from cars a more attractive central business district, a better view of parking lots from nearby buildings, dividing of larger parking lot zones into smaller ones, migration of hidden parking lots and stronger access control to parking lots where problems with this kind of crime have occurred have been suggested as overall changes. The corresponding place-specific changes are to remove vegetation that is blocking the view, better lighting and to put up signs with information about increased risk of exposure to crime at parking lots with the most problems. To decrease the amount of office burglaries overall changes as to create a better view of the area from nearby surroundings, move bigger office compartments or divide them into smaller units, rebuild characteristic buildings and increase security by strengthening the access control to offices with these kinds of problems could be useful. Finally there are possibilities to decrease office burglary by using place-specific measures as surveillance cameras combined with signs containing information about these, high fences and better lighting around the buildings where a higher risk of being exposed to this kind of criminality is present.

Stärkande omvårdnad : En litteraturstudie om förlossningsrädsla under graviditet och förlossning

Förlossningsrädsla utgör en speciell utmaning för mödrahälsovården och förlossningsvården.En konsekvens av rädslan är att kvinnor allt oftare kräver kejsarsnitt utan medicinsk indikation. Syftet med denna studie var att belysa faktorer som ligger till grund för förlossningsrädsla samt att ta reda på hur omvårdnadspersonal kan ge stärkande omvårdnad till denna sårbara grupp. Metoden var en systematisk litteraturstudie som omfattade fjorton vetenskapliga artiklar. Materialet till litteraturstudien identifierades via datoriserad och manuell sökning i databaser och tidsskrifter på Högskolan Dalarnas bibliotek samt sjukhus biblioteket på Falu Lasarett. Sökningen gjordes i databaserna ELIN@dalarna, Pub Med, Swe Med, Libris och Google sholar. Sökord som användes var: Fear of childbirth. Resultatet visade att rädslans innehåll och natur hänger samman med kvinnans personliga förutsättningar samt den sociala situation hon lever i. En slutsats blev att många kvinnor behöver hjälp för sin oro inför förlossningen och många har i högre grad än andra väntande kvinnor haft besvär med psykisk ohälsa. En viktig förutsättning för ett optimalt och professionellt bemötande av den förlossningsrädda kvinnan är ett gott samarbete mellan hela vårdkedjan, så alla har samma synsätt. Genom att alla säger samma saker skapas en trygghet.

Förlossningsrädda kvinnors erfarenheter av Aurorasamtal ett till två år efter förlossning

Bakgrund: Av alla gravida kvinnor räknas omkring 5 % lida av svår förlossningsrädsla. Kvinnor med förlossningsrädsla löper högre risk för komplikationer under och efter graviditeten. I Sverige läggs idag mycket resurser på Auroraverksamhet för att hjälpa kvinnor med förlossningsrädsla. Det saknas omfattande utvärdering av Auroraverksamheten. Syfte: Syftet med detta fördjupningsarbete var att undersöka upplevelse och effekt av Aurorasamtal inför förlossning samt upplevelse av den efterföljande förlossningen bland först- och omföderskor. Metod: Studien har en retrospektiv studiedesign där datainsamling skedde via en enkätundersökning. Datamaterialet sammanställdes därefter i SPSS. Resultat: Majoriteten av kvinnorna upplevde att samtalen hjälpte dem till en mer positiv förlossningsupplevelse. Fler förstföderskor än omföderskor önskade planerat kejsarsnitt när de kom till Auroramottagningen. De flesta kvinnor som önskade vaginal förlossning blev vaginalt förlösta. Över hälften av kvinnorna som deltog i studien var mindre rädda för förlossning 1 – 2 år efter förlossningen än de upplevde att de var innan Aurorasamtalet och förlossningen. Konklusion: Aurorasamtal förefaller ha störst betydelse för omföderskor och för de kvinnor som önskar vaginal förlossning.

Förståelse, bedömningar och hjälpinsatser : Socialarbetares arbete med män som våldsoffer

This report outlines the background to, and presents the results from the Crime Victim Compensation and Support Authority funded project "Social Workers' understanding of men as victims of crime". The project aimed at describing and analyzing how social workers understand and work with male victims of violence. More precisely, the research has focused on how social workers describe men's vulnerability and how they understand men's needs for assistance, what assistance that is provided and the way the constellations of perpetrators and victims of different gender and contexts in which the violence occurs in affect the understanding of male victims of violence. The study has also been devoted to the question of whether the Support Centers for young crime victims in Sweden provide different types of and different amount of help to young men and women afflicted of violence. The project was conducted in three substudies. The results from substudy 1 show that more young men than women seek support from the Support centers studied. Men predominate in number of cases and in the different categories of crime. The results also show that young men on average receive less assistance over a shorter average duration than young women. This applies irrespective of the category of offense that the vulnerability applies to. Furthermore, the young men, compared to the women, proportionally receive fewer interventions characterized as support and a greater proportion of interventions in the form of information. The results also show that the young men are referred on for further action to a lesser extent than is the case for women. The results from substudy 2 show that social workers tend to focus on whether, and to what extent, young men who are victims of violence themselves have behaved provocatively before the violence incident and if they have put themselves in a social situation that could be interpreted as having contributed to an escalation of the violence they have been subjected to. The results from substudy 2 also show that social workers talk about the men as active in the violent situations they have been involved in and dwell on the extent to which the young men's own actions have contributed to the violence. The results also show that young men who are victims of violence are described as "reluctant" victims who are trying to cope with their situation on their own without the involvement of professional or other helper. The young men are also described as reluctant to talk about their feelings. The results of substudy 3 show that social workers believe that young men, when they become victims of violence, risks losing their sense of autonomy, initiative and decisiveness, that is, attributes that are often linked to the dominating cultural image of masculinity. Furthermore, the results show that social workers estimate that men's practicing of their masculinity, but also the response that men who are traumatized get from society, creates difficulties for them to get help. The results from substudy 3 also shows that attributes and actions that can be connected to the masculinity of young men's, as well as a lack of such attributes and actions are considered to be adequate explanations for the violence the men has suffered. When it comes to violence in public places it is the masculinity that explains the violence and its escalation. When it comes to domestic violence it is the lack of expected male attributes and actions that are used as explanations for the violence that have occurred. The discussion is devoted to the question of how the results should be understood based on the concepts of self-performance, interpretation, negotiation and categorizations, and the consequences the results obtained should have for gender sensitive social work given to abused men.

Vem är den ekonomiske brottslingen? : En jämförelse mellan länder och brottstyper

Who is the economic criminal? A comparison between countries and types of crime In white collar crime research two particularly competing definitions (Sutherland versus the Revisionists) have dominated the field during the last two decades. Sutherland’s definition states that the sociodemographic profile is homogeneous (entrepreneur with high education and high or regular income), despite type of white collar crime or context. The definition given by the Revisionists states that white collar criminals’ demographic profile is heterogeneous (everyone can be convicted for white collar crime). As a consequence of this divided definitional approach we have a contradictive outcome of who the white collar criminal is. Our purpose is to investigate the qualification of the two definitions by analyzing heterogeneity/ homogeneity based on crime type and national context. The investigation is based on seven countries from the EES 2004 (European Social Survey). We use four types of crime. The results show a rather homogeneous demographic profile but there is also a certain substantial heterogeneity depending on kinds of crime and context. The results altogether indicate that the Revisionists’ definition is more correct in its description of the white collar criminal than Sutherland’s definition. The demographic profile of the white collar criminal seems to be more complex than a profile confined to just one social category would be and the contextual factor has an impact on the variety of the demographic profile. An important task for future research is to hold the door open for further demographic investigations depending on the type of crime and country that the study is based on. 

Förlåtelse, försoning och oförsonlighet i överlevandes berättelser efter kriget i Bosnien

Forgiveness, reconciliation and implacability in narratives of survivors after the war in Bosnia and Herzegovina In this article I analyze verbally portrayed experiences of 27 survivors from the 1990s’ war in Bosnia and Herzegovina. One aim of the article is to analyze markers for reconciliation and implacability, the second is to describe the terms for reconciliation which are actualized in those stories. The interactive dynamics, which occurred during the war, make the post-war reconciliation wartime associated. Narratives about reconciliation, implacability and terms for reconciliation, are not only formed in relation to the war as a whole but also in relation to one’s own and others’ wartime actions. The narratives about reconciliation become an arena in which we and them are played against each other in different ways – not least by rejecting the others’ acts during the war. In the interviewees stories implacability is predominant but reconciliation is presented as a possibility if certain conditions are met. These conditions are, for instance, justice for war victims, perpetrators’ recognition of crime and perpetrators’ emotional commitment (for example the display of remorse and shame).

Kvinnors erfarenheter av sjuksköterskors bemötande i vårdandet av deras bröstcancer En litteraturöversikt

Bakgrund: Bröstcancer är den vanligaste cancerformen bland kvinnor i Sverige. Att drabbas av bröstcancer beskrivs som en utmaning för kvinnans självkänsla, självbild, kvinnlighet och existens. Kvinnorna vill bli bemötta som en enskild individ och inte som en diagnos samt uppleva känslomässigt stöd från sjuksköterskorna. Syfte: Syftet är att genom en vetenskaplig litteraturöversikt beskriva vad kvinnor med bröstcancer har för erfarenheter av sjuksköterskors bemötande. Metod: Underlaget till denna litteraturöversikt består av 15 kvalitativa artiklar varav två delvis kvantitativa. Litteraturen har sökts via databaserna PubMed och Cinahl. Resultatet har sammanställts med hjälp av en analysmetod för kvalitativ forskning. Resultat: Majoriteten av kvinnorna var nöjda och tillfreds med sjuksköterskornas bemötande. Få kvinnor uttryckte missnöje. Kvinnorna uttryckte att sjuksköterskorna hade en viktig roll under deras sjukdomstid och kunde tillmötesgå deras behov. Sjuksköterskornas bemötande uppfattades empatiskt, hänsynsfullt och omtänksamt. De negativa erfarenheter vissa kvinnor beskrev var dålig uppföljning, obesvarade frågor om psykiska besvär, brist på emotionellt stöd och en rädsla av att vara till besvär. Slutsats: Sjuksköterskorna spelar en central roll i mötet med- och i tillfrisknandet hos kvinnor med bröstcancer.

Barnmorskans uppfattning om indikationer och effekter av förlossning med elektiva kejsarsnitt på humanitär indikation utifrån arbetslivserfarenhet : En intervjustudie

Bakgrund: Statistik visar på ökat antal elektiva kejsarsnitt internationellt och nationellt. Ett kejsarsnitt kan rädda liv på mor och barn om komplikationer uppstår, elektivt kejsarsnitt är även liksom andra stora operationer förenat med risker för komplikationer. Antalet elektiva kejsarsnitt på humanitär indikation har ökat i Sverige och cirka 17 % av alla förlossningar sker via kejsarsnitt. Att vårda och stödja kvinnor före, under och efter en förlossning med kejsarsnitt hör till barnmorskans arbete. Syftet med studien var att beskriva barnmorskors uppfattning om indikationer och effekter av förlossning med elektiva kejsarsnitt på humanitär indikation belyst utifrån arbetslivserfarenheter. Metod: kvalitativ metod: semistrukturella intervjuer med nio barnmorskor. Materialet analyserades via fenomenografisk analys i sju steg. Resultat: Fyra beskrivningskategorier framkom, Elektivt kejsarsnitt på humanitär indikation är ett etiskt dilemma, Elektivt kejsarsnitt på humanitär indikation är en stor operation, Elektivt kejsarsnitt på humanitär indikation påverkar organisation och barnmorskans arbetsmiljö och Elektivt kejsarsnitt på humanitär indikation påverkar kvinnans förlossningsupplevelse. Vidare framkom nio kategorier som beskriver barnmorskors uppfattningar. Slutsats Barnmorskor uppfattar elektiva kejsarsnitt som något komplext, att de med sina yrkeskunskaper värnar det naturliga vid kejsarsnitt på humanitär indikation och att de har brist på mandat att stödja och stärka kvinnors informerade val om elektivt kejsarsnitt på humanitär indikation. Klinisk tillämpbarhet: Resultatet kan användas vid undervisning kring barnmorskans stödjande och vårdande arbete i samband med förlossning via kejsarsnitt. Vidare kan resultatet vara underlag till diskussioner inom mödrahälsovård och förlossning i syfte att ge barnmorskor stärkt mandat till sina stödjande och informativa uppgifter.