'Moving On' and Transitional Bridges : Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

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.

Informations- och kommunikationsteknologi som stöd för patienter med astma och kronisk obstruktiv lungsjukdom avseende egenvård. En litteraturstudie.

Bakgrund: Astma och KOL är två vanlig kroniska sjukdomar som är kopplade till stort sjukdomslidande och lägre livskvalité. Många personer som idag lever med sjukdomarna lever isolerat från andra. Idag har vi en ständig utveckling av sociala nätverk som öppnar en ny möjlighet för egenvård. Egenvård kan göra att patienter får en bättre vardag samt att det lättare kan få ett socialt umgänge. Syfte: Syftet är sammanställa befintlig litteratur och där undersöka hur informations- och kommunikationsteknologi underlättar egenvården för patienter med astma och KOL. Metod: Litteraturstudie där artiklarna söktes i databaser för omvårdnadsvetenskap så som Web Of Science, pubmed och Cinahl. Litteraturstudien baseras på 16 vetenskapliga artiklar som både är kvalitativa och kvantitativa. Artiklarna som valdes är inte äldre än 10 år gamla, skrivna på engelska och publicerade i en vetenskaplig tidning. Resultat: Resultatet som artiklarna påvisade är grundade på IKT i form av datorer, mobiltelefoner, surfplattor och web-baserad program. Artiklarna visar att egenvården kan förbättras genom ökad livskvalité, bättre kommunikation och bättre sjukdomsinsikt när man använder IKT. Slutsats: IKT är en viktig roll i våran hälso- och sjukvård idag. Det finns dock liten forskning på hur egenvården kring astma och KOL påverkas av IKT. Den forskning som finns pekar åt är att den förbättrar för patienter. Det behövs även mer forskning kring IKT som en resurs för egenvård kring ett omvårdnadsperspektiv.

‘Moving on’ : Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden

Background Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care. Method Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis. Findings A balancing actbetween keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition. Conclusions If confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on “moving on” and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.

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.

Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke : an explorative observational study

BACKGROUND: People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke. METHODS: The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables "unfulfilled needs for rehabilitation" and "dissatisfaction with care" were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses. RESULTS: Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08). CONCLUSIONS: Thirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients' needs and aid peoples' reorientation; this would apply particularly to those with poor coping capacity.

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

Religion and Subjective Well-Being Among China’s Elderly Population

Evidence from developed and developing countries alike demonstrates a strongly positive relationship between religiosity and happiness, particularly for women and particularly among the elderly. Using survey data from the oldest old in China, we find a strong negative relationship between religious participation and subjective well-being in a rich multivariate logistic framework that controls for demographics, health and disabilities, living arrangements and marital status, wealth and income, lifestyle and social networks, and location. In contrast to other studies, we also find that religion has a larger effect on subjective well-being on men than women.

Redes sociais e empresas II

Este relatório apresenta uma análise da bibliografia brasileira e da bibliografia internacional (anglo-saxã) sobre redes e empresas com o objetivo de contribuir para o debate teórico e orientar futuras pesquisas empíricas sobre o tema no Brasil, especialmente no campo da teoria das organizações e sociologia econômica. Para tanto, analisamos a bibliografia publicada nos últimos 10 anos (1990 a 2003) que trabalham com a abordagem de redes em três campos específicos: 1) a formação de redes entre empresas e o local onde estão inseridas; 2) o papel das redes na promoção de mudanças organizacionais e inovação; 3) o desenvolvimento de relações de confiança entre empresas e seu impacto na definição de estratégias empresariais.

Segmentos populares, consumo e participação cultural

Esta pesquisa investigou como a cultura pode se tornar um recurso econômico, social e político para os segmentos menos favorecidos da população. Foram estudados três grupos de artesanato e três grupos de música, bem como entrevistou-se representantes de órgãos estatais, para-governamentais e do terceiro setor, que atuam na área da cultura. A conclusão é a de que a cultura pode ser um recurso econômico, social e político, quando se verifica a conjugação de alguns fatores-chave: os grupos de artistas conseguem se organizar coletivamente; suas lideranças agem de modo empreendedor e articulando-se a redes sociais diversificadas; parcerias são estabelecidas com organizações governamentais, para-governamentais e do terceiro setor, comprometidas com os objetivos desses grupos. Constatou-se que a sustentabilidade dos empreendimentos associativos na área cultural depende de políticas transversais, visando o desenvolvimento local integrado e sustentado.

Desenvolvimento local, cidadania e redes sociais: um estudo em Minas Gerais

The objective of this essay was to verify if the practices of local development in these small towns (population under 20.000 inhabitants) of Lavra¿s small region have contributed to the formation and/or strengthening of social network. The work was conducted from a theoretical discussion about local development, citizenship, local development with citizenship and social network. Afterward interviews were made semi-structured with a sample formed of 54 citizens of six towns of Lavra¿s small region in Minas Gerais. The speech analysis was used in the treatment of the dates. As results, considering the strengthening and formation of social network, it is possible to say: about the strengthening, that there is not a possibility, because the social networks structured as we understand it, do not exist or are still to embryonic, prevailing, in the formation towns, the pyramidal structure. And about the formation, it is notable that there are more negative aspects than positive to the development of these networks, however some initiative point out to the possibilities of creation. Therefore, we can conclude that the practice of local development contribute, still, in a very incipient and limited manner to the formation of social networks in the state¿s town. Incipient because the identified initiatives that points towards the creation are recent and are still in a structure stage; and limited because there are too many negative aspects that make the construction difficult.

Ontologia para moelos de negócios de redes sociais na internet: um ensaio teórico-exploratório

Atualmente, uma profusão de soluções chamadas de Web 2.0 e redes sociais está causando um grande impacto no desenvolvimento da Internet, comparando-se à era “ponto-com” em termos de crescimento, investimentos e empolgação. Estas iniciativas possuem em comum um elevado grau de formação de comunidades, e de criação e compartilhamento de conteúdo por parte do usuário, dentre outras características. Acredita-se que as redes sociais possuam um grande potencial inovador e disruptivo tanto para a sociedade quanto para o mundo empresarial. Entretanto, como transformar as redes sociais e aplicações Web 2.0 em modelos de negócios auto-sustentáveis ainda é um desafio para o mercado. Esta dissertação objetiva auxiliar a compreensão e abordagem deste tema propondo uma ontologia específica para modelos de negócios de redes sociais na internet. Isto se realiza por meio do desenvolvimento de um ensaio teórico de viés exploratório, baseado em extensa, porém não exaustiva, revisão de literatura abordando modelos de negócios, redes sociais e demais temas relacionados. A ontologia criada é então aplicada na representação de modelos de negócio de redes sociais na internet. Este trabalho também fornece uma visão geral do fenômeno Web 2.0, abordando algumas de suas principais características tecnológicas e socioeconômicas.

The market strategies alternatives of an e-business start-up in Brazil

The e-business market is one of the fastest growing markets in Brazil, with e-business sales accounting for BRL 14.8 billion in 2010 and a growth of 40% per year (+1000% over the past 7 years). Sales-event clubs and collective bargaining websites are one of the most dynamic segments of the e-business market: the number of new players is increasing rapidly, with over 1200 collective bargaining websites currently operating in Brazil. In that context, growth and differentiation seem to be two key success factors for Coquelux. According to webshopper (23rd Edition, e-bit), growth can be achieved by targeting middle and low-income consumers from class C, who represent 50% of the total e-commerce sales. But Coquelux, which is specialized in desire and luxury brands, has built its reputation and competitive advantage through its “exclusivity”, by targeting wealthier consumers from classes A and B who are attracted by its fashionable and high-end positioning. The evolution (growth?) of this market and the development of its competition naturally raise a strategic question for Coquelux’s managers: can Coquelux grow and still maintain its competitive advantage? Should it grow by expanding its consumer base to class C? If so, how? Consumers from classes A, B or C must be targeted through the same online communication channels. Recent studies from the ABEP/ABIPEME emphasized the importance of social networks as a tool for converting new clients and gaining their loyalty, regardless of their social class. However, high-income and low-income e-consumers do not have the same consumption habits, do not respond to the same type of marketing strategies, and most importantly, do not share the same values. Thus, it seems difficult to expand Coquelux’s consumer base to class C without changing its marketing strategies and altering its image Three options were identified for Coquelux: reinforcing its leadership on the luxury segment and focusing on a small niche market (1), which would threaten its survival in the long run; completely changing its strategy and competing for a mass market through commercial brands (2), which requires major financial investments that managers don’t have access to; or finding an intermediary solution (3). This thesis’ recommendation for the third option consists in focusing on premium brands (rather than luxury) in order to increase sales volume (Coquelux’s most profitable sales happened with local desire brands) with products that appeal to class B but also attract the emerging class C which is looking for brand recognition. It could thus implement a slow entry strategy towards the mass market without damaging its main competitive advantage.

Pré-decisão em políticas públicas: a entrada da temática da inclusão digital na agenda do Governo do Estado de São Paulo

O objetivo da presente dissertação é analisar como a temática da inclusão digital entrou na agenda governamental do Estado de São Paulo e como foi concebido o programa de inclusão digital Acessa São Paulo. Ao estudar essa política pública, buscou-se identificar quem foram às pessoas que discutiram esse tema, por que fizeram, como foi feito, quem participou, enfim, entrar nos bastidores dessas discussões que antecederam a concepção dessa política pública. Para se chegar aos atores relevantes que participaram da concepção da política pública de inclusão digital no Estado de São Paulo, foi realizado um levantamento bibliográfico sobre o tema e vários contatos foram feitos via email e/ou redes sociais buscando nomes que participaram dessas discussões que antecederam a implantação do programa de inclusão digital no Estado de São Paulo. A partir da confirmação do envolvimento desses atores foi feito um convite para que esses participassem do trabalho através de uma entrevista. A entrada da temática da inclusão digital foi um processo lento e gradual que se iniciou desde a posse do governador Mario Covas para seu primeiro mandato (1995-1998). O uso da informatização pelo governo estava previsto em seu plano de governo em 1994 como forma de modernizar a maquina administrativa e aproximar o Estado dos cidadãos. A necessidade de se criar um programa de inclusão digital para que os cidadãos de baixa renda pudessem ter acesso à internet deve, sobretudo, as iniciativas de governo eletrônico promovidas pelo governo do Estado que tinha por objetivo disponibilizar serviços públicos via internet aos cidadãos. No inicio da década de 2000 acesso a internet era privilégio para poucos. Daí a necessidade de se pensar em uma política que promovesse a inclusão digital dessas pessoas. Essa foi a razão principal para que o governo assumisse que a questão da inclusão digital era um problema a ser resolvido. E entrasse definitivamente na agenda do governo e posteriormente dando origem ao Acessa São Paulo.

Desconcentração da polícia técnica e científica do Estado de Rondônia: uma política de administração pública

Este estudo apresenta como questão central: Por que desconcentrar o Departamento de Polícia Técnica e Científica com a criação e implantação de coordenadorias nas sub-regiões da Secretaria de Segurança Pública, Defesa e Cidadania do Estado de Rondônia? Para responder tal questão que norteia o presente estudo volta-se o enfoque para a gestão dos serviços praticados pelos órgãos de perícia técnica nas diversas regiões do Estado visando o princípio da eficiência e da produtividade, bem como do aspecto social dos órgãos de segurança pública, pois, em última análise, são estes os que deveriam agir em conjunto com a sociedade visando a garantia da aplicação da lei e da justiça a todos, com o objetivo de contribuir na gestão dos órgãos regionais, além de atender ao controle social pelo cidadão, com a criação de coordenadorias regionais naquela instituição. Como instrumento para coleta de dados optou-se pelo questionário com perguntas selecionadas sobre os conceitos dos temas abordados, e sobre as perspectivas de mudanças de formatação diferenciada da perícia no interior do estado aplicado através do fórum dos Peritos Criminais do Estado de Rondônia, via internet. Também foram realizadas pesquisas bibliográficas, documentais e a análise de dados populacionais, geográficos, de ocorrências policiais e de número de peritos. Os dados mostram que entre os profissionais da área existe um desconhecimento da distinção entre os conceitos de desconcentração e de descentralização. Apesar desse fato, as respostas apontam para a unanimidade com relação à necessidade de haver uma desconcentração do setor, que visa o reconhecimento das unidades regionais e a melhoria do trabalho produzido para a sociedade. Ao confrontar os dados referentes à área de atuação de cada uma das sub-regiões do Instituto de Criminalística, dentre as quais as unidades existentes e as desarticuladas (com área geográfica de atuação, população atingida e número de ocorrências realizadas por período de tempo escolhido), com os dados obtidos simultaneamente na sede fixada à capital do estado, ficou ainda mais clara a necessidade de desconcentração da perícia criminal no interior do estado, constatando-se a urgente e necessária criação de polos gestores em sintonia com o órgão central, desde que tal seja realizado como política pública.