Twice as many women as men suffer from mental ill-health. The negative trend of mental problems among teenagers continues. In certain places in Sweden, 40 per cent of the teenage girls have outspoken symptoms of depression. This is why it is important to observe mental ill-health in a public health perspective.   One effect evaluation of the DISA method (Depression In Swedish Adolescents) drew the conclusion that this universal depression preventive method is well working. The DISA method includes cognitive behavioural techniques that change negative pattern of thinking, give practice of communication, strategies of problem solution plus exercises to strengthen the social network. The purpose, in current investigation, was to let the group leaders’ estimations of the carrying through and of future prospects of the method be the basis of the method development as the method can be more effective. Six persons, who recently had became group leaders of DISA in Västmanland, were selected as interviewees by structured selection. Qualitative interviews were completed. A manifest qualitative content analysis carried through on the transcriptions.   Generally speaking, the interest of the method is great and there are bright prospects, according to the result of investigation. The basic education of DISA could however be experienced as heavy and intensive with a negative focus. The structured method material has an advanced language and a stereotyped gender perspective that influence the group meetings, which takes a lot of work and time. The supervision facilitates for the group leaders, as they through supervision will learn from each other’s experiences. A conclusion is that good anchorage of the method facilitates for the group leaders during implementation where the group meetings are carried through. / Dubbelt så många kvinnor som män lider av psykisk ohälsa. Den negativa trenden av psykiska besvär bland tonåringar fortsätter. På vissa ställen i Sverige har 40 procent av tonårsflickorna uttalade depressionssymptom. Därför är det viktigt att uppmärksamma psykisk ohälsa ur ett folkhälsoperspektiv.   En effektutvärdering av DISA-metoden (Depression In Swedish Adolescents) drog slutsatsen att denna universella depressionsförebyggande metod är välfungerande. DISA-metoden innefattar kognitiva beteendetekniker som förändrar negativa tankemönster, ger kommunikationsträning, problemlösningsstrategier samt övningar till att stärka det sociala nätverket. Syftet, i aktuell undersökning, var att låta gruppledarnas bedömningar av genomförandet och av metodens framtidsutsikter utgöra grund för metodutvecklingen, då metoden kan bli mer verkningsfull. Sex nyblivna DISA-gruppledare i Västmanland valdes ut som intervjupersoner genom strategiskt urval. Kvalitativa intervjuer fullbordades och manifest kvalitativ innehållsanalys genomfördes på transkriberingarna.   Intresset för metoden är generellt sett stort och framtidsutsikterna är goda, enligt undersökningsresultatet. Grundutbildningen i DISA kan emellertid upplevas som tung och intensiv med negativt fokus. Det strukturerade metodmaterialet har ett avancerat språk och stereotypt genusperspektiv, vilket inverkar på gruppträffarna som kräver mycket arbete och tid. Handledningen underlättar för gruppledarna, då de under handledningen kan lära av varandras erfarenheter. En slutsats är att god förankring av metoden underlättar för DISA-gruppledarna under implementeringen där gruppträffarna genomförs.

Teenage pregnancies are often not intended, and there is a high risk that unintended pregnancies will lead to abortion. The wide-spread availability of Youth Clinics, the subsidizing of contraceptives and the introduction of new and effective contraceptives have failed to lower the abortion rates. The aim of this thesis was to study possible risk groups and to highlight underlying reasons for contraceptive failure. Methods: Study I and II were quantitative studies with the aims of investigating whether teenagers who sought emergency contraception (Paper I) and teenage mothers (Paper II) were at risk for new unintended pregnancies during a 12-month follow-up period. Study III and IV were qualitative studies. The aim in study III was to see how contraceptive use was documented in medical records (MRs) concerning teenagers who had attended for induced abortion. In study IV the aim was to find out reasons for non- use or inconsistent use of contraceptives among teenagers attending for abortion. Results: In study I and II data were collected from medical and antenatal records. The results showed that both groups, despite contraceptive counselling, were at high risk for new unintended pregnancies leading to abortion. Attendance at the postpartum visit was low and 24% of the teenage mothers did not receive any recommendation about using a particular contraceptive method. Within 12 months 25% had a new pregnancy and of these one third led to legal abortion. In Study III two themes were generated from the analysis of the MRs; ‘Contraceptive methods previously used’ and ‘Plan for future contraceptive use’. All MRs did not contain information about contraceptive use. In study IV one theme was generated from the analysis of the interview text: ‘Struggling with feelings of uncertainty and patterns of behaviour’. Conclusion: Teenagers using emergency contraceptive pills and teenage mothers were at high risk for unintended pregnancies. Contraceptive failure in teenagers who have had an abortion may be due to in part to the absence of contraceptive counselling at abortion visits and in part to problems with contraceptive use due to insufficient knowledge and not knowing what do when side-effects occurs.

Den här studien utgår ifrån en dokumentanalys med syftet att undersöka på vilket sätt socialpedagogik tar sig uttryck i Socialstyrelsens rapport om utredningssystemet BBIC, Barns behov i centrum. Centrala begrepp för studien är socialisation och inklusion och det är även utifrån dessa vår frågeställning utgår ifrån. Undersökningen är gjord med hjälp av en riktad kvalitativ innehållsanalys med ett socialpedagogiskt perspektiv som tolkningsram. I vårt material fann vi två kategorier för inklusion och två för socialisation. Kategorierna för inklusion är Med barnet i fokus, där vikten av barnet som en central del i allt som rör barnet betonas, och Delaktighet, där innehållet tar upp vikten av människors deltagande i barnavårdsärenden och i samhällets olika system. Kategorierna för socialisation är Utveckling i interaktion, där man betonar vikten av barnet som ett aktivt subjekt, och Inträde till gemenskapen, vilken uttrycker att människor i socialisationsprocessen behöver ha vissa kunskaper och kompetenser för att uppnå en lyckad socialisation. Vår tolkning av materialet är att innehållet i våra kategorier uttrycker ett socialpedagogiskt förhållningssätt genom målet att arbeta inkluderande samt genom medvetenheten om barns utveckling och socialiseringsprocess.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

Introduction The beggars are one the most vulnerable and stigmatized groups in the European society and are determined to live in substandard conditions, characterized by lack of sanitation and overcrowdings, and bare the harsh weather conditions to earn their living. Often, they have limited access to healthcare and their lifestyle has a great impact upon their health. However, little is known about their own perceptions of their health and their strategies to keep it. Aim The aim was to explore the Romanian beggars’ perceptions of their health prior to and during begging, the perceived consequences of begging on their health, and their coping strategies to maintain health while begging in Uppsala, Sweden. Method Data was collected from 8 semi-structured interviews in Uppsala, Sweden during March 2015. The collected data was then analysed using manifest qualitative content analysis. Findings The Romanian beggars in Uppsala perceived their health status to be affected through their activity. Physical consequences involved developing new illnesses and conditions, but also aggravating previous health conditions, and mental consequences included degrading and marginalizing effects of begging, but also harassment from passersby. Access to healthcare in Sweden was limited and determined the beggars to develop alternative strategies for health management or to return to Romania for treatment.     Conclusion The health status was found to be both negatively and positively affected through complex interactions between the individual and the surrounding levels: social network, community, institutions and society. More attention should be given to this group from all levels to improve their health status.

The aims of this thesis were to explore nurses' experiences of stress in the ICU (I), to analyze experiences of moral concerns in intensive care nursing from the perspective of relational ethics (II), to describe the synthesis of the concept of moral stress and to identify preconditions for moral stress (III) and to analyse and describe lived experiences of support in situations characterized by critical care situations and moral stress in intensive care (IV).The design was exploratory and descriptive. Material in studies I, II and IV consisted of interviews with intensive care nurses (10 head nurses and 26 staff nurses) employed in general, thoracic and neonatal intensive care units in five hospitals located in different parts of Sweden. The material in study III data from two studies of professional issues in nursing were used for the analysis: one concerned psychiatric nursing and the other was the previously referred study I.In study I qualitative content analysis and descriptive interpretation was used in the analysis. The main theme 'stress induced by dissonant imperatives' formulated in the analysis. Dissonant imperatives are composed of the four sub-themes: 1) controlled by the working situation - needing to be in control, 2) constrained by prioritisation - wanting to do more, 3) lacking authority to act - knowing that something should be done, and 4) professional distance - interpersonal involvement. In study II qualitative content analysis and descriptive interpretation were used in the analysis. A main theme was formulated, 'caring about-caring for: tensions between moral obligations and work responsibilities in intensive care nursing'. Five sub-themes were formulated 1) believing in a good death, 2) knowing the course of events, 3) feelings of distress, 4) reasoning about the physicians and 5) expressing moral awareness. In the study III a hypothetical-deductive method was used. The findings indicate that moral stress is independent of context-given specific pre-conditions: 1) nurses are morally sensitive to the patient's vulnerability, 2) nurses experience external factors preventing them from doing the best for the patient, and 3) nurses feel that they have no control over the situation. In the study IV an interpretive method was used. The first level of analysis of data identified contextual factors, such as type and purpose of support and working conditions. Thereafter five tentative interpretations were revealed: 1) receiving organised support is a matter of self-determination, 2) whether to participate or to be off duty is experienced mutually as exclusive, 3) dealing with moral stress is experienced as a private matter, 4) colleagues managing moral stress serve as models in stress support, and 5) not being able to deal with moral stress urges one to seek outside support. A comparison of these interpretations identified three major themes: availability, accessibility and receptivity of support. The main interpretation of data was: "lived experience of moral stress support involves an interconnectedness between structural and existential factors".A comprehensive understanding was formulated using the four studies (I, II, III and IV). Moral stress was found to be influential on the caring competence. Conflicts between different competences were found leading to a shift in focus away from the patients leading to a possible decrease in the caring competence. Moreover, the subtle resistance among nurses toward participation in organized moral stress support may obstruct the development of nurses' caring competence. Accordingly, imbalance, due to moral stress, between different competences hinders the development of collectively shared caring competence.

In Sweden, there is currently no consensus addressing the screening, diagnostics and treatment of gestational diabetes mellitus (GDM). In addition, there is little knowledge on the impact of GDM on the daily life of pregnant women and the experiences of health care professionals providing maternal health care to women with GDM. Using different perspectives, this thesis examines the experiences of GDM and the performance of screening for GDM in a regional context in Sweden. The studies used qualitative and quantitative methods. In the qualitative studies, grounded theory was applied in two studies and qualitative content analysis in one study. In the quantitative study, a combination of questionnaire data and data from medical records of pregnancy and birth were processed. Surprisingly, screening for GDM was reduced despite local clinical guidelines stipulating the risk factors indicating an OGTT. Furthermore, the prevalence of the risk factors for GDM in the population investigated was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors for GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. The experiences of pregnant women with GDM revealed that being diagnosed with and living with GDM during pregnancy might be understood as a process ‘from stun to gradual balance’. The experience comprised both negative and positive dimensions. Despite the challenges, the inconveniences and the changes involved, gradually adapting to an altered lifestyle and finding their balance in daily life was ‘the prize’ the women ‘were willing to pay’ to secure optimal maternal and foetal health. The experiences of midwives comprised managing conflicting demands providing antenatal care to pregnant women diagnosed with GDM. Most midwives felt the obligation to control and monitor the complicated pregnancy, to initiate and motivate the recommended changes in life style together with providing an empowering and caring relation with the women. These assignments disclosed complex conflicting situations and the midwives appeared to choose strategy for managing the situation depending on their perception of the circumstances. The experiences of the obstetricians were understood as ‘dealing with ambiguity’. The ambiguity permeated all aspects of working as an obstetrician within the maternal health care counselling women with GDM: the role of the obstetrician, the context of the organization, balancing the multifaceted interests of the maternal and foetal conditions and the lack of consensus, recommendations and evidence-based knowledge.   The studies revealed the complexity of the situation for the affected pregnant women as well as for the health care professionals providing antenatal care to women diagnosed with GDM. Furthermore, the performance of screening of GDM in pregnant women with risk factors for GDM was insufficient in the investigated region. The findings in this thesis may be useful to increase knowledge of the experiences of pregnant women living with or managing GDM. The findings may also be useful when planning for improvements of maternal health care directed to pregnant women diagnosed with GDM during pregnancy.

Background The definition of self-harm used in this project is repeated, impulsive behaviour causing tissue damage, yet not intended as a suicide attempt. Instead of wishing to die, the person who self-harms wishes to be relieved from anxiety. The thesis comprises four studies and the overall aim was to describe experiences of care among people who self-harm, professional caregivers, and close relatives (parents), and to explore interpretative repertoires that jointly construct the interaction between people who self-harm and their professional caregivers. Methods The participants were nine women who self-harmed (I), six nurses, three of each sex (II), five mothers and one stepfather (III), and six women who self-harmed in two psychiatric inpatient wards and their caregivers (IV). Data were collected through narrative interviews (I, II, III), participant observations (IV), and informal interviews (IV). The interviews lasted between 40 and 50 minutes (I), between 40 and 65 minutes (II), and between 30 and 85 minutes (III). The observations including informal interviews in study IV comprised 150 hours of descriptive observations and 40 hours of focused observations. The data were analysed using qualitative content analysis (I, II), phenomenological hermeneutics (III), and discursive psychology (IV). Results People who self-harmed experienced care as inferior, not satisfying their needs. The findings presented a paradox; on the one hand, the women realised that society considered self-harm an inappropriate way to alleviate mental suffering, and on the other hand, they experienced self-harm as the only way to survive and to foster hope in themselves (I). Caregivers felt powerless and burdened when unable to identify and satisfy the women’s needs. Feelings of fear, frustration, and abandonment created a significant burden for caregivers (II). Parents’ lived experience of the professional care and caregivers of their self-harming adult children could be described as a hostage drama. As in a hostage situation, parents felt held to emotional ransom by deficient care and sometimes hostile caregivers (III). The interpretative repertoires that jointly constructed the interaction between those who self-harmed and their professional caregivers, were for the caregivers a fostering and a supportive repertoire, and for the women who self-harmed a victim and an expert repertoire. The interactions between a fostering caregiver and a woman as expert or as victim, and between a supportive caregiver and a woman as victim, were complicated and promoted feelings of hopelessness among the participants. Interactions between a supportive caregiver and a woman as expert were more satisfying and raised hope among the participants (IV). Synthesis of findings Hope and hopelessness ran together as a thread of meaning throughout the studies. All participants experienced and expressed hope and hopelessness in various ways. The self-harming women hovered between hope and hopelessness, hoping for help and support, but led back to hopelessness by their experiences in care. The women used self-harm as a way to cope and to maintain hope in themselves. The parents initially had confidence in healthcare and hoped for help. However, their experiences of meeting deficient care often made them feel hopeless. Parents paid an emotional ransom when they accepted deficient care for their daughters. The caregivers felt frustrated, angry, and powerless, and their view of self-harm as an endless behaviour led to hopelessness. However, they struggled to see the women’s abilities, not only their difficulties, and described how they had to try to see self-harm in another way. Caregivers who were convinced that it was possible to stop self-harming and leave it behind were able to bring hope to themselves, to parents, and to the women who self-harmed. The present studies suggest that there is a difference between self-harm and suicide attempts or suicide. Other researchers echo these findings. Conclusions Paradoxically, self-harm usually seems to be a life sustaining act, a way of raising hope in oneself. The importance of caregivers who listen and try to understand people who self-harm, as well as their close family members, is evident. By asking open-ended questions and being non-judgemental, listening, and showing a genuine interest in the person’s lived experience; caregivers can inspire hope in people who self-harm. / Bakgrund Självskadebeteende definieras i denna avhandling som ett upprepat, impulsivt beteende där hudskada uppstår. Avsikten med handlingen är inte att begå självmord, stället har personen en önskan att lindra ångest. Avhandlingen består av fyra delstudier och det övergripande syftet var att beskriva erfarenheter av vård bland personer med självskadebeteende, professionella vårdare och närstående (föräldrar), samt att belysa tolkningsrepertoarer som konstruerar interaktionen mellan personer med självskadebeteende och deras professionella vårdare. Metod Deltagarna var nio kvinnor med självskadebeteende (I), sex sjuksköterskor, tre av vardera kön (II), fem mammor och en styvpappa (III) samt sex kvinnor med självskadebeteende som vårdades vid två psykiatriska slutenvårdsavdelningar och deras professionella vårdare (IV). Datainsamlingsmetoder var narrativa intervjuer (I, II, III), deltagande observationer samt informella intervjuer (IV). De narrativa intervjuerna varade mellan 40 och 50 minuter (I), mellan 40 och 65 minuter (II) samt mellan 30 och 85 minuter (III). Beskrivande deltagande observationer genomfördes, totalt 150 timmar, varav ca 40 timmar var fokuserade deltagande observationer. Data analyserades med hjälp av kvalitativ innehållsanalys (I, II), fenomenologisk hermeneutik (III) samt diskurspsykologi (IV). Resultat Personerna med självskadebeteende upplevde att vården var undermålig och att den inte tillfredställde deras behov. Resultaten visar en paradox, å ena sidan insåg kvinnorna att samhället i stort anser att självskadebeteende är ett oacceptabelt sätt att hantera psykiskt lidande, å andra sidan, upplevde kvinnorna att självskadandet var det som gjorde det möjligt att överleva och att inge sig själv hopp (I). Professionella vårdare kände sig maktlösa och tyngda när de inte kunde identifiera och tillfredsställa kvinnornas behov av vård. Vårdarnas rädsla, frustration och känsla av övergivenhet, vilka medförde en känsla av att vara belastad, framkom (II). Den levda erfarenheten av professionell vård och vårdare bland föräldrar till vuxna barn med självskadebeteende beskrevs som ett gisslandrama. Föräldrar till en dotter i en gisslansituation betalade en känslomässig lösensumma när de mötte en undermålig och ibland fientlig vård (III). De dominerande tolkningsrepertoarerna som tillsammans konstruerade interaktionen för vårdarna var en fostrande och en stödjande repertoar. För kvinnorna med självskadebeteende dominerade en offer och en expertrepertoar. Interaktionen mellan en fostrande vårdare och kvinna som expert eller offer, samt en stödjande vårdare och en kvinna som offer, var mer komplicerad och ingav hopplöshet bland deltagarna. Interaktionen mellan en stödjande vårdare och en kvinna som expert var mer tillfredsställande och främjade hopp bland deltagarna. Syntes av resultat Hopp och hopplöshet visade sig vara ”en röd tråd” genom delstudierna. Alla deltagare upplevde och uttryckte hopp och hopplöshet på olika sätt. Kvinnorna svävade mellan känslor av hopp och hopplöshet, med önskningar om hjälp och stöd men deras erfarenheter av vård ingav hopplöshet. Kvinnorna använde självskada som en hanteringsstrategi och som ett sätt att inge sig själv hopp. Föräldrarna hade initialt ett förtroende för vården och hade förhoppningar om hjälp, men deras erfarenheter av att möta en undermålig vård ingav istället en känsla av hopplöshet. Föräldrarna betalade en känslomässig lösensumma när de accepterade en dålig vård för sin dotter. Vårdarna kände sig frustrerade, arga och maktlösa och deras syn på självskadebeteende som något ändlöst ingav hopplöshet. Vårdarna kämpade för att se kvinnornas förmågor, inte bara deras svårigheter och försökte förstå självskadebeteende. Vårdare som var övertygade om att det var möjligt att sluta skada sig och lämna det bakom sig lyckades inge sig själv, föräldrarna och kvinnorna med självskadebeteende hopp. Resultaten från föreliggande studier tyder på en skillnad mellan självskadebeteende och självmordsförsök eller självmord, vilket även stöds av andra forskare. Slutsatser Paradoxalt nog verkar självskadebeteende vara ett livsuppehållande beteende, ett sätt att inge sig själv hopp. Betydelsen av vårdare som lyssnar och försöker förstå personen som skadar sig och närstående är tydlig. Genom att ställa öppna frågor och tala på ett icke dömande sätt, samt genom att lyssna och visa ett genuint intresse för personens upplevelser, kan vårdare förmedla hopp.

Η παρούσα εργασία επιδιώκει να παρουσιάσει τον τρόπο με τον οποίο παρουσιάζονται οι Έλληνες και οι άλλοι λαοί στα σχολικά βιβλία Ιστορίας της Γ' Λυκείου από το 1965 έως σήμερα. Στόχος είναι να ανιχνευθεί ο τρόπος με τον οποίο κατασκευάζονται η ιστορική μνήμη και η εθνική ταυτότητα, σκιαγραφώντας έτσι την αντίληψη που είναι πιθανό να διαμορφώσουν οι μελλοντικοί πολίτες για τον εθνικό τους «εαυτό» (national ‘‘self’’) αλλά και για τους γείτονες λαούς, δηλαδή τον εθνικό «άλλο» (national ‘‘other’’).Η εργασία χωρίζεται σε δύο μέρη, το θεωρητικό και το ερευνητικό. Στο πρώτο μέρος γίνεται λόγος για το Σχολικό Εγχειρίδιο (Textbook), για τη Διεθνή Έρευνα των Διδακτικών Εγχειριδίων (International Textbook Research) αλλά και για το ρόλο της εικονογράφησης (the role of Textbook Pictures).Στο δεύτερο μέρος γίνεται η παρουσίαση της έρευνας των σχολικών βιβλίων Ιστορίας , τόσο ως προς το κείμενο όσο και ως προς το περικείμενο. Η παρουσίαση ακολουθεί την πορεία της ποιοτικής ανάλυσης περιεχομένου (qualitative content analysis), που επιλέχθηκε ως ερευνητική μέθοδος. / The current essay focuses on the way Greeks and the other nations are presented in the new textbooks of History in High school at the period 1695 to 2007. The purpose of the author is to enlight the way the historic memory and the national identity are shaped, so that it will be understood –up to a point- what the future Greeks will think about their ‘self’ and the other nations due to the books.The essay is separated in two parts. In the first part, the basic relevant theory and terminology are presented. In particular, the author is referring to Textbooks, to International Textbook Research and to the role of Textbook Pictures.In the second part, the analysis of the textbooks and their pictures is presented according to the process of the qualitative content analysis that had been chosen as the method of analysis.

This study is an exploration of the representation of masculinity in film, with particular focus on the way in which the leading male characters in a purposive sample of action genre and romantic comedy genre films represent masculinity. It is posited that masculinity is a construct, the meaning of which is dependent on the social context of the individual. Film being a social artefact could then possibly influence individuals understanding of the construct. Therefore an exploration of the kind of masculinity, the variations thereof across genres, and masculine characteristics of masculinity prevalent in each genre, is a first step in understanding possible influences of the definition of masculinity. In order to accomplish this exploration, a combination of methods is used to analyse these fictional characters according to a set of codes and „real‟ world norms. The real world norms are based on seven theoretically derived norms of masculinity developed from previous research on masculinity conducted by Levant, Hirsch, Celentano, Cozza, Hill, MacEachern, Marty and Schnedekerl (1992). The results of the findings from this study indicate that the way in which male characters are created for each genre are different, with male lead characters from the action genre having more characteristics that align with the „real‟ world norms of masculinity (Levant et al 1992). Alternatively, the male lead characters from the romantic comedy genre, have fewer characteristics that align with the seven theoretically derived norms of masculinity. The masculinity represented in the romantic comedy genre is more emotionally available and expressive, less aggressive, more compromising and reliant on others; while in the action genre masculinity is more independent, stoic, aggressive and more physically adventurous. The male lead characters in the romantic comedy genre are more about the emotional aspects of masculinity while the male lead characters in the action genre are more about the physical aspects of masculinity. / Communication Science / M.A. (Communication)