Baseline data from a planned RCT on attitudes to female genital cutting after migration: when are interventions justified?

OBJECTIVES: To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration. DESIGN: Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden. SETTING: Sweden. PARTICIPANTS: 372 Somali men and women, 206 newly arrived (0-4 years), 166 established (>4 years). PRIMARY OUTCOME MEASURES: Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent. RESULTS: The support for anatomical change of girls and women's genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%-83% among established and 53%-67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration. CONCLUSION: A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention. TRIAL REGISTRATION NUMBER: Trial registration number NCT02335697;Pre-results

Assessing the Multiple Dimensions of Poverty. Data Mining Approaches to the 2004-14 Health and Demographic Surveillance System in Cuatro Santos, Nicaragua.

We identified clusters of multiple dimensions of poverty according to the capability approach theory by applying data mining approaches to the Cuatro Santos Health and Demographic Surveillance database, Nicaragua. Four municipalities in northern Nicaragua constitute the Cuatro Santos area, with 25,893 inhabitants in 5,966 households (2014). A local process analyzing poverty-related problems, prioritizing suggested actions, was initiated in 1997 and generated a community action plan 2002-2015. Interventions were school breakfasts, environmental protection, water and sanitation, preventive healthcare, home gardening, microcredit, technical training, university education stipends, and use of the Internet. In 2004, a survey of basic health and demographic information was performed in the whole population, followed by surveillance updates in 2007, 2009, and 2014 linking households and individuals. Information included the house material (floor, walls) and services (water, sanitation, electricity) as well as demographic data (birth, deaths, migration). Data on participation in interventions, food security, household assets, and women's self-rated health were collected in 2014. A K-means algorithm was used to cluster the household data (56 variables) in six clusters. The poverty ranking of household clusters using the unsatisfied basic needs index variables changed when including variables describing basic capabilities. The households in the fairly rich cluster with assets such as motorbikes and computers were described as modern. Those in the fairly poor cluster, having different degrees of food insecurity, were labeled vulnerable. Poor and poorest clusters of households were traditional, e.g., in using horses for transport. Results displayed a society transforming from traditional to modern, where the forerunners were not the richest but educated, had more working members in household, had fewer children, and were food secure. Those lagging were the poor, traditional, and food insecure. The approach may be useful for an improved understanding of poverty and to direct local policy and interventions

Trends and factors related to adolescent pregnancies: an incidence trend and conditional inference trees analysis of northern Nicaragua demographic surveillance data

Background We aimed to identify the 2001-2013 incidence trend, and characteristics associated with adolescent pregnancies reported by 20-24-year-old women. Methods A retrospective analysis of the Cuatro Santos Northern Nicaragua Health and Demographic Surveillance 2004-2014 data on women aged 15-19 and 20-24. To calculate adolescent birth and pregnancy rates, we used the first live birth at ages 10-14 and 15-19 years reported by women aged 15-19 and 20-24 years, respectively, along with estimates of annual incidence rates reported by women aged 20-24 years. We conducted conditional inference tree analyses using 52 variables to identify characteristics associated with adolescent pregnancies. Results The number of first live births reported by women aged 20-24 years was 361 during the study period. Adolescent pregnancies and live births decreased from 2004 to 2009 and thereafter increased up to 2014. The adolescent pregnancy incidence (persons-years) trend dropped from 2001 (75.1 per 1000) to 2007 (27.2 per 1000), followed by a steep upward trend from 2007 to 2008 (19.1 per 1000) that increased in 2013 (26.5 per 1000). Associated factors with adolescent pregnancy were living in low-education households, where most adults in the household were working, and high proportion of adolescent pregnancies in the local community. Wealth was not linked to teenage pregnancies. Conclusions Interventions to prevent adolescent pregnancy are imperative and must bear into account the context that influences the culture of early motherhood and lead to socioeconomic and health gains in resource-poor settings

Ekonomistyrning i projekt : Redovisning, Styrning och uppföljning av långa projekt

Denna rapport avser att behandla ekonomistyrning explicit i långa projekt och lyfta ut och granska de problem som kan uppkomma. Vi har valt att avgränsa undersökningen till långa projekt då dessa inte med automatik fungerar i verksamhetens normala budgeterings och bokslutsprocess. Vi undersöker om det finns specifika problem med att projektets löptid sträcker sig över flera år och över årsbokslut. Vi har valt att genomföra undersökningen genom en fallstudie där vi har valt ut ett företag som arbetar med väldigt långa projekt. Vi tittar på hur budgetering och uppföljning fungerar och vilka problem som kan uppstå. Företaget har erbjudit total insyn i hur projekt hanteras och vi har också haft möjligheter att intervjua ett antal personer som arbetar med och har erfarenheter från ledning och styrning av projekt. Vi kan konstatera att den problematik som uppstår, inte nämnvärt skiljer sig från den problematik som ryms inom ekonomistyrning i stort. Nyckeltalen måste följa som ett led av verksamhetens övergripande strategi och förankras inom organisationen för att vinna validitet och förtroende. Resultatet måste kommuniceras regelbundet så att utfallet kan värderas mot uppsatta mål och förbättras. Vi har funnit att problematiken för ekonomistyrningen i långa projekt ligger främst i att de systemstöd som finns på marknaden i första hand stödjer de legala bokslutsperioderna och inte alltid erbjuder den flexibilitet som behövs i långa projekt. Det finns system på marknaden som stödjer planering och ledning men kopplingen mot redovisning och ekonomistyrning är fortfarande svag. Genom att generalisera finns dock möjligheter att få en fullgod uppföljning och ekonomistyrning även av långa projekt

Ekonomistyrning i projekt : Redovisning, Styrning och uppföljning av långa projekt

Denna rapport avser att behandla ekonomistyrning explicit i långa projekt och lyfta ut och granska de problem som kan uppkomma. Vi har valt att avgränsa undersökningen till långa projekt då dessa inte med automatik fungerar i verksamhetens normala budgeterings och bokslutsprocess. Vi undersöker om det finns specifika problem med att projektets löptid sträcker sig över flera år och över årsbokslut. Vi har valt att genomföra undersökningen genom en fallstudie där vi har valt ut ett företag som arbetar med väldigt långa projekt. Vi tittar på hur budgetering och uppföljning fungerar och vilka problem som kan uppstå. Företaget har erbjudit total insyn i hur projekt hanteras och vi har också haft möjligheter att intervjua ett antal personer som arbetar med och har erfarenheter från ledning och styrning av projekt. Vi kan konstatera att den problematik som uppstår, inte nämnvärt skiljer sig från den problematik som ryms inom ekonomistyrning i stort. Nyckeltalen måste följa som ett led av verksamhetens övergripande strategi och förankras inom organisationen för att vinna validitet och förtroende. Resultatet måste kommuniceras regelbundet så att utfallet kan värderas mot uppsatta mål och förbättras. Vi har funnit att problematiken för ekonomistyrningen i långa projekt ligger främst i att de systemstöd som finns på marknaden i första hand stödjer de legala bokslutsperioderna och inte alltid erbjuder den flexibilitet som behövs i långa projekt. Det finns system på marknaden som stödjer planering och ledning men kopplingen mot redovisning och ekonomistyrning är fortfarande svag. Genom att generalisera finns dock möjligheter att få en fullgod uppföljning och ekonomistyrning även av långa projekt

The next of kin experiences of symptoms and distress among patients with colorectal cancer : diagnosis and treatment affecting the life situation

Purpose To identify symptoms/distress among patients with colorectal cancer undergoing chemotherapy, from the viewpoint of the next of kin, and to establish whether there are any barriers to reporting these problems. Methods Individual face-to-face interviews with fourteen next of kin were conducted. Qualitative content analysis was used to analyse the transcripts. Results Three areas were identified: symptoms presented, barriers to reporting symptoms/distress, and influences on life for the next of kin. Nine symptoms were raised as most common by the next of kin. Almost all the next of kin denied that they had experienced any barriers to reporting symptoms/distress but some did exist, namely barriers to proper communication and barriers of time. The next of kin made another interpretation of barriers; they did not interpret it as hinder or obstacle. All next of kin talked to a large extent about how the patient's disease and treatment affected them as next of kin. It affected them psychologically, they had to re-valuate their life, and it influenced their social life. Conclusions The symptoms reported during chemotherapy were similar to those found in other studies on patients. Barriers to reporting symptoms were mentioned, but not to a great extent. Although it was not the main purpose of the study, the next of kin raised concerns about the patient's disease and treatment and how it influenced next of kin life

Calcium addition to EDTA plasma eliminates falsely positive results in the RSR GADAb ELISA

BACKGROUND: The RSR ELISAs for GADAb and IA-2Ab are now widely used but due to a considerable number of falsely positive GADAb results obtained with EDTA plasma, it is recommended that only serum samples are run in these two assays. However, as EDTA plasma is often the preferred sample type in Europe we have assessed the possibility that adding Ca(2+) to plasma would reduce the number of falsely positive results. METHODS: Antibody positive as well as antibody negative diabetic subjects were included in the study (n=80). Serum and EDTA plasma were collected from the same subjects at the same occasion. Samples were divided into three groups; sera, EDTA plasma and EDTA plasma+Ca(2+). ELISA kits were supplied by RSR((R)) Ltd and performed according to the manufacturers instructions. RESULTS: GADAb analyses with plasma showed a markedly increased prevalence of GADAb positive subjects (81%) compared to sera (36%), indicating falsely positive results with plasma. Addition of Ca(2+) reduced the number of GADAb positive results to the same number obtained with serum. IA-2Ab positivity was not different between sera and plasma. CONCLUSION: EDTA plasma can be used in the RSR GADAb and IA-2Ab ELISAs if Ca(2+) is added prior to assay

Factors associated with the support of pricking (female genital cutting type IV) among Somali immigrants : a cross-sectional study in Sweden

Background: Pricking, classified as female genital cutting (FGC) type IV by the World Health Organization, is an under-researched area gaining momentum among diaspora communities. Our aim was to explore factors associated with being supportive of pricking among Somalis in Sweden. Methods: In a cross-sectional design, attitudes and knowledge regarding FGC, and measures of socioeconomic status, acculturation, and social capital, were assessed by a 49-item questionnaire in four municipalities in Sweden. Data were collected in 2015 from 648 Somali men and women, ≥ 18 years old, of which 113 supported the continuation of pricking. Logistic regression was used for the analysis. Results: Those more likely to support the continuation of pricking were older, originally from rural areas, and newly arrived in Sweden. Further, those who reported that they thought pricking was: acceptable, according to their religion (aOR: 10.59, 95% CI: 5.44–20.62); not a violation of children’s rights (aOR: 2.86, 95% CI: 1.46–5.61); and did not cause long-term health complications (aOR: 5.52, 95% CI: 2.25–13.52) had higher odds of supporting pricking. Religion was strongly associated with the support of pricking among both genders. However, for men, children’s rights and the definition of pricking as FGC or not were important aspects in how they viewed pricking, while, for women, health complications and respectability were important. Conclusions: Values known to be associated with FGC in general are also related to pricking. Hence, there seems to be a change in what types of FGC are supported rather than in their perceived values