Communicative work : Establishing communication by severely disabled children in small group homes

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Factors affecting self-evaluated general health status and the use of professional health care services

The idea of health has been given different meanings throughout history. The “Pippin perspective” introduced here contrasts the seemingly prevailing cultural climate of fascination and concern with personal health, uneasiness and “elevating health to a super value, a metaphor for all that is good in life” (1). What Pippin might help to illustrate is the reported historical trend toward a broadening of the range of problems and social phenomena being conceptualized in terms of health and illness (1-4). To the primary health care system, involved with the care of iliness experience — although accused for being basically centred on disease — such changes have obvious strong implications. The main topics of the present analyses are the exploration of factors involved in health and illness perceptions and the use of health care services. The first challenge when trying to face these topics is the conceptual approach

Reducing uncertainties in global HIV prevalence estimates: the case of Zambia

BACKGROUND: The premise for using antenatal care (ANC) clinic data for estimating HIV prevalence in the general population is the finding from community studies in sub-Saharan Africa that total HIV prevalence in pregnant women attending ANC clinics closely approximate levels in the total general population of both women and men aged 15–49 years. In this study, the validity of national level HIV prevalence estimates for the total general population 15–49 years made from ANC clinic and population survey data was assessed. METHODS: In 2001–2002, a national population HIV prevalence survey for women 15–49 years and men 15–59 years was conducted in Zambia. In the same period, a national HIV sentinel surveillance survey among pregnant women attending ANC clinics was carried out. RESULTS: The ANC HIV prevalence estimates for age-group 15–49 years (rural: 11.5%; 95% CI, 11.2–11.8; urban: 25.4%; 95% CI, 24.8–26.0; adjusted national: 16.9%; 95% CI, 16.6–17.2) were similar to the population survey estimates (rural: 10.8%; 95% CI, 9.6–12.1; urban: 23.2%; 95% CI 20.7–25.6; national: 15.6%; 95% CI, 14.4–16.9). The HIV prevalence urban to rural ratio was 2.2 in ANC and 2.1 in population survey estimates. CONCLUSION: The HIV prevalence estimate for the total general population 15–49 years derived from testing both women and men in the population survey was similar to the estimate derived from testing women attending ANC clinics. It shows that national HIV prevalence estimates for adults aged 15–49 years can also be obtained from ANC HIV sentinel surveillance surveys with good coverage when ANC attendance and fertility are high

Strategisk regnskapsanalyse og fundamental verdsettelse av Kværner ASA

Vi har i denne masterutregningen gjennomført en fundamental verdsettelse av Kværner ASA, omtalt som bare Kværner. Vi har først utarbeidet en strategisk analyse av eksterne og interne forhold for Kværner. Deretter har vi gjennomført en regnskapsanalyse, og sammenlignet Kværners prestasjoner mot konkurrentene. Innsikten fra analysene har vi benyttet til å utarbeide et fremtidsregnskap. Kontantstrømmene fra fremtidsregnskapet diskonteres så med utarbeidede avkastningskrav for å finne dagens verdi av Kværners egenkapital. Fra den strategiske analysen fant vi at det er overkapasitet i bransjen, samt at dagens lave oljepris gjør at det er få aktuelle kontrakter for Kværner å konkurrere om de nærmeste årene. Samtidig besitter Kværner en kompetanse på norske feltutbygginger som gir et varig fortrinn. Dette gjør at vi mener Kværner vil være konkurransedyktige i fremtiden. Fra regnskapsanalysen fant vi at Kværner har hatt en vesentlig høyere egenkapitalrentabilitet og omløp til netto driftskapital enn resten av bransjen. Vi benyttet så innsikten fra analysene til å utarbeide et fremtidsregnskap. Der forventer vi et fall i driftsinntekter i de nærmeste tre årene, før vi forventer at markedet vil bedre seg og vi ser vekst i driftsinntektene igjen. Vi har også laget prognoser på fremtidsbalanser, regnskap og kontantstrømmer, som vi så har benyttet til å utarbeide et verdiestimat på egenkapitalen til Kværner. Et gjennomsnitt av de to metodene vi benyttet for å beregne egenkapitalverdien gav en verdi på 8,27 NOK per aksje. Vi har så gjennomført en sensitivitetsanalyse for å belyse effekten av endringer i forutsetningene for vårt verdiestimat. En handlingsstrategi ble utarbeidet for en Kværner-aksje basert på verdiestimatet. Der anbefaler vi kjøp dersom aksjeverdien er under 7,44 NOK, selg for verdi over 9,10 NOK og hold for verdier mellom dette. Børsverdi av en Kværner-aksje på 8,31 NOK per 02.12.2015 gjør at vi anbefaler en hold strategi for Kværner.nhhma

Small streams make big rivers : exploring motivation and idealism in Norwegian personalised aid initiatives in the Gambia

Master thesis development management - University of Agder 2016Little is known about personalised aid organisations in Norway, and those initiatives are not recognised as part of the official Norwegian development aid structure. The organisations are small in size and by themselves do not raise enormous amounts of money, nor do they individually have a massive developmental effect. But collectively it is believed that their influence, both on sponsors in Norway as well as on aid recipients in the Global South, is quite substantial. This study explores the motivation of initiators of six personalised aid organisation in Norway, which all run development projects in the Gambia. The characteristics of a personalised aid organisation are often linked to the motivation of the initiative’s founder, such as the small size of the organisation which allows the aid worker to be close to and exert considerable control over the project. However, the personal control raises questions about project ownership and sustainability. The study finds that, in as much as there is a need for help at the recipient level, donors are also motivated by an inherent need to help

Comparative Validity of Screening Instruments for Mental Distress in Zambia

Background: The recognition of mental health as a major contributor to the global burden of disease has led to an increase in the demand for the inclusion of mental health services in primary health care as well as in community-based health surveys in order to improve screening, diagnosis and treatment of mental distress. Many screening instruments are now available. However, the cultural validity of these instruments to detect mental distress has rarely been investigated in developing countries. In these countries, limited trained staff and specialized psychiatric facilities hamper improvement of mental health services. It is therefore imperative to develop a quick, low cost screening instrument that does not require specialized training. We validated different well established screening instruments among primary health care clinic attendees in Lusaka, Zambia. We also assess the face, content and criterion validity of the SRQ’s and determined the most commonly reported symptoms for mental distress. Methods: The screening instruments, SRQ-20, SRQ-10 and GHQ-12 were used as concurrent criteria for each other and compared against a gold standard, DSM-IV. Their correlation, sensitivity and specificity were assessed. All instruments were administered to 400 primary health care clinic attendees. In-depth interviews were also conducted with 28 of these clinic attendees. Results: Both the SRQ-20 and SRQ-10 had high properties for identifying mental distress correctly with an AUC of 0.96 and 0.95 respectively while the GHQ-12 had modest properties (AUC, 0.81). The optimum cut-off points for this population were 7 and 3 for the SRQ and GHQ-12 respectively. The SRQ was also found to have good face and content validity. Conclusion: The study establishes the utility of the SRQ-20 for detecting mental distress cases and also underscores the importance of validating instruments to suit the context of the target population. It also validates the SRQ-10 as the first reliable abbreviated and easy-to-use screening instrument for mental distress in primary health care facilities in Zambia

Family-like Relationships and Wellbeing of Young Refugees in Finland, Norway, and Scotland

Abstract: In this article, we explore the role of family-like relationships in creating wellbeing for unaccompanied minor refugees (UMRs) to Europe. Our theoretical point of departure is a relational approach to wellbeing as conceptualized by Sarah C. White. The data comprises interviews with 51 settled UMRs in Finland, Norway, and Scotland, focused on their social networks, and a selection of paired interviews with young people alongside someone they defined as family-like and important for their wellbeing today. Findings illuminate the important role family-like relationships have in meeting the daily needs of young refugees. These relationships are ascribed meaning in the context of young people’s wider networks and ideas of ‘what family should do’. Family-like relationships gain particular importance for UMRs in two different ways: first, the physical absence of the family of origin enforces children and young people’s need to create trusted, reciprocal networks. Second, building family-like relationships is necessary in a new country where UMRs grow up and face new expectations, needs, and opportunities. We argue that relational wellbeing is built in a hybrid ‘third space’. A welfare state should support the wellbeing of UMRs by nurturing welcoming communities and providing UMRs help with building family-like relationships through formal and other support networks.Family-like Relationships and Wellbeing of Young Refugees in Finland, Norway, and ScotlandpublishedVersio

Relasjonelt aktørskap : Vilkår for medverknad når barn og unge med utviklingshemming bur i barnebustad

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Effects of neighbourhood-level educational attainment on HIV prevalence among young women in Zambia

<p>Abstract</p> <p>Background</p> <p>Investigations of the association between socio-economic position indicators and HIV in East, Central and Southern Africa have chiefly focused on factors that pertain to individual-level characteristics. This study investigated the effect of neighbourhood educational attainment on HIV prevalence among young women in selected urban and rural areas in Zambia.</p> <p>Methods</p> <p>This study re-analysed data from a cross-sectional population survey conducted in Zambia in 2003. The analyses were restricted to women aged 15–24 years (n = 1295). Stratified random cluster sampling was used to select 10 urban and 10 rural clusters. A measure for neighbourhood-level educational attainment was constructed by aggregating individual-level years-in-school. Multi-level mixed effects regression models were run to examine the neighbourhood-level educational effect on HIV prevalence after adjusting for individual-level underlying variables (education, currently a student, marital status) and selected proximate determinants (ever given birth, sexual activity, lifetime sexual partners).</p> <p>Results</p> <p>HIV prevalence among young women aged 15–24 years was 12.5% in the urban and 6.8% in the rural clusters. Neighbourhood educational attainment was found to be a strong determinant of HIV infection in both urban and rural population, i.e. HIV prevalence decreased substantially by increasing level of neighbourhood education. The likelihood of infection in low vs. high educational attainment of neighbourhoods was 3.4 times among rural women and 1.8 times higher among the urban women after adjusting for age and other individual-level underlying variables, including education. However, the association was not significant for urban young women after this adjustment. After adjusting for level of education in the neighbourhood, the effect of the individual-level education differed by residence, i.e. a strong protective effect among urban women whereas tending to be a risk factor among rural women.</p> <p>Conclusion</p> <p>The findings suggested structural effects on HIV prevalence. Future research should include more detailed mapping of neighbourhood factors of relevance to HIV transmission as part of the effort to better understand the causal mechanisms involved.</p