How do we understand children's restlessness? A cooperative and reflexive exploration of children's restlessness as a bioecological phenomenon

This thesis is a reflexive and cooperative exploration of children’s restlessness as bioecological phenomenon. According to the ecological systems model, development can be understood as the result of interactions between the child’s biological qualities and qualities in the surrounding ecological systems. According to the ADHD diagnosis, children’s restlessness can be understood as a neurodevelopmental disorder that can be observed as biological, psychological and social symptoms and dysfunction. As a form of vitality, restlessness can be experienced and expressed as a certain combination of movement, time, force, space and intention/directionality. In this thesis, restlessness is defined as the label given to an experienced form of vitality that appears in the space between the described and the describer. This definition points to the importance of the observing adult, and binds the acting child and the observing adult together in mutual revelation. Possible biological mechanism that can give rise to children’s restlessness include maturation, different genetic susceptibility, and play behaviour. Possible psychological mechanisms include motivation, identity formation, and musical improvisation. Possible social mechanisms include cultural mothering ideals, socioeconomic status, and child maltreatment. An ecological systems model allows for the exploration of complex and multi-level relations between the person, the context and time. A community music therapy approach points to the importance of exploring the qualities involved in these ecological processes. Children’s restless behaviours have been understood and met in different ways within music therapy, partly depending on the context and on the music therapist/researcher. I critically reflect on what happens when children’s boundaries are violated, whether restlessness can be related to gender, on the relative lack of system focus, and on the implicit goals of music therapy. I also reflect on whether theoretical orientation is related to therapeutic action, where the restlessness comes from and whether it can be understood as inter-contextual tension. Paper 1 is a critical exploration of the position of the biopsychosocial model and ADHD in Norway. I argue that the different understandings discussed can be seen as pertaining to different levels of inquiry. These come with certain possibilities and limitations. Paper 2 presents ecologically valid understandings of children’s restlessness, that were created through cooperative inquiry with professionals and parents. Data were analysed using thematic analysis. Children’s restlessness was understood as individual trait, expectations to be seen and heard, result of traumatisation, relational phenomenon, parent’s problems, lack of cooperation in the community, and as lack of structures and resources. Paper 3 is a case study of a collaborative community music therapy process with one boy and his friends. Their process is understood in terms of exploring musical vitality, consolidating positions, performing together and discovering ecological ripple effects. Children’s restlessness be understood as a bioecological phenomenon, where biological, psychological and social aspects are interrelated and co-constituting. Adding two ‘new’ levels to the ecological systems model can allow for a more precise integration of findings, and facilitate exploration of relations between findings that belong to different ecological levels. Children’s restlessness be also understood as results of interactions between process, person, context and time. Actions, vitality forms and development can be seen as taking place within a certain space of appearance. Action can be seen as inherently unpredictable, as conditioned by plurality, and as defined in relation to an already existing web of relations. Children’s restlessness can be understood on the premise that children and adults are participating subjects acting on each other. Different contexts offer different possibilities and limitations, and music therapy can be used to increase children’s possibilities for action. By regarding health as relational, function and development can be understood as relational and context-dependent. A relational approach to health can increase adults’ possibilities for action and understanding. It also points to adults’ responsibilities related to understanding children better and creating better contexts for children

Do we understand children’s restlessness? Constructing ecologically valid understandings through reflexive cooperation

Attention-deficit/hyperactivity disorder (ADHD) is the most widely used children’s mental health diagnosis today, but the validity of the diagnosis is controversial, for instance, because it might conceal relational and ecological dimensions of restlessness. We invited parents and professionals from one local community in western Norway to participate in cooperative group discussions on how to conceptualize and understand children’s restlessness. We carried out a thematic and reflexive analysis of the cooperative group discussions on ADHD and children’s restlessness, and present findings related to three ecological levels inspired by Bronfenbrenner’s ecological systems model. At the level of the individual, restlessness was discussed as individual trait, as the expectation to be seen and heard, and as a result of traumatization. At the level of dyad, group or family, restlessness was discussed as a relational phenomenon and as parents’ problems. At the level of community, restlessness was discussed as lack of cooperation and lack of structures or resources. Our findings show how contextualized and cooperative reflexivity can contribute to more valid understandings of children’s restlessness, and how cooperative inquiry can stimulate reflections about solidarity and sustainability in relation to adult’s actions.publishedVersio

Relation of delayed recovery of myocardial function after takotsubo cardiomyopathy to subsequent quality of life

Takotsubo cardiomyopathy (TTC) has generally been regarded as a relatively transient disorder, characterized by reversible regional left ventricular systolic dysfunction. However, most patients with TTC experience prolonged lassitude or dyspnea after acute attacks. Although this might reflect continued emotional stress, myocardial inflammation and accentuated brain-type natriuretic peptide (BNP) release persist for at least 3 months. We therefore tested the hypotheses that this continued inflammation is associated with (1) persistent contractile dysfunction and (2) consequent impairment of quality of life. Echocardiographic parameters (global longitudinal strain [GLS], longitudinal strain rate [LSR], and peak apical twist [AT]) were compared acutely and after 3 months in 36 female patients with TTC and 19 age-matched female controls. Furthermore, correlations were sought between putative functional anomalies, inflammatory markers (T2 score on cardiovascular magnetic resonance, plasma NT-proBNP, and high-sensitivity C-reactive protein levels), and the physical composite component of SF36 score (SF36-PCS). In TTC cases, left ventricular ejection fraction returned to normal within 3 months. GLS, LSR, and AT improved significantly over 3-month recovery, but GLS remained reduced compared to controls even at follow-up (-17.9 ± 3.1% vs -20.0 ± 1.8%, p = 0.003). Impaired GLS at 3 months was associated with both persistent NT-proBNP elevation (p = 0.03) and reduced SF36-PCS at ≥3 months (p = 0.04). In conclusion, despite normalization of left ventricular ejection fraction, GLS remains impaired for at least 3 months, possibly as a result of residual myocardial inflammation. Furthermore, perception of impaired physical exercise capacity ≥3 months after TTC may be explained by persistent myocardial dysfunction

Increased Left Ventricular Torsion in Uncomplicated Type 1 Diabetic Patients: The role of coronary microvascular function

We used speckle tracking echocardiography to study the early changes in left ventricular (LV) torsion in young patients with uncomplicated type 1 diabetes and stress magnetic resonance imaging (MRI) to assess its interrelationships with coronary microangiopathy

From community to assemblage? : ICT provides a site for inclusion and exclusion in the global south

The role of information and communication technology (ICT) in development has been discussed from two distinctly different perspectives: some view it as a means for opening new alleys for the facilitation of development and democracy, while others assess it as counterproductive. Furthermore, it has been emphasised that people in cities and rural areas utilise ICT in different ways, as do people with wealth and education compared to poor people. In Africa, Kenya has declared itself an ICT hub. The state has emphasised ICT in promoting services, much less freedom of expression. This article discusses ICT and development via the filter of assemblage, a key concept developed by Deleuze and Guattari (2004/1980. A Thousand Plateaus: Capitalism and Schizophrenia. London: Continuum.). They emphasised fluidity as well as micro- and macro-level dichotomies. When communities based on sharing and consistent social order meet new technology, the change goes deeper than that of improved services. The basic difference might be the fact that a community is constructed on cultural ties developed over time, which strengthens immobility and stability, while an assemblage is characterised by mobility and fluidity. Thus, a system of values, hierarchies, and inherited traditions is challenged, mixed with ‘new’ problems brought about by individualised behaviour.Peer reviewe

The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation

Background - Few of the many behavioral sexual health interventions in Africa have been rigorously evaluated. Where biological outcomes have been measured, improvements have rarely been found. One of the most rigorous trials was of the multi-component MEMA kwa Vijana adolescent sexual health programme, which showed improvements in knowledge and reported attitudes and behaviour, but none in biological outcomes. This paper attempts to explain these outcomes by reviewing the process evaluation findings, particularly in terms of contextual factors. Methods - A large-scale, primarily qualitative process evaluation based mainly on participant observation identified the principal contextual barriers and facilitators of behavioural change. Results - The contextual barriers involved four interrelated socio-structural factors: culture (i.e. shared practices and systems of belief), economic circumstances, social status, and gender. At an individual level they appeared to operate through the constructs of the theories underlying MEMA kwa Vijana - Social Cognitive Theory and the Theory of Reasoned Action – but the intervention was unable to substantially modify these individual-level constructs, apart from knowledge. Conclusion - The process evaluation suggests that one important reason for this failure is that the intervention did not operate sufficiently at a structural level, particularly in regard to culture. Recently most structural interventions have focused on gender or/and economics. Complementing these with a cultural approach could address the belief systems that justify and perpetuate gender and economic inequalities, as well as other barriers to behaviour change

Modelling human musculoskeletal functional movements using ultrasound imaging

<p>Abstract</p> <p>Background</p> <p>A widespread and fundamental assumption in the health sciences is that muscle functions are related to a wide variety of conditions, for example pain, ischemic and neurological disorder, exercise and injury. It is therefore highly desirable to study musculoskeletal contributions in clinical applications such as the treatment of muscle injuries, post-surgery evaluations, monitoring of progressive degeneration in neuromuscular disorders, and so on.</p> <p>The spatial image resolution in ultrasound systems has improved tremendously in the last few years and nowadays provides detailed information about tissue characteristics. It is now possible to study skeletal muscles in real-time during activity.</p> <p>Methods</p> <p>The ultrasound images are transformed to be congruent and are effectively compressed and stacked in order to be analysed with multivariate techniques. The method is applied to a relevant clinical orthopaedic research field, namely to describe the dynamics in the Achilles tendon and the calf during real-time movements.</p> <p>Results</p> <p>This study introduces a novel method to medical applications that can be used to examine ultrasound image sequences and to detect, visualise and quantify skeletal muscle dynamics and functions.</p> <p>Conclusions</p> <p>This new objective method is a powerful tool to use when visualising tissue activity and dynamics of musculoskeletal ultrasound registrations.</p

Masculinity, sexuality and vulnerability in 'working' with young men in South African contexts: 'you feel like a fool and an idiot...a loser'

South Africa has seen a rapid increase in scholarship and programmatic interventions focusing on gender and sexuality, and more recently on boys, men and masculinities. In this paper, we argue that a deterministic discourse on men's sexuality and masculinity in general is inherent in many current understandings of adolescent male sexuality, which tend to assume that young women are vulnerable and powerless and young men are sexually powerful and inevitably also the perpetrators of sexual violence. Framed within a feminist, social constructionist the oretical perspective, the current research looked at how the masculinity and sexuality of South African young men is constructed, challenged or maintained. Focus groups were conducted with young men between the ages of 15 and 20 years from five different schools in two regions of South Africa, the Western and Eastern Cape. Data were analysed using Gilligan's listening guide method. Findings suggest that participants in this study have internalised the notion of themselves as dangerous, but were also exploring other possible ways of being male and being sexual, demonstrating more complex experiences of manhood. We argue for the importance of documenting and highlighting the precariousness, vulnerability and uncertainty of young men in scholarly and programmatic work on masculinities.IBS