Exploring the context of sedentary behaviour in older adults (what, where, why, when and with whom)

BACKGROUND: Older adults are the most sedentary segment of the population. Little information is available about the context of sedentary behaviour to inform guidelines and intervention. There is a dearth of information about when, where to intervene and which specific behaviours intervention should target. The aim of this exploratory study was to obtain objective information about what older adults do when sedentary, where and when they are sedentary and in what social context. METHODS: The study was a cross-sectional data collection. Older adults (Mean age = 73.25, SD ± 5.48, median = 72, IQR = 11) volunteers wore activPAL monitors and a Vicon Revue timelapse camera between 1 and 7 days. Periods of sedentary behaviour were identified using the activPAL and the context extracted from the pictures taken during these periods. Analysis of context was conducted using the Sedentary Behaviour International Taxonomy classification system. RESULTS: In total, 52 days from 36 participants were available for analysis. Participants spent 70.1 % of sedentary time at home, 56.9 % of sedentary time on their own and 46.8 % occurred in the afternoon. Seated social activities were infrequent (6.9 % of sedentary bouts) but prolonged (18 % of sedentary time). Participants appeared to frequently have vacant sitting time (41 % of non-screen sedentary time) and screen sitting was prevalent (36 % of total sedentary time). CONCLUSIONS: This study provides valuable information to inform future interventions to reduce sedentary behaviour. Interventions should consider targeting the home environment and focus on the afternoon sitting time, though this needs confirmation in a larger study. Tackling social isolation may also be a target to reduce sedentary time

“A memorable consultation”: Writing reflective accounts articulates students’ learning in general practice

The Meeting between the Patient and the Doctor Experiences among Somali refugees and medical trainees Kristian Svenberg Abstract Background and aim. The overall aim of the thesis is to explore the patient‐doctor encounter based on experiences among Somali refugees and medical interns in Sweden. Though research in this area is scarce, it has demonstrated that the transcultural meeting in health care suffers shortcomings. This applies to treatment and rapport as well as to outcomes of treatment and care. Starting from the experiences of medical students reflecting on a memorable consultation (paper I), the thesis illuminates the experiences of health and illness and of encounters with Swedish health care of one group of patients, Somali refugees (papers II, III). The thesis further explores the experiences among Swedish vocational trainees in general practice of their encounters with patients from Somalia (paper IV). Method. The thesis is based on four qualitative studies. In paper I, data was gathered from written reflective accounts. In paper II and III, data was collected through individual interviews and in paper IV through focus group interviews. Data was analysed using qualitative content analysis (paper I), a hermeneutic‐phenomenological methodology (paper II, III) and phenomenography (paper IV). Findings. Paper I. Involving students in writing reflective accounts stimulated them in articulating practice experiences of the consultation. Main themes of students’ learning experiences were “The person beyond symptoms”, “Facing complexity” and “In search of a professional role”. Paper II. Somali refugees were interviewed as to their experiences in relation to health and illness. One essential theme emerged: “a life in exile”. This was expressed in thematic aspects dealing with longing for the homeland, experience of pain, discrimination and the comforting role of religion. Paper III illuminates the experiences of Somali refugees encountering Swedish health care. Ambiguous feelings of high expectations and disappointment were expressed including sentiments of being rejected and not taken seriously, often resulting in a decision to go abroad for medical care. In paper IV, vocational trainees in Swedish general practice give voice to their experiences of meeting Somali patients. In meeting the patient, they faced high expectations and noticed a certain cultural distance. Perceptions of being both pleased and confused were articulated. Obstacles in the meeting were expressed by a majority of the informants, on a linguistic level as well as of intricacies in understanding the patients’ problem in general. To control this situation, some conformed to an authoritarian strategy, whereas others used approaches coined by curiosity. Conclusion. Somali refugee patients, with problems and complaints frequently caused by a life in exile, often experience rejection in the medical encounter. A major finding of the thesis is the importance of seeing the patient as a person, thus throwing light on the complex web of factors influencing the patients’ symptoms. To promote this, strategies of curiosity and an interest in the patients’ personal history should be encouraged among health care providers. Key words. Medical encounter, experience, medical student, vocational trainee, Somali, refugee, health, illness ISBN 978‐91‐628‐8339‐3 http://hdl.handle.net/2077/2796

The genetic legacy of lower sea levels: does the confluence of rivers during the last glacial maximum explain the contemporary distribution of a primary freshwater fish (Pseudobarbus burchelli, Cyprinidae) across isolated river systems?

The primary freshwater fish Pseudobarbus burchelli (Smith 1841) occurs across four presently isolated river systems in the south-western cape floristic region of South Africa. Mitochondrial DNA cytochrome b (701 base pairs) and control region (601 base pairs) genes were sequenced to assess the evolutionary history of P. burchelli and evaluate the role of climatic and landscape changes in shaping patterns of genetic variation in this species. We identified three historically isolated lineages in P. burchelli: a widespread lineage that occurs across three isolated river systems and two geographically restricted lineages. The results were evaluated against predictions of the confluence of river systems during low sea levels of the last glacial maximum. Occurrence of the widespread Breede lineage in the Duiwenhoks River system is consistent with reconstructed palaeoriver systems. However, the occurrence of this lineage in the Goukou river system that formed part of the eastern Gourits–Goukou palaeoriver system can only be explained by translocation or a recent river capture or episodic inundation of low drainage divides. Extreme ecological gradients or the potential presence of instream physical barriers could have prevented an exchange of lineages between the Breede and Heuningnes river systems.Table Mountain Fund and Prince Bernhard Scholarships, the National Research Foundation (South Africa) and the Claude Leon Foundation.http://link.springer.com/journal/10750hb201