“I base my life on sadness”: Apparently paradoxical sources of resilience among young Haitians

Haitian expressions of resilience also hold deep knowledge of human vulnerability. This longitudinal, qualitative study with young Haitians from urban shantytowns combines ethnographic and participatory methods to explore the complexities behind such idioms. Artistic and creative products made by or with the youth facilitated interviews, focus group discussions, and workshops. Through the life stories of participants and rich ethnographic material, this study presents locally situated idioms of resilience (and distress). By including local social ecology, the idioms were framed as historically and culturally rooted, thus shaping contextual, pragmatic, and gendered coping strategies grounded in embodied experiences of vulnerability and resistance. The study adds essential insights into Haitian resilience, revealing the local logics behind seemingly paradoxical statements. By drafting a conceptual framework for further studies on idioms of resilience, the study also makes a theoretical contribution to international resilience research

Estimating the high risk group for cardiovascular disease in the Norwegian HUNT 2 population according to the 2003 European guidelines: modelling study.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVE: To estimate the high risk group for cardiovascular disease in a well defined Norwegian population according to European guidelines and the systematic coronary risk evaluation system. DESIGN: Modelling study. SETTING: Nord-Tröndelag health study 1995-7 (HUNT 2), Norway. PARTICIPANTS: 5548 participants of the Nord-Tröndelag health study 1995-7, aged 40, 50, 55, 60, and 65. MAIN OUTCOME MEASURES: Distribution of risk categories for cardiovascular disease, with emphasis on the high risk group. MAIN RESULTS: At age 40, 22.5% (95% confidence interval 19.3% to 25.7%) of women and 85.9% (83.2% to 88.6%) of men were at high risk of cardiovascular disease. Corresponding numbers at age 50 were 39.5% (35.9% to 43.1%) and 88.7% (86.3% to 91.0%) and at age 65 were 84.0% (80.6% to 87.4%) and 91.6% (88.6% to 94.1%). At age 40, one out of 10 women and no men would be classified at low risk for cardiovascular disease. CONCLUSION: Implementation of the 2003 European guidelines on prevention of cardiovascular disease in clinical practice would classify most adult Norwegians at high risk for fatal cardiovascular disease

The Intangible Legacy of the Indonesian Bajo

The Sama-Bajau, or Bajo diaspora, extends from the southern Philippines and Sabah (Malaysian Borneo) to the eastern part of Indonesia. The Indonesian Bajo, now scattered along the coasts of Sulawesi (Celebes) and East Kalimantan, the Eastern Lesser Sunda Islands and Maluku, were once mostly nomadic fishermen of the sea or ocean freight carriers. Today, the Bajo are almost all fishermen and settled. Their former and present ways of life made them favour intangible forms of culture: it is impossible to transport bulky artefacts when moving frequently by boat, or when living in stilt houses, very close to the sea or on a reef. It is therefore an intangible legacy that is the essence of the Bajo\u27s culture. Sandro healers have a vast range of expertise that allows them to protect and heal people when they suffer from natural or supernatural diseases. On the other hand, music and especially oral literature are very rich. In addition to song and the pantun poetry contests, the most prestigious genre is the iko-iko, long epic songs that the Bajo consider to be historical rather than fictional narratives. The Bajo\u27s intangible heritage is fragile, since it is based on oral transmission. In this article, I give a description of this heritage, dividing it into two areas: the knowledge that allows them to “protect and heal” on the one hand, and to “distract and relax”, on the other

From wholes to fragments to wholes—what gets lost in translation?

The highly demanding and, in a certain sense, unique, working conditions of general practitioners (GPs) are characterized by two phenomena: First, they involve an increasing familiarity with individual patients over time, which promotes a deepening of insight. Second, they enable the GP to encounter all kinds of health problems, which in turn facilitates pattern recognition, at both individual and group levels, particularly the kind of patterns currently termed “multimorbidity.” Whereas the term “comorbidity” is used to denote states of bad health in which 1 disease is considered to predate and evoke other ailments or diseases, the term multimorbidity is applied when finding several presumably separate diseases in a person who suffers from them either sequentially or simultaneously. Encounters with patients whose suffering fits the biomedical concept and terminology of multimorbidity are among the most common which GPs face, presenting them with some of their most demanding tasks. The term multimorbidity needs to be examined, however. As it alludes to a multiplicity of diseases, it rests on an assumption of separateness of states of bad health that might not be well founded. An adequate determination of what to deem a “separate” state of bad health would require that the biomedical concept of causation be scrutinized

En syk kilde

«A well» er ifølge ordboken både en bølge, en kilde, en brønn og en beholder i bunnen av et rom, en bygning, et skip. Ordet bør her forstås så vel konkret som symbolsk og metaforisk og assosieres med både medisinsk historie og vitenskapsteori som sosialpolitikk. Fra en dyp kilde kan det springe liv, vekst og helse – men også sykdom, nød og død

Knowing patients as persons: Senior and Junior GPs explore a professional resource

As part of a research project exploring inter-professional communication in Norwegian healthcare, junior and senior general practitioners (GPs) participated in focus group interviews regarding the medical relevance of acquiring and sharing knowledge about their patients as persons. The transcripts were interpreted using phenomenological- hermeneutical and discourse analysis. Both GP groups expressed concern over the lack of emphasis on person-oriented knowledge in the healthcare system and pointed out factors which interfere with the documentation and sharing of such knowledge. Senior GPs attributed more importance to person-related knowledge than did junior GPs while displaying considerably more verbal authority and professional independence. The seniors’ discourse was dominated by ethical considerations while juniors focused more on legal arguments. Our study documents how, with experience, GPs’ reflections and decision-making become more oriented towards solutions adapted to each patient’s life circumstances. To conceptualize expert GPs’ purposeful application of person-centered knowledge, we propose the term "situated gaze.

Knowing patients as persons: Senior and Junior GPs explore a professional resource

As part of a research project exploring inter-professional communication in Norwegian healthcare, junior and senior general practitioners (GPs) participated in focus group interviews regarding the medical relevance of acquiring and sharing knowledge about their patients as persons. The transcripts were interpreted using phenomenological- hermeneutical and discourse analysis. Both GP groups expressed concern over the lack of emphasis on person-oriented knowledge in the healthcare system and pointed out factors which interfere with the documentation and sharing of such knowledge. Senior GPs attributed more importance to person-related knowledge than did junior GPs while displaying considerably more verbal authority and professional independence. The seniors’ discourse was dominated by ethical considerations while juniors focused more on legal arguments. Our study documents how, with experience, GPs’ reflections and decision-making become more oriented towards solutions adapted to each patient’s life circumstances. To conceptualize expert GPs’ purposeful application of person-centered knowledge, we propose the term "situated gaze.

Standardization meets stories: contrasting perspectives on the needs of frail individuals at a rehabilitation unit

Background: Repeated encounters over time enable general practitioners (GPs) to accumulate biomedical and biographical knowledge about their patients. A growing body of evidence documenting the medical relevance of lifetime experiences indicates that health personnel ought to appraise this type of knowledge and consider how to incorporate it into their treatment of patients. In order to explore the interdisciplinary communication of such knowledge within Norwegian health care, we conducted a research project at the interface between general practice and a nursing home. Methods: In the present study, nine Norwegian GPs were each interviewed about one of their patients who had recently been admitted to a nursing home for short-term rehabilitation. A successive interview conducted with each of these patients aimed at both validating the GP’s information and exploring the patient’s life story. The GP’s treatment opinions and the patient’s biographical information and treatment preferences were condensed into a biographical record presented to the nursing home staff. The transcripts of the interviews and the institutional treatment measures were compared and analysed, applying a phenomenological hermeneutical framework. In the present article, we compare and discuss: (1) the GPs’ specific recommendations for their patients; (2) the patients’ own wishes and perceived needs; and (3) if and how this information was integrated into the institution’s interventions and priorities. Results: Each GP made rehabilitation recommendations, which included statements regarding both the patient’s personality and life circumstances. The nursing home staff individualized their selection of therapeutic interventions based on defined standardized treatment approaches, without personalizing them. Conclusion: We found that the institutional voice of medicine consistently tends to override the voice of the patient’s lifeworld. Thus, despite the institution’s best intentions, their efforts to provide appropriate rehabilitation seem to have been jeopardized to some extent