Increasing access to abortion : perspectives on provider availability from different settings

Background: Unsafe abortion is estimated to cause around 23000 maternal deaths yearly, most of those deaths are preventable by proper use of contraception and access to safe abortion. Barriers to access to safe abortion include legal frameworks, infrastructure and shortage of eligible and trained providers. Lack of knowledge, stigma and cultural aspects influence women’s abortion-seeking behavior. Aim: The overall aim of this thesis is to study factors that influence access to comprehensive abortion care focusing on increasing provider availability in different settings. Materials, methods and results Study I: A cross sectional survey including 1996 medical students found that disallowing attitudes and misconceptions were common. Very few had any clinical practice in abortion care. It is important to improve medical education and clinical training in abortion care services to influence medical student’s attitudes and ensure their future abortion provision. Study II: In-depth interviews were conducted with 23 medical students using a topic guide. Thematic analysis with an inductive approach was used to analyze data. Participants described a fear to provide abortion in their future practice, and their understanding of the law was limited. They also had limited clinical experience and were influenced by societal tradition and norm. Improved medical education including clinical practice is needed to increase the possibility that today’s medical students will become tomorrow’s abortion providers. Study III: A cost-effectiveness analysis was conducted alongside a randomized controlled equivalence trial to determine the cost-effectiveness of nurse-midwife provision of medical abortion compared with physicians. Average direct costs were EUR 45 for the nurse-midwife group and EUR 58 for the physician group. Increased effectiveness of the intervention gave an ICER at EUR -831 for direct costs and of EUR-1769 for total costs per avoided surgical intervention. Study IV: A systematic review was undertaken assess the effectiveness, safety and acceptability of non-physician provision of early medical abortion care including medical treatment for incomplete abortion. Electronic databases were searched using a search strategy based on PICOs. Six publications were included. Medical abortion by non-physicians using misoprostol regimens is equally effective as treatment by physicians. Acceptability among women, measured as overall satisfaction, is similar between groups. Quality of evidence range from low to moderate. Conclusion: Provider availability is an important component for abortion access. It is important to focus on curricula for medical students and include abortion care to reduce stigma and ensure future provider availability. Midlevel provision of medical abortion is costeffective, effective and acceptable to women. Thus task-shifting is a way to increase access to safe abortion. In order to truly improve access to safe abortion care, increased knowledge is needed among providers and women

Improving animal health on organic dairy farms: stakeholder views on policy options

Although ensuring good animal health is a stated aim of organic livestock farming and an important reason why consumers purchase organic products, the health states actually achieved are comparable to those in conventional farming. Unfortunately, there have been no studies to date that have assessed stakeholder views on different policy options for improving animal health on organic dairy farms. To address this deficit, stakeholder consultations were conducted in four European countries, involving 39 supply-chain stakeholders (farmers, advisors, veterinarians, inspectors, processors, and retailers). Stakeholders were encouraged to discuss different ways, including policy change, of improving organic health states. Acknowledging the need for further health improvements in organic dairy herds, stakeholders generally favoured establishing outcome-oriented animal health requirements as a way of achieving this. However, as a result of differing priorities for animal health improvement, there was disagreement on questions such as: who should be responsible for assessing animal health status on organic farms; and how to define and implement minimum health requirements. The results of the study suggest that future research must fully explore the opportunities and risks of different policy options and also suggest ways to overcome the divergence of stakeholders’ interests in public debates

Brittle basement deformation during the Caledonian Orogeny observed by K‐Ar geochronology of illite‐bearing fault gouge in west‐central Sweden

This study presents K-Ar ages of illite from fault gouges in crystalline basement in centralwestern Sweden. Samples were taken from two faults that localized brittle deformation marginal to and within mafic dikes that intruded Paleoproterozoic granitoids. K-Ar ages from ten separated grain fractions span from 823 to 392 Ma. Older ages obtained (823 to 477 Ma) were influenced by a mixture of illite and K-feldspar; the latter likely formed during a hydrothermal event prior to faulting. The remaining ages (442.1±9.7 to 391.7±6.1 Ma) were obtained from fractions from both faults hosting only authigenic illite, and show that illite crystallized during the Scandian Caledonian orogeny. These results indicate that previously presumed autochthonous Caledonian basement was involved in continental contraction and subsequent collapse of the Caledonian orogen, influencing both the mode and depth of penetration of deformation into Baltica

Helicobacter pylori Adapts to Chronic Infection and Gastric Disease via pH-Responsive BabA-Mediated Adherence

International audienceThe BabA adhesin mediates high-affinity binding of Helicobacter pylori to the ABO blood group antigen-glycosylated gastric mucosa. Here we show that BabA is acid responsive-binding is reduced at low pH and restored by acid neutralization. Acid responsiveness differs among strains; often correlates with different intragastric regions and evolves during chronic infection and disease progression; and depends on pH sensor sequences in BabA and on pH reversible formation of high-affinity binding BabA multimers. We propose that BabA's extraordinary reversible acid responsiveness enables tight mucosal bacterial adherence while also allowing an effective escape from epithelial cells and mucus that are shed into the acidic bactericidal lumen and that bio-selection and changes in BabA binding properties through mutation and recombination with babA-related genes are selected by differences among individuals and by changes in gastric acidity over time. These processes generate diverse H. pylori subpopulations, in which BabA's adaptive evolution contributes to H. pylori persistence and overt gastric disease

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

What´s in it for me? : A qualitive study on employee engagement´s effects on intrinsic motivation

Ämnet för denna uppsats växte fram då vi blev uppmärksammade på Anna Tufvessons bok Aktivt medarbetarskap (2017). Kraven på en anställd sträcker sig längre än att bara komma i tid och sköta sina arbetsuppgifter. En medarbetare bör idag ta ansvar för sig själv samt för sina kollegor, kommunikationen, relationerna och sin hälsa. Detta fick oss att tänka på hur offentlig verksamhet, som tydligt arbetar utifrån medarbetarskapets premisser, upprätthåller och bibehåller sin personal. Vad är det som motiverar anställda inom offentlig verksamhet när kraven är så tydliga och de yttre motivatorerna relativt frånvarande? Vår tanke var att inom medarbetarskapet finns det faktorer som påverkar medarbetarnas inre motivation i en positiv riktning. Denna uppsats ämnar söka förståelse för detta.  I undersökningens teoretiska referensram uppmärksammas medarbetarskap som arbetsform, inre motivation som fenomen och autonomi och kunskapsutveckling som nyckelfaktorer. Vårt metodval består av en kvalitativ ansats där det empiriska materialet samlats in med tio fysiska ansikte mot ansikte intervjuer. Respondenterna är verksamma inom kommunal verksamhet i en mellanstor svensk stad. Samtliga intervjuer har spelats in och ordagrant transkriberats inför analysprocessen. Det empiriska materialet har bearbetats och analyserats utifrån metoden innehållsanalys. Uppsatsen syfte besvaras genom dess tre frågeställningar. Slutsatserna är att respondenterna inom den kommunala verksamheten upplever sig ha en god autonomi i sitt arbete samt goda möjligheter för kunskapsutveckling. De faktorer inom medarbetarskapet som främjar den inre motivationen visar sig vara meningsfulla arbetsuppgifter, egenkontroll, samarbete och gemenskap samt kunskapsutveckling och en känsla av kompetens.

What´s in it for me? : A qualitive study on employee engagement´s effects on intrinsic motivation

Ämnet för denna uppsats växte fram då vi blev uppmärksammade på Anna Tufvessons bok Aktivt medarbetarskap (2017). Kraven på en anställd sträcker sig längre än att bara komma i tid och sköta sina arbetsuppgifter. En medarbetare bör idag ta ansvar för sig själv samt för sina kollegor, kommunikationen, relationerna och sin hälsa. Detta fick oss att tänka på hur offentlig verksamhet, som tydligt arbetar utifrån medarbetarskapets premisser, upprätthåller och bibehåller sin personal. Vad är det som motiverar anställda inom offentlig verksamhet när kraven är så tydliga och de yttre motivatorerna relativt frånvarande? Vår tanke var att inom medarbetarskapet finns det faktorer som påverkar medarbetarnas inre motivation i en positiv riktning. Denna uppsats ämnar söka förståelse för detta.  I undersökningens teoretiska referensram uppmärksammas medarbetarskap som arbetsform, inre motivation som fenomen och autonomi och kunskapsutveckling som nyckelfaktorer. Vårt metodval består av en kvalitativ ansats där det empiriska materialet samlats in med tio fysiska ansikte mot ansikte intervjuer. Respondenterna är verksamma inom kommunal verksamhet i en mellanstor svensk stad. Samtliga intervjuer har spelats in och ordagrant transkriberats inför analysprocessen. Det empiriska materialet har bearbetats och analyserats utifrån metoden innehållsanalys. Uppsatsen syfte besvaras genom dess tre frågeställningar. Slutsatserna är att respondenterna inom den kommunala verksamheten upplever sig ha en god autonomi i sitt arbete samt goda möjligheter för kunskapsutveckling. De faktorer inom medarbetarskapet som främjar den inre motivationen visar sig vara meningsfulla arbetsuppgifter, egenkontroll, samarbete och gemenskap samt kunskapsutveckling och en känsla av kompetens.

Patienters upplevelse av bemötande på akutmottagning : En litteraturstudie

Validerat; 20110627 (anonymous

Genus i bilderboken : En analys av hur karaktärerna framställs i tre bilderböcker

The picture book is the children's first contact with the world of literature. The aim of our study is to look at how children and adults are portrayed in the picture book, from a gender perspective. Our aim is to critically examine how girls and boys, men and women are presented when it comes to both characteristics and appearance. Our research also focuses on how the text and images complete each other and we conduct a qualitative text and image analysis. We use Nikolajevas (2000) analytical model for picture books and previous research that already exists within the subject. In our paper we have clarified the concepts related to gender: gender, gender roles, gender equality and the picture book. We have also emphasized and described which gender patterns are found in each book. In order to obtain our results, we have examined three picture books that were published during the 2000s. Based on the analysis, we discovered that there are still stereotypical roles in the books. This also counts for the environment, clothes and accessories of the characters in the books. In all three books, however, we could also see some gender awareness and the willingness to question clear gender patterns