Seeking the Leviathan, the General Will and the Invisible Hand in Rural Guinea, West Africa: A Science of Human Nature

The dissertation builds a bridge from the social-philosophical works of Hobbes, Rousseau, and Smith to current game theoretical models explaining social order to two empirical applications in a rural region of Guinea. The work focuses on the central role of natural resources for human societies and uses two empirical studies to test general hypotheses on the drivers of the sustainable exploitation and the equitable distribution of natural resources. The work strictly follows a quantitative empirical approach. After discussing the methodological foundations of statistical causal analysis in a first step, the various approaches are evaluated in a simulation study. Finally, the most successful of these approaches finds its application in the analysis of the empirical data, which was collected during field research in Guinea. In the observational study, socioeconomic data are combined with environmental data to model the influence of humans on the occurrence of wild species that are exploited for economic purposes in the study area. In the experimental study, socioeconomic data is linked to experimental data from a resource distribution game to identify factors affecting the people’s behavior when sharing a common natural resource. Both the exploitation of wild species and the sharing of a natural resource show that the social context is crucial for the understanding of human behavior, as postulated by Hobbes, Rousseau, and Smith: reputation, market integration, inequality and homogeneity of the population, as well as the salience of moral norms and property rights are essential dimensions.Die Dissertation widmet sich der zentralen Rolle von natürlichen Ressourcen für menschliche Gesellschaften. Anhand zweier empirischer Studien werden allgemeine Hypothesen zu den Determinanten der nachhaltigen Ausbeutung und gerechten Verteilung von natürlichen Ressourcen getestet. Dabei wird in der Arbeit eine Brücke von den Werken der Sozialphilosophen Hobbes, Rousseau und Smith, über aktuelle spieltheoretische Modelle zur Erklärung sozialer Ordnung, hin zu zwei empirischen Anwendungen in einer ländlichen Region Guineas geschlagen. Die Arbeit folgt strikt einem empirischen quantitativen Ansatz. Nach der Erörterung der methodischen Grundlagen der statistischen Kausalanalyse werden die verschiedenen Ansätze im Rahmen einer Simulationsstudie evaluiert. Schließlich findet der erfolgreichste dieser Ansätze in der Auswertung der Daten, die bei der Feldforschung in Guinea erhoben wurden, Anwendung. In der Beobachtungsstudie werden sozioökonomische Daten mit ökologischen Daten verknüpft, um den Einfluss der Menschen auf das Vorkommen von wilden Arten, die zu ökonomischen Zwecken ausgebeutet werden, im Untersuchungsgebiet zu modellieren. In der Experimentalstudie werden sozioökonomische Daten mit Experimentaldaten aus einem Ressourcenverteilungsspiel verknüpft, um Faktoren zu identifizieren, welche sich auf das Verhalten von Menschen beim Teilen einer gemeinsamen natürlichen Ressource auswirken. Sowohl für die Ausbeutung der wilden Arten, wie auch für das gemeinsame Teilen einer natürlichen Ressource gilt, dass der soziale Kontext für das Verhalten der Menschen von großer Relevanz ist, wie von Hobbes, Rousseau und Smith postuliert: Reputation, Marktintegration, Ungleichheit und Homogenität der Bevölkerung sowie die Salienz moralischer Normen und Eigentumsrechte sind entscheidende Dimensionen

The association between timed up and go test and history of falls: The Tromsø study

BACKGROUND: Fall-related injuries in older adults are a major health problem. Although the aetiology of falls is multifactorial, physical factors are assumed to contribute significantly. The "Timed up and go test" (TUG) is designed to measure basic mobility function. This report evaluates the association between TUG times and history of falls. METHODS: A retrospective, observational, population-based study was conducted on 414 men and 560 women with mean age 77.5 (SD 2.3). TUG time and falls during the previous 12 months were recorded. Covariates were age, sex, medical history and health-related mobility problems. Means, confidence intervals and test characteristics for TUG were calculated. Odds ratios and influence of covariates were examined by logistic regression. RESULTS: The mean TUG time was 11.1s (SD 2.5) among male non-fallers and 13.0s (SD 7.8) among fallers. The difference was 1.9s (95%CI 0.9–3.0). The odds ratio for fallers being in the upper quartile was 2.1 (95%CI 1.4–3.3). Adjusted for covariates, the odds ratio was (OR = 1.8, 95%CI 1.1–2.9). The corresponding mean was 13.0s (SD 5.74) among female non-fallers and 13.9s (SD 8.5) among fallers. The difference was 0.9 (95%CI -0.3–2.1). The odds ratio for fallers being in upper quartile was 1.0 (95%CI 0.7–1.4). The area under the ROC curve was 0.50 (95%CI 0.45–0.55) in women and 0.56 (95%CI 0.50–0.62) in men. CONCLUSION: TUG is statistically associated with a history of falls in men but not in women. The ability to classify fallers is poor, and the clinical value of the association is therefore limited

Profession and life: Separate worlds

How do physiotherapists relate to and examine patients? This question was the point of departure for this article and it immediately gave rise to another: what is the relationship between professional knowledge and general experience? Data were collected as part of a project where encounters between patients and physiotherapists are analysed. The encounters were directly observed and videotaped, and the participants individually interviewed afterwards. The article is based on a detailed analysis of two encounters. It is shown how both therapists direct their examination towards local symptoms and conditions; the emphasis being on joint mobility. The information obtained is adapted to the therapists' biomedical frame of reference. Their interpretations, assessments, and treatment proposals are well within the same frame. In this way historical and clinical data are not 'revealed' but rather constructed; a process which helps transform the patients' problems to solvable problems--for the therapists. Despite the fact that the conception of the body implicit in their diagnostic practice was dualistic, both therapists related to their patients as embodied subjects in many of their general actions. They examined the body as a physical object extrinsic to the self and added the human factor by being interested in the patients as persons through general communication actions. It is argued that the discrepancy between these two views of the body justifies the conclusion that the therapists were operating with unintegrated worlds of knowledge. The findings are interpreted in light of general perspectives on the relationship between general and particular knowledge, between the 'scientific' context-free attitude and every-day contextualized knowledge.embodiment physiotherapy clinical knowledge decision-making

Fysioterapeuters journaler - en undersøkelse av språkbruk

The background for the study is the lack of systematic knowledge on physiotherapists records. The article presents major findings of an hermeneutically inspired analysis of language use in physiotherapists' records in a Norwegian hospital. The text material is collected from three wards in a somatic hospital and consists of 67 records. Nine therapists participated. They were all trained in Norway, they ranged in age from 25 to 46, and seven of them were women. The study documents pronounced differences at the ward level, and the material as a whole displays disparate knowledge traditions and a combination of professional terminology and daily language. In the records from neurological and partly from rheumatological ward the sentence content is linked by linguistic means so that assessments of patients' function are made apparent. In these texts both patient and therapist are presented as active participants. In the texts from orthopaedics and rheumatological ward the linguistic connections are fewer and the evaluative aspects of physiotherapy are almost absent. The authorial voice is weak, and the patients are not presented with any clarity in these texts. It is underscored that charting has become more important due to new legislation, and that it is a challenge to write records in ways that clarify the contributions of physiotherapists with respect to understanding and treating patients' health problems. In this context the use of language plays a crucial role

Visual disturbances and movement an observational study of patients with acquired brain injury

Purpose: To explore whether and how vision disturbances influence how patients with acquired brain injury move during physiotherapy treatment. Method and material: The sample consisted of two patients with vision disturbances and movement disorders. Both were admitted for hospital based rehabilitation in Norway, receiving treatments from physiotherapist and vision teacher (separately). One physiotherapy session with each patient was video filmed, and vision teacher and physiotherapist were interviewed in order to acquire background information for the video analysis. Recurrent features and patterns in the data material were identified after thorough analysis. Result: Vision disturbances is of consequence for how the patients move, among other things by impairing precision during arm movements, making it difficult to initiate turns, and influencing posture. The findings indicate that vision disturbances influence the patients habitual ways of moving. Conclusion: Knowledge of how vision disturbances influence the manner of movement gives a more comprehensive understanding of the patients possibilities and limitations for moving. Taking measure for such conditions will thus be of importance for producing adequate treatment

Communication – relationship – physiotherapy. An interview study about home visits with elderly people

Purpose: To obtain an extended understanding of how communication and relationship between patient and physiotherapist mutually influence each other and the performance of physiotherapy during home visits to elderly people. Design: Semi-structured interviews. Material: Six experienced physiotherapists in different municipalities in Norway were interviewed. Method: The authors read the transcribed material thoroughly several times before identifying the entities of meaning. These formed the basis for themes from which subthemes were determined. After further interpretation citations were chosen to enlighten the participants’ voices. Findings: Two main themes each with a subtheme, are presented: «Function as the pivotal» and «Distribution of roles». The home as context is decisive for the physiotherapeutic assessment and planning of treatment. Social norms and rituals affect the meeting between patient and physiotherapist, in that the latter is a guest in the home of the former. Relationship and interaction are integrated parts of professional practice and trust acts as a tool to facilitate and improve the exercising of physiotherapy. Conclusion: The study highlights the interplay between communication, relationship and physiotherapy during home visits with elderly people. By allowing the home as a context to be a significant part of the functional assessment and being aware of the social processes and roles, the physiotherapist can facilitate meaningful rehabilitation

The use of positions and movements in yoga. An interview study

Purpose: To document experiences with and reflections on the use of positions and movements in yoga. Design, material and method: Qualitative semistructured interviews of yogainstructors trained as physiotherapists. Interviews with four informants were performed using audio-recorder and an interview guide, and the recordings were transcribed and subjected to a content analysis. Results: Three main themes with sub-themes emerged about the use of positions and movements: i) variation in space and direction, ii) performance with emphasis on tempo and effort and iii) self-acceptance with respect to setting limits and coping. The interplay between the different components was a vital feature of yoga according to the informants, and they underscored focused awareness both as a means and an end in yoga practise. Conclusion: The informants presented yoga as an approach to movements with effects of both a physical and mental character. They emphasized self-acceptance and patience as prerequisites for obtaining change and personal development

Conversations in physiotherapy practice – an observational study of first encounters

Background: Medically unexplained musculoskeletal disorders are common among women, and many female patients are referred to physiotherapists for such complaints. This study investigates conversations in first encounters between physiotherapists and women with medically unexplained musculoskeletal disorders. The aim is to gain an insight into the topics that are explored and emphasized. Method: Non-participating observations of two first encounters between physiotherapists and their patients were conducted. Results: One topic from each conversation is presented and discussed. The first regards a mismatch between the understanding of the patient’s health problem expressed in the discharge summary from a physician, and the patient’s own experience. The other subject discussed in this article deals with family relations and –care. The therapists are attentive to and take the patients’ concerns seriously. During the conversation they gather information which is decisive for further examination and treatment. Conclusion: This article contributes to knowledge about the physiotherapists’ understanding of connections between body, gender and the patients’ situation in life. Moreover, it is demonstrated how the patients’ experiences function as a central source of knowledge

Posture – frames of meaning and practice. An interview study

Purpose: To discuss posture as a phenomenon, emphasis in the examination of posture, and the role of posture in clinical practice. Design, material and method: Qualitative semi-structured interviews with three experienced physiotherapists with different specializations. The interviews were analyzed based on hermeneutic understanding. Results: The informants’ understanding of posture is based on different frames of meaning, which leads to an orientation towards different elements of posture during examination and treatment. Different frames of meaning also influence the approach to the body in clinical contexts resulting in different functional assessments. The interviews are characterized by ambiguous descriptions of the body. The body is expounded in dualistic terms, i.e. as an outer entity expressing inner processes and as a perceiving subject. In the informants’ descriptions of their practices, the body comes through as more unambiguous and their practical approach embraces the body as the centre of all experience. Conclusion: Different frames of meaning result in different functional assessments and different approaches to the body in the clinic. A probing and individualized approach to examination and treatment makes room for the body as perceiving subject