“Living Between Two Different Worlds”: Experiences of Leaving a High‑Cost Religious Group

The aim of this interdisciplinary study is to gain a comprehensive understanding of individuals’ subjective experiences after leaving a high-cost religious group and how these experiences have affected their lives. In-depth interviews were done with 18 participants who had left different religious communities in Finland. The interviews were analysed through a thematic analysis. The results show that religious disaffiliation is a life change that may affect an individual’s life in profound ways. Life after being a member of a high-cost group may involve experiences of fear, guilt, sorrow, pain, loss and even suffering on an existential level. These experiences can have serious implications for one’s well-being and health. However, life after religious disaffiliation also includes many positive aspects, such as experiences of joy, freedom, relief, gratitude and empowerment.publishedVersio

A caring science study about the understanding of life and creative writing

Creative writing is a known valuable aid for reflection on one’s life and involves the human being in a holistic way. This article has a caring science perspective and focuses on the understanding of life when creative writing is used to tackle unforeseen change. The unsolicited narratives of three authors were analysed in a study. The included texts were published autobiographical works and creative writing guides. A thematic network analysis was used as a method of analysis. The analysis ended up in a global theme that shows the understanding of life as a humble stance towards its changefulness. This theme entails acknowledging the uncertainty in life, seizing of opportunities and transformation through suffering. Creative writing is found to aid the human being to handle the changefulness of life.publishedVersio

Caring as temporal turns in life through creative writing

Aim: A person’s experience of time in life is assumed to change through suffering. This assumption developed an interest in investigating the connection between creative writing and caring, as caring may ease suffering and promote health as wholeness. The study aims to deepen the understanding of how creative writing may facilitate caring by investigating the time experience included in creative writing and its significance in relation to caring. Method: Seven hobby writers were asked to describe the meaning of creative writing in their lives. These accounts were analysed hermeneutically to gain an in-depth understanding through a dialogic process. Findings: The result show six themes: Acknowledging a childhood’s powerlessness, dealing with losses in life, capturing memories and revisiting them, building a new relationship to one’s past, living in the here and now, and being in between the past and the future. Findings suggest that caring may be viewed as temporal turns in life through creative writing, thus promoting experiences of wholeness in connection to time in life. Value: This study shows that creative writing can provide caring experiences through both the freedom of movement of the mind and by enabling a foothold in life’s temporality.publishedVersio

Suffering of Life after Religious Disaffiliation: A Caring Science Study

Background and aim: There are many circumstances where an individual, either voluntarily or involuntarily, may leave part of their life behind. Religious disaffiliation, the focus in this study, has become increasingly common and may under certain circumstances have a profound impact on a human being’s life, health and wellbeing. The aim of this caring science study was to gain a deeper understanding of the suffering that human beings may endure after religious disaffiliation. Participants and methods: In-depth interviews were conducted with 18 participants who had left various religious communities in Finland. The data material was analyzed through a qualitative thematic analysis according to Clarke and Braun. Results and conclusion: The results show that life after religious disaffiliation entails different forms of suffering of life. Suffering of life was expressed as: Pain and sorrow over being rejected, Overwhelmed by guilt and shame, Living in constant fear of both life and death and Humiliated as a human being. Eriksson’s concept suffering of life is relevant and valuable in understanding the results of this study. Ultimately, suffering of life refers to the violation of a human being’s dignity. Further research is needed on what constitutes caring and how suffering can be alleviated in this context.publishedVersio

Multi-professional ethical competence in healthcare – an ethical practice model

Introduction The starting point is that ethical competence is the basis for ethical healthcare practices and quality of care. Simultaneously, there is a need for research and development from a holistic multi-professional perspective. Aim The aim is to create a proposed model for multi-professional ethical competence grounded in clarified meanings and dimensions of ethical competence studied from a multi-professional healthcare perspective. The research questions are, what is ethical competence from a multi-professional healthcare perspective and what strengthens a multi-professional ethical healthcare practice? Research design The research has a qualitative approach and hermeneutic application research design. Two groups with six participants from clinical practice and two scientific researchers in each group met four times for dialogue. Thematic analysis was used as an analysis method. Ethical considerations The research is approved by the Declaration of Helsinki, the General Data Protection Regulations, and ethical permission was asked from the Norwegian Centre for Research Data (NSD). Results The proposed model for multi-professional ethical competence encompasses a three-dimensional ethical value base that is underpinned by: Ethical attitude – a personal desire to do good; Ethical basis – the best for the patient as a common goal and Ethical culture – common goals and values in the organization. Multi-professional ethical competence is strengthened by: Reflection – to see with new wondering eyes; Time for talk – interdisciplinary teamwork and Leadership – an ethical role model and support. Discussion Ethical competence has a strong link to the core of caring ethics and a deeper personal value base and attitude. Ethical competence involves the whole culture and is seen as a shared value base and a responsibility to do the best for the patient as a multi-professional team and organization. Ethical competence becomes active in healthcare practice by opening up for meaningful multi-professional talks and reflections.publishedVersio

Møtet – å se og bli berørt av pasienten: En grunn for etisk kompetanse hos helsepersonell

The purpose of this caring science study is to deepen the understanding of health personnel’s experiences of challenges and the fundamental basis for maintaining ethical competence in clinical practice. The study has a qualitative design. The methodology is hermeneutic application research. Twelve participants from several professions were divided into two groups for dialogue and reflection about ethical competence. Systematic text condensation was used as an analysis method.   The analysis resulted in four themes, ethics are challenged in complex clinical situations, to create space for reflection, to see the human being, and to be touched by the patient. The results confirm that the encounter between health personnel and the patient is significant and that the encounter itself is immanent ethics. Health personnel work with a tension between a system characterized by busyness and chores and seeing the patient as a human being and being overwhelmed by his or her suffering. In this field of tension, health personnel can be in the movement of becoming and reflecting on what promotes and maintains ethical competence.I denne omsorgsvitenskaplige studien søker vi en dypere forståelse av helsepersonells erfaringer av utfordringer og grunnlag for å opprettholde etisk kompetanse i klinisk praksis. Studien har et kvalitativ design. Metodologien er hermeneutisk applikasjonsforskning. Tolv deltakere fra ulike profesjoner, fordelt på to grupper, deltok i dialoger om etisk kompetanse. Systematisk tekstkondensering er brukt som metode for å analysere dataene. Funnene presenteres i fire temaer: I komplekse kliniske erfaringer blir etikken utfordret, Å skape rom for refleksjon, Å se mennesket og Å bli berørt av pasienten. Resultatet bekrefter at møtet mellom helsepersonell og pasient er betydningsfullt, og at møtet i seg en iboende etikk. Helsepersonell arbeider i en spenning mellom å se mennesket i pasientrollen og å bli overveldet av lidelse i et system preget av travelhet og gjøremål. I dette spenningsfeltet kan helsepersonell være i en danningsprosess, gjennom refleksjon som fremmer og opprettholder etisk kompetanse. Funnene presenteres i fire temaer: I komplekse kliniske erfaringer blir etikken utfordret, Å skape rom for refleksjon, Å se mennesket og Å bli berørt av pasienten. Resultatet bekrefter at møtet mellom helsepersonell og pasient er betydningsfullt, og at møtet i seg en iboende etikk. Helsepersonell arbeider i en spenning mellom å se mennesket i pasientrollen og å bli overveldet av lidelse i et system preget av travelhet og gjøremål. I dette spenningsfeltet kan helsepersonell være i en danningsprosess, gjennom refleksjon som fremmer og opprettholder etisk kompetanse

Social, health and rehabilitation sector educators’ competence in evidence-based practice: A cross-sectional study

Aim The purpose of the study was to identify and describe the characteristic profiles of evidence-based practice competence of educators in the social, health and rehabilitation sectors and to establish relevant background factors. Design This study was carried out as a descriptive cross-sectional study. Methods Data were collected from social, health and rehabilitation sector educators working in the 21 Finnish universities of applied sciences and seven vocational colleges (n = 422; N = 2,330). A self-assessment instrument measuring evidence-based practice competence was used. Competence profiles were formed using a K-cluster grouping analysis. Results Three distinct competence profiles were identified and delineated. Most educators feel that they can guide students' critical thinking and are able to seek and produce scientific knowledge. Evidence-based practice competence was explained by background factors such as year of graduation (for higher degree), level of education, job title, current employer and current field of work.publishedVersio

Genome-wide association identifies nine common variants associated with fasting proinsulin levels and provides new insights into the pathophysiology of type 2 diabetes.

OBJECTIVE: Proinsulin is a precursor of mature insulin and C-peptide. Higher circulating proinsulin levels are associated with impaired β-cell function, raised glucose levels, insulin resistance, and type 2 diabetes (T2D). Studies of the insulin processing pathway could provide new insights about T2D pathophysiology. RESEARCH DESIGN AND METHODS: We have conducted a meta-analysis of genome-wide association tests of ∼2.5 million genotyped or imputed single nucleotide polymorphisms (SNPs) and fasting proinsulin levels in 10,701 nondiabetic adults of European ancestry, with follow-up of 23 loci in up to 16,378 individuals, using additive genetic models adjusted for age, sex, fasting insulin, and study-specific covariates. RESULTS: Nine SNPs at eight loci were associated with proinsulin levels (P < 5 × 10(-8)). Two loci (LARP6 and SGSM2) have not been previously related to metabolic traits, one (MADD) has been associated with fasting glucose, one (PCSK1) has been implicated in obesity, and four (TCF7L2, SLC30A8, VPS13C/C2CD4A/B, and ARAP1, formerly CENTD2) increase T2D risk. The proinsulin-raising allele of ARAP1 was associated with a lower fasting glucose (P = 1.7 × 10(-4)), improved β-cell function (P = 1.1 × 10(-5)), and lower risk of T2D (odds ratio 0.88; P = 7.8 × 10(-6)). Notably, PCSK1 encodes the protein prohormone convertase 1/3, the first enzyme in the insulin processing pathway. A genotype score composed of the nine proinsulin-raising alleles was not associated with coronary disease in two large case-control datasets. CONCLUSIONS: We have identified nine genetic variants associated with fasting proinsulin. Our findings illuminate the biology underlying glucose homeostasis and T2D development in humans and argue against a direct role of proinsulin in coronary artery disease pathogenesis

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe