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This paper uses data for 53 countries from the World Values Survey in a multilevel regression analysis that seeks to disentangle individual, institutional and other-regarding factors affecting ethical decision-making. The dependent variable is an index of how intolerant people are of unethical conduct. The explanatory variables indicate the perceived trustworthiness and fairness of others. Controls include variables for individual and institutional factors. Findings are that perceptions of trustworthiness in people unknown to them and perceptions of fairness in others correlate with a greater tolerance of unethical behavior, especially in countries with moderate levels of institutional quality. High institutional quality moderates the negative relationship between perceptions and ethical attitudes. The findings confirm the relevance of other-regarding factors and reinforce the importance of quality institutions in supporting ethical decision-making. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents qualitative research findings from the evaluation of a Parkinson's Dance well-being venture in the UK. Methods: Qualitative data was gathered to see how bespoke dancing sessions helped people with Parkinson's (PwP) to manage their conditions and improve their lives and prospects. Principles of a participatory approach were incorporated and methods included semi-structured interviewing, researchers participant observation and an elicitation-based activity. Nineteen PwP, six carers, four dance artists and seven helpers participated in the study. Results: Participating in Parkinson's Dance sessions meant that PwP could experience the possibilities to dance, develop a "can do" attitude, experience fun, enjoyment, social connection, exercise, movement to music, improvement and/or maintenance of their balance, suppleness, coordination and confidence with movement, symptoms being pushed back and ability to learn new things. Conclusions: Our findings add to the evidence-base about the benefits of dance for people experiencing Parkinson's and through novel application of the Life-world based well-being framework of K. T. Galvin and Todres (2011) we propose a theoretical basis for Parkinson's Dance as a resource for well-being. There is scope to consider application of the well-being framework to other arts activities and as the basis of an arts and well-being evaluation tool. [ABSTRACT FROM AUTHOR]

This article traces the origin, sustenance and implications of a persistent rumour that is responsible for low measles mumps and rubella (MMR) vaccination uptake in the Somali diaspora in a number of countries across the globe. The rumour stipulates that the MMR vaccine – the silent shot – causes autism spectrum disorder (ASD). Although the association between MMR and ASD is non-causal, and various public health initiatives have promoted health information campaigns, the rumour continues to circulate in the Somali diaspora in many countries, including Sweden. This paper shows that there are valid reasons for this. The findings from this paper draw on a systematic scoping review and qualitative interview data from Sweden. The results show that the Somali community experiences higher than average rates of ASD compared to the general population. Moreover, ASD does not exist in the Somali language or their home country, is considered a Western disease that only affects Somali children in the diaspora, and is a highly stigmatised disease. Also, the Somali diaspora has had negative experiences with ASD diagnosis and care. The rumour has been sustained by the absence of an answer to their ASD fear and through active diaspora networks on social media. The network that surrounds the rumour has arguably further helped to create an epistemic community for a community whose concerns have been silenced. [ABSTRACT FROM AUTHOR]

Previous research has suggested that older trans and gender non-conforming (TGNC) people may face particular challenges related to stigma, social exclusion and discrimination in later life. However, direct data on social support and needs in older TGNC population both internationally and within the UK is limited due to the small, dispersed nature of this population, and the absence of specific data collection on aging TGNC populations. During the UK COVID-19 lockdown in summer 2020, older people and those with long-term health conditions were advised to adopt particular precautions. This study aimed to explore older TGNC people's social support networks, key concerns and unmet needs during the COVID-19 'lockdown'. A UK cross-sectional survey of LGBT + people aged 60+ (n = 375) was undertaken during the lockdown. This paper analyses responses from the subset (n = 38) of TGNC participants. The majority of TGNC respondents described diverse social networks, often centered around friends and non-kin social networks, although partners and adult children were also significant for some. In most cases, those with existing strong networks continued to maintain social connections during lockdown, albeit with some regrets about loss of activities and face-to-face connection. However, a minority of respondents had experienced greater challenges prior to lockdown, and may have been at increased vulnerability during the pandemic, for example indicating that they had no-one to call on for practical support in an emergency. When asked about unmet needs and challenges, social isolation was repeatedly raised as the most frequent concern. Several respondents also mentioned issues specifically affecting TGNC communities, including access to gender affirming care and a perceived rise in social intolerance. Health and social care providers should be aware of the diversity of support networks within TGNC communities. There may also be benefits in community sector interventions to help older TGNC build and maintain strong social networks. [ABSTRACT FROM AUTHOR]

This review articulates current understanding of the aesthetic, artistic and creative contributions that Dance makes to Health and Wellbeing across the lifecourse within publications 2000–2019, an under-researched area. Review Questions: What are the aesthetic, artistic and creative contributions that Dance makes to Health and Wellbeing across the lifecourse? And what methodologies are appropriate for investigating these contributions? A database keyword search identified 769 articles and 91 evaluations. 109 documents were identified for further in-depth analysis and rating, resulting in 24 papers (11 articles, 3 PhD studies, 10 evaluation reports), which were thematically analysed. Findings offer seven interrelated contributions that Dance makes to Health and Wellbeing: embodiment, identity, belonging, self-worth, aesthetics, affective responses and creativity. There was less insight regarding different methodologies, and discussions focused on quantitative data's limitations. There were insights into inclusion of embodied voices, subjective accounts, and lived experiences. Whilst acknowledging challenges, this paper illuminates the key contributions of dance to arts and health. It provides a future conceptual research agenda (prioritizing identity and creativity) and associated methodological developments. It recommends expanding geographical/lifecourse research, better defining terms, fuller epistemological critiques to open space for new methodologies, and continued attendance to appropriate rigour criteria. [ABSTRACT FROM AUTHOR]

Venous leg ulcer is a recognized condition, affecting people globally. Ulcers mainly affect the elderly and recurrences are not uncommon. There is knowledge about life with venous leg ulcers, but the situation after healing is unexplored. This paper explores and describes meanings of experiences of daily life after healing of a hard-to-heal venous leg ulcer. Lived experiences of 15 individuals with healed hard-to-heal venous leg ulcers generated data for this study. Interviews were recorded for analysis using a reflective lifeworld research approach. An essence emerged, further described by its constituents. Memories of a difficult time with leg ulcer were ever present, in a way becoming part of the self. A striving for control in daily life entailed a struggle to do what was best for the own body. After healing, a new normal emerged in daily life, a reality that encompassed the risk for a new ulcer. The body had changed physically, with marks alongside those from ageing, in a life that still went on. For those who had healed from a venous leg ulcer, life had changed. Even if they referred to life as normal, it was not the same normal as before. [ABSTRACT FROM AUTHOR]

A satellite attitude dynamics simulator (SADS) is a low-cost, ground-based equipment for laboratory simulation of the space environment as satellite weightless, sun and magnetic field simulation as well as implementation of diverse attitude determination and control algorithms. Precise estimation of mass properties plays a significant role in guidance and control algorithms application. The objective of this paper is mass properties identification includes moment of inertia tensor and centre of mass position of a three-degrees-of-freedom SADS at the Space Research Laboratory. This paper investigates the well-known methods to estimate mass properties, i.e. Batch Least Squares and Classical Kalman Filter and presents an innovative approach using the Classical Levenberg–Marquardt (CLM) to solve this major problem. In order to verify the proposed technique, a MATLAB® SIMULINK® model of the SADS is employed. The experimental results indicate that the parameter estimation process using CLM technique is more accurate and reliable than other methods. [ABSTRACT FROM AUTHOR]

There have been increasing calls for collaboration between Indigenous health practitioners (IHPs) and allopathic health practitioners (AHPs) in Africa. Despite this, very few successful systems exist to facilitate formal collaboration. Direct relationships between providers, and at a health systems level are crucial to successful collaboration, but the nature and extent of these relationships have yet to be adequately explored. To explore the relationship between IHPs and AHPs in Africa, and to discuss the implications of this for future collaboration. An interpretive qualitative synthesis approach, combining elements of thematic analysis, meta-ethnography, and grounded theory, was used to systematically bring together findings of qualitative studies addressing the topic of collaboration between Indigenous and allopathic health practitioners in Africa. A total of 1,765 papers were initially identified, 1,748 were excluded after abstract, full text and duplicate screening. Five additional studies were identified through references. Thus, 22 papers were included in the final analysis. We found that the relationship between Indigenous and allopathic health practitioners is defined by a power struggle which gives rise to lack of mutual understanding, rivalry, distrust, and disrespect. The power struggle which defines the relationship between IHPs and AHPs in Africa is a hindrance to their collaboration and as such could partly account for the limited success of efforts to foster collaboration to date. Future efforts to foster collaboration between IHPs and AHPs in Africa must aim to balance the power disparity between them if collaboration is to be successful. Since this would be a novel approach, decision-makers and organisations who trial this power balancing approach to facilitate collaboration should evaluate resultant policies and interventions to ascertain their feasibility and efficacy in fostering collaboration, and the lessons learnt should be shared. [ABSTRACT FROM AUTHOR]

Background: While research on trans People of Color's experiences has been increasing in recent years, this intersectional work has often not included a focus on the specificities of multiracial and multiethnic trans experiences. Aims: This study explores shifts in racial identity by multiracial/multiethnic trans people as they transition gender and the ways Whiteness and nationalist ideology shape their racialized gender experiences. Methods: This paper is based on six in-depth, semi-structured interviewswith self-identifiedmultiracial, multiethnic, andmulti-heritage trans people in the USA. Data collection centered participants' experiences of self-identification and interactionswith others (e.g., family, acquaintances, and strangers). Results: As participants transitioned gender and were acknowledged by others in their gender identity, shifts in their embodiment were used by others to ascribe a new racialized gender. This often resulted in participants reflecting on their sense of self and racialized gender identities in new ways. Discussion: Multiracial and multiethnic transgender people's experiences in transitioning race confirm the importance of intersectional analysis, reveal the intersectional fluidity of social categories, explicate how social understandings of one category (e.g., race) influence another category (e.g., gender), demonstrate that the meanings associated with racialized gender are based in relations of power, and show that, in transgender studies particularly, we must attend to the ways that the concept of transition implicates not only gender, but also other categories such as race and nationality. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander peoples have been the longstanding targets of racism and discrimination in Australia. This paper presents the findings of a systematic literature review designed to identify and synthesise the available evidence exploring these intergroup attitudes, and the factors that correlate with them. Searches were conducted in Medline, Psychology and Behavioural Sciences Collection, ProQuest Psychology Database and PsycINFO databases. Eligible studies were required to measure attitudes of non-Indigenous Australians towards Aboriginal and Torres Strait Islander peoples. Twenty studies met the eligibility criteria (n = 2,958). The results outlined: (a) the prevalence of negative attitudes, (b) attitudes were most commonly conceptualised as modern racism, and (c) that there are a range of factors that are associated with negativity towards Aboriginal and Torres Strait Islander peoples. The review outlined the relationship between attitudes towards Aboriginal and Torres Strait Islander peoples and demographic, ideological, individual differences, and intergroup factors. This review highlights the need for continued research in this domain to inform appropriate prejudice reduction strategies. KEY POINTS What is already known about this topic: Aboriginal and Torres Strait Islander peoples face continued adversity, prejudice, and discrimination on their own land. This heightened propensity to be targeted for prejudice is a known social determinant of poorer health and wellbeing. Understanding racial attitudes towards this group is an imperative step in understanding and combating this health disparity. What this topic adds: There is a paucity of academic research exploring negativity towards Aboriginal and Torres Strait Islander peoples The limited quantity of evidence does establish a range of correlates with negative attitudes that can be clustered into four themes – demographic factors, ideological variables, individual differences factors, and intergroup factors. More research is warranted in this domain to further establish a body of evidence on intergroup attitudes towards Aboriginal and Torres Strait Islander peoples, with a renewed focus needed on prejudice reduction techniques. [ABSTRACT FROM AUTHOR]

The introduction of progesterone vaginal ring (PVR) in sub-Saharan Africa calls for insights on the product's role in promoting women's autonomy regarding their reproductive decision-making and behaviour. Such insights could inform the positioning of the method within family planning programmes in the region. In this paper, we explore husbands' experiences with PVR as perceived by their wives and as reported by husbands of a subset of women users in Kenya, Nigeria, and Senegal. We discuss how such experiences might influence women's rights and autonomy regarding their reproductive decisions and contraceptive behaviour. We use a mixed-methods approach drawing on data from quantitative interviews with 174 women and qualitative in-depth interviews with 10 husbands of a subset of the women in the three countries. The findings show that husbands appreciated PVR's attributes relating to user-control (women could insert and remove the method themselves), ease of use, and non-interference with sex and flow of breast milk. Wives' perceptions of their husbands' experiences regarding PVR's non-interference with sex were consistent with the husbands' own reports. In addition, health care providers played important roles in supporting sustainable use of the method through giving information, counselling, and assisting women who experienced ring slippage to manage those challenges. The findings suggest that self-managed health technologies such as PVR could expand women's choices and control over their reproductive decisions. The findings further suggest that sustainable use of such products could require linkages with appropriate health systems structures to address challenges with use if and when they arise. [ABSTRACT FROM AUTHOR]

Purpose: Despite increased focus on parenting support internationally, there is a lack of agreement in what constitutes parenting support. This paper explores the experiences of parenting support activities from the perspective of stakeholders in Norwegian basic schools. Methods: Five focus group interviews were conducted with representatives from the schools' parent work committee, class teachers, health nurses, and social workers from nine schools. The data were interpreted using an inductive thematic analysis. Results: Three main themes emerged from the data: (1) A community for the best of the child, (2) uniting through relations, and (3) sharing knowledge and language. Parenting support was experienced as universal, relational, and multidimensional. It was related to everyday life interactions between the home, school, and the parenting community with the best interest of the child as a goal. Conclusion: To avoid reducing parents to passive recipients of expert advice, parenting support activities should be an integral part of everyday school-home-parenting community collaborations. Abbreviation: EU-The European Union; UN-The Unition Nations; CoE-The Council of Europe; NSD-The Norwegian Centre for Research Data; CTP-Class teachers in primary school; CTJS-Class teachers in junior secondary school; P-Parents; H-Health nurses; SW-Social workers [ABSTRACT FROM AUTHOR]

Purpose: Self-reliance and social participation are strongly promoted by social policy. Both concepts are linked to the concept of vulnerability, for people who do not meet these standards are labelled "vulnerable people". In this paper, the insider's perspective takes central stage by seeking to explore what it means to be labelled a "vulnerable person", and through this to further our insight into the meaning of the concept of vulnerability. Method: Thirty-three in-depth interviews were conducted with 16 allegedly vulnerable people. The data were subjected to thematic content analysis. Results: Our analysis revealed three main dimensions and eight sub-dimensions of perceived vulnerability, outlining an insider's concept of vulnerability. This concept includes manifestations of vulnerability, feelings coexisting with vulnerability, and the image of vulnerable people. Conclusion: The perception of vulnerability changes when interacting with others in society, especially with social policy implementers. In this interaction, the perceived vulnerability increases and becomes societal vulnerability. It concerns a dependency situation in which one's strength and self-determination are not recognized, and the help needed is not provided. By acknowledging the insider's perspective, social policy can fulfil a more empowering role towards "vulnerable people" and contribute to people's well-being. [ABSTRACT FROM AUTHOR]

Everyone who serves in the military (and survives the experience) will eventually become a Veteran, and most will face the challenge of finding a civilian job. This paper investigates how contemporary Veterans experience the transition period between military exit and entrance into civilian life and how their own actions before separation shape their post-transition outcomes. We follow 35 servicemembers through the transition process, interviewing them before and several months after they left the military. These interviews reveal the importance of three factors - the conditions triggering their exit, the strength of their military identity, and their own planning (or lack thereof) for the transition to civilian life - in enhancing or detracting from achievement of a stated post-military goals and objective success in moving into work or school. The strength and depth of an individual's institutional identity shapes how and when servicemembers plan for military exit and how they adjust to unanticipated military exits. Early planning reflects anticipatory socialization for new civilian roles and is associated with better post-military outcomes. But early planning is often hindered by a strong military identity or facilitated by a weak military identity. These findings have important implications for the military and advocates who serve them with the recent military policy changes to transition assistance and the retirement pension system that encourage early planning for post-military life. [ABSTRACT FROM AUTHOR]

In low- and middle-income countries, nutrition support strategies are often suboptimal or non-existent in hospital settings. This is further compounded by high rates of malnutrition in these countries. The first four dietitians graduated in Malawi in 2017 providing a new opportunity to build capacity to introduce nutrition support in an acute care setting. A paediatric nutrition support program was implemented at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi including the hiring of a local dietitian. This capacity building paper explains the development and introduction of the nutrition support program including a description of perceptions of health professionals at QECH working alongside the dietitian. In the first four months of the program at QECH, the dietitian provided nutrition support to 183 different patients across paediatric wards. Nutritional interventions predominantly included infant formula and breastmilk fortification, provision of therapeutic feeds orally or via nasogastric tubes, increased dietary protein intake for children identified to be at high risk, and nutritional counselling to caregivers. More complex nutritional interventions were also given such as the insertion of gastrostomy tubes to deliver nutrition directly to the stomach. Following the introduction of the program, qualitative interviews were done with health professionals at QECH including nurses (n = 5) and physicians (n = 11). All participants emphasized the importance and impact of the nutrition support program in enhancing the care of hospitalized children, therefore improving outcomes such as tolerability of clinical interventions, decreased duration of stay, and reduced risk of hospital readmission. In conclusion, there is a need for nutrition support provided by a dietitian for different paediatric patients which was corroborated by positive feedback from health professionals at QECH. Integration of dietitians into the healthcare system by respective Ministries of Health will require advocacy around the potential for nutrition support to strengthen the quality of care of vulnerable children. A Chichewa abstract for this paper is available in a supplementary file. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this paper was to determine the extent to which dry needling is instructed in entry-level education programs for physical therapists. Methods: Program directors from 226 entry-level education programs recognized by the Commission on Accreditation in Physical Therapy Education were recruited via e-mail to participate in an anonymous 35-item electronic survey during the 2017-2018 academic year. The survey evaluated dry needling curricula, faculty qualifications, attitudes and experience, and programs' future plans for teaching dry needling. Results: A total of 75 programs responded to the survey (response rate = 33.1%). Forty (53.3%) had integrated dry needling theory and psychomotor training into their programs and 8 (10.6%) planned to include such content in their curriculum in the future. Of the 40 respondents, 28 indicated that dry needling education was integrated into a required course, 4 indicated that dry needling was an elective course, and 8 did not specify how dry needling education was integrated. Faculty teaching dry needling appear to be well qualified, with the majority having 5-10 years of experience using dry needling in clinical practice. The primary reason for programs not teaching dry needling is that it was not considered an entry-level skill. Discussion: There appeared to be variability in how dry needling was integrated into the curricula, as well as in the depth and breadth of instruction. Our research may serve as a baseline for faculty to assess existing dry needling curricula and as a guide for developing curricula in new or existing physical therapy programs. [ABSTRACT FROM AUTHOR]

Adolescents in Tanzania are at risk of many health problems attributed to limited access to quality sexual and reproductive health services. Health professionals are a crucial part of service delivery, and their perspective on providing care is important in understanding the barriers that hamper access to sexual and reproductive health services for adolescents. Better understanding these barriers will support the development of more effective interventions. This paper explores these perspectives in view of the health-policy context that surrounds them. This study has aimed to explore and understand health professionals' perceptions and attitudes regarding the provision of adolescent sexual and reproductive health care in a selected national sexual and reproductive health programme in the Arusha region and Kilimanjaro region, Tanzania. A qualitative cross-sectional interview design was applied. Sixteen in-depth interviews were conducted with health professionals and community health workers. Data was analysed following inductive thematic analysis. Four main themes are identified in the data: concern about the stigma directed towards adolescents; over-medicalisation of services; difficulty involving adolescent males; and ambiguous policies and contradictory messages. The findings suggest that health professionals providing care in the current adolescent sexual and reproductive health programme must navigate the legacy of vertical health programmes as well as contradicting views and messages that are influenced by social norms, by uncertainties about current laws and by statements from political leaders. The findings suggest that future research, policies and health programmes should consider the perspectives of health professionals and their challenges in delivering care for adolescents to help improve the understanding of how to effectively and sensitively implement sexual and reproductive health programmes for adolescents. [ABSTRACT FROM AUTHOR]

Background: Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving 'Health for All.' The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana's flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services. Objectives: This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved. Method: Three dimensions of access to CHPS care were investigated: geographic, social, and financial. Focus group data were collected in 40 sessions conducted in eight communities located in two districts each of the Northern and Volta Regions. Groups were comprised of 327 participants representing four types of potential clientele: mothers and fathers of children under 5, young men and young women ages 15–24. Results: Posting trained primary health-care nurses to community locations as a means of improving primary health-care access is emphatically supported by focus group participants, even in localities where CHPS is not yet functioning. Despite this consensus, comments on CHPS activities suggest that CHPS services are often compromised by cultural, financial, and familial constraints to women's health-seeking autonomy and by programmatic lapses constrain implementation of key components of care. Respondents seek improvements in the quality of care, community engagement activities, expansion of the range of services to include emergency referral services, and enhancement of clinical health insurance coverage to include preventive health services. Conclusion: Improving geographic and financial access to CHPS facilities is essential to UHC, but responding to community need for improved outreach, and service quality is equivalently critical to achieving this goal. [ABSTRACT FROM AUTHOR]

This paper draws on Te Rangahau o Te Tuakiri Māori me Ngā Waiaro ā-Pūtea | The Māori Identity and Financial Attitudes Study (MIFAS). The MIFAS is a nationwide study that examines the relationship between Māori identity and economic attitudes and values. The MIFAS embeds the Multidimensional Model of Māori Identity and Cultural Engagement (MMM-ICE), which assesses Māori identity in relation to eight domains. We report data regarding three aspects of economic activity: risking iwi (tribal) assets for profit; individualism at work; and preferences for workplaces that promote Māori culture and identity. We find Māori who are more strongly oriented towards a traditional Māori belief system are less likely to be individualistic at work, more likely to prefer workplaces that respect Māori development and less likely to support commercialising iwi assets. We also find marked heterogeneity and suggest 'Māori success as Māori' may not solely reflect 'traditional' Māori values. [ABSTRACT FROM AUTHOR]

Abortion stigma is experienced not only by women but also by providers and health professionals in a wide range of legal contexts. This paper analyses interviews with providers who work in the public health system in the Metropolitan Area of Buenos Aires, Argentina. A court ruling in 2012, FAL/12, changed the interpretation of abortion's legal status, clarifying the decriminalisation of abortion in cases of rape, and also requiring public policies and procedures to speed up access to legal abortion. Between 2014 and 2017, we conducted 27 in-depth, semi-structured interviews with abortion providers in public facilities across healthcare services in the Metropolitan Area of Buenos Aires. We found the way that health providers dealt with abortion stigma evolved over the course of time, as the abortion debate moved from the margins to the heart of political debate and public policies in Argentina between 2007 and 2017. Providers' experiences changed as the social and legal context changed. FAL/12 – as a clear, legal ruling – was a landmark and turning point in the way health professionals in public health facilities conduct their activities, making it possible for them to move from providing silent and hidden abortion care, to acknowledging it with pride. [ABSTRACT FROM AUTHOR]

Roma health mediators are part of a government funded, community-led health intervention. One of the programme's central aims is to improve access to reproductive care for Roma women, often said to be one of the most disadvantaged population groups in Europe. This paper is a critical analysis of mediation in Romania, focusing on how social determinants shape access to family planning and how mediators are employed to address inequalities. It is based on ethnographic observations of mediators at work, as well as indepth interviews with community members, health professionals, and mediators. Health professionals tended to see Roma families as wanting and having an unreasonably large number of children and tried to curtail this through the promotion of contraception. This contrasted with the perspective of community members, who appeared not to choose having many children but who instead struggled to access contraception for financial reasons. Roma health mediators generally seemed aware of multiple and intersecting pressures that women were facing, but ultimately tended to frame family planning as a matter of choice, culture, and knowledge. I set these perspectives against the background of anti-Roma racism and eugenic sentiments, reflected in popular discourses about Roma reproduction. I explore how an intervention that nominally aims to promote the emancipation of Roma communities, in fact entrenches some of the racially fused assumptions that are connected to inequalities of access to reproductive health care in the first place. The discussion has implications for Roma reproductive health interventions across Europe, and for participatory interventions more globally. [ABSTRACT FROM AUTHOR]

This paper presents a historical outline of how Sápmi cultural heritage has been taken into consideration in EIAs within the Swedish Sápmi region. Since the first EIAs were drafted in Sweden in the late 1990s, the assessment of Sami cultural heritage has exclusively been limited to tangible heritage. Components, which the Sami people consider vital elements within their cultural heritage, such as traditional knowledge, biological heritage, and oral history, have not been taken into consideration. Since 1998, the Swedish National Heritage Board has allocated funds for the support of Sami cultural heritage with four support programs between 1998 and 2012. These programs focused exclusively on tangible cultural heritage. In 2010, the Swedish Sami People’s National Association published guidelines on how Sami land use should be integrated into the EIA process. The document includes a clear presentation of the Sami people’s worldview and clarifies what they consider their cultural heritage. The following year Swedish Sami Ragnhild Svonni, representing the same organization at the Swedish National Heritage Board’s annual conference, spoke about the Sami people and their cultural heritage. Nonetheless, EIAs nowadays are still compiled with a rigorously objectified and westernized point-of-view with little consideration to the Sami people’s worldview. [ABSTRACT FROM AUTHOR]

This paper analyzes the relations between social capital, institutions, and trust. These concepts are full of ambiguity and confusion. This paper attempts to dissolve some of the confusion, by distinguishing trust and control, and analyzing institutional and relational conditions of trust. It presents a tool for the analysis of the foundations of trust, and a diagnosis of its strength and viability. [ABSTRACT FROM AUTHOR]

Many people in developed countries fail to consume a healthy diet. This phenomenon has been linked to the contested existence of ‘food deserts’ in the UK, and the occurrence of ‘food insecurity’ in the USA and elsewhere. ‘Food deserts’ remain contested theoretical territory at least partly because no firm definition has been proposed. This paper argues that the barriers to consumption of a healthy diet may be classified according to whether such barriers are financial, physical, or derive from the mental attitude and knowledge of the consumer. The perception of ‘unsupportive food environments’ by some consumers is contrasted with the geographical existence of multiple sources of fresh fruit and vegetables in certain locations. Using a total of 234 semi—structured interviews in various UK locations, qualitative evidence is gathered for the existence of at least ten different types of ‘food desert’. The paper then goes on to show how such a three fold classification may be developed, using a modified ternary diagram, to assess the most appropriate initiatives to tackle ‘food deserts’ and to monitor progress in alleviating their effects. [ABSTRACT FROM AUTHOR]

This paper examines the concept of‘professional trust’ and argues that trust is an essential component of what it means to be a‘professional’. The first part of the paper discusses the nature of trust in general and attempts to establish two main points: that we are all involved in relationships of trust and that all trust involves risk. The second section examines the idea of professional trust and draws on an analysis of knowledge provided by Michael Oakeshott that divides knowledge into two components,‘information’ and‘judgement’. The central argument is that the exercise of judgement through the possession of‘discretionary powers’ is central to being a professional, but that judgement itself resists reduction to propositional formulation because it is essentially tacit and individual. The paper's focus is fairly narrow and does not examine, for example, the role of trust in teacher–pupil relationships, how trust may be related to learning or the role of trust in the pursuit of collaborative educational research. [ABSTRACT FROM AUTHOR]

Axel Mundigo has been a close working partner even though his intellectual trajectory is situated outside the feminist field. His paper, 'Reconceptualizing Men's Role in the post-Cairo Era', however, draws extensively on feminist conceptual tools. This is not a trivial observation. Studies on masculinity are not always inspired by feminist ideas. Consequently, for those of us working within feminism, Mundigo's endeavour is both flattering and engaging. The paper is like a mirror in which the winding road of contemporary feminist thinking is reflected, modified and, eventually, simplified. This mirror effect is what inspired my commentary. It has not been written as an exclusive dialogue with the author, but as a review and appraisal of our own (feminist) conceptualization. I will initially focus attention on the concepts and uses of 'patriarchy', 'gender', and 'power'. Later, I want to problematize notions of 'male responsibility' and 'male involvement'. [ABSTRACT FROM AUTHOR]

Background: The relationship between attitudes and behaviour has led to a focus on the role played by attitudes in the teaching and learning of mathematics. Purpose: This paper reports on an investigation into studentteachers' self-reported attitudes towards mathematics in the context of a mathematics education programme. The programme had been developed by the authors in response to a new, reformed four-year undergraduate initial teacher education (ITE) for primary teachers in Ireland. The authors aimed to use the feedback to evaluate and develop the course further. Sample: We report on the attitudes of 345 pre-service primary teachers enrolled in a four-year undergraduate ITE programme. 281 of these participants had matched survey data before and after participating in the mathematics education programme. Method and Design: Four evaluation criteria were used as a conceptual framework for the evaluation of the mathematics education programme. A multi-method approach was taken in investigating the students' attitudes to mathematics by using a scale as a quantitative measure of attitude alongside open-ended survey items that provided qualitative insights into changes in attitudes. Results and conclusions: Results from the survey data suggested overall that the participants' attitudes towards mathematics were more positive after they had experienced the mathematics education programme. Overall, the written responses suggested that according to self-reportage, participants perceived that participation in the mathematics education programme had affected their attitudes towards mathematics positively. Comments indicated that the 'small group' tutorial structure was particularly well received and was associated with opportunities to actively engage, explore, interact and reflect. Suggestions offered by the participants will be used to inform planning and development of the mathematics programme. [ABSTRACT FROM AUTHOR]

Impact significance determination lies at the heart of environmental impact assessment (EIA) but conflict and misunderstanding around the concept is common. This paper attempts to make sense of impact significance in EIA based on four essential components of significance synthesised from the literature to ensure that: (1) a clear operational framework for significance determination applies throughout EIA, (2) attention focuses only on significant issues, (3) the term significance is specified and applied consistently, and (4) significance determinations are transparent to all EIA stakeholders. To provide a practical perspective, the extent to which EIA institutional provisions in Western Australia uphold these significance determination components is reviewed. Overall the Western Australian approach generally meets all four components, but areas for improvement include better guidance encouraging proponents to adopt a more consultative approach to determining relevant environmental factors and objectives to better focus EIA, and distinguishing between terms used for significance within EIA documentation. A new significance framework approach in Western Australia represents a clear attempt to uplift practice, but opportunity exists to improve the way impact significance determinations are presented to stakeholders. EIA practitioners may benefit from mapping and making sense of impact significance in their own jurisdiction using the four components presented. [ABSTRACT FROM AUTHOR]

Sweden, by many regarded as the archetypal welfare state, has recently experienced severe problems of weak economic performance, sharply rising unemployment and cutbacks in social policies. In this paper, data from national surveys over the last decade are analysed in order to assess whether recent changes in the political arena point to more long-term problems of legitimacy for Swedish welfare policies. The purposes are (a) to track the overall attitudes to various aspects of Swedish welfare policies in order to assess which, if any, parts and aspects of the welfare state have experienced a fall in public support, and (b) to analyse what changes have taken place in how various structural cleavages are linked to attitudes. It has been argued, from a variety of theoretical perspectives, that the former class-based conflicts around welfare policies are increasingly diluted, or superseded, by other conflicts emanating from gender, sector employment, client status, housing conditions or other possible sources of identity and interests. The results in this paper indicate that such claims are exaggerated, and that stability, in aggregate responses, attitudinal patterns and social cleavages, characterizes attitudes to Swedish welfare policies. [ABSTRACT FROM AUTHOR]

Four approaches may be used to reduce prejudices in students: Exhortation; providing information; intergroup contact; and development of cognitive sophistication. The paper describes a teaching model which focuses on the last approach - development of cognitive sophistication-as a means of preparing social work students for culturally sensitive practice. Developed by the author, the model was offered as a three-hour class unit, descriptively named "Identifying the `Isms' ". The unit content was presented in three stages: (a) Bias was defined in a manner such that all students willingly admitted that they were biased against some category of persons, (b) the functions of bias were discussed, and (c) a series of vignettes were given to the class for analysis as to whether bias existed in the situation described and, if it existed, what function it served. Feedback from students suggests that the model is effective in encouraging students to admit and to confront their own biases and in developing students' critical think- ing skills when examining their and others' biases. The paper concludes with a discussion of the model `s applicability to other class settings. [ABSTRACT FROM AUTHOR]

This paper is centrally concerned with criticism of inter-racial contact as a means of improving race relations. It aims, amongst other things, to highlight the damaging implications of the criticism on practices hitherto thought useful in combating racial prejudice. The main focus of the paper is the charge that a reduction in prejudice towards individual members of the group does not transfer to the group as a whole. it is argued that whilst there is much evidence to support this charge, the acquisition of positive attitudes towards an entire racial or ethnic group is not an aim that educationalists should seek to realise. In the light of this objection, an alternative view of the purpose of inter-racial contact is proposed such that the value of contact be judged in terms of whether it helps diminish the tendency to indulge in unsupported generalisations. To promote this goal it is urged that wherever practicable, inter-racial contact, under specified conditions, should form part of a programme that emphasises that nature, and particularly the dangers, of generalisation. It is acknowledged, however, that there are some children and some forms of prejudice that will remain impervious to the potential benefits of any form of contact. [ABSTRACT FROM AUTHOR]

The paper is concerned with student altitudes and views of the certificate of further education and illustrates that the marker against winch students assess both the course and college is school It also explores the nature and forms of student resistance, arguing that for those students who stay the course, the most significant form of resistance is against youthful dependence and the process of infantalisation In addition it is argued that much of student behaviour that is apparently resistant should be understood as a mode of accomodation, as a strategy of survival The paper illustrates that many students have an instrumental commitment toward their course and that in some cases the experience of the course enhanced and strengthened this orientation. [ABSTRACT FROM AUTHOR]

Trust is an issue to which Keynesians and post-Keynesians have paid relatively little attention. However, properly understood it is an aspect of almost all activity, including key elements of socio-economic reality. Without trust, market exchange is at the very least problematic, if not impossible. Moreover, trust is intrinsic to a variety of issues with which Keynes, and subsequent Keynesianism have been concerned. In this paper we provide a general social theory conceptualisation of trust and then set out some of the areas where this concept resonates with the work of Keynes in terms of the role of conventions. Conventions quintessentially involve trust and that trust can be unstable, can be withdrawn and can require rebuilding. We illustrate this with reference to central bank policy and the Bank of England's introduction of Forward Guidance. Exploring the problem of trust in the context of banking also highlights a challenge for the continued relevance of Keynes' work. We now live in a neoliberal world and this provides a quite different context for state intervention than was previously the case. Keynes' work is now an argument for the alternative, and as such it requires more than a technical economic argument, it must also address the problem of trust in state policy-makers. We briefly illustrate the challenge this poses with reference to Europe. [ABSTRACT FROM AUTHOR]

The aim is to identify facilitators and barriers for physical activity (PA) experienced by morbidly obese adults in the Western world. Inactivity and a sedentary lifestyle have become a major challenge for health and well-being, particularly among persons with morbid obesity. Lifestyle changes may lead to long-term changes in activity level, if facilitators and barriers are approached in a holistic way by professionals. To develop lifestyle interventions, the perspective and experiences of this group of patients are essential for success. The methodology of the systematic review followed the seven-step procedure of the Joanna Briggs Institute and was published in a protocol. Six databases were searched using keywords and index terms. Manual searches were performed in reference lists and in cited citations up until March 2015. The selected studies underwent quality appraisal in the Joanna Briggs-Qualitative Assessment and Review Instrument. Data from primary studies were extracted and were subjected to a hermeneutic text interpretation and a data-driven coding in a five-step procedure focusing on meaning and constant targeted comparison through which they were categorized and subjected into a meta-synthesis. Eight papers were included for the systematic review, representing the experiences of PA among 212 participants. One main theme developed from the meta-data analysis: "Identity" with the three subthemes: "considering weight," "being able to," and "belonging with others." The theme and subthemes were merged into a meta-synthesis: "Homecoming: a change in identity." The experiences of either suffering or well-being during PA affected the identity of adults with morbid obesity either by challenging or motivating them. A change in identity may be needed to feel a sense of "homecoming" when active. [ABSTRACT FROM AUTHOR]

Background:The implementation of inclusive education creates challenges for classroom teachers who have to meet the learning needs of students with and without special educational needs (SEN). Research has revealed that teachers’ readiness and willingness to accommodate the learning needs of students with SEN was determined by their training. Though much research on teacher training and inclusive education has been conducted over two decades, less is known about the adequacy of such training in terms of components and effectiveness. Purpose:The purpose of this review is to present a focused analysis of: (1) studies that examined, in detail, the components of teacher training programmes for pre-service or in-service teachers in regular primary schools in terms of content, length, etc., and (2) consideration of the effectiveness of these training programmes. Design and methods:The literature review was restricted to empirical studies published in international peer-reviewed journals after 1994 (i.e. since the Salamanca statement was signed) by using the electronic browser ‘EBSCO host Complete’. After applying the keywords ‘teacher’ and ‘educator’, they were combined with the following terms: training, disabilities, inclusion, inclusive education, impairment, special educational needs, children with special needs and disorder. The search was deliberately restricted to papers where study participants were pre-service or in-service teachers in regular primary schools, and ultimately yielded a small core of 13 studies for detailed review. The first research question was analysed in terms of the training programme’s structure and content, covering aspects such as type of disability, topic, length, medium of course delivery and learning activities. For the second research question, the effectiveness of the quantitative studies was evaluated based on the Cohen’sdeffect size, whereas the qualitative studies were considered as effective based on the calculation of percentage of non-overlapping data (PND). Conclusions:Analysis indicated that the majority of training programmes focused on attitude, knowledge and skills. The training programmes were also centred on what might be considered short-term practice and supplemented with field experiences. Although the training programmes appeared to have positive effects on teachers’ attitudes, knowledge and skills, follow-up sessions and students’ outcomes measures may increase training effectiveness. [ABSTRACT FROM PUBLISHER]

Background: Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily) for patient care. Design: A multiple case study was carried out between March and August 2012 at the antenatal care (ANC) clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC).Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Results: Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. Conclusions: We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers) and individual skills and motivation. [ABSTRACT FROM AUTHOR]

If environmental assessment is to more effectively assist in the move towards sustainability goals, deeper consideration of substantive, value-based questions associated with this field is required. Such questions relate, for example, to the way in which we conceive of and value the environment, the various stakeholder perceptions of development and the types of knowledge most appropriate to the environmental assessment endeavour. These issues are explored in this paper, which is based on the Applied Integrative Sustainability Guide (2010) produced by the Council for Scientific and Industrial Research (CSIR) in South Africa. In so doing, the authors draw on the work of leading thinkers in the fields of complexity theory, environmental ethics, development economics and planning. [ABSTRACT FROM PUBLISHER]

Suffering and well-being are significant aspects of human existence; in particular, suffering and well-being are important aspects of patients' experiences following diseases. Increased knowledge about existential dimensions of illness and healthcare experiences may be needed in order to improve care and reduce unnecessary suffering. Therefore, the aim of this paper is to illuminate the phenomenon of suffering experienced in relation to healthcare needs among patients in hospital settings in Sweden. In this study, we used a reflective lifeworld approach. The data were analysed with a focus on meanings. The results describe the essential meaning of the phenomenon of suffering in relation to healthcare needs. The patients were suffering during care-giving when they felt distrusted or mistreated and when their perspective on illness and health was overlooked. Suffering was found to arise due to healthcare actions that neglected a holistic and patient-centred approach to care. Unfortunately, healthcare experiences that cause patients to suffer seem to be something one needs to endure without being critical. The phenomenon can be described as having four constituents: to be mistreated; to struggle for one's healthcare needs and autonomy; to feel powerless; and to feel fragmented and objectified. The study concludes that there are problems associated with patients experiencing suffering at the hands of healthcare providers, even if this suffering may not have been caused deliberately to the patient. Consequently, conscious improvements are needed to lessen the suffering caused by care-giving, as are strategies that promote more patient-centred care and patient participation. [ABSTRACT FROM AUTHOR]

Understanding the attitude of stakeholders towards forest management is important for the conservation of forests. In this paper we examine attitudes of primary stakeholders towards forest conservation management in Ghana, with Subri Forest Reserve as the study area. Using a survey methodology, 300 households from 10 communities around the reserve were randomly selected and interviewed with structured questionnaires. The results revealed that primary stakeholders have positive attitudes towards forest management and this was not dependent on the location of the community. They support sanctioning people who degrade the forest and accept the need to get a permit before harvesting. However, they are not in favour of strict protection of the reserve. Their attitude towards forest management is influenced by their perception of forest values, concern about degradation of the reserve, economic benefits they derive from the reserve, exposure to resource-use conflicts and membership of conservation organizations. Our findings suggest that primary stakeholders are interested in forest conservation management. But, to achieve sustainable development, it will be necessary to identify the types and quantity of forest products used and their economic significance and to develop initiatives that will support rural livelihoods. [ABSTRACT FROM PUBLISHER]

This paper presents a qualitative study conducted in 2009 of provider and patient perceptions of primary level reproductive health services provided by commune health stations (CHSs), and the implications for Viet Nam's 2011–2020 National Strategy for Reproductive Health Care. In the three provinces of Thai Nguyen, Thua Thien Hue, and Vinh Long, we interviewed the heads of CHSs, held focus group discussions with midwives and women patients, and observed facilities. Half the 30 CHSs visited were in poor physical condition; the rest were newly renovated. However, the model of service delivery was largely unchanged from ten years before. Many appeared to fall short in meeting patient expectations in terms of modern medical equipment and technology, range of drug supplies, and levels of staff expertise. As a result, many women were turning to private doctors and public hospitals, at least in urban areas, or seeking medication from pharmacies. To make CHS clinics sustainable, promotion of access to reproductive health services should be undertaken concurrently with quality improvement. A responsive payment scheme must also be developed to generate revenues. Efforts should be made to reduce the unnecessary use of more costly services from private clinics and higher level public facilities. Cet article présente une étude qualitative réalisée en 2009 sur les perceptions chez les prestataires et les patients des services de santé génésique de niveau primaire assurés par les centres de santé communaux (CSC) et leurs conséquences pour la Stratégie nationale de soins de santé génésique 2011–2020 du Viet Nam. Dans les trois provinces de Thai Nguyen, Thua Thien Hue et Vinh Long, nous avons interrogé les chefs des CSC, organisé des discussions par groupe d'intérêt avec des sages–femmes et des patientes, et observé les installations. La moitié des 30 CSC visités étaient en mauvais état ; les autres venaient d'être rénovés. Néanmoins, lemodèle de prestation de services n'avait presque pas changé depuis dix ans. Beaucoup de CSC ne semblaient pas répondre aux attentes des patientes du point de vue de la modernité de l'équipement médical et de la technologie, du choix de médicaments disponibles et du niveau de compétence du personnel. Beaucoup de femmes s'adressaient donc à des médecins privés et des hôpitaux publics, au moins dans les zones urbaines, ou demandaient des médicaments dans les pharmacies. Pour que les CSC deviennent viables, la promotion de l'accès aux services de santé génésique doit être entreprise conjointement avec l'amélioration de la qualité. Un plan de paiement réactif doit aussi être mis au point pour créer des recettes. Il faut s'efforcer de réduire le recours inutile aux services coûteux de médecins et de centres privés ou d'installations publiques de niveau supérieur. En este artículo se presenta un estudio cualitativo realizado en 2009 de las percepciones del personal de salud y pacientes en cuanto a los servicios de salud reproductiva proporcionados en el primer nivel de atención por estaciones de salud comunitarias (CHS por sus siglas en inglés) y las implicaciones para la Estrategia Nacional de Servicios de Salud Reproductiva en Vietnam, del 2011 al 2020. En las tres provincias de Thai Nguyen, Thua Thien Hue y Vinh Long, entrevistamos la dirección de las CHS, realizamos discusiones en grupos focales con parteras profesionales y mujeres pacientes y observamos las unidades de salud. La mitad de las 30 CHS visitadas se encontraban en malas condiciones físicas; el resto había sido renovado recientemente. Sin embargo, hubo muy pocos cambios en el modelo de prestación de servicios creado diez años atrás. En muchas de las CHS hubo considerable insatisfacción por parte de las pacientes en cuanto al equipo médico moderno y la tecnología, la variedad de medicamentos y los niveles de conocimientos y experiencia del personal. Por consiguiente, muchas mujeres estaban acudiendo a médicos particulares y hospitales públicos, por lo menos en las zonas urbanas, o buscando medicamentos en las farmacias. Para lograr la sostenibilidad de las CHS, se debe promover el acceso a los servicios de salud reproductiva a la vez que se mejora la calidad. Además, se debe elaborar un esquema de pago receptivo para generar ingresos y se deben realizar esfuerzos por reducir el uso innecesario de servicios costosos proporcionados por médicos y clínicas particulares y unidades públicas de nivel superior. [ABSTRACT FROM AUTHOR]

In Bangladesh, the formal public health system provides few services for common sexual and reproductive health problems such as white discharge, fistula, prolapse, menstrual problems, reproductive and urinary tract infections, and sexual problems. Recent research has found that poor women and men resort to informal providers for these problems instead. This paper draws on interviews with 303 providers and 312 women from two rural and one urban area of Bangladesh from July 2008 to January 2009. Both informal and formal markets played an important role in treating these problems, including for the poor, but the treatments were often unlikely to resolve the problems. Providers ranged from village doctors without formal training to qualified private practitioners. The health system is heavily marketised and boundaries between "public" and "private" are blurred. There exists a huge, neglected domain of sexual and reproductive health needs which are a source of silent suffering and for which there are no trained health staff providing treatment in government facilities. The complexity of this situation calls for engaged debate in Bangladesh on how to improve the quality of existing services, discourage or prevent obviously harmful practices, and develop financing mechanisms to enable women to access effective treatment, regardless of the source, for these neglected problems. Au Bangladesh, le système de santé officiel s'occupe peu des affections de santé génésique courantes, comme les pertes blanches, les fistules, les prolapsus, les problèmes menstruels, les infections de l'appareil génital et urinaire et les troubles sexuels. Des recherches récentes ont révélé que les femmes et les hommes pauvres s'adressent à des prestataires informels pour ces problèmes. L'article se fonde sur des entretiens avec 303 prestataires et 312 femmes de deux zones rurales et d'une zone urbaine du Bangladesh, de juillet 2008 à janvier 2009. Les marchés formels et informels jouaient tous deux un rôle important, notamment pour les pauvres, mais les traitements avaient peu de chances de résoudre ces problèmes. Les prestataires allaient de médecins villageois sans formation officielle à des praticiens privés qualifiés. Le système de santé est fortement influencé par les lois du marché et les frontières entre le « public » et le « privé » sont floues. Il existe un vaste domaine négligé de besoins de santé génésique qui sont une source de souffrances silencieuses et pour lesquels on ne dispose pas de personnel de santé formé à traiter les patientes dans les centres gouvernementaux. La complexité de la situation nécessite un débat engagé au Bangladesh pour trouver comment améliorer la qualité des services, décourager ou prévenir les pratiques manifestement dangereuses et créer des mécanismes de financement qui donneront accès aux femmes à un traitement efficace, quelle qu'en soit la source, de ces problèmes oubliés. En Bangladesh, el sistema oficial de salud pública ofrece pocos servicios para problemas comunes de salud sexual y reproductiva como secreción blanca, fistula, prolapso, problemas menstruales, infecciones del tracto reproductivo y de las vías urinarias y problemas sexuales. En recientes investigaciones se ha encontrado que las mujeres y los hombres pobres recurren a prestadores de servicios extraoficiales para resolver estos problemas. Este artículo se basa en entrevistas con 303 prestadores de servicios y 312 mujeres de dos zonas rurales y una urbana, en Bangladesh, desde julio de 2008 hasta enero de 2009. Ambos el mercado oficial y el extraoficial desempeñaron un papel importante para tratar estos problemas, incluso para gente pobre, pero a menudo resultó improbable resolver los problemas con sus tratamientos. Entre los prestadores de servicios figuraban desde médicos del pueblo sin formación académica hasta practicantes particulares calificados. El sistema de salud es muy comercializado y la línea divisoria entre los sectores "público" y "privado" es borrosa. Existe una enorme gama de necesidades desatendidas de salud sexual y reproductiva que son una fuente de sufrimiento silencioso y para las cuales no hay personal de salud capacitado ofreciendo tratamiento en unidades gubernamentales. Esta compleja situación en Bangladesh requiere un debate abierto sobre cómo mejorar la calidad de los servicios actuales, impedir o poner freno a las prácticas obviamente dañinas y crear mecanismos de financiamiento para que las mujeres tengan acceso a tratamientos eficaces, independientemente de la fuente, para estos problemas desatendidos. [ABSTRACT FROM AUTHOR]

Abstract: As part of efforts to achieve Millennium Development Goal 5 – to reduce maternal mortality by 75% and achieve universal access to reproductive health by 2015 – the Malawi Ministry of Health conducted a strategic assessment of unsafe abortion in Malawi. This paper describes the findings of the assessment, including a human rights-based review of Malawi''s laws, policies and international agreements relating to sexual and reproductive health and data from 485 in-depth interviews about sexual and reproductive health, maternal mortality and unsafe abortion, conducted with Malawians from all parts of the country and social strata. Consensus recommendations to address the issue of unsafe abortion were developed by a broad base of local and international stakeholders during a national dissemination meeting. Malawi''s restrictive abortion law, inaccessibility of safe abortion services, particularly for poor and young women, and lack of adequate family planning, youth-friendly and post-abortion care services were the most important barriers. The consensus reached was that to make abortion safe in Malawi, there were four areas for urgent action – abortion law reform; sexuality education and family planning; adolescent sexual and reproductive health services; and post-abortion care services. [Copyright &y& Elsevier]

This paper presents findings on hysterectomy prevalence from a 2010 cross-sectional household survey of 2,214 rural and 1,641 urban, insured and uninsured women in low-income households in Ahmedabad city and district in Gujarat, India. The study investigated why hysterectomy was a leading reason for use of health insurance by women insured by SEWA, a women's organisation that operates a community-based health insurance scheme. Of insured women, 9.8% of rural women and 5.3% of urban women had had a hysterectomy, compared to 7.2% and 4.0%, respectively, of uninsured women. Approximately one-third of all hysterectomies were in women younger than 35 years of age. Rural women used the private sector more often for hysterectomy, while urban use was almost evenly split between the public and private sectors. SEWA's community health workers suggested that such young women underwent hysterectomies due to difficulties with menstruation and a range of gynaecological morbidities. The extent of these and of unnecessary hysterectomy, as well as providers' attitudes, require further investigation. We recommend the provision of information on hysterectomy as part of community health education for women, and better provision of basic gynaecological care as areas for advocacy and action by SEWA and the public health community in India. L'article présente les conclusions d'une enquête transversale sur la prévalence de l'hystérectomie auprès de femmes (2214 rurales et 1641 urbaines) assurées et non assurées dans des ménages à faible revenu de la ville et du district d'Ahmedabad à Gujarat, Inde. L'étude souhaitait déterminer pourquoi l'hystérectomie était une raison majeure de recours à l'assurance maladie de la part des femmes assurées chez SEWA, une organisation féminine qui gère un plan communautaire d'assurance maladie. Parmi les assurées, 9,8% des femmes rurales et 5,3% des femmes urbaines avaient subi une hystérectomie, contre 7,2% et 4,0% respectivement des femmes non assurées. Environ un tiers des hystérectomies avait été réalisées chez des femmes de moins de 35 ans. Les femmes rurales utilisaient plus souvent le secteur privé pour l'hystérectomie, alors qu'en ville, l'utilisation était répartie de manière égale entre les secteur public et privé. Les agents de santé communautaire de SEWA ont suggéré que ces jeunes femmes avaient subi une hystérectomie pour des troubles de la menstruation et différentes morbidités gynécologiques. Il convient de réaliser des recherches complémentaires sur l'étendue de ces interventions et des hystérectomies inutiles, ainsi que sur les attitudes des prestataires. Nous recommandons la diffusion d'informations sur l'hystérectomie dans le cadre de l'éducation sanitaire communautaire des femmes, et de meilleurs soins gynécologiques essentiels comme domaines de plaidoyer et d'action de SEWA et de la communauté de santé publique en Inde. En este artículo se presentan los hallazgos sobre la prevalencia de la histerectomía de una encuesta domiciliaria transversal, realizada en 2010, de 2214 mujeres rurales y 1641 urbanas aseguradas y no aseguradas, en viviendas de bajos ingresos en la ciudad y el distrito de Ahmedabad, en Gujarat, India. El estudio investigó por qué la histerectomía era una razón principal para el uso de seguro médico por mujeres aseguradas por SEWA, una organización de mujeres que administra un plan de seguro médico comunitario. De las mujeres aseguradas, el 9.8% de las mujeres rurales y el 5.3% de las urbanas habían tenido una histerectomía, comparado con el 7.2% y el 4.0%, respectivamente, de las mujeres no aseguradas. Aproximadamente una tercera parte de todas las histerectomías se efectuaron en mujeres menores de 35 años de edad. Las mujeres rurales acudieron al sector privado con más frecuencia para una histerectomía, mientras que las urbanas se dividieron casi exactamente por la mitad entre los sectores público y privado. Los trabajadores comunitarios de la salud empleados por SEWA sugirieron que estas jóvenes tuvieron histerectomías debido a sus dificultades con la menstruación y una variedad de morbilidades ginecológicas. La gravedad de éstas y la frecuencia de histerectomías innecesarias, así como las actitudes del personal de salud, requieren más investigación. Recomendamos el suministro de información sobre la histerectomía como parte de la educación de las mujeres comunitarias sobre la salud, y mejor prestación de los servicios ginecológicos básicos, como áreas de promoción y defensa y acción por parte de SEWA y la comunidad de salud pública en India. [ABSTRACT FROM AUTHOR]

This paper reports on an evaluation of a domestic violence intervention in the maternity and sexual health services of a UK hospital. The intervention encompassed guidelines, staff training, inclusion of routine enquiry for domestic violence with all patients, and referral of women disclosing violence to an on-site advocacy service. An "assumption querying" approach was applied to evaluate the intervention. Programmatic assumptions were identified and tested using interviews with service providers and patients, review of patient records, and pre- and post-training questionnaires. Domestic violence training resulted in changes in health professionals' knowledge and practice in the short-term, but universal routine enquiry was not achieved even in a context of organisational support, guidelines, training and advocacy. Potential and actual harm occurred, including breaches of confidentiality and failure to document evidence, limiting women's ability to access civil and legal remedies. Advocacy support led to positive outcomes for many women, as long as support to maintain positive changes, whether women stayed with or left the violent partner, continued to be given. Maternity and sexual health services were found to be opportune points of intervention for domestic violence services that combine routine enquiry by clinicians, support after disclosure and attention to harm reduction. Cet article décrit l'évaluation d'une intervention en matière de violence domestique dans les services de santé génésique et de maternité d'un hôpital britannique. L'intervention comportait des directives, la formation du personnel, une enquête systématique auprès de toutes les patientes sur la violence domestique et l'aiguillage des femmes révélant des violences vers un service de sensibilisation sur place. L'intervention a été évaluée avec une approche de « questionnement des postulats ». On a identifié et testé les postulats des programmes par des entretiens avec les prestataires de services et les patientes, l'examen des dossiers des patientes et des questionnaires avant et après la formation. La formation sur la violence domestique a changé à court terme les connaissances et la pratique des professionnels de santé, mais n'a pas réussi à les inciter à questionner systématiquement toutes les patientes, même dans un contexte de soutien organisationnel, de directives, de formation et de sensibilisation. On a constaté des préjudices potentiels et réels, notamment des violations de la confidentialité et l'incapacité à réunir des preuves, limitant ainsi la possibilité des femmes d'avoir accès à des réparations civiles et juridiques. Le soutien à la sensibilisation a eu des résultats positifs pour beaucoup de femmes, tant que le soutien s'est poursuivi pour maintenir des changements positifs, que les femmes restent ou non avec le partenaire violent. Les services de santé génésique et de maternité se sont révélés des points précieux d'intervention pour les services de violence domestique car ils associent l'enquête systématique des cliniciens, le soutien après la révélation et l'attention à la réduction des risques. Este artículo resume la evaluación de una intervención relacionada con la violencia doméstica en los servicios de salud materna y sexual de un hospital del Reino Unido. La intervención comprendió guías, capacitación del personal, indagación rutinaria de todas las pacientes respecto a la violencia doméstica y referencia de las que denunciaron violencia a un servicio de promoción y defensa in situ. Se aplicó un enfoque de "investigación de suposiciones" para evaluar la intervención. Las suposiciones programáticas fueron identificadas y probadas utilizando entrevistas con profesionales de la salud y pacientes, revisión de los expedientes médicos y cuestionarios pre- y post-capacitación. La capacitación en violencia doméstica produjo cambios en los conocimientos y las prácticas de los profesionales de la salud a corto plazo, pero no se logró establecer una rutina de indagación universal, ni tan siquiera en un contexto con apoyo organizacional, guías, capacitación y promoción y defensa. Ocurrieron daños posibles y reales, como violación de confidencialidad e incumplimiento de documentar la evidencia; éste último limitó la capacidad de las mujeres para acceder remedios civiles y jurídicos. El apoyo de promoción y defensa llevó a resultados positivos para muchas mujeres, siempre y cuando se les continuara brindando apoyo para mantener cambios positivos, independientemente de que la mujer permaneciera con su pareja violenta o la dejara. Se concluyó que los servicios de salud materna y sexual son puntos oportunos de intervención para los servicios contra la violencia doméstica, que combinan la indagación rutinaria por parte del personal de salud, apoyo después de confirmada la violencia y atención a la reducción de daños. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study in 2007–08 on the abortion experiences of teenage women from deprived backgrounds in Hong Kong. Twenty-nine young women aged 13–24 who had undergone one or more induced abortions in their teen years were interviewed and participated in group empowerment sessions. Ten were unemployed, four were students, the rest were employed on low pay in unskilled occupations. Abortion services are legal and available in public and private services, but they charge fees ranging from HK$310 to $10,000, and do abortions only up to 24 weeks of pregnancy. Many young women resort to poor quality illegal clinics and clinics in mainland China because the cost is lower, they do not wish to tell their parents, who would be asked for consent, and/or they want to protect their sex partners, who may be reported and prosecuted if the girl is under-age. There is a need to strengthen services for teenage women in Hong Kong, especially those who are pregnant and from deprived backgrounds. There is also a need for professionals who deliver adolescent health and social welfare services, and for society to rethink and re-examine its views and attitudes towards teenage pregnancy, sexuality and abortion. En 2007–08, une étude qualitative a porté sur les expériences de l'avortement d'adolescentes issues de milieux défavorisés à Hong Kong. Vingt-neuf jeunes femmes âgées de 13 à 24 ans qui avaient avorté une ou plusieurs fois pendant leur adolescence ont été interrogées et ont participé à des séances d'autonomisation de groupe. Dix étaient au chômage, quatre étaient étudiantes, les autres occupaient des emplois non qualifiés et peu rémunérés. Les services d'avortement sont légaux et disponibles dans des services publics et privés ; mais ils perçoivent des honoraires allant de HK$310 à HK$10 000 et ne pratiquent les avortements que jusqu'à 24 semaines de grossesse. Beaucoup de jeunes femmes ont recours à des centres illégaux de mauvaise qualité ou des centres en Chine continentale car ils sont moins coûteux, elles ne souhaitent pas le dire à leurs parents qui devraient donner leur consentement, et/ou elles veulent protéger leur partenaire sexuel, qui pourrait être dénoncé et poursuivi si la fille est mineure. Il faut renforcer les services pour adolescentes à Hong Kong, en particulier celles qui sont enceintes et issues de milieux défavorisés. On a également besoin de professionnels qui assurent des services de santé et de protection sociale des jeunes alors que la société devrait repenser et réexaminer ses idées et ses attitudes à l'égard de la grossesse, la sexualité et l'avortement chez les adolescentes. En este artículo se informa acerca de un estudio cualitativo realizado en 2007–08 sobre las experiencias de aborto de mujeres adolescentes de clases carenciadas en Hong Kong. Se entrevistaron 29 jóvenes de 13 a 24 años de edad, que habían tenido uno o más abortos inducidos entre los 13 y 19 años, quienes también participaron en sesiones de empoderamiento en grupo. Diez estaban desempleadas, cuatro eran estudiantes y el resto de ellas estaban empleadas en ocupaciones no especializadas de bajo salario. Los servicios de aborto son legales y accesibles en establecimientos públicos y privados, pero estos cobran entre HK$310 y $10,000 y realizan abortos sólo hasta las 24 semanas del embarazo. Muchas jóvenes recurren a clínicas ilegales de mala calidad y a clínicas en China continental porque el costo es más bajo, no quieren informar a sus padres, a quienes se les pediría su consentimiento, y/o quieren proteger a su pareja sexual, quien podría ser denunciada y enjuiciada si la niña es menor de edad. Es necesario fortalecer los servicios para mujeres adolescentes en Hong Kong, especialmente para aquéllas que están embarazadas y son de clases carenciadas. Además, es necesario que la sociedad y los profesionales que proporcionan servicios de salud y asistencia social a las adolescentes reconsideren y reexaminen sus puntos de vista y actitudes hacia el embarazo, la sexualidad y el aborto en la adolescencia. [ABSTRACT FROM AUTHOR]

This paper is about how female circumcision/female genital mutilation (FC/FGM) was viewed by women and men aged 18–89 in Bobo-Dioulasso, Burkina Faso, now that it has been against the law for almost 15 years. The findings come from 11 months of field research, participant observation and interviews in 2008. The practice of FC/FGM was an important issue in Bobo-Dioulasso, even though prevalence seems to be falling. The most important argument for continuing it was not a traditional role, but the need to control female sexuality – regarded as very active – not to negate it, but to ensure morally acceptable behaviour. When I talked about female genital cosmetic surgery it emerged that Bobolaise women used various substances to enhance sexual pleasure for men, both to keep the relationship and to protect the gifts and money many women needed to survive and for their children. FC/FGM was seen as a socio-cultural obligation, necessary to achieve a respectable status. Other forms of genital modification were seen as a means of satisfying male sexual needs, though vaginal tightening to hide sexual experience was also a way of demonstrating respectability. What emerged overall is that Bobolaises had their own perspectives about all the forms of female genital modification that were discussed. Cet article décrit l'idée que les femmes et les hommes âgés de 18–89 ans se font de l'excision/la mutilation sexuelle féminine à Bobo-Dioulasso, Burkina Faso, alors qu'elle est désormais illégale depuis près de 15 ans. Ces conclusions proviennent d'une recherche de terrain de 11 mois, d'observation participante et d'entretiens en 2008. La mutilation sexuelle féminine était un problème important à Bobo-Dioulasso, même si sa prévalence semble diminuer. L'argument le plus important pour la poursuivre n'était pas son rôle traditionnel, mais la nécessité de contrôler la sexualité féminine, considérée très active, non pas de la nier, mais de garantir un comportement moralement acceptable. Quand j'ai parlé de chirurgie plastique des organes génitaux féminins, il est apparu que les Bobolaises utilisaient différentes substances pour augmenter le plaisir masculin, à la fois dans le but de garder leur partenaire et conserver les cadeaux et l'argent dont beaucoup de femmes ont besoin pour survivre et pour leurs enfants. La mutilation sexuelle féminine était considérée comme une obligation socioculturelle, nécessaire pour jouir d'un statut respectable. D'autres formes de modification génitale étaient jugées comme un moyen de satisfaire les besoins sexuels masculins, même si le rétrécissement vaginal pour cacher l'expérience sexuelle était aussi une manière pour la femme de démontrer sa respectabilité. Il est apparu dans l'ensemble que les Bobolaises avaient leurs propres opinions sur toutes les formes de modification génitale féminine évoquées. En este artículo se examina la manera en que la circuncisión femenina/mutilación genital femenina (CF/MGF) era vista por mujeres y hombres de 18 a 89 años de edad, en Bobo-Dioulasso, Burkina Faso, ahora que ha sido ilegal por casi 15 años. Los hallazgos provienen de 11 meses de investigación en el campo, observación participante y entrevistas realizadas en 2008. La práctica de CF/MGF era un asunto importante en Bobo-Dioulasso, aunque la prevalencia parece haber disminuido. El argumento más importante para continuarla no era su función tradicional, sino la necesidad de controlar la sexualidad femenina – considerada como muy activa – no negarla, pero sí asegurar comportamiento moralmente aceptable. Cuando hablé sobre cirugía cosmética de los genitales femeninos, resultó que las mujeres de Bobolaise utilizaban diversas sustancias para realizar el placer sexual de los hombres, tanto para mantener la relación como para proteger los regalos y el dinero que muchas mujeres necesitaban para sobrevivir y para sus hijos. La CF/MGF era vista como una obligación sociocultural, necesaria para lograr una condición social respetable. Otras formas de modificación genital eran consideradas un medio de satisfacer las necesidades sexuales del hombre, aunque apretar la vagina para ocultar la experiencia sexual también era una manera de demostrar respetabilidad. En general, se determinó que las personas de Bobolaise tenían sus propias perspectivas sobre todas las formas de modificación genital femenina discutidas. [ABSTRACT FROM AUTHOR]

This paper provides a systematic review of research on sexual compliance in heterosexual relationships. Three perspectives shed light on which individuals are the most likely to comply with a sexually interested partner's desire for sex and why. A gender perspective highlights the common male-female asymmetry in compliant sexual behavior and identifies factors that contribute to women's greater likelihood of being the sexually compliant partner. A motivational perspective distinguishes between approach and avoidance motives for compliance and considers the possible consequences of these motives for emotional reactions, sexual risk taking, and sexual violence. A relationship maintenance perspective views sexual compliance as illustrative of broader patterns of sacrifice in committed relationships. Each perspective suggests important new directions for empirical research. [ABSTRACT FROM AUTHOR]

Using a more conversational analytical approach, this paper examines the various situated ways in which secondary school students, in interaction with teachers, describe and explain their disruptive classroom behaviour. The focus is on how students account for their behaviour and force accountability on teachers. Students gave accounts and made teachers accountable by defining disruptive behaviour in relation to schoolwork and claims about normality, and by drawing on common understandings about teacher identity. In doing so, various discursive devices were used such as extreme case formulations, introducing corroborating witnesses, deploying the notion of consistency, giving detailed descriptions, making category contrasts, and displaying uncertainty and incomprehension. The different accounts all worked in the direction of emphasising the role of the teacher, and the analysis raises questions about power relations in school and the empowerment of students. [ABSTRACT FROM AUTHOR]

There is widespread demand for the development of female controlled methods of protection against sexually transmitted diseases (STDs) and HIV. The success of such methods will not only depend on their acceptability to women but also to their male partners. This paper reports on men's attitudes to female controlled methods in south west Uganda. Data was gathered in individual interviews with 50 men and 7 focus group discussions with 42 men. Male attitudes to the male condom, the female condom and female controlled methods of protection generally were characterized by ambiguity and anxiety. They liked the male condom because it protects against infection and unwanted pregnancy, but were worried by rumours that it was unreliable. The central theme in the discussions was men's anxiety about retaining control over their female partners. The men wanted women to be protected (and therefore safe as potential partners) but they also wanted to remain in control, at least to some extent, of the means of protection. Once suitable female controlled methods have been identified, it will be necessary to use education and social marketing in such a way that men can be reassured of the positive benefits of these products to them, as well as to women. [ABSTRACT FROM AUTHOR]

This paper presents findings from an elicitation study that focused on the sexual risks and condom use behaviour of African American crack smokers. Of interest were the attitudes, beliefs, and barriers that affect the adoption and maintenance of condoms as an HIV prophylactic. Thick descriptive data were collected from 64 heterosexual African Americans who smoke crack cocaine. Data were content analysed for descriptions of condom use attitudes, normative beliefs, and barriers or facilitators of condom use. Participants described few positive condom use outcome expectations, while detailing several negative expectations. Normative beliefs were found to be weakly related to condom use with casual partners. However, descriptions of sexual relationships with intimate partners indicated that the normative expectations of the partner strongly influenced condom use. Participants described few contextual barriers to condom use, although situational barriers, including crack addiction, were identified. [ABSTRACT FROM AUTHOR]