Conflicting discourses of church youths on masculinity and sexuality in the context of HIV in Kinshasa, Democratic Republic of Congo.

Masculinity studies are fairly new and young churchgoers are an under-researched group in the current Congolese church context. In response to this knowledge gap, this paper attempts to explore discourses of young churchgoers from deprived areas of Kinshasa regarding masculinity and sexuality in the era of HIV. A series of 16 semi-structured interviews were conducted with unmarried young churchgoers from the Salvation Army, Protestant and Revival churches. The interviews were tape-recorded, transcribed verbatim and analysed using discourse analysis. Five main discourses emerged: 'we are aware of the church message on sex', 'young men need sex', 'young women need money', 'to use or not to use condoms' and 'we trust in the church message'. Although all informants knew and heard church messages against premarital sex, many of them were sexually active. The perception was that young men were engaged in sexual activities with multiple partners as a result of sexual motivations surrounding masculinity and sexual potency, while young women sought multiple partners through transactional and intergenerational sex for economic reasons. These sexual practices of young people conflicted with church messages on sexual abstinence and faithfulness. However, a small number of participants challenged current gender norms and suggested alternative ways of being a man or a woman. To elucidate these alternatives, we suggest that church youths and church leaders might take concrete actions to deconstruct misconceptions about being men. In this way, they can possibly enhance a frank and fruitful dialogue on sex, sexuality and gender to promote positive masculinities and constructive partnerships to prevent HIV.

"Struggling with daily life and enduring pain": a qualitative study of the experiences of pregnant women living with pelvic girdle pain.

BACKGROUND: Few studies have investigated the experiences of living with pelvic girdle pain (PGP) and its impact on pregnant women's lives. To address this gap in knowledge, this study investigates the experiences of women living with PGP during pregnancy. METHODS: A purposive sample, of nine pregnant women with diagnosed PGP, were interviewed about their experiences. Interviews were recorded, transcribed to text and analysed using a Grounded Theory approach. RESULTS: The core category that evolved from the analysis of experiences of living with PGP in pregnancy was "struggling with daily life and enduring pain". Three properties addressing the actions caused by PGP were identified: i) grasping the incomprehensible; ii) balancing support and dependence and iii) managing the losses. These experiences expressed by the informants constitute a basis for the consequences of PGP: iv) enduring pain; v) being a burden; vi) calculating the risks and the experiences of the informants as vii) abdicating as a mother. Finally, the informants' experiences of the consequences regarding the current pregnancy and any potential future pregnancies is presented in viii) paying the price and reconsidering the future. A conceptual model of the actions and consequences experienced by the pregnant informants living with PGP is presented. CONCLUSIONS: PGP during pregnancy greatly affects the informant's experiences of her pregnancy, her roles in relationships, and her social context. For informants with young children, PGP negatively affects the role of being a mother, a situation that further strains the experience. As the constant pain disturbs most aspects of the lives of the informants, improvements in the treatment of PGP is of importance as to increase the quality of life. This pregnancy-related condition is prevalent and must be considered a major public health concern during pregnancy.

Interprofessional teamwork in Swedish pediatric cardiology: a national exploratory study.

This paper aims to describe the nature of pediatric cardiology teams (PCTs) based in Sweden through the use of a mixed methods approach. Questionnaires examining issues about the organization/ways of working, functions/tasks and attitudes were answered by 30 PCTs. Focus group interviews were conducted with six PCTs, selected purposefully by size and location, and information on experiences and attitudes on interprofessional teamwork was explored in depth. Results from the quantitative indicated that in 17 of the teams, where the nurse acted as the central coordinator, there was a positive attitude to the value of teamwork. In the interviews, different problems and needs of improvements were mentioned regarding structure, leadership, presence of physicians in the team as well as the team's mandate. All of the participants, however, agreed that interprofessional teams were required to manage the complexity of the children's care. In conclusion, this study suggests that PCTs need further support to develop structure, leadership and coordination of resources to function in a more effective manner. National plans or recommendations that mandate the organization and working methods of PCTs would be helpful for the ongoing development of PCTs in Sweden.

Phenomenographic study of basic science understanding-senior medical students' conceptions of fatigue.

INTRODUCTION: Helping students learn to apply their newly learned basic science knowledge to clinical situations is a long-standing challenge for medical educators. This study aims to describe how medical students' knowledge of the basic sciences is construed toward the end of their medical curriculum, focusing on how senior medical students explain the physiology of a given scenario. Methods A group of final-year medical students from two universities was investigated. Interviews were performed and phenomenographic analysis was used to interpret students' understanding of the physiology underlying the onset of fatigue in an individual on an exercise bicycle. RESULTS: Three categories of description depict the qualitatively different ways the students conceptualized fatigue. A first category depicts well integrated physiological and bio-chemical knowledge characterized by equilibrium and causality. The second category contains conceptions of finite amount of substrate and juxtaposition of physiological concepts that are not fully integrated. The third category exhibits a fragmented understanding of disparate sections of knowledge without integration of basic science and clinical knowledge. DISCUSSION: Distinctive conceptions of fatigue based with varying completeness of students' understanding characterized the three identified categories. The students' conceptions of fatigue were based on varying understanding of how organ systems relate and of the thresholds that determine physiological processes. Medical instruction should focus on making governing steps in biological processes clear and providing opportunity for causal explanations of clinical scenarios containing bio-chemical as well as clinical knowledge. This augments earlier findings by adding descriptions in terms of the subject matter studied about how basic science is applied by students in clinical settings.

Integrating virtual patients into courses: follow-up seminars and perceived benefit.

CONTEXT: The use of virtual patients (VPs) suggests promising effects on student learning. However, currently empirical data on how best to use VPs in practice are scarce. More knowledge is needed regarding aspects of integrating VPs into a course, of which student acceptance is one key issue. Several authors call for looking beyond technology to see VPs in relation to the course context. The follow-up seminar is proposed as an important aspect of integration that warrants investigation. METHODS: A cross-sectional explanatory study was performed in a clinical clerkship introduction course at four teaching hospitals affiliated to the same medical faculty. The VP-related activities were planned collaboratively by teachers from all four settings. However, each setting employed a different strategy to follow up the activity in the course. Sixteen questionnaire items were grouped into three scales pertaining to: perceived benefit of VPs; wish for more guidance on using VPs, and wish for assessment and feedback on VPs. Scale scores were compared across the four settings, which were ranked according to the level of intensity of students' processing of cases during VP follow-up activities. RESULTS: The perceived benefit of VPs and their usage were higher in the two intense-use settings compared with the moderate- and low-intensity settings. The wish for more guidance was high in the low- and one of the high-intensity settings. Students in all settings displayed little interest in more assessment and feedback regarding VPs. CONCLUSIONS: High case processing intensity was related to positive perceptions of the benefit of VPs. However, the low interest in more assessment and feedback on the use of VPs indicates the need to clearly communicate the added value of the follow-up seminar. The findings suggest that a more intense follow-up pays off in terms of the benefit perceived by students. This study illustrates the need to consider VPs from the perspective of a holistic course design and not as isolated add-ons.

Measuring the value of older people's production: a diary study.

BACKGROUND: The productive capacity of retired people is usually not valued. However, some retirees produce much more than we might expect. This diary-based study identifies the activities of older people, and suggests some value mechanisms. One question raised is whether it is possible to scale up this diary study into a larger representative study. METHODS: Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data. RESULTS: Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used. CONCLUSIONS: An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life.

How to think about interprofessional competence: a metacognitive model.

Different professions meet and work together in teams every day in health and social care. To identify and deliver the best quality of care for the patient, teamwork should be both professionally and interprofessionally competent. How can enhanced education prepare teamworkers to be both professionally and interprofessionally competent? To achieve interprofessional skills and design effective interprofessional curricula, there is a need for metacognitive frameworks focusing on the relationship between theories and the problem-solving process as well as the structure and content of professional competence. The aim of this article is to discuss the need for shared metacognitive structures/models as a tool for securing successful interprofessional learning and developing personal, professional and interprofessional competence to improve the quality of care. A metacognitive model for interprofessional education and practice is presented in this article. This model has been developed as a tool for analyzing professional competence on three levels: individual, team and organization. The model comprises seven basic components of professional competence and the way they are related and interact. Examples of how this metacognitive model can be used in the early, middle and late stages in interprofessional education are given.

Parents' expectations about participating in antenatal parenthood education classes.

Our objective was to assess parents' expectations about participating in antenatal parenthood education classes and to determine whether their expectations might be related to gender, age, and educational level. Data from 1,117 women and 1,019 partners residing in three cities in Sweden were collected with a questionnaire in a cross-sectional study. Participants believed that antenatal education classes would help them to feel more secure as parents and to be better oriented toward childbirth. Men had more positive expectations about the childbirth than the women. The participants mostly wanted help in preparing for parenthood and in learning infant care skills, followed by help in preparing for childbirth. The participants' expectations were affected by gender, age, and educational level. The expectant parents appeared to want more focus on preparation for parenthood than on childbirth.

What does it mean to be a mentor in medical education?

BACKGROUND: Mentor programmes are becoming increasingly common in undergraduate education. However, the meaning attached to being a mentor varies significantly. AIM: The aim of this study is to explore how teachers in medical and dental education understand their role as mentors. METHOD: Twenty mentors in two different mentor programmes for undergraduate medical and dental students were interviewed. The transcripts were analysed using a phenomenographic approach. RESULTS: The findings comprise three qualitatively different ways of understanding what it means to be a mentor, which are described as: (1) a mentor is someone who can answer questions and give advice, (2) a mentor is someone who shares what it means to be a doctor/dentist, and (3) a mentor is someone who listens and stimulates reflection. The way the mentors understood their role also affected what they did as mentors, their relationships with their mentees and their perceived benefits as mentors. CONCLUSIONS: Being a mentor can be perceived in qualitatively different ways also within the same mentor programme. This understanding affects the mentors' actions, their relationships with their mentees and their perceived benefits of being a mentor. Awareness of one's own understanding is important in improving practices and the findings of this study can be used by mentors, teachers and educational developers to facilitate improved effectiveness in mentor programmes, both for mentors and mentees.

Diet and lifestyle of the Sami of southern Lapland in the 1930s--1950s and today.

OBJECTIVES: To describe the lifestyle of the Sami of southern Lapland 50 to 70 years ago in relation to the present-day Sami and non-Sami populations and, thereby, to provide a basis for future studies of culturally related determinants of health and illness. STUDY DESIGN: A qualitative analysis, and a quantitative comparison of Sami and non-Sami groups. METHODS: Semi-structured interviews were conducted with 20 elderly Sami concerning their parents' lifestyle and diet 50 to 70 years ago. Questionnaire data from 81 reindeer-herding Sami, 226 non-reindeer-herding Sami and 1,842 sex-, age- and geographically matched non-Sami from the population-based Västerbotten Intervention Project were analysed by non-parametric tests and partial least squares methodology. RESULTS: Surprisingly, fatty fish may have been more important than reindeer meat for the Sami of southern Lapland in the 1930s to 1950s, and it is still consumed more frequently by reindeer-herding Sami than nonreindeer-herding Sami and non-Sami. Other dietary characteristics of the historical Sami and present-day reindeer-herding Sami were higher intakes of fat, blood and boiled coffee, and lower intakes of bread, fibre and cultivated vegetables, compared with present-day non-Sami. Physical activity was also a part of the daily life of the Sami to a greater extent in the 1930s to 1950s than today. Sami men often worked far from home, while the women were responsible for fishing, farming, gardening (which was introduced in the 1930-1950 period), as well as housework and childcare. CONCLUSIONS: For studies investigating characteristic lifestyle elements of specific ethnic groups, the elements of greatest acknowledged cultural importance today (in this case reindeer meat) may not be of the most objective importance traditionally.

Experiencing virtual patients in clinical learning: a phenomenological study.

Computerised virtual patients (VPs) are increasingly being used in medical education. With more use of this technology, there is a need to increase the knowledge of students' experiences with VPs. The aim of the study was to elicit the nature of virtual patients in a clinical setting, taking the students' experience as a point of departure. Thirty-one students used VPs as a mandatory part of an early clinical rotation in rheumatology. Using the qualitative approach of phenomenology, we interviewed these students and then analysed data regarding their experiences of VPs as a learning activity. The result shows that students perceived VP activities in relation to actual patients, the clinical context and other learning activities. The VPs represented typical clinical cases which encouraged clinical reasoning and allowed for decision making. The students experienced the activities as integrating biomedical knowledge and clinical experience, providing structure that prepared for the unstructured clinical environment and patient encounters under unstressful conditions. However, the VPs were experienced as lacking the emotional interactivity and complexity of actual patients. Theoretical frameworks of clinical reasoning and experiential learning are suggested as foundations for further educational integration of VPs in the clinical environment. VP activities during clinical rotations provide experiences of clinical reality and allow students to solve problems actively. These features are dependent on VP technology but are also contingent on the surrounding environment.

Are female students in general and nursing students more ready for teamwork and interprofessional collaboration in healthcare?

BACKGROUND: Interprofessional Education (IPE) is now spreading worldwide and many universities are now including IPE in their curricula. The aim of this study was to investigate whether or not such student characteristics as gender, previous working experience in healthcare, educational progress and features of the learning environment, such as educational programmes and curriculum design, have an impact on their open-mindedness about co-operation with other professions. METHODS: Medical and nursing students at two Swedish universities were invited to fill in the Readiness for Interprofessional Learning Scale (RIPLS). Totally, 955 students were invited and 70.2% (n=670) participated in the study. A factor analysis of the RIPLS revealed four item groupings (factors) for our empirical data, but only one had sufficient internal consistency. This factor was labelled "Team Player". RESULTS: Regardless of the educational programme, female students were more positive to teamwork than male students. Nursing students in general displayed more positive beliefs about teamwork and collaboration than medical students. Exposure to different interprofessional curricula and previous exposure to interprofessional education were only to a minor extent associated with a positive attitude towards teamwork. Educational progress did not seem to influence these beliefs. CONCLUSIONS: The establishment of interprofessional teamwork is a major challenge for modern healthcare. This study indicates some directions for more successful interprofessional education. Efforts should be directed at informing particularly male medical students about the need for teamwork in modern healthcare systems. The results also imply that study of other factors, such as the student's personality, is needed for fully understanding readiness for teamwork and interprofessional collaboration in healthcare. We also believe that the RIPL Scale still can be further adjusted.

Breaking bad news: an interview study of paediatric cardiologists.

UNLABELLED: Technical developments in paediatric cardiology over the last few decades have increased expectations on professionals, demanding of them more emotional competence and communicative ability. The aim of this study was to examine the approach of paediatric cardiologists in informing and communicating with the family of the patient. METHOD: A qualitative interview method was first tested in a pilot study with two paediatric cardiologists. There were nine subsequent semi-structured interviews that were carried out with paediatric cardiologists. A researcher performed all the interviews, which were taped, transcribed, decoded, and analysed. RESULTS: Among paediatric cardiologists, how to break bad news to the family is an important concern, evident in findings regarding the significance of trust and confidence, the use of different emotional positions, and a common ambition to achieve skills to handle the situation. There is a need for reflection, education, and sharing of experiences. The cardiologists desire further development of teamwork and of skills in medical students and residents for delivering bad news. CONCLUSIONS: Doctors are expected to cope with the complexities of diagnoses and decisions, while simultaneously being sensitive to the feelings of the parents, aware of their own emotions, and able to keep it all under control in the context of breaking the bad news to the parents and keeping them informed. These conflicting demands create a need to expand the professional role of the doctor by including more training in emotional competence and communicative ability, beginning in medical school and continuing through consultancy.

Experiences of working with induced abortion: focus group discussions with gynaecologists and midwives/nurses.

BACKGROUND: While there exists an extensive amount of research regarding the medical aspects of abortion, there is a great lack of studies investigating staff's views and experiences of working in abortion services. AIMS: To elucidate gynaecologists' and midwives'/nurses' experiences, perceptions and interactions working in abortion services, their experiences of medical abortions and abortions performed at the woman's home. An additional aim was to illustrate gynaecologists', midwives' and nurses' visions of their future professional roles within the abortion services. METHOD: Three focus group discussions within each profession were carried out in 1-hour sessions with a total of 25 gynaecologists and 15 midwives/nurses from three different hospitals. RESULTS: The content analysis reflected that gynaecologists and midwives/nurses had no doubts about participating in abortions despite the fact that they had experienced complex and difficult situations, such as repeat and late-term abortions. They experienced their work as paradoxical and frustrating but also as challenging and rewarding. However, they were rarely offered ongoing guidance and continuously professional development education. For gynaecologists, as well as midwives/nurses, their experiences and perceptions were strongly linked to the concurrent development of abortion methods. The interaction between the professions was found to be based on great trust in each other's skills. CONCLUSIONS: In order to promote women's health, gynaecologists' and midwives'/nurses' need for a forum for reflection and ongoing guidance should be acted on. With a higher number of abortions done medically and a higher proportion of home abortions, midwives/nurses will get increased, responsibilities in the abortion services in the future.

What does it mean to be a good teacher and clinical supervisor in medical education?

The aim of this study was to describe the different ways medical teachers understand what constitutes a good teacher and a good clinical supervisor and what similarities and differences they report between them. Data was gathered through interviews with 39 undergraduate teachers at a medical university. The transcripts were analysed using a phenomenographic approach. Three categories regarding what it means to be a good teacher and clinical supervisor respectively were identified. Similarities between the two hierarchies were seen with the most inclusive categories of understanding what it means to be a good teacher or supervisor focuses on students' learning or growth. In the third category a good teacher and supervisor is seen as someone who conveys knowledge or shows how things are done. However, the role of being a clinical supervisor was perceived as containing a clearer focus on professional development and role modelling than the teacher role did. This is shown in the middle category where a good clinical supervisor is understood as a role model and someone who shares what it is like to be a doctor. The middle category of understanding what it means to be a good teacher instead focussing on the teacher as someone who responds to students' content requests in a partially student-centred perspective. In comparing the ways individual respondents understood the two roles, this study also implies that teachers appear to compartmentalise their roles as teachers and clinical supervisors respectively.

Trust and ambivalence in midwives' views towards women developing pelvic pain during pregnancy: a qualitative study.

BACKGROUND: The Swedish midwife plays a significant role in the antenatal care (ANC) system, and a majority of pregnant women are satisfied with their ANC. Pelvic pain during pregnancy (PP) is prevalent. The study investigated the views, perceptions and attitudes of midwives currently working in ANC regarding PP during pregnancy. METHODS: The informants were ten midwives between the ages of 35 to 64 years, with a combined experience of 250 years of midwifery. In-depth interviews (n = 4) and one focus group discussion (n = 6) were conducted. The data were interpreted using a qualitative content analysis design. RESULTS: PP was considered a common, clinical problem that had most likely increased in prevalence in recent decades and could feature prominently in a woman's experience of pregnancy. The informants had developed a strategy for supporting pregnant women affected by PP. The pregnant woman's fear of not being believed concerning her symptoms and the risk of being regarded as a malingerer were acknowledged. Mistrust between a midwife and a woman might occur when the patient's symptoms were vague and ill defined. PP was not considered as something that complicated delivery, and women experiencing it were advised to await 'the natural course of the pregnancy'. CONCLUSIONS: PP was considered a common, clinical problem and the informants had developed a strategy for supporting pregnant women affected by PP. However, the woman's fear of not being believed concerning her symptoms of PP was acknowledged and mistrust might occur between a midwife and a woman if vague symptoms were reported.

Interprofessional learning as a means of enhancing professional competence.

This paper explores some core features of interprofessional learning (IPL) and provides an example from the Swedish context. At Linköping university IPL was made an integral part of the problem based learning (PBL) programs that were implemented in 1986 at the Faculty of health sciences. A description of how the IPL strand is designed and some conclusions from evaluation studies are as well provided.

Being a mentor for undergraduate medical students enhances personal and professional development.

BACKGROUND: There is increasing evidence of the positive effects of mentoring in medical undergraduate programmes, but as far as we know, no studies on the effects for the mentors have yet been described in the field of medicine. AIM: This study aims to evaluate an undergraduate mentor programme from the mentors' perspective, focusing particularly on the effect of mentorship, the relationships between mentoring and teaching and the mentors' perceived professional and personal development. METHODS: Data was gathered through a questionnaire to all 83 mentors (response rate 75%) and semi-structured interviews with a representative sample of 10 mentors. RESULTS: Findings show, for example, that a majority of respondents developed their teaching as a result of their mentorship and improved their relations with students. Most respondents also claimed that being a mentor led to an increased interest in teaching and increased reflections regarding their own values and work practices. CONCLUSION: Being a mentor was perceived as rewarding and may lead to both personal and professional development.

A systematic approach to isolate mono-disperse membrane proteins - purification of zinc transporter ZntB.

Obtaining mono-disperse and stable protein is a requirement for successful structural and biochemical investigation of proteins. For membrane proteins, such preparation is one of the major hurdles, which consequently has contributed to the slow progress in studying them. During the past few years, many screening methods have been developed to make studies of membrane proteins more efficient. Despite these advances, many membrane proteins remain challenging to even isolate in a stable and homogeneous form. The bacterial zinc transporter ZntB is such a protein, for which no isolation procedure has been reported. Here, we present a systematic approach to obtain homogeneous and mono-disperse zinc transporter ZntB in quantities sufficient for structural and biochemical studies. Important aspects of this study that can be applied to other membrane proteins are also discussed.

"Keeping up a front": narratives about intimate partner violence, pregnancy, and antenatal care.

Nine women who had been subjected to severe intimate partner violence during pregnancy narrated their ambiguous and contradictory feelings and the various balancing strategies they used to overcome their complex and difficult situations. Because allowing anyone to come close posed a threat, the women mostly denied the situation and kept up a front to hide the violence from others. Three women disclosed ongoing violence to the midwives, but only one said such disclosure was helpful. This article highlights the complexity of being pregnant when living with an abusive partner and challenges antenatal care policies from the perspective of pregnant women.