Patients' experiences of living with superior canal dehiscence syndrome.

OBJECTIVE: The study investigated how the symptoms of superior canal dehiscence syndrome (SCDS) affected patients in their daily life, and how patients coped with the disease. DESIGN: This was a qualitative study; semi-structured interviews were performed and analysed according to the systematic text condensation method. STUDY SAMPLE: Twelve of 13 identified patients with SCDS in the county of Norrbotten, Sweden, were included in the study. RESULTS: Five main categories were created based on the patients' experiences of living with SCDS: (1) Experiencing strange symptoms: One "new" symptom was identified - mental fatigue. (2) A restricted life socially, physically and at work: All patients experienced some extent of limitation in their daily life. (3) To accept and to protect oneself: All patients had developed strategies to protect their ears from noise. (4) Misunderstood in health care: The diagnosis was sometimes delayed several years due to lack of knowledge among healthcare workers. (5) Carefully considering treatment (surgery): Symptoms were weighed against the risk of side effects. CONCLUSIONS: SCDS was rendered an invisible disability. In the present study, we identified mental fatigue as a symptom not previously considered in the literature.

Time trends of comparative self-rated health in adults aged 25-34 in the Northern Sweden MONICA study, 1990-2014.

Self-rated health (SRH) accounts comprehensively for many health domains. The aim of this paper was to investigate time trends and associations between age-comparative self-rated health and some known determinants in a general population aged 24-34 years. Population-based cross-sectional surveys were performed in 1990, 1994, 1999, 2004, 2009 and 2014 in Northern Sweden. Out of 3500 invited persons, 1811 responded. Comparative SRH was measured on a three-grade ordinal scale by the question: "How would you assess your general health condition compared to persons of your own age?" with the alternatives "better/worse/similar". Over the period 1990 to 2014, the percentage of women rating comparative SRH as "worse" increased steadily, from 8.5% in 1990 reaching 20% in 2014 (p for trend 0.007). Among men, this pattern was almost the opposite, with increasing proportions rating "better" (p for trend <0.000). Time trends for physical activity in leisure time; length of education; Body Mass Index; anxiety; depressive emotions and satisfaction with economy showed a similar pattern for men and women. Factors that might contribute to the development of time trends for comparative SRH are discussed.

Experiences and explanations of mental ill health in a group of devout Christians from the ethnic majority population in secular Sweden: a qualitative study.

OBJECTIVE: To explore existential meaning-making in an ethnic-majority subgroup with mental ill health and to increase knowledge about the importance of gaining access to such information in mental healthcare. DESIGN: Qualitative study using in-depth interviews and systematic text condensation analysis. PARTICIPANTS: 17 devote Christians with an ethnic-Swedish background, 12 women and 5 men, 30-73 years old, from different congregations across Sweden, having sought medical care for mental ill health of any kind. SETTING: The secular Swedish society. RESULTS: A living, although asymmetric, relationship with God often was seen as the most important relationship, giving hope and support when ill, but creating feelings of abandonment and fear if perceived as threatened. Symptoms were interpreted through an existential framework influenced by their view of God. A perceived judging God increased feelings of guilt, sinfulness and shame. A perceived merciful God soothed symptoms and promoted recovery. Existential consequences, such as being unable to pray or participate in congregational rituals, caused feelings of 'spiritual homelessness'. Participants gave biopsychosocial explanations of their mental ill health, consonant with and sometimes painfully conflicting with existential explanations, such as being attacked by demons. Three different patterns of interaction among biopsychosocial and existential dimensions in their explanatory systems of illness causation were identified: (a) comprehensive thinking and consensus; (b) division and parallel functions and (c) division and competitive functions. CONCLUSIONS: Prevailing medical models for understanding mental ill health do not include the individual's existential experiences, which are important for identifying risk and protective factors as well as possible resources for recovery. The various expressions of existential meaning-making identified in this devout religious subgroup illustrate that existential information cannot be generalised, even within a small, seemingly homogenous group. The three identified patterns of interactions formed a typology that may be of use in clinical settings.

Human Puumala hantavirus infection in northern Sweden; increased seroprevalence and association to risk and health factors.

BACKGROUND: The rodent borne Puumala hantavirus (PUUV) causes haemorrhagic fever with renal syndrome in central and northern Europe. The number of cases has increased and northern Sweden has experienced large outbreaks in 1998 and 2006-2007 which raised questions regarding the level of immunity in the human population. METHODS: A randomly selected population aged between 25 and 74 years from northern Sweden were invited during 2009 to participate in a WHO project for monitoring of trends and determinants in cardiovascular disease. Health and risk factors were evaluated and sera from 1,600 participants were available for analysis for specific PUUV IgG antibodies using a recombinant PUUV nucleocapsid protein ELISA. RESULTS: The overall seroprevalence in the investigated population was 13.4 %, which is a 50 % increase compared to a similar study only two decades previously. The prevalence of PUUV IgG increased with age, and among 65-75 years it was 22 %. More men (15.3 %) than women (11.4 %) were seropositive (p < 0.05). The identified risk factors were smoking (OR = 1.67), living in rural areas (OR = 1.92), and owning farmland or forest (OR = 2.44). No associations were found between previous PUUV exposure and chronic lung disease, diabetes, hypertension, renal dysfunction, stroke or myocardial infarction. CONCLUSIONS: PUUV is a common infection in northern Sweden and there is a high life time risk to acquire PUUV infection in endemic areas. Certain risk factors as living in rural areas and smoking were identified. Groups with increased risk should be targeted for future vaccination when available, and should also be informed about appropriate protection from rodent secreta.

What does age-comparative self-rated health measure? A cross-sectional study from the Northern Sweden MONICA Project.

AIMS: Self-rated health comprehensively accounts for many health domains. Using self-ratings and a knowledge of associations with health domains might help personnel in the health care sector to understand reports of ill health. The aim of this paper was to investigate associations between age-comparative self-rated health and disease, risk factors, emotions and psychosocial factors in a general population. METHODS: We based our study on population-based cross-sectional surveys performed in 1999, 2004 and 2009 in northern Sweden. Participants were 25-74 years of age and 5314 of the 7500 people invited completed the survey. Comparative self-rated health was measured on a three-grade ordinal scale by the question 'How would you assess your general health condition compared to persons of your own age?' with the alternatives 'better', 'worse' or 'similar'. The independent variables were sex, age, blood pressure, cholesterol, body mass index, self-reported myocardial infarction, stroke, diabetes, physical activity, smoking, risk of unemployment, satisfaction with economic situation, anxiety and depressive emotions, education and Karasek scale of working conditions. Odds ratios using ordinal regression were calculated. RESULTS: Age, sex, stroke, myocardial infarction, diabetes, body mass index, physical activity, economic satisfaction, anxiety and depressive emotions were associated with comparative self-rated health. The risk of unemployment, a tense work situation and educational level were also associated with comparative self-rated health, although they were considerably weaker when adjusted for the the other variables. Anxiety, depressive emotions, low economic satisfaction and a tense work situation were common in the population. CONCLUSIONS: Emotions and economic satisfaction were associated with comparative self-rated health as well as some medical variables. Utilization of the knowledge of these associations in health care should be further investigated.

GPs asking patients to self-rate their health: a qualitative study.

BACKGROUND: In epidemiological research, self-rated health is an independent predictor of mortality, cardiovascular diseases, and other critical outcomes. It is recommended for clinical use, but research is lacking. AIM: To investigate what happens in consultations when the question 'How would you assess your general health compared with others your own age?' is posed. DESIGN AND SETTING: Authentic consultations with GPs at health centres in Sweden. METHOD: Thirty-three planned visits concerning diabetes, pain, or undiagnosed symptoms were voice-recorded. Dialogue regarding self-rated health was transcribed verbatim and analysed using a systematic text condensation method. Speaking time of patients and doctors was measured and the doctors' assessment of the value of the question was documented in a short questionnaire. RESULTS: Two overarching themes are used to describe patients' responses to the question. First, there was an immediate reaction, often expressing strong emotions, setting the tone of the dialogue and influencing the continued conversation. This was followed by reflection regarding their functional ability, management of illnesses and risks, and/or situation in life. The GPs maintained an attitude of active listening. They sometimes reported a slight increase in consultation time or feeling disturbed by the question, but mostly judged it as valuable, shedding additional light on the patients' situation and making it easier to discuss difficulties and resources. The patients' speaking time increased noticeably during this part of the consultation. CONCLUSION: Asking patients to comparatively self-rate their health is an effective tool in general practice.

Self-rated health and standard risk factors for myocardial infarction: a cohort study.

OBJECTIVE: To investigate the relationship between self-rated health, adjusted for standard risk factors, and myocardial infarction. DESIGN: Population-based prospective cohort study. SETTING: Enrolment took place between 1990 and 2004 in Västerbotten County, Sweden PARTICIPANTS: Every year, persons in the total population, aged 40, 50 or 60 were invited. Participation rate was 60%. The cohort consisted of 75 386 men and women. After exclusion for stroke or myocardial infarction before, or within 12 months after enrolment or death within 12 months after enrolment, 72 530 persons remained for analysis. Mean follow-up time was 13.2 years. OUTCOME MEASURES: Cox regression analysis was used to estimate HRs for the end point of first non-fatal or fatal myocardial infarction. HR were adjusted for age, sex, systolic blood pressure, total cholesterol, smoking, diabetes, body mass index, education, physical activity and self-rated health in the categories very good; pretty good; somewhat good; pretty poor or poor. RESULTS: In the cohort, 2062 persons were diagnosed with fatal or non-fatal myocardial infarction. Poor self-rated health adjusted for sex and age was associated with the outcome with HR 2.03 (95% CI 1.45 to 2.84). All categories of self-rated health worse than very good were statistically significant and showed a dose-response relationship. In a multivariable analysis with standard risk factors (not including physical activity and education) HR was attenuated to 1.61 (95% CI 1.13 to 2.31) for poor self-rated health. All categories of self-rated health remained statistically significant. We found no interaction between self-rated health and standard risk factors except for poor self-rated health and diabetes. CONCLUSIONS: This study supports the use of self-rated health as a standard risk factor among others for myocardial infarction. It remains to demonstrate whether self-rated health adds predictive value for myocardial infarction in combined algorithms with standard risk factors.

A cross-sectional and semantic investigation of self-rated health in the northern Sweden MONICA-study.

BACKGROUND: Self-Rated Health (SRH) correlates with risk of illness and death. But how are different questions of SRH to be interpreted? Does it matter whether one asks: "How would you assess your general state of health?"(General SRH) or "How would you assess your general state of health compared to persons of your own age?"(Comparative SRH)? Does the context in a questionnaire affect the answers? The aim of this paper is to examine the meaning of two questions on self-rated health, the statistical distribution of the answers, and whether the context of the question in a questionnaire affects the answers. METHODS: Statistical and semantic methodologies were used to analyse the answers of two different SRH questions in a cross-sectional survey, the MONICA-project of northern Sweden. RESULTS: The answers from 3504 persons were analysed. The statistical distributions of answers differed. The most common answer to the General SRH was "good", while the most common answer to the Comparative SRH was "similar". The semantic analysis showed that what is assessed in SRH is not health in a medical and lexical sense but fields of association connected to health, for example health behaviour, functional ability, youth, looks, way of life. The meaning and function of the two questions differ - mainly due to the comparing reference in Comparative SRH. The context in the questionnaire may have affected the statistics. CONCLUSIONS: Health is primarily assessed in terms of its sense-relations (associations) and Comparative SRH and General SRH contain different information on SRH. Comparative SRH is semantically more distinct. The context of the questions in a questionnaire may affect the way self-rated health questions are answered. Comparative SRH should not be eliminated from use in questionnaires. Its usefulness in clinical encounters should be investigated.

Lifelong significance of disempowering experiences in prenatal and maternity care: interviews with elderly Swedish women.

In this article I show how the effects of harsh and humiliating treatment, experienced by a number of Swedish women in antenatal care and childbirth in the mid-20th Century, endured for the rest of their lives. This treatment was carried out by medical staff in conformity with a view of expectant mothers as irresponsible and ignorant and with the prevalent idea of "natural birth." These effects were findings in an interview investigation that, with a colleague, I conducted into paid and unpaid work and health of 20 women, seen in a lifetime perspective. Our biomedical way of understanding risks and complications during pregnancy and birthing was confronted with many participants' feelings of distress, guilt, and grief linked to their childbearing experience. I interpret the treatments as "violations of dignity" and as abuse. The consequences are similar to those following traumatic birth experiences described in today's literature.

Pharyngeal Chlamydia trachomatis is not uncommon any more.

BACKGROUND: The significance of Chlamydia trachomatis (Ct) infection in the pharynx, and possible symptoms, are under discussion. Most studies have involved only homo/bisexual men. We report findings of pharyngeal Ct (PhCt) infections in patients with long-lasting throat discomfort and the prevalence of PhCt in genitally Ct-infected young people in a Swedish primary care setting. METHOD: Sub-study 1 (SS1) included 48 persons aged 15-35 y, with pharyngeal discomfort for more than 14 days. Sub-study 2 (SS2) included 150 persons, aged 15-35 y, with genital Ct. Questionnaires concerning symptoms, sexual behaviour and sexual identity were completed for both groups. Samples for Ct testing were taken from the pharynx, and in SS1, samples were also collected to ascertain genital Ct. RESULTS: In SS1, 2 of 48 persons (4%) with pharyngeal discomfort had PhCt. In all, 35 of the 48 persons (73%) included in SS1 reported unprotected oral sex during the previous year. In SS2, 11 of 92 women (12%) and 4 of 58 men (7%) tested positive for PhCt. More women (94%) than men (83%) had given unprotected oral sex. Persons with PhCt had more symptoms from the upper respiratory tract (p = 0.04). CONCLUSIONS: Some primary care patients with long-lasting throat discomfort have a PhCt infection. PhCt infection is not uncommon in genitally infected sexually active people. More heterosexual women than heterosexual men had given unprotected oral sex and were infected by Ct in the pharynx. Thus, research on PhCt should not focus on homo/bisexual men only. Information about Ct should include the risk of contracting a PhCt infection as well as a gender perspective.

Rethinking scientific responsibility.

Researchers should be made co-responsible for the wider consequences of their research focus and the application of their findings. This paper describes a meta-reflection procedure that can be used as a tool to enhance scientific responsibility and reflective practice. The point of departure is that scientific practice is situated in power relations, has direction and, consequently, power implications. The contextual preconditions and implications of research should be stated and discussed openly. The reflection method aims at revealing both upstream elements, such as for instance preconceptions, and downstream elements, for example, public consequences of research. The validity of research might improve from such discussions. Validity should preferably be understood as a broader concept than the methodological concerns in science.

"You really do something useful with kids": mothering and experienced health and illness in a group of elderly Swedish women.

This article is based on in-dept interviews with 20 elderly Swedish women, and deals with mother's child-caring work and related health and illness. Mothering included invisible work as well as physically heavy tasks, both aspects often neglected in research. The attitude of the children's father had a great impact on the work. Feelings of success or failure at bringing up their children affected the women's experience of health/ill health throughout their lives. Their health as elderly women depended on the health and happiness of their, now adult, children.

Health-promoting aspects of a paid job: findings in a qualitative interview study with elderly women in Sweden.

This article is one aspect of a larger, qualitative interview study and deals with health-promoting aspects of gainful employment, as experienced by a group of elderly Swedish women. Through these interviews we demonstrate the central importance of outside employment for many of the women, although they belonged to a generation where outside work conflicted with societal norms. We will illustrate a wide variety of ways in which gainful employment can contribute to women's well-being and, ultimately, their health.

Humour, beauty, and culture as personal health resources: experiences of elderly Swedish women.

AIM: This paper explores how a group of elderly women used humour, beauty, and cultural activities to maintain physical and mental well-being. METHODS: The paper reports on one aspect of a qualitative study on women's work and health in a lifetime perspective. Interviews with 20 strategically selected Swedish women, aged 63 to 83 years, were audiotaped and analysed according to a phenomenological approach. RESULTS: During the interview process, the researchers became increasingly aware that the women had clear ideas about what enabled them to feel well and healthy - even when actually quite diseased. Creating and enjoying humour, beauty, and culture formed part of such strategies. Joking with workmates made hard, low-status jobs easier, helped them endure pain, and helped balance marital difficulties. Creating a nice and comfortable home gave pleasure and a little luxury in a life filled with necessities. Making articles for everyday use more beautiful was regarded as worthwhile, because it gave delight to them and their families. Gains from cultural activities were social, aesthetic, and existential - the latter through a feeling of self-recognition and being heard. CONCLUSIONS: Humour, beauty, and culture formed a greater part of these women's survival strategies than expected. Making everyday life more aesthetic is an undervalued aspect of women's health-creating work in the family. Through their lifelong experience as carers and homemakers, elderly women possess special knowledge regarding what may promote health, a knowledge that should be tapped. When supplying elderly women with social care, their needs for humour, beauty, and culture should be respected.

"It's heavenly to be alone!": a room of one's own as a health-promoting resource for women. Results from a qualitative study.

AIM: This paper describes strategies developed by women to handle lack of time for themselves, and lack of freedom, in private life. METHODS: The paper reports on one self-assessed health resource identified in a larger qualitative study on women's paid and unpaid work and health/sickness. Twenty strategically selected women were interviewed, elderly women being chosen to obtain a lifetime perspective. The interviews were audio-taped and analysed according to a phenomenological approach. RESULTS: Expectations had been placed on the interviewees as women: to give care, always to be available for other family members, to adjust to their husbands. Many of them recalled seeking privacy ("a room of one's own") to avoid constant demands and interruptions, and as a refuge from partner domination. This was a conscious health-promoting strategy on their part. A room of one's own did not necessarily mean a physical room, but the right to -- and the possibility of -- a life of one's own. Forms of privacy included gainful employment, a separate bedroom, own social engagements. CONCLUSIONS: Family life still demands more from women than from men, putting many women under constant time pressure and without time for themselves. In heterosexual relationships, women frequently feel controlled. Prevailing norms for married women and mothers, causing blame and feelings of guilt, remain obstacles to women wanting "a room of their own". The health resource of having such a room, and strategies for creating one, should be given attention in medical research and practice -- not least in primary care.

Compulsive sensitivity--a consequence of caring: a qualitative investigation into women carer's difficulties in limiting their labours.

Women are expected to care, both in public and private life, for the sick as well as the healthy. Some women have difficulties in limiting their caring, despite being deeply careworn. In this life-course study, based on in-depth interviews with elderly women in Sweden, the concept "compulsive sensitivity" presents a way toward understanding their difficulties. Compulsive sensitivity denotes the compulsion to see and respond to other people's needs, whatever one's own situation.