An inquiry into Kjølstad's self-straightening orthopedics in 19th century Norway - One historical root of physiotherapy.

Enhancing and facilitating change or optimization of body awareness and movement behaviors have been sustained throughout history as central objectives in physiotherapy. Focus will be on the thoughts and practice of orthopedist Gunder Nielsen Kjølstad (1794-1860). He is, in a Norwegian context, one of the forefathers of physiotherapy. Kjølstad was unique for his time in the sense that he did not limit himself to medicine, but drew on vast array of disciplines, among them philosophy, geometry, physics, and dance. Fundamental to his treatment method was a pedagogy that rested on the active participation of the patient; an approach that stood in stark contrast to the established clinical practices. Through this approach, he developed a treatment for 'crooked backs' which constituted a historic break with the common treatment regimens of the nineteenth century.

Negotiating the social and medical dangers of abortion in Addis Ababa: An exploration of young, unmarried women's abortion-seeking journeys.

Unmarried, young women constitute a significant proportion of women who undergo unsafe abortion in Ethiopia. Based on material from an ethnographic study, the experiences of young, unmarried women who had been admitted to the hospital in the aftermath of an unsafe, clandestine abortion are explored in this article. The routes the young women followed in their search of abortion services and the concerns and realities they had to negotiate and navigate are at the fore. Despite their awareness of the dangers involved in clandestine and illegal abortion, the young women felt they had no choice but to use medically unsafe abortion services. Two reasons for this are highlighted: such services were affordable and, significantly, they were considered socially safe in that the abortion remained unknown to others and the stigma of abortion and its consequences could hence be avoided. In situations in which choices had to be made, social safety trumped medical safety. This indicates a need for abortion services that address both the medical and social safety concerns of young women in need of such services.

The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment.

BACKGROUND: Opioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. This article aims to generate nuanced knowledge about violent crime among a group of imprisoned, OMT-enrolled individuals by exploring their understandings of the role of substances in violent crime prior to and during OMT, moral values related to violent crime, and post-crime processing of their moral transgressions. METHODS: Twenty-eight semi-structured interviews were undertaken among 12 OMT-enrolled prisoners. The interviews were audio recorded and transcribed verbatim. An exploratory, thematic analysis was carried out with a reflexive and interactive approach. FINDINGS: Prior to OMT, substances and, in particular, high-dose benzodiazepines were deliberately used to induce 'antisocial selves' capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Yet, to conduct a (violent) criminal act does not necessarily imply that one is without moral principles. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes. CONCLUSIONS: Substances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes. Being simultaneously enrolled in OMT and imprisoned for a (violent) crime might evoke feelings of 'double' shame and guilt for both the criminal behavior prior to treatment and the actual case(s) one is imprisoned for while in OMT. Treatment providers should identify individuals with histories of violent behavior and, together with them, explore concrete episodes of violence and their emotional reactions. Particular attention should be given to potential relationships between substance use and violence and treatment approaches tailored accordingly. What appears as severe antisocial personality disorder may be partly explained by substance use.

Same-sex practicing men in Tanzania from 1860 to 2010.

This article offers a review of published texts describing sexual relations between men in Tanzania in the period 1860-2010. It explores ways in which men who have sex with men have been named and understood; describes the sexual and social roles associated with differing same-sex identities and subjectivities; tracks politics, policies, and sociocultural expressions relating to sex between men; and explores the ways in which men's same-sex sexual practices have been responded to in the context of health and HIV. Among the impressions emerging from the historical record is that sex between men is not (and has not been) uncommon in Tanzania; that a significant conceptual distinction exists between men who are anally receptive and men who penetrate anally; and that there has been a range of views on, and opinions about, same-sex relations within the wider society. There is evidence that same-sex practicing men in Tanzania have been affected by HIV at least since 1982, with one seroprevalence study indicating that the burden of HIV among men who have sex with men was quite disproportionate as far back as 2007. However, while men who have sex with men have been defined as a "vulnerable population" with respect to HIV in national frameworks since 2003, this had not led to any significant amount of targeted HIV prevention work being reported by either local or international actors by 2010.

Execution of control among 'non-compliant', imprisoned individuals in opioid maintenance treatment.

Strict control routines of prescribed opiate intake in opioid maintenance treatment, OMT, are used to reduce the risk of diversion and non-prescribed methadone and buprenorphine use. While maintaining a focus on aspects of control, this article explores motivations for and practices of methadone and buprenorphine use, both inside and outside of prison and among imprisoned individuals in OMT. The participants in this qualitative study were subjected to tight external control regimes in their opioid maintenance schemes in prison, as they were prior to imprisonment due to varying degrees of 'non-compliance'. We nevertheless found them to exhibit a considerable amount of self-control, self-regulation and/or self-initiation of external control. Among the participants, a ceaseless surveillance of processes associated with methadone and buprenorphine use throughout diverse situations, relations and contexts was encountered. We conclude that, in opioid maintenance treatment, some individuals might know what particular configurations of internal and external control they need in order to achieve their own treatment goals. The drug users' capacities for execution of control, as well as their delegations of control to others, may be seen as resources throughout the course of treatment.

Gays, guys, and mchicha mwiba: same-sex relations and subjectivities in Dar es Salaam.

Drawing on 15 months of fieldwork, this article explores ways in which same-sex relations are perceived and performed in Dar es Salaam, Tanzania. While several different constructions of same-sex sexuality coexist in Dar es Salaam, it is common to conceive of same-sex practicing men as falling into two main categories. Men belonging to each of these differ with respect to the corporeal, gendered, and social positions that are open to them, and typically form dyads across the conceptual boundary of difference that runs between them. The article speaks to the importance of examining sexuality and gender in particular sociocultural settings.

'Diversion' of methadone or buprenorphine: 'harm' versus 'helping'.

BACKGROUND: 'Non-compliant' individuals in opioid maintenance treatment, OMT, are often met with tight control regimes to reduce the risk of 'diversion', which may lead to harm or death among persons outside of OMT. This article explores reported practices of, and motivations for, diversion of methadone and buprenorphine, in a group of imprisoned individuals in OMT. FINDINGS: 28 in-depths interviews were conducted among 12 OMT-enrolled, imprisoned individuals, most of whom were remand prisoners. All had experienced tight control regimes prior to imprisonment due to varying degrees of 'non-compliance' and illicit drug use during treatment. Their acquired norm of sharing with others in a drug using community was maintained when entering OMT. Giving one's prescription opioids to an individual in withdrawal was indeed seen as an act of helping, something that takes on particular significance for couples in which only one partner is included in OMT and the other is using illicit heroin. Individuals enrolled in OMT might thus be trapped between practicing norms of helping and sharing and adhering to treatment regulations. 'Diversion', as this term is conventionally used, is not typically understood as practices of giving and helping, but may nevertheless be perceived as such by those who undertake them. CONCLUSIONS: As we see it, the need to sustain oneself as a decent person in one's own eyes and those of others through practices such as sharing and helping should be recognized. Treatment providers should consider including couples in which both individuals are motivated for starting OMT.

Seeking balance between the past and the present: Vietnamese refugee parenting practices and adolescent well-being.

This qualitative study examines the resources that Vietnamese refugee parents use in raising their adolescent youth in exile and how they, and their adolescents, regard their experiences of different parenting styles. The study is based on 55 semi-structured interviews and several focus groups performed with a small sample of Vietnamese refugee parents and their adolescent children. Three main themes from the interviews were identified: the role of the extended family and siblings in bringing up children; language acquisition and cultural continuity and, finally, religion and social support. Our findings suggest extended kin are involved in the raising of adolescent children, providing additional family ties and support. Parents regarded Vietnamese language acquisition by their youth as facilitating both communication with extended kin and cultural transmission. Several parents stressed the importance of religious community to socialising and creating a sense of belonging for their youth. Vietnamese refugee parents seek a balance between Vietnamese values and their close extended family social networks, and the opportunities in Norway to develop autonomy in pursuit of educational and economic goals. Together these parenting practices constituted a mobilization of resources in support of their youth. These findings may have important implications for future research on resiliency and the role of these strategies as protective factors mediating mental health outcomes. They may also have implications for treatment, in terms of the types of resources treatment can access and for prevention strategies that maximize key cultural resources for Vietnamese refugee youth.

The tale of the hearts: deciding on abortion in Ethiopia.

In contemporary Ethiopia, abortion decision-making is a challenging process involving moral and/or religious dilemmas, as well as considerations of health and safety. Amidst widespread condemnation of female premarital sex and clear moral sanction against induced abortion, young Ethiopian women are nevertheless sexually active and induced abortions are still sought and performed, with the potential for grave physical harm and social stigmatization. This paper examines young unmarried Ethiopian women's narratives of abortion decision-making. In particular, it identifies and explores the operations of a particular discursive shape from within in such narratives, here described as The tale of the hearts. Analysing The tale of the hearts as a decision-making resource, it is argued, allows us to explore the particular, local, historical and cultural character of Ethiopian women's abortion decision-making dilemmas and the culturally available resources contributing to their resolution.

Not at all so hard-to-reach: same-sex attracted men in Dar es Salaam.

Based on research in Tanzania, this paper critically examines the widely circulating notion that African same-sex attracted men are hard-to-reach individuals and populations. Despite expectations to the contrary, it was neither time consuming nor difficult to identify and get to know same-sex attracted men in Dar es Salaam. On the contrary, a large and diverse group of such men could readily be encountered, befriended and involved in HIV-related research. The fieldwork was characterised by communicative openness and the researcher was treated with immense kindliness, hospitality and inclusivity. While we may not be in a position to say that the situation is identical everywhere else, we find reason to caution against accepting and propagating unexplained, unexamined and unverified claims to the effect that same-sex attracted men in Africa cannot be reached. We argue that such claims contribute to stigmatise same-sex attracted men and to hinder much-needed HIV-related research and programming.

Parents and Children Only? Acculturation and the Influence of Extended Family Members among Vietnamese Refugees.

The nuclear family is often the point of departure in much of the existing acculturation research on refugee youth and children of refugees. The influence of other extended family members appears to receive less attention in understanding acculturation processes and intergenerational perspectives. This qualitative study explores the influence of extended family members upon a small sample of Vietnamese refugee parents and their adolescents while they undergo acculturation through their long-term resettlement process in Norway. With repeated interviews over a time span of 3 years, we identified situations and processes in family life in which extended kin become particularly activated and influential. Vietnamese refugee families in Norway keep close contact with extended kin even in the face of geographical distance to kin remaining in Vietnam, or globally dispersed. Aunts, uncles, and cousins are experienced as significant persons in the lives of many adolescents. Additionally, birth order of parents can often influence relationship dynamics among siblings and siblings children. Extended kin surfaced as especially important and influential at critical stages and crisis situations in family life. Extended family, and in particular, parental siblings play important roles in the acculturation experience and family functioning of Vietnamese refugee families in Norway. This has important implications for the study of Vietnamese and other refugee and immigrant families in acculturation research.

Mandates of trust in the doctor-patient relationship.

We examine the conditions for trust relationships between patients and physicians. A trust relationship is not normally negotiated explicitly, but we wanted to discuss it with both patients and physicians. We therefore relied on a combination of interviews and observations. Sixteen patients and 8 family physicians in Norway participated in the study. We found that trust relationships were negotiated implicitly. Physicians were authorized by patients to exercise their judgment as medical doctors to varying degrees. We called this phenomenon the patient's mandate of trust to the physician. A mandate of trust limited to specific complaints was adequate for many medical procedures, but more open mandates of trust seemed necessary to ensure effective and humane treatment for patients with more complex and diffuse illnesses. More open mandates of trust were given if the physician showed an early interest in the patient, was sensitive, gave time, built alliances, or bracketed normal behavior.

A room for reflection: self-observation and transformation in participatory HIV prevention work.

This article looks at HIV prevention projects in which established stigmatized and stigmatizing roles were actively reversed and manipulated in pursuit of HIV harm reduction. In two Norwegian projects, sex workers and drug users carried out harm-reduction activities with other drug users and sex workers. Although HIV-related harm reduction was the aim of the projects, termination or reduction of drug use or sex work was not. Such changes nevertheless occurred among the sex workers and drug users who took active part in the project. The article considers these changes in order to reflect on the meanings and roles of participation in HIV prevention work. In particular, the discussion theorizes on possible ways in which alteration of roles and subject positions may produce self-reflective effects with transformative potentials.

[Qualitative methods in medical research--an ethnographic perspective]. / Kvalitative metoder i medisinsk forskning--et etnografisk perspektiv.

In the social sciences, "method" refers not only to practical techniques of investigation but also to the underlying assumptions regarding how knowledge is generated (epistemology) and to the strategies derived for knowledge accumulation. In order to consider fruitfully the role of qualitative methods in health research, this three-dimensional understanding of method must be kept in mind. Specifically, in order to understand the contribution of ethnography to health research, the foundational epistemological and research strategic assumptions must be clarified. With examples from Norway and other Western countries and from more traditional regions of ethnographic research, the authors discuss how ethnographic research can be carried out and how ethnography might complement other qualitative methodologies as well as epidemiological research.

[Young gay men and absence of adequate signs and cultural images]. / Unge homofile menn og fravaer av adekvate tegn og kulturelle bilder.

This article is based on a qualitative, exploratory HIV-related study among young gay men in Norway. In addition to generating HIV-related knowledge, the study provided insights into phenomena associated with the general cultural conditions under which young gay men grow up. Those who are not yet members of gay communities or friendship groups have to rely on the public discourse for their acquisition of knowledge and signs relating to sex and sexuality. However, among the signs and images available through this discourse, only a few mediate a homosexual reality. Furthermore, of the few that exist, hardly any can be found that is not derived from the heterosexual domain. In effect this implies that young gay men will have to make sense of their lives and their sexuality through signs and images that basically mediate a reality different from theirs. In encounters between health workers and young gay men, knowledge about and awareness of such processes may be vital.