Mathilde Sengoelge

Objective Numerous studies focus on women’s experiences of intimate partner violence (IPV), but there is a lack of qualitative studies focusing on women who, as victims, become perpetrators. The study explored the lived experiences and perceptions of incarcerated women convicted of IPV against their partner in Maputo, Mozambique. Design and setting A qualitative approach was utilised with females purposively sampled for one-on-one semi-structured interviews in the Maputo female prison setting. Data were analysed using Interpretive Phenomenological Analysis (IPA). Participants Nine females over the age of 18 convicted and incarcerated for perpetrating IPV against their violent partners. Findings The analysis revealed three themes: Theme 1: Childhood exposure to violence, with subthemes: direct violence in childhood, witnessing violence in the family and the role of alcohol consumption in violence within the family. Theme 2: Living in a violent intimate relationship with subthemes: psychological violence, coping strategies as victims of IPV and use of self-defence during violent episodes. Theme 3: Consequences of IPV perpetration, with subthemes incarceration experience, mistrust of prison psychology services, disintegration of their families and plans for the future. Conclusions Mozambican women incarcerated for IPV described their lived experiences marked by family violence growing up and IPV in their relationships and how this may have shaped their coping strategies, risk appraisal and responses to threat. These factors were central to understanding the circumstances that preceded their offence. The women identified a current need for psychosocial services independent of prison staff. Sustained investment in IPV prevention and victim protection services is warranted to potentially reduce both prolonged victimisation and the risk of subsequent lethal violence.

Denna artikel presenterar masterprogrammet i hälsoekonomi, policy och management (HEPM) vid Institutionen för lärande, informatik, management och etik (LIME) på Karolinska Institutet (KI). Genom utvalda exempel på masteruppsatser illustreras hur programmet främjar evidensbaserat tänkande inom hälsoekonomi, policy och ledarskap genom att utbilda framtidens beslutsfattare. Uppsatserna visar på användningen av olika metoder, inklusive kvalitativa metoder, budgetpåverkansanalyser och hälsoekonomiska utvärderingar, för att bedöma olika hälso- och sjukvårdsteknologier. Tillsammans bidrar de till en fördjupad förståelse av prioriteringar inom sjukvården, kostnadseffektivitet, produktivitet på sjukhusavdelningar och budgetmässiga konsekvenser.Trots att de representerar ett begränsat urval, speglar uppsatserna metodologisk bredd och praktisk relevans, och erbjuder värdefulla insikter som kan stödja informerade beslut för att förbättra hälsoutfall inom ramen för begränsade sjukvårdsbudgetar.

Frontline practitioners play a crucial role in the implementation and enforcement of child protection laws. Yet, studies on how they experience applying those laws are scarce, not least in the sub-Saharan Africa region where rates of violence against children are persistently high. This study provides an insight into the views of frontline practitioners in the implementation and enforcement of child protection laws, with a focus on what they experience as barriers and facilitators. Interviews were conducted with 17 frontline practitioners from child protection services in Maputo City, Mozambique's capital. The interviews addressed barriers, facilitators, gender norms and attitudes and forms of violence. Audio recorded interviews were transcribed, translated, and thematically analysed. The results resolved around two overarching themes: 1) barriers to the implementation and enforcement of child protection laws, including system-related deficiencies (material, human and organizational); Law related shortcomings (gaps in the content and constraints); and sociocultural norms and attitudes perpetuating violence. 2) facilitators to the implementation and enforcement of child protection laws, including access to resource support from non-governmental organisations and newly established multisectoral mechanism for responding to violence. Effective implementation and enforcement of child protection laws in Mozambique requires adequate resource allocation and funding to strength child protection services. It may also be necessary to enhance multisectoral coordination and harmonization of child protection laws. Furthermore, adapted evidence-based interventions from the WHO INSPIRE framework may help to improve both the prevention and response to violence against children.

This narrative review provides an overview of the link between the sensorimotor system, cognition, emotion and pain syndromes in persons due to deconditioning or delayed sensorimotor development, then applied to persons with cerebral palsy (CP). The brain damage that occurs before, during or even after birth pathophysiologically alters the structure and subsequent function of the sensorimotor function, which is inseparably linked to cognition, emotion, behavior and pain. This damage results in a functional developmental disorder that also affects the structure and function of the neuromatrix in a graded manner due to chronic deconditioning. It is the basis for both primary and secondary chronic degenerative diseases. This leads to an increasing prevalence of chronic pain syndromes, which may be very high in persons with CP. Thus, CP is both a disposing factor and a causal factor for nociplastic pain, defined as persistent pain arising from altered nociception without evidence of tissue or somatosensory damage. Therapy interventions are crucial to optimize movement, cognition and emotion, as well as pain reduction in persons with CP.

Objectives To analyse the past 30-year trends in mortality and morbidity of interpersonal violence against children, its demographic distribution and correlation with specific risk factors. Design Ecological study at the country and regional level. Setting 46 countries and 4 subregions of sub-Saharan Africa (SSA): Central, Eastern, Southern and Western. Participants Children aged 0–19 years old. Primary and secondary outcome measures Trends in mortality rates and disability-adjusted life-years (DALYs) attributed to interpersonal violence injuries in children; correlation between socio-demographic index (SDI)/alcohol consumption per capita and child interpersonal violence. Results Deaths and DALYs per 100 000 population from child violence-related injuries in SSA declined from 4.0 (95% uncertainty interval (UI): 3.3–4.9) to 3.1 (95% UI: 2.3 to 3.9) and 334.9 (95% UI: 276.4 to 407.7) to 260.3 (95% UI: 197.9 to 321.9) respectively from 1990 to 2019 (reductions of 22.5% and 22.3%). Southern SSA had the highest deaths/DALYs rates for each type of physical violence (sharp object/firearm/other) and Central SSA for sexual violence. Alcohol consumption correlated significantly with deaths and DALYs, but SDI showed a non-significant correlation. Conclusions Rates of child interpersonal violence deaths and DALYs decreased from 2009 to 2019 in SSA, driven by remarkable decreases in the Southern subregion. Understanding the determinants of these downward trends and implementation of policies targeting known risk factors like alcohol consumption may pave the way for enhanced child safety protection. Further curbing the disparities between countries and subregions necessitates long-term commitment to evidence-based action plans.

The number of patients with neurological disorders and severe disability is increasing globally. These patients often need help with positioning and the amount of support varies with their level of impairment. High rates of work-related musculoskeletal disorders are observed among healthcare professionals (HCP) with patient contact due to injuries during manual handling. There is insufficient research on manual handling by nurses and other HCP. The primary aim of this study was to explore manual handling strategies by HCP in neurological inpatient and outpatient settings. A secondary aim was to explore pain during and post manual handling activities. A convergent parallel mixed methods design. A quantitative survey was combined with qualitative semi-structured telephone interviews of HCP. The inclusion criteria were licensed allied HCP with at least seven years of experience with neurological patients in inpatient and/or outpatient settings and expertise in manual handling. Exclusion criteria included insufficient proficiency in German and pre-existing illness prior to start of professional education. The survey data were analysed using descriptive statistics and interviews were evaluated through inductive-reflexive thematic analysis. Ten nurses, 10 occupational, 12 physiotherapists participated. Survey findings showed moderate time pressure, body strain, and low back and neck pain during patient transfers. HCPs spent an average of 7.3 (± 5.5) hours per week on personal endurance and strength training. They considered transfer aids moderately important and accessible, predominantly using the transfer board. Interdisciplinary collaboration in patient transfers was reported as crucial and usually available. We identified three themes from interviews: (1) individualised manual handling; (2) facilitating active patient participation during transfers; (3) maintaining personal physical fitness. Neurological symptoms, patient fears, and goal setting necessitated personalised transfer strategies. Patient characteristics, lack of space and time complicated transfers, prompting HCPs to use perception-oriented techniques, leverage, gravity, and momentum.

The link between post-migration stressors and mental ill health is well documented in refugees resettled in high-income host countries, but the consequences of these stressors on refugees’ health-related quality of life (HRQoL) are less known. This study examined the association between post-migration stressors and HRQoL among Syrian adult refugees resettled in Sweden using a preference-based value set obtained from the general Swedish population. A total of 1215 Syrian adults, ages 18–64 years, granted residency in Sweden, responded to a postal questionnaire in 2016 regarding various aspects of their resettlement. The European Quality of Life Five Dimensions Five Level (EQ–5D–5L) questionnaire was used to assess HRQoL through an EQ–5D–5L index score (range; 0=dead to 1=full health). The index score was preference weighted using a Swedish population value set. Predictors were four self-reported post-migration stressors related to daily living in the host country: financial strain, social strain, competency strain and perceived discrimination divided into low, medium and high levels of experienced stress. Multivariable linear regression models were employed to assess the association between post-migration stressors and HRQoL index score, adjusting for potentially traumatic events in the pre- and peri-migration phase as well as sociodemographic confounders/covariates (sex, age, education, civil status, immigration year). The Syrian refugees had a mean EQ–5D–5L index score of 0.863 (SD = 0.145). There was strong evidence of a negative dose-response association in both unadjusted and adjusted models between HRQoL and the post-migration stressors financial strain and social strain—i.e., there was a stepwise, and statistically significant, decrease in HRQoL when going from low to medium to high strain. Competency strain and discrimination were only associated with lower HRQoL when experienced at high levels in fully adjusted models. High exposure to potentially traumatic experiences before or during flight was also associated with lower HRQoL. Syrian refugees resettled in Sweden reported a lower HRQoL than the general Swedish population and lower than age-matched Swedish adults. The present study results point to the possible adverse effects of post-migration stressors on HRQoL.

Older people have the highest rates of suicide, yet the evidence base on effective suicide preventions in late-life is limited. This systematic review of reviews aims to synthesize data from existing reviews on the prevention and/or reduction of suicide behavior in late-life and evidence for effectiveness of interventions. A systematic database search was conducted in eight electronic databases from inception to 4/2020 for reviews targeting interventions among adults ≥ 60 to prevent and/or reduce suicide, suicide attempt, self-harm and suicidal ideation. Four high quality reviews were included and interventions categorized as pharmacological (antidepressant use: 239 RCTs, seven observational studies) and behavioral (physical activity: three observational studies, and multifaceted primary-care-based collaborative care for depression screening and management: four RCTs). The 2009 antidepressant use review found significant risk reduction for suicide attempt/self-harm (OR = 0.06, 95% CI 0.01–0.58) and suicide ideation (OR = 0.39, 95% CI 0.18–0.78) versus placebo. The 2015 review found an increased risk of attempts with antidepressants versus no treatment (RR = 1.18, 95% CI 1.10–1.27) and no statistically significant change in suicides versus no treatment (RR = 1.06, 95% CI 0.68–1.66) or ideation versus placebo (OR = 0.52, 95% CI 0.14–1.94). Protective effects were found for physical activity on ideation in 2 out of 3 studies when comparing active versus inactive older people. Collaborative care demonstrated significantly less attempts/ideation (OR = 0.80, 95% CI 0.68–0.94) in intervention group versus usual care. The results of this review of reviews find the evidence inconclusive towards use of antidepressants for the prevention of suicidal behavior in older people, thus monitoring is required prior to start, dosage change or cessation of antidepressants. Evidence to date supports physical activity and collaborative management for reduction of suicide ideation, but additional trials are required for a meta-analysis. To build on these findings, continued high-quality research is warranted to evaluate the effectiveness of interventions in late life.

We will provide a review of the knowledge base from studies on injuries in the WHO European Region from 2010 to 2019, both cross-country and within-country, for all causes and cause-specific. The focus is whether inequalities between countries and within countries persist such that people from low socioeconomic status and from less affluent areas tend to die by injury to a greater extent than others. This has previously been observed for most causes of injury (e.g., traffic, self-directed violence, interpersonal violence, poisoning, burns) but also for several settings (e.g., home, work, transport) based on a review of socioeconomic disparities in injury risks from 1990-2006. In addition, the pandemic touches upon factors with a known impact, directly or indirectly, on the risk and social distribution of injuries (e.g. social isolation, change in transportation mode and volume, alcohohol consumption, etc.). Until the 2020-2021GBD data are available at the regional level for Europe, we hypothesise on how the pandemic may have affected the social distribution of injuries in the Region. For example, we hypothesise a significant decrease in road traffic related injuries due to lockdown measures (reduced commuting to work, 24-hour curfews). There may also be an increase in unintentional injuries related to children spending increased hours in the home environment and an increase in do-it-yourself injuries in adults. We also see a possible increase in self-harm injuries due to the mental ill health burden related to confinement and social isolation, but data thus far from single EU countries do not report an increase in suicides. We will then present a research agenda for investigating how the pandemic has affected the injury burden in the Europe Region.

A number of post-migration stressors have been shown to adversely affect mental health in refugees resettled in high-income countries, including poor social integration, financial difficulties and discrimination, and recent evidence suggests that these effects are gender specific. Social support has been found to buffer against post-migration stress in some studies on refugee populations, though the evidence on this is mixed. The present study used cross-sectional survey data from a nationwide, randomly sampled group of adult refugees from Syria resettled in Sweden between 2008 and 2013 (N_sample = 4,000, n_respondents = 1,215, response rate 30.4%) to investigate gender-specific associations between post-migration stressors and subjective well-being (SWB) and whether these associations were modified by social support. SWB was measured with the WHO-5 Well-being Index (scaled 0–100), dichotomized into high (≥50) and low (high vs. low strain, males = 10.30 [4.91–21.6], p < 0.001 vs. OR_{high vs. low strain, females}= 3.84 [1.68–8.79], p = 0.002), and high social strain, only in males (OR_{high vs. low strain, males} = 9.21 [3.96–21.4], p < 0.001 vs. OR_{high vs. low strain, females} = 1.03 [0.40–2.64], p = ns). There was some evidence that social support buffered the adverse association of financial strain with SWB. In conclusion, the present study found clear support of gender-specific effects of post-migration stressors on SWB. Mitigation strategies and interventions should be aware of and sensitive to these potential gendered effects, and future research exploring mental health in the context of resettlement stress should have a heightened focus on the important role of gender.