Introduction Antimicrobial resistance (AMR) has a critical global impact, mostly affecting low- and middle-income countries. A major knowledge gap exists in understanding the transmission pathway of the gut colonisation with AMR bacteria between healthy humans and their animals in addition to the presence of those AMR bacteria in the surrounding environment. A One Health (OH) approach is necessary to address this multisectoral problem. Methods and analysis This cross-sectional, mixed-method OH study design will use both quantitative and qualitative methods of data collection. Quantitative methods will be carried out to assess the prevalence and risk factors associated with multidrug resistant Gram-negative bacteria and vancomycin-resistant enterococci in humans, animals (cattle) and the environment. The focus will be on cattle rearing as an exposure risk for AMR among humans. The assessment of AMR in the population of Jimma, Ethiopia with or without exposure to cattle will reinforce the importance of OH research to identify the impending exchange of resistance profile between humans and animals as well as its ultimate dissemination in the surrounding environment. The targeted semistructured key stakeholder interviews will aid to strengthen the OH-AMR surveillance in Ethiopia by understanding the acceptability of an integrated AMR surveillance platform based on the District Health Information Software-2 and the feasibility of its context-specific establishment. Ethics and dissemination The study has been approved by the Regional Ethics Committee, Norway, and the Institutional Review Board of Jimma University, Ethiopia. The study's data will be stored on a secure server known as Services for Sensitive Data hosted by the University of Oslo. In addition, the new European Union Global Data Protection Guidelines for data sharing, storage and protection will be followed. We will publish the results in peer-reviewed journals and present the findings at national and international conferences. ; Understanding transmission ...
Background: Health care agencies report that the major limiting factor for implementing effective health policies and reforms worldwide is a lack of qualified human resources. Although many agencies have adopted policy development and clinical practice guidelines, the human resources necessary to carry out these policies towards actual reform are not yet in place. Objectives: The goal of this article is to evaluate the current status of human resources quality, availability and distribution in Northern Tanzania in order to provide emergency obstetric care services to specific districts in this area. The article also discusses the usefulness of distribution indicators for describing equity in the decision-making process. Methods: We conducted a quantitative facility survey in six districts of Northern Tanzania. We collected data from all 129 facilities that provide delivery services in the study area. The data includes information on the emergency obstetric care indicators, as described by the WHO/UNICEF/UFPA guidelines for monitoring the provision of obstetric care. The inventory also includes information on the numbers of qualified health personnel at the basic and comprehensive emergency obstetric care level. We analysed the distribution and workload of the available human resources in a wider policy context with a particular focus on equity, use and quality, by means of descriptive statistics and the Spearman's correlation test. Results: We determined that there are adequate human resources allocated for health care provision in Tanzania, according to national standards. Compared to similar countries however, Tanzania has a very low availability of health care staff. Most qualified staff are concentrated in a few centralized locations, while those remaining are inequitably and inefficiently distributed in rural areas and lower-level services. Rural districts have restricted access to government-run health care, because these facilities are understaffed. In fact, voluntary agency facilities in these districts have more staff than the government facilities. There is a statistical correlation between availability of qualified human resources and use of services, but the availability of qualified human resources does not automatically translate into higher availability of qualified emergency obstetric care services. Conclusion: National guidelines for human resources for health care in Tanzania require focused revisions in order to reflect the quality indicators more adequately when monitoring and setting criteria for HR distribution. Availability of qualified personnel as well as institutional management and capacity determine the quality of emergency obstetric care services and personnel. The current wide distribution of staff of inadequate quality should be reconsidered. The use of distribution indicators alone is not useful to properly monitor equity. This article suggests increasing access to high-quality health care instead of distributing low-quality services widely. ; publishedVersion
Background: Worldwide, including Norway, overweight and obesity present some of the greatest health challenges. Since the 1980s, the incidence has tripled, leading to a subsequent high prevalence of chronic lifestyle diseases or non-communicable diseases (NCDs), such as cardiovascular disorder, diabetes type 2, some types of cancer, muscle and skeleton disorders and mental health challenges. This has led to an increased focus on lifestyle interventions that emphasise self-management of the condition, as well as the need for users to be readily involved and participating. Therefore, self-management support (SMS) and user involvement have become two important concepts in health services in today's society. The Norwegian Directorate of Health recommended the establishment of Healthy Life Centres (HLCs) in all municipalities to help facilitate and empower people to obtain a greater mastery of the health challenges they face. HLCs assist persons at risk of NCDs or those in need of support for health behaviour changes or weight management. Behaviour change refers to efforts to change people's personal habits to prevent disease. The purpose of these self-management interventions is mainly to promote and improve people's physical activity and diets. There is no clear way of addressing overweight and obesity in primary care; knowledge regarding lifestyle interventions in HLCs and what works is still sparse and needs further investigation. Aim: The overall aim of this PhD-study was to contribute to a deeper understanding of service users' needs, beneficial SMS and user involvement in lifestyle interventions in Norwegian primary care HLCs. The study explored adult service users' and healthcare professionals' (HPs) experiences and perceptions of these phenomena. Three sub-studies were conducted. The aim of the first study was to explore HLC service users' experiences of living with overweight or obesity and their perceptions of seeking help to change dietary and activity habits. The second study aimed to explore service users' experiences of beneficial SMS and user involvement. The aim of the third study was to explore how HPs provide SMS and what user involvement implies for HPs in HLCs. Methods: This study involved a qualitative, explorative and interpretative design grounded in hermeneutic methodology and tradition. Semi-structured in-depth interviews with service users participating in lifestyle interventions in HLCs were conducted and analysed using qualitative content analysis. A total of 13 service users (five men and eight women), aged 30-69, from five different HLCs, participated (Papers I and II). Focus groups were used to collect data from healthcare professionals working in HLCs and this was analysed using thematic analysis. 10 healthcare professionals from eight different HLCs participated in two focus group interviews (Paper III). Results: The analysis of the first study (Paper I) resulted in one main theme: Searching for dignity, which could be split into two themes: 1) Needing to justify avoidance of personal responsibility and 2) A desire to change. In the second study (Paper II), one main theme was identified: Regaining self-esteem and dignity through active involvement and long-term self-worth support in partnership with others. This main theme comprised four themes: 1) Selfefficacy through active involvement and better perceived health, 2) Valued through HPs acknowledgement, equality and individualised support, 3) Increased motivation and self-belief through fellowship and peer support and 4) Maintenance of lifestyle change through accessibility and long-term support. The analysis in the third study (Paper III) resulted in one overall theme: A partnership based on ethical awareness, a non-judgemental attitude, dialogue and shared responsibility, comprising four interrelated themes: 1) Supporting self-efficacy, self-worth and dignity through an attitude of respect, acknowledgement and generosity, 2) Promoting self-belief and self-perceived health, 3) Collaborating and sharing responsibility and 4) Being flexible, adjusting and sharing time. Conclusion and implications for practice: A synthesis of the findings in the three papers can provide a deeper understanding of service users' needs, beneficial SMS and user involvement by means of three new themes. The first theme, The dual face of responsibility in health – the burden and the value is based on the service user's search for dignity and the emotional alternation between shame, guilt and pride. This duality can be understood as a burden of shame and weight stigma that influence the user's capability to assume personal responsibility. The value can be understood as a perception of dignity, pride, active involvement and assuming responsibility. HPs need to address self-conscious feelings like guilt, shame and internalised stigma, as well as responsibility related to dilemmas about right and wrong lifestyles. The second theme, The art of acting ethically seems to be an integrated attitude of beneficence in HPs' practice and is demonstrated by their capability to engage in a person-centred approach and to see the service users' existential needs in a vulnerable situation. HPs' self-worth support is based on ethical awareness, a non-judgemental attitude, dialogue and shared responsibility. This may help the service users to increase their self-efficacy and self-management and regain their integrity, self-respect and dignity. The last theme, The challenges and possibilities in sharing responsibility, is built on the findings related to HPs treating service users as equal partners in a collaborative partnership based on shared responsibility. The challenges are related to the need for long-term follow-up, emotional and social support, personal responsibility in an obesitypromoting environment and structural and political responsibility. An important therapeutic mechanism in beneficial SMS and user involvement may lie in the possibility of sharing responsibility, which may reduce the burden of personal responsibility, shame, guilt and weight stigma. This may also increase self-efficacy and help service users live a healthier life and experience a better quality of life and wellbeing. Accordingly, there is a possibility of sharing responsibility at a relational level and to highlight collective approaches from a socio-ecological perspective.
Master i sosialfag ; The alienation, discrimination and marginalization experiences of subaltern communities continue to spawn vast literature but equal attention is hardly paid to how these communities respond. This thesis examines the responses of members of marginalised groups to the dominant bordering discourse. Specifically how communities like the Hakki-Pikki and the Roma use the resources and tools available to them to cope with their othering as stigmatised communities. The thesis analyses the ways in which members of marginalised communities accept or reject these dominant discourses My research interest lies in the area of resistances, especially the unstated and everyday forms it takes. I am interested in how these forms of resistances of the subordinated have a role in altering the dominant boundary discourse. In this thesis, I have examined how the bordering discourses are created and maintained in the public discourses through media representations, policy, and governance frameworks. I have also analysed the various kind's responses to these dominant discourses which can take cognitive, individual, social, cultural, economic and political forms. Overall, the members of these marginalised communities are observed to make strategic claims of belonging and un-belonging in coping with their othering and discrimination experiences. I have examined the ideological and cognitive tools that are used by the members of these communities in helping them negotiate the pervasive and entrenched discrimination Based on field work, conducted in Karnataka, India and different parts or the U.K, I establish the stigmatised and reified depictions in the dominant discourse taking different structural forms in both cases. The responses of communities to these discourses can largely be classified as pro-dominant, anti-dominant and avoidant. Strategic claims of belonging are found to be made by communities based on the resources and cultural, social, political tools available to them. I have demonstrated how un-belonging claims of the Migrant Roma and Hakki-Pikki are rooted in the discrimination experience. How psychological belonging underlies repeated performances of certain stigmatised actions and how that could lead to boundary negotiations. ; publishedVersion
Master in International Education and Development (NOMA) ; This thesis is based on six weeks of fieldwork in Buenos Aires, Argentina in the autumn 2009. It investigates the lived experiences of a group of teenage mothers who have grown up in institutions. Although biomedical literature states that pregnancy is risky in medical terms only at the very start of the teenage years, adolescent pregnancy is as a norm depicted as a public health problem, or even a 'social epidemic', by policymakers, public officials, the press and the public at large. Commonly, teenage pregnancy is understood as a cause of poverty, rather than the consequence of it. This perception is not necessarily in accordance with the opinions of the mothers themselves. While appreciating that every case is individual and that the circumstances under which my informants became pregnant is not subject for generalisations, the objective of this thesis is to explore the informants' experience of motherhood from the moment of conceiving to the present in an effort to understand their views on teenage pregnancy. The theoretical framework of Amartya Sen, Martha Nussbaum, Erving Goffman and Howard Becker will be used to analyse the girls' perceptions of their own capabilities and notion of stigma. The study will be contextualised by drawing an overview of the legislative framework for pregnancies and abortions in Argentina and the available support system. ; Denne oppgaven er basert på et seks ukers feltarbeid i Buenos Aires, Argentina høsten 2009. Oppgaven undersøker erfaringene til en gruppe tenåringsmødre som har vokst opp i institusjoner. Selv om medisinsk litteratur hevder at graviditet, sett fra et biologisk synspunkt, bare er risikabelt tidlig i tenårene, er tenåringsgraviditet en norm som er fremstilt som et offentlig helseproblem og en 'sosial epidemi' av beslutningstakere, politikere, pressen og offentligheten generelt. Ofte forstås tenåringsgraviditet som en årsak til fattigdom, ikke som konsekvensen av den. Denne oppfatningen er ikke nødvendigvis i samsvar med det mødrene selv mener. Til tross for forståelsen for at hver graviditet er unik, og mine informanter ikke kan være gjenstand for generaliseringer, er målet for oppgaven å undersøke informantenes syn på mammarollen, fra det øyeblikket de ble gravide til i dag, i et forsøk på å forstå deres meninger om tenåringsgraviditet. Det teoretiske rammeverket utviklet av Amartya Sen, Martha Nussbaum, Erving Goffman og Howard Becker vil bli drøftet i forhold til jentenes oppfatning av sine egne evner, samt begrepet stigma. Dette vil bli satt i kontekst ved å finne paralleller med det juridiske rammeverket for svangerskap og aborter i Argentina, samt tilgjengelige støtteordninger. ; La tesis se basa en seis semanas de trabajo de campo realizado en otoño de 2009 en Buenos Aires, Argentina, y tiene por objetivo investigar las experiencias de un grupo de madres adolescentes que han sido criadas en instituciones. A pesar de que la literatura biomédica defiende que el embarazo conlleva gran riesgo solamente al principio de la adolescencia, tanto políticos y funcionarios públicos como la prensa y el público en general lo consideran un problema de salud pública, o incluso una 'epidemia social'. El embarazo adolescente se entiende comúnmente como una de las causas de pobreza, en lugar de una consecuencia de ésta. Esta percepción, sin embargo, no es necesariamente compartida por las propias madres. Si bien cada caso analizado es único y las circunstancias en que mis informantes se quedaron embarazadas no son generalizables, el objetivo de esta tesis es explorar la experiencia de las adolescentes desde el momento de la concepción hasta el presente, en un esfuerzo por comprender sus puntos de vista sobre el embarazo adolescente. El marco teórico aplicado se basa en las contribuciones teóricas de Amartya Sen, Martha Nussbaum, Erving Goffman y Becker Howard, para analizar las percepciones que tienen las niñas en cuanto a sus propias capacidades y a la noción de estigma. El estudio será contextualizado trazando una visión general del marco legislativo Argentino en tema de embarazo y aborto, así como del sistema de apoyos disponible. Suponiendo que el sistema jurídico es reflejo de la sociedad, se discutirá también la influencia de la religión en estas leyes.
The study aimed at investigating the concentrations and geographical patterns of 11 polychlorinated biphenyls (PCBs) and 15 organochlorine pesticides (OCPs) in reindeer muscle samples (n = 100) collected from 10 grazing districts in Norway, 2009. Concentrations were examined for patterns related to geographical region as well as age and sex of animals. Concentrations measured for PCBs and OCPs in reindeer meat samples were generally low. Geographical patterns were revealed and districts with previous mining activities, military trenches, or those that were in the vicinity of the Russian border exhibited slightly elevated concentrations compared to other districts. Calves (10 months) exhibited higher concentrations than young (1.5 year) and old animals (>2 years) adjusted for sex, whereas males exhibited higher concentrations than females, adjusted for age. All PCB congeners inter-correlated strongly with each other, whereas oxy-chlordane and heptachlor epoxide were the strongest inter-correlated OCP compounds. Concentrations of PCBs and OCPs in reindeer meat were all considerably lower than the maximum levels set for those contaminants in foodstuffs for safe human consumption by the European Commission. Thus, reindeer meat is not likely to be a substantial contributor to the human body burden of persistent organic pollutants.
Background - Physical inactivity and chronic pain are both major public health concerns worldwide. Although the health benefits of regular physical exercise are well-documented, few large epidemiological studies have investigated the association between specific domains of physical exercise and chronic pain in young adults. We sought to investigate the association between frequency, intensity and duration of physical exercise, and chronic pain. Methods - Data stem from the SHoT2018-study, a national health survey for higher education in Norway, in which 36,625 fulltime students aged 18–35 years completed all relevant questionnaires. Chronic pain, defined according to the International Classification of Diseases 11th Revision (ICD-11), was assessed with a newly developed hierarchical digital instrument for reporting both distribution and characteristics of pain in predefined body regions. Physical exercise was assessed using three sets of questions, measuring the number of times exercising each week, and the average intensity and the number of hours each time. Results - The majority (54%) of the students reported chronic pain in at least one location, and the prevalence was especially high among women. The overall pattern was an inverse dose-response association between exercise and chronic pain: the more frequent, harder or longer the physical exercise, the lower the risk of chronic pain. Similar findings were generally also observed for the number of pain locations: frequent exercise was associated with fewer pain locations. Adjusting for demographical, lifestyle factors and depression had little effect on the magnitude of the associations. Conclusion - Given the many health benefits of regular exercise, there is much to be gained in facilitating college and university students to be more physically active, ideally, thru a joint responsibility between political and educational institutions. Due to the cross-sectional nature of the study, one should be careful to draw a firm conclusion about the direction of causality.
Aims: In three days at the beginning of the COVID-19 pandemic, the Copenhagen Emergency Medical Services developed a digital diagnostic device. The purpose was to assess and triage potential COVID-19 symptoms and to reduce the number of calls to public health-care helplines. The device was used almost 150,000 times in a few weeks and was described by politicians and administrators as a solution and success. However, high usage cannot serve as the sole criterion of success. What might be adequate criteria? And should digital triage for citizens by default be considered low risk? Methods: This paper reflects on the uncertain aspects of the performance, risks and issues of accountability pertaining to the digital diagnostic device in order to draw lessons for future improvements. The analysis is based on the principles of evidence-based medicine (EBM), the EU and US regulations of medical devices and the taxonomy of uncertainty in health care by Han et al. Results: Lessons for future digital devices are (a) the need for clear criteria of success, (b) the importance of awareness of other severe diseases when triaging, (c) the priority of designing the device to collect data for evaluation and (d) clear allocation of responsibilities. Conclusions: A device meant to substitute triage for citizens according to its own criteria of success should not by default be considered as low risk. In a pandemic age dependent on digitalisation, it is therefore important not to abandon the ethos of EBM, but instead to prepare the ground for new ways of building evidence of effect.
Alcohol-related harm has gained increased attention in high-income countries (HICs) in recent years which, alongside government regulation, has effected a reduction in alcohol consumption. The alcohol industry has turned its attention to low-income and middle-income country (LMIC) markets as a new source of growth and profit, prompting increased consumption in LMICS. Alcohol use in LMICs is also increasing. There is a need to understand particularly in LMICs the impact of industry strategy in shaping local contexts of alcohol use. We draw on conceptualisations from food systems research, and research on the commercial determinants of health, to develop a new approach for framing alcohol research and discuss implications for alcohol research, particularly in LMICs, focusing on South Africa as an illustrative example. We propose a conceptualisation of the 'alcohol environment' as the system of alcohol provision, acquisition and consumption—including, critically, industry advertising and marketing—along with the political, economic and regulatory context of the alcohol industry that mediates people's alcohol drinking patterns and behaviours. While each country and region is different in terms of its context of alcohol use, we contrast several broadly distinct features of alcohol environments in LMICs and HICs. Improving understanding of the full spectrum of influences on drinking behaviour, particularly in LMICs, is vital to inform the design of interventions and policies to facilitate healthier environments and reduce the harms associated with alcohol consumption. Our framework for undertaking alcohol research may be used to structure mixed methods empirical research examining the role of the alcohol environment particularly in LMICs.
Background - Globally, there is a huge lack of relevant research about widespread lifestyle diseases and living conditions in indigenous communities. Northern and Middle Norway have a history of multiple ethnic groups and the Sami has been acknowledged as the indigenous people of Norway by the Norwegian State. The SAMINOR 2 Clinical Survey, a part of the SAMINOR Study, was carried out to provide health information about the Sami population in Norway. Methods - The cross-sectional population-based SAMINOR 2 Clinical Survey consists of both questionnaires and a clinical examination performed in 10 municipalities during 2012–2014. Results - In total, 6004 men and women (participation rate 48%) aged 40–79 years took part in this study. In inland Finnmark, the Sami are in the majority (80–90%) as opposed to the coastline of Troms and Nordland, where the Sami population form a minority (20%). More women than men participated (54% versus 43%, respectively). Obesity was prevalent in this sample and a high mean glycated haemoglobin was observed. Conclusions - This article describes the methods and data collection of the SAMINOR 2 Clinical Survey and presents some characteristics of the sample. The definition of ethnic groups is a core question in the survey and includes several criteria. To ensure that indigenous values and priorities are reflected in the research themes, we recommend that future research projects be directed in close collaboration with the Sami Parliament and the local communities.
Source at https://doi.org/10.1016/S2468-2667(19)30036-2. ; Background - Since 2005, Russia has made substantial progress, experiencing an almost doubling of per-capita gross domestic product by purchasing power parity (GDP [PPP]) to US$24 800 and witnessing a 6-year increase in life expectancy, reaching 71·4 years by 2015. Even greater gains in GDP (PPP) were seen for Moscow, the Russian capital, reaching $43 000 in 2015 and with a life expectancy of 75·5 years. We aimed to investigate whether mortality levels now seen in Russia are consistent with what would be expected given this new level of per-capita wealth. Methods - We used per-capita GDP (PPP) and life expectancy from 61 countries in 2014–15, plus those of Russia as a whole and its capital Moscow, to construct a Preston curve expressing the relationship between mortality and national wealth and to examine the positions of Russia and other populations relative to this curve. We adjusted life expectancy values for Moscow for underestimation of mortality at older ages. For comparison, we constructed another Preston curve based on the same set of countries for the year 2005. We used the stepwise replacement algorithm to decompose mortality differences between Russia or Moscow and comparator countries with similar incomes into age and cause-of-death components. Findings - Life expectancy in 2015 for both Russia and Moscow lay below the Preston-curve-based expectations by 6·5 years and 4·9 years, respectively. In 2015, Russia had a lower per-capita income than 36 of the comparator countries but lower life expectancy than 60 comparator countries. However, the gaps between the observed and the Preston-expected life expectancy values for Russia have diminished by about 25% since 2005, when the life expectancy gap was 8·9 years for Russia and 6·6 years for Moscow. When compared with countries with similar level of income, the largest part of the life expectancy deficit was produced by working-age mortality from external causes for Russia and cardiovascular disease at older ages for Moscow. Interpretation - Given the economic wealth of Russia, its life expectancy could be substantially higher. Sustaining the progress seen over the past decade depends on the ability of the Russian Government and society to devote adequate resources to people's health.
Most research on transactional sex frame men as buyers and females as sellers of sex. We conducted a systematic mapping review of the empirical research on transactional sex where women form the demand (buyer) and men the supply (seller). We included 46 studies, of which 25 explicitly researched women as buyers of sex from male sellers, and 21 studies where this topic was a subset of larger topics. The majority of research on women who trade sexual services from men is published in the last 15 years, by female researchers, using cross-sectional or qualitative/ethnographic design, and from the perspective of males as sellers. While the women appear to be mature and financially independent, the men are young and socioeconomically vulnerable. Men's main motivation for the sexual-economic exchanges with women is financial, whereas women's motivations are largely satisfaction of sexual needs and a stereotyped erotic fantasy of black male hypersexuality. Condoms are often not used. Our review shows that there is a – possibly growing and diversifying – female consumer demand for male sexual services, and transactional sex where women trade sex from men is a complex social phenomenon firmly grounded in social, economic, political, and sexual relations.
Source at http://dx.doi.org/10.1136/bmjopen-2019-029892 . ; Objectives - The aim of this study was to explore determinants of psychosocial distress and pain in patients who have survived severe extremity amputation in Gaza. Setting - This study was conducted in a secondary care rehabilitation centre in Gaza, Palestine. The clinic is Gaza's sole provider of artificial limbs. Participants - We included 254 civilian Palestinians who had survived but lost one or more limb(s) during military incursions from 2006 to 2016. We included patients with surgically treated amputation injuries who attended physical rehabilitation at a specialist prosthesis centre in Gaza. Amputees with injuries prior to 2006 or non-military related injuries were excluded. We assessed their pain and psychological stress using the General Health Questionnaire (GHQ-12). We used income, amputation severity scored by proximity to torso, current employment status, loss of family members and loss of home as independent variables. Results - The amputees median age was 23 years at the time of trauma, while a median of 4.3 years had passed from trauma to study inclusion. Nine of 10 were male, while 43 were children when they were amputated (17%≤18 years). One hundred and ninety-one (75%) were unemployed and 112 (44%) reported unemployment caused by being amputated. Pain was the most frequent problem, and 80 amputees (32%) reported to suffer from daily pain. Family income was significantly correlated with the physical pain (OR=0.54, CI 0.36 to 0.80, p=0.002). Psychological distress was higher among unemployed amputees (OR=1.36, CI 1.07 to 1.72, p=0.011). We found no association between psychological distress (GHQ-scores) and the extent of the initial amputation. Conclusion - Pain and psychological distress following war-related extremity amputation of one or more limbs correlated stronger with deteriorated family economy and being unemployed than with the anatomical and medical severity of extremity amputations.
The official published article is available online at https://doi.org/10.1176/appi.ps.201700505. ; The Arctic Council, a collaborative forum among governments and Arctic communities, has highlighted the problem of suicide and potential solutions. The mental health initiative during the United States chairmanship, Reducing the Incidence of Suicide in Indigenous Groups: Strengths United Through Networks (RISING SUN), used a Delphi methodology complemented by face-to-face stakeholder discussions to identify outcomes to evaluate suicide prevention interventions. RISING SUN underscored that multilevel suicide prevention initiatives require mobilizing resources and enacting policies that promote the capacity for wellness, for example, by reducing adverse childhood experiences, increasing social equity, and mitigating the effects of colonization and poverty.
Source at https://www.hca.westernsydney.edu.au/gmjau. ; The aim of this article is to explore how the political, technological and economic development of recent decades has influenced the identity construction of Sami people with disabilities. While Sami identity work is described as a continuous process carried out in everyday life, the subject is addressed through a presentation and discussion of three narratives. The analysis demonstrates how different types of development have expanded access for Samis with disabilities to participate in traditional Sami activities in many ways and, as such, have increased their opportunities to identify themselves as Sami. At the same time, however, changes in laws and regulations concerning ownership and use of land and sea resources seem to constitute political barriers that hinder disabled Samis from pursuing traditional Sami occupations and activities such as fishing and reindeer herding. Furthermore, 'cultural blindness' among professionals within the welfare system seems to block opportunities for Samis with disabilities to access their own culture through language and traditional Sami way of life. This lack of connection to traditional Sami activities is problematic as it may lead to the perception among both disabled Sami individuals and other Samis that these individuals are not entitled to define themselves as Sami.
